Adani-run hospital, a lifeline in Kutch

Nearly a decade before the National Institution for Transforming India or the NITI Aayog, envisaged private partnership in rural healthcare, a PPP-run hospital in Gujarat's Kutch district – India's largest -has transformed hundreds of lives. The Adani Foundation-run Gujarat Adani Institute of Medical Sciences (GAIMS) in Bhuj–was ostensibly India's maiden successfully operating PPP model in the healthcare sector.

From earth quake rubble to a state-of-the-art hospital that caters to more than 1000 patients a day, it's a historic journey of community empowerment and nation building. Over the years the successful model has contributed in creating confidence which led to rollout plans of six brownfield self-financed medical colleges in Tapi, Dahod, Panchmahals, Banaskantha, Bharuch and Amreli districts by upgrading the government hospitals through PPP.

Its healthy ripple effects can now be felt at the national level. Last year, the NITI Aayog also accepted the merits of the model and invited private players to partner with government hospitals at the district level.

The government approached many corporates such as Narayana Hrudalaya and Manipal Education, to adopt the hospital on PPP basis. But none of the proposals worked owing to feasibility challenges.

Since 2009, when the Adani Group entered into a PPP partnership the group invested a Capex of around Rs. 100 crore in ramping up infrastructure among other things. A decade since then the cumulative operating deficit stands at 25 crores.

"Adani G. K. General Hospital caters specifically to the healthcare needs of the poor and marginalized sections of the society. People from special and deserving categories receive further specialized and free IPD services. In addition, the hospital also connects people with various government schemes such as AyushmanYojana, MA Yojana, students' healthcare programme etc." said Vasant Gadhavi, Director Administration - GAIMS

Sea change in hospital infrastructure and human capital

GAIMS always had fairly robust infrastructure. But considering the massive geography of the Kutch region it needed consistent upgradation - something that became a seamless process following the private partnership.

From Outdoor Patient Wards to the Operation Theatres and Labour Rooms to Intensive Care Units every critical aspect of the hospital infrastructure grew manifolds (see table 1 below for details).

Likewise every specialised treatment such as Dermatology, Psychiatry, Paediatric, Surgery, Orthopaedic, Ophthalmology, and ENT among others recorded rapid augmentation from time to time. Retaining quality talent pool in remote locations has been one of the key challenges for most sectors and pressure is even worse for healthcare.

However, the hospital management did remarkable job in building a team of top line medical experts. Medical officers, nurses, technicians and the outsourced team of support were deployed at par with growing patients' footfalls in the region.

Establishment of GAIMS Medical College

While the pillars of the hospital facilities became stronger, the PPP-model also anchored the establishment of the GAIMS Medical College in 2009. Today the medical college offers 150 seats for under-graduate courses and 51 seats for post graduate courses. Specialisations offered at the facility comprise Physiology, General Surgery, Anatomy, ENT, Microbiology, Obstetrics & Gynaecology, Respiratory Medicines, Orthopaedics, Dermatology, Ophthalmology, Pathology, Paediatrics, Radiology and Anaesthesiology; thus creating dependable pool of talented doctors to service ailing patients of Kutch.

Improving health indicators

Health indicators have improved remarkably following the takeover. For instance, the number of OPDs nearly tripled from 1, 39,199 in 2014-15 to 3, 17,361 in 2017-18.

Likewise there has been steady rise in child births as well. From catering to just over 2000 deliveries in 2014-15 the number rose by nearly 35% in 2017-18.

At the same time a combination of preventive and curative measures has ensured that the infant mortality rate has been brought down from 5.62% in 2014-15 to 3.65% in 2018-19 (April-January).

Geographical challenges

G K General Hospital is the only referral hospital in Kutch district and often considered the last resort by patients arriving from the farthest corner. Moreover, the expanse of Kutch district increases travel time for patients and thereby adversely impact the chances of recovery/survival. Further several cases referred to GAIIMS comprise terminally ill patients comprising critical infants and elderly patients. Unlike private hospitals which reject admission such patients, the GAIMS administration goes an extra mile to accommodate such patients. A classic case in point is evident in the wide difference in the infant mortality rates of inborn and outborn patients. Among the infants born in the hospital the mortality is 11% while the same in case outborn cases stands at 26%.