CHAPTER VII

CHARACTERISTICS OF 'NOT-FOR-PROFIT' HOSPITALS IN DELHI

Characteristics of 'Not-for-profit' Hospitals in Delhi

The following section will focus on the characteristics ofthe non-profit hospitals that

has been obtained from data from the RTI and questionnaire survey (Annexure 3). At first we

look at the proportion of secondary and tertiary level hospitals across the three sectors i.e.

state run, for-profit and non-profit hospitals and their district-wise distribution followed by

some characteristics of the non-profit hospitals.

Distribution of Public I For-profit I Non-profit

Relative proportions of non-profit to the public and for-profit hospitals are shown in

the table below (!'able 7.1). Most of the larger private hospitals are non-profit. The for-profits

are smaller and more in number while the non-profit hospitals are fewer in number with more

number of beds. The for-profit sector is mostly established by doctors as sole proprietorship

, or as partner collaborations. The non-profit is established mostly by faith-based organisations

and business houses. An interesting finding in a study on private nursing homes (for-profit

and non-profit) in Delhi gives the social background of promoters. The promoters hailed from

business, professional and medical backgrounds and as the size of establishment increased,

the percentage of promoters from business background also increased. The background of a

promoter therefore relates to the availability of capital for investing on a nursing home

(VHAI, 1993). Going by the all India proportions of non-profit hospitals, Delhi has a larger

proportion of these institutions that corroborates with the fact that these institutions are

visible more in urban cities.

Table 7.1 -Relative proportion of hospitals across three sectors at the secondary and tertiary · levels of care

Type of Hospital Total no. of Beds (approx.) allopathic hospitals

Public hospitals 91 (14 %) 19695 (61.4 %) For-profit (regd.) 488 (74.7 %) 5623 (I 7.5 %) Not-for-profit (regd.) 74 (11.3 %) 6758 (21. I %) Total 653 (100 %) 32076 (100 %)

Source: Directory of Health Services, 2005-06; InformatiOn from RTI

District wise distribution of public/for-profit I non-profit

There is larger concentration of hospitals (all types) in West, North-west, and South

followed by East Delhi. Concentration of private ('for' and 'not-for' profit) allopathic

lhA

hospitals is also in these districts (Table 7.2). From the data gathered from the questionnaire

for non-profit hospitals- 5 were set up pre-Independence, 19 were set up post-independence

between 1950 and 1980 and there are 46 that came up post 1980 (Table 7.3). The old non­

profit hospitals are concentrated in the North and Central areas. South has a larger

concentration of not-for-profit hospitals followed by North-West and West district. These

include mostly that emerged from the late 1980s to the present North and Central district

consist of the old not-for-profits as these areas constitute the older areas of Delhi while West,

North-West and South Delhi have developed post 70s. The Map 7.1 shows the spatial

distribution and expansion in the distribution of non-profits (for data available for 2006) over

the years from their concentration at Central district. The non-profit institutions have not

spread to the peripheries as the population density is less in those areas.

165

0

Distribution of 'Not-for-Profit' Hospitals bv the Year of Establishment in Delhi ...

I<Jio meters 5 10 20

Ltgtud

o.';pitals (Yt>ar ofFstablislnnNlt ) St>ttl t>m t>nt S t atu .~ IC't'u .m .• ~ OO lt

Data Not Availab le Villag es

• Pre-Independence

0 1950 to 1980

• 1980 to Present

Census Towns

- DMC (Urban)

NDMC

- Delhi Cant.

166

Table 7.2- District-wise distribution of hospitals

Districts Public For-profit Not-for- Total % hospitals hospitals/n profit (public popula

ursing sector + tion home (registere private) (registered) d)

North-west II 87 14 112 20.65 South 15 73 20 108 16.37 West 8 127 10 145 15.37 North-east 5 39 2 46 12.77 South-west 8 29 5 42 12.67 East 4 67 10 81 10.57 North 5 31 9 45 5.64 Central 8 34 4 46 4.67 New Delhi 3 3 0 6 1.29 Total 67* 490 74 631 100

Source: compiled from Drrectory of Health Services, 2005-06

Typology of Non-profit Hospitals by Year of Establishment

. '

The ·hospitals have been categorised by the year of their establishment from the

}Uestionnaire survey. Though some of the hospitals may have been established in the 80s the

rusts associated with them are old. There are 5 non-profit hospitals that emerged in colonial

)elhi; 19 between 1950 and 1980 and; 46 non-profit hospitals were established post 1980.

S.N

I

Table 7.3- Non-profit hospitals by year of establishment

Name of the Hospital

Sant Nirankari Charitable Hospital (previously known

Year of establishment of

9 as Sant Nirankari Charitable Dispensary) (Society}

District

N

167

S.N. Name of Hospital Year established District

10 Tirath Ram Shah Charitable Hospital (Trust) 1955 N

II Holy Family Hospital (Society) 1955 s Moolchand Khairati Ram Hospital (Moolchand 1958 (Trust was s

12 Medcity 2005) (Trust) established in 1928 Lahore)

13 Dr. B.L. Kapoor Hospital (not registered with 1959 c government) (Trust)

14 Aggarwal Dharmarth Charitable Hospital 1963 NW

15 Temple Nursing Home (Trust) 1969 c 16 Janki Das Kapoor Memorial Hospital 1976 w 17 Maharaja Agarsain Charitable Hospital 1974 NW

18 Rural Medicare Society(Society) 1976 s 19 Nazar Kanwar Surana Memorial Hospital(Trust) 1979 N

20 Sitaram Bhartia Institute of Science and Research 1979 s (Trust)

21 Jivodaya Hospital (Mission hospital) (Society) 1980 NW 22 Venu Eye Institute and Research Institute (Society) 1980 s 23 All India Blind Relief Society Hospital (Society) s 24 Comprehensive Model Family Planning (Society) sw

-~~ri~~~3F)l~~1:1:~-~~~-~~~ Old Trusts/Societies (established before 1950)

25 Leprosy Mission HoSpital (Leprosy Mission Trust is 1984 NE very old)

Pushpawati Singhania Research Institute for Liver 1996 s 26 Renal Digestive'Services (Lakshmipat Singhania

Medical Foundation}{Socie!)')

