The Ministry of Shipping had constituted a committee to study how the existing healthcare infrastructure at major ports can be upgraded under PPP mode to provide world class health services, along with affordable medical and paramedical education.
The committee was constituted in this regard in 2016 under the chairmanship of Dr. Ved Prakash Mishra, Chancellor of Krishna Institute of Medical Sciences (Deemed University), Karad and Chairman of the Academic Committee of the Medical Council of India, New Delhi.
The committee has submitted its report recently. It recommended the following:
1. The present mode of Public Private Partnership in terms of the notification dated 29th December, 2015, issued by the Government of India, on the recommendations of Medical Council of India defines a single mode of the Public Private Partnership, where-under an appropriate govt. can transfer its minimum 300 bedded hospital to a private party for opening of a medical college by the concerned private party as an applicant within the scope and meaning of Section 10(A) of the IMC Act, 1956. The interest of the Central Govt. in regard to the extent of permissible admissions and utility of hospital services from the attached hospitals thereat is limited. As such, this mode does not go to fulfill the legitimate requirement of the Central Government to have its own medical colleges under the proposed Public Private Mode.
2. The proposed Public Private Mode contemplates recognition to the staff working in the non-teaching district/ referral hospital as ‘teachers’ in the cadre of Professor, Associate Professor and Assistant Professor strictly in conformity with the eligibility prescribed under the governing Teacher Eligibility Qualification Regulation, of Medical Council of India, which would be non-conducive as staff at such hospitals conforming to the said eligibility may be either miniscule in number or non-existent. As such, the problem of requisite number of teaching faculty with prescribed qualifications would be hard to procure and tough to find.
3. It would be appropriate to pursue the amendment to the Notification of 29th December, 2015, proposed by the Medical Council of India at its meeting held on 30th March, 2016, modifying Clause 2, whereby under the Public Private Partnership Mode the State Govt. instead of transferring its district minimum 300 bedded district hospital under an MOU would be required only to permit the utilization of facilities thereat, which would be far more conducive to the legitimate interest of the State Govt.
4. It would be equally appropriate to pursue the intent of the Central Govt. as depicted in their communication dated 28th January, 2016, addressed to the Secretary, Medical Council of India to extend the provision of scheme of equivalence and recognition of teachers in case of Employee State Insurance Corporation run hospital for opening of new medical colleges to the proposed medical colleges to be opened under the Central Sponsored Scheme (CSS).
5. It would be in the fitness of things to propose to the Central Govt. that the applicability of the provision of scheme of equivalence and recognition of teachers in case of Employees State Insurance Corporation run hospitals for opening of new medical colleges be made applicable as it is to the Public Private Partnership Mode contemplated vide the Notification of 29th December, 2015, by appropriately amending Clause 7 thereat so that the provision of conformity with eligibility prescribed by the Teachers Eligibility Qualification Regulation is done away with, so that the problem of appointment of requisite number of faculty in conformity with the prescribed standard regulatory requirements are dispensed of and are found to be easy to tackle.
6. It may be pursued by the Central Govt. and the Medical Council of India to broaden the ambit of the Notification of 29th December, 2015, so as to include Public-Public Partnership Mode therein, whereby by a suitable collaboration with the Public companies and undertakings which per se in their individual capacity are not covered as eligible to be an applicant for starting of a medical college, within the scope and meaning of the eligibility criterion prescribed under the governing Establishment of New Medical College Regulation may be availed by the Central Govt. to open its own run medical colleges.
7. The Public-Public Partnership model will definitely give a desired fillip to the Central Govt. to open new medical colleges commensurate with the need and requirement of the State with least financial burden as compared to any other model as in vogue for the said purpose.
8. In the fitness of things it would be appropriate to await the outcome of the two core pending issues namely, a) the broadening of the ambit of the notification of 29th December, 2015 and b) the broadening of the ambit of Teachers Eligibility Qualification Regulation in terms of the applicability of 06.09.2012 Notification by the Government of India, before embarking on the present available mode of Public Private Partnership.
9. During the pendency of the same the Central Govt. may avail the model of starting of a medical college as has been evoked by the Govt. of Union Territory of Andaman and Nicobar where under the concerned State Govt. availing his own District Hospital has started a State run and managed medical college, having full control on the admission of students thereto.
10. Further, the Ministry of Shipping, Government of India, availing its owned more than 200 bedded Port Hospitals and getting it converted into a teaching hospital may venture in starting of a medical college owned and managed by the Central Govt. itself thereby having complete and total control of the same.
