Sector Wide Approach to Strengthening Health ( SWASTH )

Bihar Technical Assistance Support Team (BTAST)
Government of Bihar initiative supported by Department for International Development, UK


Rogi Kalyan Samitis help health care facilities become patient friendly

Set up to ensure patient welfare, Rogi Kalyan Samitis are responsible for proper functioning and management of government health care facilities in Bihar.

Manju Devi holds the hand of her 18-year-old sister-in-law Pinky Devi and walks confidently into the Sub-Divisional Hospital (SDH) in the Mahua block of Vaishali district in Bihar. Pinky Devi is into the eighth month of her pregnancy.

After a brief enquiry at the information kiosk, installed right at the entrance of the hospital, Manju Devi steps ahead with her sister to consult a gynaecologist.

Manju and Pinky are among many women who repeatedly visit the hospital and avail of health care services. Talking about their experiences, they say that it is the helpful behaviour of the nurses and doctors towards them and refurbished hospital infrastructure that encourage them to avail of the services.

Similar experiences in other districts have come about as a result of the Bihar government’s initiative to strengthen and activate the Rogi Kalyan Samitis (RKS) in the state. The RKS or the Patient Welfare Committees have been set up to ensure patient welfare. The committees, which are registered under the Societies Registration Act, have a group of trustees overseeing the day to day affairs of the hospital facility. The RKS comprises members from local Panchayati Raj Institutions (PRIs), NGOs, local elected representatives and officials from the government sector who are responsible for proper functioning and management of health facilities, which could be a district hospital, Community Health Centre or First Referral Unit.

The RKS initiative was introduced in 2005 under the National Health Mission (NHM) or the erstwhile National Rural Health Mission (NRHM). However, until recently, most committees were dormant and ineffective leading to failure of utilisation of funds locally. In the absence of efficient utilisation of funds, most health facilities had poor infrastructure and lacked equipment essential for providing primary health care services, including of maternal and child health. Not surprisingly, local communities had little faith in these health facilities.

The initiatives taken up by the RKS for hospital welfare have included provision of diagnostic facilities, ambulance services and auxiliary services such as laundry. The RKS has also ensured the provision of medicines, neat and clean facilities and easier access to facilities and display of signposts at key junctions.

The RKS makes arrangements for adopting sustainable and environment friendly measures like scientific waste disposal, solar refrigeration, water harvesting and water recharging systems.

The BTAST Quality Assurance consultants equipped with the Government of India checklist developed by National Health Systems Resource Centre play an important role by supporting hospital authorities to identify gaps in facilities and make appraisals so that appropriate corrective actions can be taken. This action has improved patient experience and welfare in facilities resulting in increased uptake of services despite the presence of many private players.

The figures at the SDH, Mahua are testimony to the fact that how consistent improvement in the services not only builds confidence of patients in the health care facilities but also encourages them to visit it whenever there is a need.

The Out-Patient Department (OPD) and the In-Patient Department (IPD) figures for registration reflect how better amenities have resulted in more  patients visiting the hospital. The number of patients (OPD+IPD) has increased from 59,328 in 2012-13 to 60,182 in the 2013-14.

The efforts of RKS can also be seen in the increased income from patient registration fee. A token fee of Rs 2 is charged from every new patient visiting the hospital. The figures show that income from the patient registration has increased manifold over the past three years.

While the income from patient registration was merely Rs 23,000 in 2012-13, it went up to Rs 100,500 in the financial year 2013-14 and Rs 122,240 in 2014-15.

Effective utilisation of funds is one of the important tasks of the RKS that helps the hospital in making various provisions including procurement of emergency medicines, payment to the contractual staff and improvement in facilities.

“Through the continuing efforts of the RKS we have upgraded the hospital like installing air-conditioners in the Labour Room as well as the New-Born Care Corner. The improved facilities have attracted many people to avail services at this hospital,” says Dr Anil Kumar, Deputy Superintendent, SDH-Mahua, and Secretary, RKS.

Prakash Kumar, Hospital Manager, SDH, Mahua, believes that RKS plays an important role in introducing patient friendly new programmes. Kumar adds that 90% of the  medicines at the facility have been purchased through RKS. “With the help of RKS this facility has started evening OPDs. These suggestions came to RKS from the community through their representatives. After realising their worth, they have been incorporated for the benefit of people,” he says.

Vigyan Swaroop Singh of Sindhara Village in Mahua block is one of the members of Rogi Kalyan Samiti, SDH, Mahua. Acknowledging the improvements brought about by RKS, Singh says that the presence of new patients registered at the hospital is proof of the success of the efforts made by RKS. However, there are challenges in the day to day functioning of the RKS as well. “We have seen that a bigger say in decision-making by RKS at the hospital improves the situation to a great extent. Unfortunately the SDO of the district who is the executive chairman of the RKS, is often unable to attend the meetings due to hectic official engagements. The RKS needs to be set up in such a way that its routine functioning is no hampered,” says Singh.

To ensure quality services at the hospital and to keep a check on various services being provided, RKS has installed closed-circuit television (CCTVs) at various points of the facility. Kumari Chanchal, a 28-year-old staff nurse, says that the installation of CCTVs in the hospital has not only ensured the punctuality of nurses in hospitals but also helped in improving security of staff and patients at the hospital. “Having CCTVs installed has helped in keeping better vigil in the hospital,” she says.

SDH, Mahua, also provides free diet to mothers three times a day. Quality food is served and the general atmosphere is also very friendly, which makes patients feel at home. Kumari Ritika, a 23-year-old staff nurse, adds, “Cleanliness and recreational facilities like a well maintained garden have encouraged more people to avail of hospital facilities. Such improvements have made a difference to the local community”.

Manorama Kumari, senior staff nurse at the hospital, says that the provision of a lady doctor round the clock and the availability of several other services at the hospital make it the first choice for many people. Such interventions have been possible only because of the allocation and utilisation of RKS funds.

Pappu Kumar, Quality Assurance Consultant, BTAST, emphatically claims that RKS has been instrumental in filling those gaps that could not be filled by using the government funds. “We identify the gaps with the help of checklist and apprise RKS and RKS takes prompt steps to fulfil such gaps,” he says.

The focus of SWASTH is to strengthen systems in the public health sector in Bihar through better planning, organisational strengthening & human resource management, decentralised decision making and convergence among key departments. The functioning of RKS, SDH, Mahua is a testimony to this.

The SWASTH programme aims to improve the health and nutritional status of people of Bihar by increasing access to better quality health, nutrition, and water and sanitation services particularly for the underserved groups. The focus of this programme is to strengthen the systems through better planning, organisational strengthening & human resource management, decentralisation and convergence among key departments. The programme also uses community level processes to manage, demand and monitor services.

The Rogi Kalyan Samiti (RKS) or the Patient Welfare Committee, introduced in the year 2005, is registered under the Societies Registration Act and has group of trustees overseeing the day to day affairs of the government health care facilities.

This story was written by Ashok Kumar at OneWorld Foundation India.

Disclaimer: SWASTH is supported by the Department for International Development (DFID)-UK and implemented by the Government of Bihar, in collaboration with the Bihar Technical Assistance Support Team. However, the views expressed in this report do not necessarily reflect either DFID’s or Govt. of Bihar’s official policies or views.