27 Gujarmal Modi Hospital (Trust) 1990 s

Red Cross Maternity & Child Care Hospital (Red 1987 NE 28 Cross General, Maternity & Child Care Hospital -

2005) (Society) New Trusts /Societies

29 Mata Chanan Devi Arya Dbarmarth Eye Hospital 1995 w (Trust)

30 Sunderlal Jain Charitable Hospital (Trust established 1986 NW in 1950s)

31 Saroj Hospital (Ganesh Das Chawla Charitable Trust) 1997 NW (the trust was set up in 1%9) (Trust)

32 Banarasi Dass Chandiwala (the society was formed in 2001 s 1951) (Society)

33 Jaipur Golden Hospital (Trust) Jaipur Golden 1991 NW Charitable Clinical Laboratory trust fomied in 1976

34 Shanti Avedna Ashram (Society) (Society was set up 1986 (first hospice in s in 1978) Bombay)

35 Dr. Vidya Sagar Kaushalya Devi Memorial Health 1981 s Centre (Society)

36 Walia Nursing and Maternity Home 1983 E Batra Hospital and Medical Research Centre (Aishi 1987 s

37 Ram Batra Charitable Trust) (Trust)

38 Fortis Flt.(Trust) Lt. Rajan DhaU (Unit of Fit. Lt. 1987 sw Rajan Dhall Ch Trust)

168

Name of Hospital Year established District

39 Escorts Heart Institute and Research Centre (from a 1988 s Society to Corporate) (Fortis Escorts 2005)

40 National Chest Institute and Research Centre (Sita 1988 s Ram Jiwarka Hospital)

41 Deepak Memorial Hospital & Medical Research 1988 E Centre (Society)

Muni Maya Ram Jain Hospital (previously Muni 1989 NW

42 Maya Ram Jain Charitable Hospital) Bhagwan Mahavir Society (Society)

43 Indian Spinal Injuries Centre (Society) 1990 sw

44 Brahma Shakti Hospital and Research Institute 1992 NW (Society)

45 Hans Charitable Hospital 1993 N

46 Jain Muni Roshan Lal Charitable Trust 1993 N

47 Bhagwan Mahavir Hospital (Society) 1993 NW

Dharamshila Cancer Foundation & Research Centre 1994 E 48 /Dharamshila Cancer Hospital and Research Centre

(Society)

49 Tagore Hospital 1994 w 50 Shanti Mukund Hospital (Trust) 1995 E

51 Lions Hospital and Research Centre (Society) 1996 s

52 Rajiv Gandhi Cancer Institute & Research Centre 19% NW (Society)

53 Sh. Mahant Gurmukh Singh Ji Charitable Hospital 1997 w Mai Kamli Wali Charitable Hospital (Trust) 1997- OPD and 1998 w

54 -IPD

55 Guru Harkishan Hospital (Trust) 1998 s 56 Birnla Devi Hospital (Dr. Walia Ch. Trust) (Trust) 1998 E

57 Dr. G.R. Kaila Memorial Hospital (Society) 1999 s 58 Bhagwati Hospital (refused to respond) (Sarvodaya 2000 NW

Health Foundation Society) 59 Jeevan Anmol Hospital 2000 E

60 Karuna Sindhu Dharmarth Charitable Hospital 2000 w 61 Jiwan Charitable Hospital (Trust) 2002 NW

62 Dashmesh Hospital (Society) 2002 w

63 All India Prayer Fellowship Mission Hospital 2003 s (Society)

64 Shri Guru Ram Dass Charitable Hospital 2003 w 65 Siddhant Hospital 2003 SW

66 Rockland Hospital (corporate trust) 2004 s

67 Sri Balaji Action Medical Institute (unit of Lala Muni 2004 w Lal Mange Ram Charitable Trust

68 Max Balaji Hospital (unit ofBalaji Medical 2005 E Diagnostic and Research Centre) (Trust)

69 Delhi ENT Hospital & Research Centre (Society) 2006 s 70 Sumermal Jain Hospital (non-functional) sw

Information not available on year of establisbnrent Parmarth Mission Hospital N Dr. Mittal Hospital (Trust) NW Mother and Child Hospital s Vidya Sagar Hospital s Jain Charitable Hospital E Sai Charitable Dispensary & Nursing Home E

169

Stories of Emergence of some Hospitals

Motivations to set up hospitals have been discussed in the context of the larger

changing socio-economic context. During the colonial rule, there was a dominant presence of

institutions by Christian missionaries and local traders. Then immediately after independence

the coming of the refugees from across the border and the ownership of these institutions

came to be dominated by the trader community and then post-80s by various industrialists

and others. But what do the providers have to say about the emergence of the institution.

What was the motivation and vision of the particular individual who conceptualised a

hospital? Since we have already discussed the pre-independence story of institutions in the

previous chapter we will look at the post-independence institutions. Some stories are given

below:

The period from 1950s-80

Moolchand Kharati Ram

"Moolchand' s legacy of philanthropic endeavours has spanned more than 80 years.