11. Alternatively, the Central Govt. following the public private partnership model as contemplated in the notification of the Medical Council of India dated 29.12.2015 and updated by another notification dated 02.02.2016 transfer a more than 200 bedded Port Hospital at Mumbai to a Society/Trust or Company, as the case may be, for starting of a medical college and protecting its interest by taking recourse to provisions included at clause No.2 of the 29.12.2015 notification in respect of admissions of students under the Govt. quota at the said medical college and patient care in the affiliated hospital of the concerned medical college on mutually agreed terms and conditions ensuring that the services that are being catered to the registered employees continue to be on the same terms and conditions for all times without causing any prejudice to their legitimate claim and entitlement.
12. In terms of the illustration availed by the Committee by an appropriate extrapolation of financial receipts and expenditures in regard to a medical college in the mode of Public Private Partnership as recommended at seriatim 11, the extent of admissions that can be availed by the Central Govt. under its quota could be 25% of the total admissions annually and 25% of the patient care in the affiliated hospital of the said medical college vide transferring more than 200 bedded Port Hospital to the concerned Society/Trust or the Company (bringing out an illustration with reference to transfer of 300 District Hospital by the State Govt.), with a rider that 15% of the annual intake should be earmarked s the NRI (Non-Resident Indian) quota towards which the higher chargeable fee would be compensating for the fee charged against with 25% Central Govt. quota as a cross subsidy mode.
13. The healthcare facilities at other port hospitals at Mumbai, Cochin, Chennai, Kolkata and Vishakhapattanam need to be upgraded into tertiary care facilities vide invocation of Public Private Partnership Mode under mutually agreeable terms and conditions ensuring that the services that are being catered to the registered employees continue to be on the same terms and conditions for all times without causing any prejudice to their legitimate claim and entitlement.
14. It would be appropriate that the upgradation to tertiary care facilities could be worked up in a manner that a particular super speciality stands assigned to a specific Port Trust Hospital, which then becomes the super speciality centre for all referral purposes by the remaining Port Hospitals. As such, Port Trust Hospital Chennai could be availed for development of tertiary care facilities in the domain of Cardiovascular Thoracic surgery, Port Trust Hospital Cochin for Nephrology, Port Trust Hospital Kolkata for Neurology and Neurosurgery and Port Trust Hospital Vishakhapattanam for Gastroenterology and Surgical Gastroenterology respectively.
15. The developmental plans as of now envisioned by the respective Port Trust Hospitals in vogue to the extent necessary be merged with the developmental suggestions made in respect to them by the present committee, so that there is no overlap and the resources do not stand squandered as they are scares and therefore precious hence are required to be availed judiciously.
16. The developmental plan in regard to Port Trust Hospital Paradip, which the committee has looked into critically is well conceived and has incorporated the suggestions proposed by this committee in its ambit to a substantial extent and hence needs to be pursued as such.
17. A venture is necessary to start postgraduate courses at the Port Hospitals other than Mumbai in the relevant specialities, where the teaching beds are allocable to the concerned speciality with available qualified teaching manpower in identified specialities in terms of provisions included at section 8(1)(A) of the Post Graduate Medical Education Regulation, 2000 notified by the Medical Council of India by making an appropriate MoU with the medical college in the geographical vicinity to fulfill the condition which is prescribed on the said count.
18. The venture of starting of post graduate courses could be feasible at Port Hospitals Chennai, Cochin, Vishakhapattanam and Kolkata.
19. In case of Port Hospital Mumbai if the feasibility of a medical college does not work up then it should be availed for starting of Post Graduate Courses in relevant specialities vide the qualified manpower available there including the requisite number of teaching beds in terms of provisions included at Section 8(1)(A) of the regulations governing Post Graduate Medical Education notified by the Government of India, on the recommendations of the Medical Council of India.
20. At Port Hospitals other than Mumbai, Cochin, Chennai, Vishakhapattanam, Kolkata and Paradip the upgradation of the existing healthcare facilities to sumptuous secondary and to some extent tertiary care level need to be augmented for enhancement of the quality of the services to be catered to the relevant stakeholders.
21. All these initiatives as proposed would be under Public Private Partnership Mode and therefore, could not end up in any financial liability on the Central Govt. and the proposed venture even for the starting of the Postgraduate courses would be in tune with the one which has been worked out for starting of a medical college in tandem with Port Trust Hospital Mumbai, including the financial implications and appropriate balancing of the resultant liabilities in an illustrative manner.
