Saga of emergency services in India

The Supreme Court of India as long back as 1989 observed that, "Every injured citizen brought for medical treatment should instantaneously be given medical aid to preserve life and thereafter the procedural criminal law should be allowed to operate to avoid negligent death. The effort to save the person should be the top priority not only of the medical professional but even of the police or any other citizen who happens to be connected with the matter or who happens to notice such an incident or a situation. It is for the Government of India to take necessary and immediate steps to amend various provisions of law which come in the way of government doctors as well as other doctors in private hospitals or public hospitals to attend to the injured or serious persons immediately".

The implications of the judgement were broadly: Safe and easy transportation of the victim to the nearest hospital through pre-hospital care based ambulance services by governments; provision of Emergency Response Services free of cost with speed, accuracy and efficiency either by government on its own or in association with an experienced organisation and deferring the so-called formal transparent competitive bidding to implement and operationalise emergency response services by the governments like awarding of government contracts through public auction or public tender on the pretext of healthy competition.

Nearly 15 years later, Emergency Management and Research Institute (EMRI) came into existence as a non-profit organisation with initial funding and technology support from B Ramalinga Raju, founder Chairman of Satyam Computers to meet the requirement of the Supreme Court Judgement. Ever since it was established, it had an architecture of nine basic elements, namely: A non-profit organisation, PPP (Public-Private Partnership) framework, leadership and partnerships, single toll-free 108 number, 24X7 unique ERS staffed by trained personnel, technology, ambulance, research and training.

EMRI and its leadership, ever since its establishment, firmly believed in Public-Private Partnership for a competitive advantage towards the fulfilment of its objectives.

The Government of India during Manmohan Singh's regime, launched the National Rural Health Mission (NRHM) in April 2005, for providing integrated, comprehensive primary health care services with special emphasis on poor and vulnerable sections of the society. Consequently, the then AP government under the 'Reproductive and Child Health Project' initiated the implementation of a scheme called 'Rural Emergency Health Transport Services' (REHTS) in rural areas and piloted through NGOs in four districts and tribal areas (ITDA districts) to transport pregnant women, infants and children and any other cases in need of emergency health care services to the nearest hospital. Initially, 122 ambulances were deployed under the scheme.

In addition to REHTS, the government of Andhra recognised EMRI as the state-level nodal agency to provide comprehensive emergency responses across the state, in PPP and signed Memorandum of Understanding (MoU) on April 2, 2005, which clearly defined the roles and responsibilities of each of them without any financial commitment from the government. EMRI on its own deployed 70 ambulances in 50 towns (urban areas) and catered to 2.5 crore population by the end of June 2006.

The state government, having piloted the REHTS, thought of expanding the scheme to the other 18 (rural) districts of the state and decided to utilise the services of the EMRI as the state level nodal agency for operationalising the balance of the 310 ambulances and accordingly signed the 2nd MoU on September 22, 2006. There was no tendering business.

The third MoU signed in October 2007 further strengthened the PPP. The government used this memorandum to add 122 more ambulances, initially launched in four districts and ITDA areas, which was operationalised by NGOs. There was a sharing of expenditure on mutually agreed terms. Later it was agreed in principle to expand the capacity of EMRI to meet the increasing number of emergencies. A revised MoU was signed in May 2008 and accordingly, the government added to its pool of 502 ambulances with another 150 new ambulances. 95 per cent of the cost was to be taken on by the government and the rest by the EMRI.

The MoUs have always been signed without any formal competitive bidding process. This aspect is not unique to Andhra Pradesh.

In Madhya Pradesh, a beginning was made with a high-level delegation from MP government by visiting EMRI on January 21, 2007. Then there was a series of correspondence between EMRI and MP government. Government of MP, based on all the above, decided to follow an indirect competition process and thus, a notification was issued inviting non-profit organisations for expression of interest for developing and operationalising comprehensive emergency response service. The entire process until the signing of MoU took more than 10 months involving several validations.

In Gujarat, when Narendra Modi was Chief Minister, a beginning was made when Joint Secretary, Health visited EMRI in May 2007. Then CEO of EMRI and I visited Gujarat and made formal presentations. On August 29, 2007, Gujarat Expansion by signing of an agreement and launching at Ahmedabad took place.

Rajasthan, Tamil Nadu, Assam, Meghalaya, Himachal Pradesh, Uttarakhand, Goa, Haryana, Punjab, Maharashtra, etc., all started the emergency response services one after another. This was the story when I left EMRI in 2009.

Having launched the 108-emergency response service on August 15, 2005, EMRI is currently operational in 16 states and Union territories. At present, there are only three players – EMRI, Ziqitza and Bharat Vikas Group who operate over 7,016 ambulance services in India using the 108 number.

The writer is the former Lead Partner and Consultant for EMRI-108 Services. Views expressed are strictly personal