Moolchand Trust was created in 1928 at Lahore, present day Pakistan and was started with an

initial endowment of Rs. 4 million. It started as an Ayurvedic Hospital and had a nurse's

training schooL The enormity of this bequest can be better understood when one considers

the fact that the profits oflndia's largest Industrial Group {Tata's) was Rs. 5 million in 1947,

almost 20 years after this bequest. The values· ofMoolchand Trust reflected the ideals of Lala

Moolchand and his son Lala Khairati Ram. Their rich spiritual legacy continues. The hospital

functioned at Lahore till the partition of India. Lala Khairati Ram family migrated to India.

To establish a similar institution in Delhi Lala Khairati Ram and other trustees applied to the

Govt. of India for the allotment of land for the purpose. The GOI through Land and

Development Office granted 9 acres of land situated on the Ring Road at Lajpat Nagar in

South Delhi. The land was allotted in April 1951. A hospital was constructed on this land

with the same name as in Lahore i.e. Moolchand Khairati Ram Hospital and Ayurvedic

Research Institute with a Nurses Training School attached to the hospital and started in 1957.

The burden of this enormous responsibility fell on the young (16 years old) Sardari Lal

Talwar who upheld the values and aspirations of the Trust over the next 70 years. In the .

1990s Suresh Talwar, Sardari Lal's son helped restructure Moolchand so that it could

compete in a world of corporate healthcare. Historically Moolchand Trust has been funded

from the profits of the Moolchand Group in keeping with their philosophy of helping to

170

create a better world. Moolchand's values and focus of helping others is a testimony to the

extraordinary courage and care of its past leaders."

Holy Family Hospital

"A little over 60 years ago a young Austrian doctor, Anna Dengel, was immersed in health

needs of Muslim women and children of North India. She was a member of Medical Mission

Sisters that was established in 1925 in Washington D.C. in United States. In 1949 Archbishop

Mulligan of Delhi-Shimla invited Mother Anna Dengel, Founder of Medical Mission Sisters

to begin a General Hospital with Nurses Training School. Thus the New Delhi Holy Family

Hospital started in 1955. In the beginning the members of the society were exclusively

medical mission sisters but in 1980 it was decided that membership should be extended to

Christian community. By 1989 it was decided that not more than two persons of other faiths

may be invited as members. It falls under the Roman Catholic Archdiocese of Delhi. The

objective of the institution is to offer service which bears witness to belief in the dignity of

the individual"

Venu Eye'Jnstitute

"The story began in 1980, when the late Dr. R.K. Seth, a reputed ophthalmologist, decided to

give up his flourishing practice of 15 years, for this humane cause. He conceive<;l the dream

of an organisation that would provide selfless eye care to the millions who were visually

impaired, and began in a small place in South Delhi. Venu literally means a flute and it

carries the voice of hope to the blind and the voice of the blind to the res~ of the world.

Significantly, the flute is made of the same bamboo reed used by the blind in India as their

pathfinder. This fenestrated hollow bamboo reed becomes an ocean of sonorous musical

notes, when someone breathes into it. Similarly, the colour blue represents hope and white for

peace. Venu, the organisation, becomes a Temple of Service when all concerned breathe

themselves into it. Prevention, cure, rehabilitation, training and spreading general awareness

are the main functions of Venu. So the activities and events are geared towards identifying,

treating and rehabilitating a person with visual affliction, even if he cannot afford it. The late

Dr. R.K. Seth, Founder of Venu, dedicated his life to the service of humanity, especially the

visually afflicted. A visionary, he created an institution with a difference. After graduating

from Amritsar Medical College, Dr. Seth did his Masters from Maulana Azad Medical

College, Delhi in 1966. Thereafter, he worked as a consultant at Tirath Ram Jessa Ram and

St. Stephen's Hospitals. He also ran clinics at Kamla Nagar, Chandini Chowk, Defence

Colony, Greater Kailash-1 and paid a weekly visit to Agra and Muzzafamagar in the 1970's.

In the summer of 1976, at the peak of his career, he suffered a major heart attack, followed by

171

a second attack in October of the same year. Two consecutive heart attacks at such a young

age set him thinking about the purpose of his life and an answer to the ever illusive question,

"What are we here for?" This is a stage that most people reach in their twilight years. On

deep introspection he came to the conclusion that he had only been receiving from the

society-he had earned name, fame and financial status, but what had he given in return? He

decided that it was an apt time to return to society what he had received from it. The best way

of doing so was to dedicate his services to the people who were poor and needy and did not

have any recourse to eye care. He was resolute on using his skills, which had gained him the

name and fame as a brilliant ophthalmologist, for the service of those visually impaired who

needed it the most but were unable to access it. It was in 1980 that his vision took the shape

ofVenu Charitable Society. Dr. R.K. Seth realised that the only way to combat the problem \

of avoidable blindness was to take eye care facilities to the doorstep of the patients, rather

than expect them to come to cities for treatment."

Ganga Ram Hospital

"Sir Ganga Ram Hospital is a hospital in India, the original hospital was established by Sir

Ganga Ram, a Civil ·Engineer in the British Government at Lahore in 1921. In 1946 . the

family of Sir Ganga Ram started a medical college by the name Balak Ram medical College

named after a son of Sir Ganga Ram. After partition it was re-established by Sh. Dharma

Vira, a Civil servant and who was a family member of Founder at New Delhi on 13th

April,l954. The first Prime Minister of India Pandit Jawaharlal Nehru laid the foundation

stone of the Hospital. The hospital is run by Board of Management, who are eminent

consultants, under the over all guidance of the Trust Society."

Nazar Kanwar Surana

"The family is originally from Churn in Rajasthan and are Marwari Terapanthi Jains who are

into business. The hospital was started some 30 years back by Seth Dungarmal Surana in

memory of his mother Shrimati Nazar Kanwar Surana. Seth Dungarmal had three daughters

and no son. Therefore he adopted a son to look after his construction business. Amongst other

things, the family also had Ayurvedic Medicine factory and several charitable schools run by

them in Rajasthan."

The period from 1981-present

Vidya Sagar Kaushalya Devi Memorial Health Centre (VIMHANS)

"VIMHANS is a living legacy of Dr. Vidya Sagar, who is also known as the Father of Indian

Psychiatry He was Superintendent of the Arm-itsar Mental Hospital and then Professor of

172

Psychiatry at Rohtak Medical College until has demise. During the period when psychiatric

services were in relative infancy Dr. Vidya Sagar spent upto 18 hours a day with patients.

Due to overflowing wards in the hospital, many a patient was accommodated at his residence

with full support from his dedicated wife Mrs. Kaushalya Devi who also relieved him of all

domestic responsibilities. Dr.Vidya Sagar was elected as President of Indian Psychiatry

Association and spent a lifetime servin~ his chosen profession and patients. A concerted

effort by close family members and well wishers of Dr. Vidya Sagar led to formation of a

society bearing the names of Dr. Vidya Sagar and Smt. Kaushalya Devi in August 1981. It

was started with Rs. 40,000 left by Dr. Vidya Sagar for this puq)ose in his will and the

hospital initiated its services in the fields of Psychaitry and Drug de-addiction with 20 beds.

Since then the path has been long and tedious but also crowned with several achievements

and accomplishments. Vimhans now has 110 beds, with assets of considerable value. From

the original field of mental health, now the hospital is ·a superspeciality institute covering 5

major medical specialities and their allied disciplines with three outreach centers in different

parts ofNorth India."

The Leprosy Mission Hospital

"Leprosy Mission Hospital. at Delhi is a subsidiary of the Leprosy Mission Trust (TLM).

Though this institution was set up in the 80s, the trust is very old. TLM's work started in

India in 1874 and it remains a key area for the Mission with over 50% of resources being

channelled there. Around 70% of all leprosy patients worldwide are in India. TLM also

fulfills the role of International Leprosy Federation coordinator in India. The Leprosy

Mission (then known as Mission to Lepers) came into existence in 1874, when Mr Wellesley

Cosby Bailey an Irish teacher was moved with compassion seeing the plight of people with

Leprosy. Right from its inception the Mission's efforts have been to provide care to those

affected by leprosy and its attendant disabilities. 130 years on, the Mission's basic focus has

not changed rather; there is a powerful new shift in terms of service. In 1972 The Leprosy

Mission Trust India was formed and registered in India as a charitable organisation under the

Registrar of Societies Act. Started in 1984, the Shahadra Community Hqspital was intended

to be a Community Hospital providing integrated medical treatment to leprosy affected and

general medical patients. Located in the Trans-Yam una area of Delhi, the hospital is vital to

the needs of the inhabitants of the various leprosy colonies in the area. It also serves the

medical needs of the people in the surrounding slum areas. Including the Delhi area, the

Hospital has the potential to treat patients from the neighbouring states of Uttar Pradesh,

Haryana, Punjab and Rajasthan. The vision of the Hospital is to attain a National Centre of

173

Excellence status. It also aims to provide an integrated approach to the treatment of leprosy

and its c<?mplications from Prevention and Early Recognition to Reconstructive Surgery to

Rehabilitation. The desire - driving all its activities - of the Hospital is to enhance the quality

of life of leprosy-infected persons."

Jaipur Golden

"Before partition, Shri Sardari Lal Bahri, Tulsi Dass Khanna, S. Makhan Singh and Shri

Murari Lal Bahri, had a business of bus service in Sargodha (in Pakistan), and had a fleet of

50 buses. After partition they shifted to India and started afresh their transportation business

as a small venture with 2 rambling trucks, operating from wooden stalls near Lahori Gate in

the year 1948. Today Jaipur Golden Transport Company is one of the largest and reputed

transport companies. The credit for this transformation· goes to the founding fathers who

nursed it with their sweat and blood. In this they were ably assisted by seasoned Directors

and a set of young dynamic executives and the entire team of loyal, trusted workers. Jaipur

Golden Hospital was started by Jaipur Golden Charitable Clinical Laboratory trust formed in

1976. Jaipur Golden family has had an abiding commitment to the cause of the sick and

underprivileged. It is out of this care and concern for the community that a small dispensary

and clinical laboratory was started at Roshanara Road in the heart of Delhi."

Banarsidas Chandiwala

"Shri Banarsidas Chandiwala Sewa Smarak Trust Society was established in 1952 by Shri

Brijkrishan Chandiwala in the memory of his father Shri Banarsidas Chandiwala. Shri

Brijkrishn Chandiwala was a freedom fighter and a close associate of Mahatma Gandhi. After

independence, he was the Founder Member of Bharat Sewak Samaj & Sadachar Samiti. He

was honoured with a Padmashri for his devotion and services to various social service

organisations. His firm belief in life was the upliftment of the weaker sections of the society.

This belief he inherited from his father and grandfather Lala Ishwardas. Janki Devi Memorial

· College was set up in ·1959 by Brikrishan Chandiwala in memory of his wife Janki Devi. Shri

Banarsidas Chandiwala Sewa Smarak Trust Society was headed by Shri Devdas Gandhi, son

of Mahatma Gandhi, in its infancy. After his demise, eminent personalities such as Dr Sushila

Nayyar and others supported the Society and helped it to grow further. Chairman of the

Committee, Shri A. Krishna took charge of the Society in 1985. Since then, the Society has

been carrying its good work under his able leadership. The Society started an eye hospital in

1995, it already had an Ayurvedic health centre. Since 2001, a multi-speciality hospital, an

Ayurvedic Health Centre, a Homeopathic Clinic, a Psychological Research Centre, a Health

174

Centre, four educational institutes, a state-of-the-art sports centre, a Guest House and a Food

Court. The Society is building an educational institute at Dwarka, New Delhi and many other

projects are in pipeline."

Saroj Hospital

"The Ganesh Das Chawla Charitable Trust was founded by Mr Ganesh Das Chawla, a

businessman in 1969 in the memory of his daughter Saroj, a victim of dowry harassment. The

hospital was set up before but was inaugurated as a multispeciality hospita~ in 1997."

Max Balaji and Max Devaki Devi

"From business to business collaboration it was decided to shift to business and customer

collaboration. The Chairman thought of entering the business of life. So after making piles of

money in various businesses Max first started with selling insurance and then entered the

health care sector".

Type of Ownership - Faith-based, Traders and Industrialists, Others

The non-profit hospitals have been categorised in terms of its ownership into faith­

based, those established by the business and industrial houses and others. Information was

available for 64 institutions. These categories are delineated on the basis of the original

founder of the institution {Table 7.4). In many instances community, caste and faith gets

merged. While an individual Jain Marwari who is a business man may have built a separate

institution, many of the individuals from this community may be also contributing donations

to institutions run by a Jain Society. So Sunderlal Jain is put in the 'business' category of

ownership and a Muni Maya Ram Jain Hospital is put in a 'faith based' .category as this is

managed by a faith-based trust. The following statement tells how intricately community,

caste and faith can get merged.

" .... Delhi baniyas mostly came from Agrawah in Haryana or UP ... Aggarwals, Khandelwals and also Maheshwaris ... Most of the Marwaris are Maheshwaris. You see there are many layers of system working .... the caste, communityand religion .... so it all gets mixed up. For example, I am a Jain, but I am an Aggarwal and from UP. My wife is from Haryana. And Banya means anyone who does business, .. Vanjya, Vaishya '. Marwari is just a descriptive term of a community. "(Philanthropist)

175

32

33

34

Table 7.4- Non-profit hospitals based on ownership (original founders)

Sitaram Bhartia Institute of Science and Research (Bhartia Group- Abhishek Bhartia (Marwari)

Escorts Heart Institute and Research Centre {from a Society to Corporate) (fortis Escorts 2005) (Nanda- Khatri) ·

s

s

176

S.No.

36

37 38

39

40

41

42

43

44

45.

46

47 48 49 50

51

52 53 54 55 56 57 58 59 60 61 62 63 64

Name of Hospital

National Chest Institute and Research Centre (Sita Ram Jiwarka Hospital)-Marwari

Ban1usidas Chandiwala

Sumermal Jain Hospital Max Balaji Hospital (unit ofBalaji Medical Diagnostic and Research Centre)(Action and Max) (Aggarwal community) Shanti Mukund Hospital R.B. Seth Jessa Ram (Fortis JesiaRam in 2004) (Fortis and Jessa Ram) (Bhatia, Dass - Khatri)

Sir Ganga Ram Hospital (Bharat Ram, Teji Ram- Industrialists)- Punjabi kbatris

Mata Chanan Devi Arya Dharmarth Eye Hospital (MDH Industries) Sri Balaji Action Medical Institute (unit of Lata Muni Lal Mange Ram Charitable Trust (Action Shoes- Aggarwal)

Janki Das Kapoor Memorial Hospital (Khatri) Dhararnshila Cancer Foundation & Research Centre (Society) /Dharamshila Cancer Hos ital and Research Centre

Rajiv Gandhi Cancer Institute & Research Centre Dr. Mittal Hospital Bhagwati Hospital (refused to respond)

Red Cross Maternity & Child Care Hospital (Red Cross General, Maternity & Child Care Hospital -2005)

Comprehensive Model Family Planning

Bimla Devi Hospital (Dr. Walia Ch. Trust) (Khatri) Delhi Council for Child Welfare

Information not available on-ownership Parmarth Mission Hospital Mother and Child Hospital Rural Medicare Society Dr. Vidya Sagar Hospital Siddhant Hospital Deepak Memorial Hospital & Medical Research Centre

Jain Charitable Hospital (Jain) Jeevan Anmol Hospital Walia Nursing and Maternity Home (Khatri) Sai Charitable Dispensary & Nursing Home

Shri Guru Ram Das Charitable Hospital (Sikh) Tagore Hospital

District

s

s sw E

E c

c

w w

w E

NW NW NW NW NE

c c s s s s s s sw sw N E w

N s s s. sw E

E E E E

w w w

177

Table 7.5- Number of non-profit hospitals based on typology of ownership

Faith-based Traders I Others Industrialists

Missionaries I Hindu I Jain I Sikh 6 I 1 I 4 I 4 31 18 .

Map 7.2 - District-wise proportion of not-for-profits by ownership

DISTRIBFTION OF NOT-FOR-PROFIT HOSPITALS BY O'VNERSIDP

Kilometers 0 2.5 5 10 15 20

178

There are many small and big business groups that have built institutions. There is a

mix of industrialists who are prominent at the national level and those that have local_

businesses. Among those business houses who have spread nationally and have their non­

profit hospitals in Delhi, we see the Modis, Singhanias, Bhartias. These are old business

houses that have set up not-for-profit hospitals dUring 80s and 90s.

Apart from business houses at the national level, several regional business groups

have also entered this arena by establishing similar hospitals in several major cities as shown

in a study done by Bam (1998). Her study on the growth of private hospitals in Hyderabad

from the late 70s shows that there was a rise of regional capital where the cultivating caste

started investing in small-scale industries. These families set up many nursing homes and

hospitals during that period. In 70s and 80s in certain rural pockets some caste groups like the

Jats, Yadavs, Kurmis in the North; Kammas, Reddys, Vanniyars and Nadars in the South;

Kumbis, Patels and Patidars in the West and Marathas in Central emerged as economically

well-off groups. Regional businesses and rich farmers from these castes diversified their

business outside agriculture in medical care and they acquired an upper middle class status

and lifestyle (Barn, 1998). Flow of people, goods, capital and ideas can bring forth a certain

kind of values and culture that may be dominant at that point in time. In the context of

partition, this shift took place almost overnight as the social composition of Delhi changed

overnight. The khatris used to be mainly administrators during the Mughal times and in

colonial times but with partition the context changed as many from their community migrated

to Delhi and they many of the community started small businesses to sustain a living. Thus

formed the newer business houses specific to the region and then expanded like the Nandas,

Kapoors, Batras, Bahris, Sawbneys and so on.

While the old institutions emerged as visions of individuals and out of donations by

the community, many of the newer institutions trusts have emerged out of industrial houses

as separate businesses. They have also emerged as a result of subsidies and income tax

exemptions provided by the government in the 1980s and essentially cater to the middle and

upper classes.

"Health and education I can say they are businesses today, they are lucrative ... many industrial houses that are now emerging also have a trust entity and their industry is funding the trust so they have money coming from their industry unlike NGOs that have to constant~v struggle for finances .... The individual philanthropists during pre and post independence kept their business separate from charity but now industrial

179

houses have built it as another industry, its like having two businesses." (Director, VenuEye)

The following observation brings the distinction between the new and old business

houses. Here the new businesses are marked as those that emerged post-partition with the

coming and settling of the khatri Punjabis. The old consisted of the Marwari Jains and

Hindus. The new business classes, according to this renowned philanthropist, despite being a

product of the national economic and social policies, have a value structure that is more

inwardly directed.

"If you were to reflect having lived in the city for so long, if you were to look at these three phases of charity moving to philanthropy to the new trusts... like Singhanias and Bhartiyas ... 1 want to say that there was a phase were there was charity and charity was built in to various activities and then there was growing of institutions pre-colonial and post-colonial it gets a new avatar in a sense. Then you have the coming of the Punjab is after partition, do you see a difference in these two types of institutions that were built? I personally feel that genuinely rich people who have been rich always, where there was education and money for 4-6 generations, they had a vision but people who became rich overnight and people who also had ill­gotten money they never had any vision ... " (a renowned philanthropist from Delhi)

Some of the traders and industrialists who established hospitals and have been in to

other charitable ventures in Delhi are listed in Table 7.6.

Table 7.6- Background of some trader and industrialist families who have established a non­profit hospital in Delhi

S.No. Nameofthe Community Business Charitable ventures trader/industrialist

l. Narayan Das Bangur Marwari Devotees of Sant Paramanand and established many educational institutes the Bangur Chaksu Chiksalya that is now Sant Paramanand Hospital

2. Seth Sunderlal Jain Marwari Jain Sunderlal Jain Eye Hospital and Sunderlal Jain Charitable Hospital

3 Ishwar Das Sawhney Khatri Triveni Tirath Ram Hospital Engineering and Industries Lirllited

4 Seth Dungarmal Surana Marwari Construction Many educational institutes Terapanthi and property in Rajasthan and Nazar Jain dealerships Kanwar Surana Hospital

5 Sardari La! Bahri, Makhan Khatris Jaipur Jaipur Golden Hospital Singh, Tulsi Dass Khanna and Golden Murari Lal Bahri Transport

I Company 6 Aggarwals Marwari Maharaja Agrasain Charitable

Hospital

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7 Gujarmal Modi Marwari Modi Temples, educational Industry institutes, rural development, (sugar, oil, Gujarmal Modi Community food ophthalmic centre in products) Modinagar, Gujarmal Modi

Hospital 8 Lala Moolchand and Lala Khatri Moolchand Khairati Ram

K.hairati Ram Talwar Hospital 9 R.B. Seth Jessa Ram Khatri Jessa Ram Charitable

Hospital 10 Sir Ganga Ram Marwari Civil Ganga Ram Hospital

Agarwal Engineer Janki Das Kapoor Khatri Atlas Cycles Janki Das Kapoor Hospital

11 Lala Juggilal Singhania and Marwari JK industry Numerous health facilities, Lala Kamlapat Singhania (sugar, Pushpawati Singhania

paper, tyre, Research Institute for liver, cement etc.) renal, and digestive diseases .

12 Raj Krishen Jain Marwari Jain Temple Nursing Home 13 Aishi Ram Batra Khatri Batra Hospital and Research

Centre 14 Sitaram Bhartia Marwari Started with Sitaram Bhartia Institute of

jute industry Science and Research in Calcutta

15 HPNanda Khatri Escorts Escorts Heart Institute and Industry Research Centre

16 G.R. Kaila Khatri G R Kaila Hospital 17 Bhai Mohan Vir Singh Sikh Khatri Ranbaxy Tie -ups with non-profit

hospitals by sister companies Fortis and Max

18 Brijkrishan Chandiwala Educational institutes, Banarsidas Chandiwala Hospital

19 Lala Mange Ram Agarwal Marwari Action Balaji Action Medical Group of Institute Companies

20 Mahashay Dharampal MDH Mata Cbanan Devi Arya ·Industries Dharmartb Hospital

21 Ganesh Das Chawla Khatri Saroj Hospital 22 Dharam Swaroop Khanna Khatri Dharamshila Cancer Hospital

Figure 7.1 combines data of year of establishment and ownership and depicts that

post 1950s the business community dominates the ownership of not-for-profit hospitals. The

'other' category mostly includes institutions built by medical professionals who may or may

not come from a business family.

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Figure 7.1 - Bar diagram showing number of non-profit hospitals by ownership and year of establishment in Delhi

20 18 16

14

12

1981-present

Type of Services in Non-profit Hospitals

o Faith based

• Business

o Others

Most of the non-profit hospitals, i.e. 60 percent of them, are those that have beds in

the range of 1-100.

Table 7. 7- Number of non-profit Hospitals by bed range

No. of beds- 1-30 31-100 100-200 >200 24 28 13 8

There are two categories of services under which the hospitals are listed for the study:

multi-speciality and specialisation. There is a category in medical services called 'general

services'. General Service as a term has always been associated with a general practitioner

who also undertakes general surgery. In most of the hospitals the number of services included

more than one service. Therefore they have been categorised under multi-speciality. This

includes a whole range of services from obstetrics, gynaecology to cardiology, and neurology

as out-patient and in-patient services and in some cases also includes super-specialisation.

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What would entail specialisation? Specialisations can also be further categorised to

super-specialisation, sub-specialisation and micro-specialisation. For example, if a hospital

specialises just in eye services there are several categories to it. Therefore, one has a cornea

specialist, a retina specialist and so on. This is specific to a particular organ in the human

body. A hospital could also specialise in one particular disease like Cancer that could affect

any part of the body. A hospital could also specialise in implementing a certain programme

like Family PI<imning services. For the present study, all these institutions are clubbed under

hospitals providing specialisation. Therefore, a hospital is listed under specialisation where

services are specific to an organ (eye, ENT, liver, chest or respiratory etc.) or a disease

(Cancer, Leprosy, Tuberculosis) or a programme (Family Planning).

Table 7.8- Type of services in the non-profit Hospitals

Types of services Bed Number Total hospitals strength of

hospitals Multi-speciality 1-100 41 60

> 100 19 Specialisations 1-100 II 14

> 100 3

Out of the 14 specialisations: organ specific are - 4 eye hospitals, 1 hospital for renal

and liver diseases, 1 specific to pulmonary medicine, 1 specific to ENT; disease specific- 3

Cancer hospitals out of which one is a hospice, l Leprosy, 1 Tuberculosis hospital; 1

programme specific hospital - Family Planning. While the eye, leprosy and tuberculosis

hospitals are old the rest of the specialisation hospitals are the newer emerging ones.

56 institutions responded to having some diagnostic services. Some of these

institutions that provide specialisations have their organ related diagnostics. 6 of the larger

institutions have all the diagnostics.

Table 7.9- Diagnostic Services in non-profit Hospitals

Pathology X-Ray Ultrasound CT Scan MRI Multi-speciality 46 44 39 17 6 Specialisation 10 2 3 3 0 All hospitals 56 46 42 20 6

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Source of Funding

Hospitals by the missionaries and philanthropists pre-independence and immediately

after independence functioned strictly on no-profit and no-loss. Surplus if any was very

limited. Government was an important source of funding for both capital and recurrent costs.

A lot of requrent costs were taken care by the annual grants by the government and through

donations. Gradually when more and more private institutions started emerging it was

realised that sustaining them was important. The for-profit received its capital from loans and

borrowings. The non-profit presently receives subsidies by government and some donations

that takes care of their capital costs to some extent but recurrent costs have to be generated by

the institution. Therefore hospitals once established rely largely on making surplus and

profits to take care of their recurrent costs.

In an unpublished study conducted in 2005 on three non-profit hospitals and one for­

profit hospital in Delhi, it was seen that hospitals spend most on establishment and

consumables.

Table 7.10- Main cost centres for the hospitals 2003-04 (in percentage)

Trust I Trust II Trust Ill For-profit Hospital

Establishment 36.55% 63% 37.500/o 66% (Administration/staff costs/ Repair and maintenance) Pharmacy I Consumables I 5.86% 26% 46.500/o 32% stores and spares Fuel electricity I water 7% 5% charges I utilities Interest and financial 2% charges Depreciation 7.07% Others 4% II%

Source: Study conducted for the National Commission on Macroeconomics and Health (2005)

It was also seen that revenue was mostly generated from sale of drugs, diagnostic

investigations/tests and bed charges.

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Table 7.11 -Main revenue earning centres 2003-04 (in percentage)

Trust I Trust II Trust III Pharmacy 27 29 Investigations and tests I Laboratories/ Radio 13.58 17 13 diagnostics Nursing home I Bed charges 21.01 27 20 Operation theatre 10.4 22 5 Maternity and paediatrics 13.24 Cath lab (cardiology) Orthopaedic Oncology Neurosurgery Nephrology Share of professional charges 7 Other medical receipts 6.98

Source: Study conducted for the National Commission on Macroeconomics and Health {2005)

Government subsidies to non-profit hospitals

.Land and infrastructure are the two major capital expenditures for establishing an

institution. Land in most cases in Delhi is acquired from the Delhi Development Authority

(DDA) and Land and Development Office. The latter has· just two hospitals in the land

provided by them while most of the land provided to the institutions is by DDA. DDA was

established to promote and secure planned development of Delhi in 1957 under the

provisions of the Delhi Development Act, 1957. It acquires land and develops lands and

properties. It also disposes of plots and properties for commercial, industrial, institutional and

residential uses in accordance with the provisions ofthe DDA's Disposal of Developed Nazul

Land Rules, 1981 popularly known as Nazul Rules. Of these Rules, Rule 5 stipulates that

DDA may allot Nazul lands for construction of hospitals and dispensaries to social or

charitable institutions. The premium and ground rent for this purpose will be determined by

the Government of India. Allotment of Nazul land to public institutions is subject to

fulfilment of certain conditions prescribed in Rule 20 which, inter alia, states that an

institution seeking allotment of institutional land should be a society registered under the

Societies Registration Act, 1860, or such institution should be owned and run by the

Government or any local authority or constituted or established under any law for the time

being in force.

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Procedure of allotment of land to individuals by DDA:

All such applications have to be essentially recommended by the concerned department of the ·

·Government of India or the Government of Delhi before consideration by DDA. The

applicant has to furnish following details along with the application:

a) Aims and objectives of the institution;

b) That it directly serves the interests of the population of Delhi;

c) That it is generally conducive to the planned development of Delhi;

d) That it is apparent from the nature of work to be carried out by the institution that the same

cannot with equal efficiency, be carried out elsewhere than in Delhi;

e) That it is registered society under the Societies Act; 1860 or owned and run by the Govt. or

local authority. Certain concessions in land rates are given to the societies working for the

poor strata of the society, receiving grants from the Govt. for running their institutions and

charging only to the extent of running such institutions. However, these facts have to be

confirmed through a recommendatory letter from the concerned department of the Ministry;

f) That it is 'non profit' making in character;

g) It has sufficient funds to meet the cost of land and building.

Capital and ~ecurrent funding of the hospitals

Many hospitals did not respond to the question on source of funding. Source of capital

funding has mostly been the government, donations, loans and borrowings. For the present

study, many institutions say that capital costs were taken care by government subsidies and

donations. According to the data, 35 out of the 74 not-for-profit hospitals received land from

the government at their time of establishment at subsidised rates or free. Few of the other

institutions that responded received additional land for capital investment from the ·

government and few received donations from international bodies from time to time for

capital investments but these are inconsistent and one time funds. For example amongst some

of the big institutions, Venu .Eye Hospital receives funds from a German Mission annually,

Indian Spinal Injuries Centre received support from government of Italy and several

foundations in the United States for its initial capital costs, Sunderlal Jain received a crore of

fund for capital investment from Japanese government and so on. Donations are mostly one­

time grants.

Only a small number of institutions that too the smaller ones like Sant Nirankari,

Guru Harkishan, the New Delhi TB Centre and Shanti Avedna (a hospice for terminally ill

Cancer patients) rely mostly on donations for recurrent and capital costs and charge very

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nominal charges. It is mostly the faith-based that still receives donations as part of recurrent

. funding. If. we look at the data, only two faith-based hospitals are tertiary and they are the

Christian mission institutions- St. Stephen's and Holy Family and both are old societies and

have expanded over the years. The rest of the faith-based institutions also choose to function

at a smaller scale and keep costs low.

The institutions that were set up by traders and businessman are bigger and tertiary

level hospitals. The following three old trust hospitals that started from donations show that

donations are not their source of funding. Table 7.12 and Table 7.13 shows that almost 100

percent of recurrent costs are met by fee-for-services and all three institutions started with

100 percent donations during the time of their establishment in 1950s.

Table 7.12- Source of financing for recurrent costs as a percentage of the sources (2004-05)

User Donations Loans and Interest Total charges borrowings received

Moolchand 99.8 - - 0.18 100

TirathRam 100 - - - -Ganga Ram 95.31 0.22 - 4.47 100

St. Stephens 98.5 1.5 - - 100

Source: Study conducted for the National Commission on Macroeconmrucs and Health (2005)

Table 7.13 -Source of finance for fresh capital investment in the hospital (2004-05) (in percentage)

User Donations Loans and Interest Charges borrowings received

Moolchand - 100 - -TirathRam - - - -Ganga Ram 95.31 0.22 4.47 St. Stei>hens 98.5 1.5 - -.

Source: Study conducted for the Nattonal CoimDlSSion on Macroeconomics and Health {2005)

Other than direct out-of-pocket payments made by patients availing services of the

hospitals there are mechanisms of generating revenue that have been introduced in recent

years. These are the following:

Afedicalinsurance

Many of these trust institutions are empanelled by the government insurance scheme

for their employees, and quasi-public and private insurance companies that have members

who buy premiums to insure themselves against risks and are voluntary. The Central

Government Health Services (CGHS) empanels many private hospitals in its list. The list of

hospitals empanelled varies from year to year as new ones get added and some old hospitals

187

drop out from the scheme. In 2007, seventeen of the non-profit hospitals in the data were

empanelled under CGHS in Delhi.

Voluntary insurance schemes have been made available by government and lately by

the private insurance companies. Members · of these insurance companies buy annual

premiums to cover them for hospitalisations if needed. All the tertiary non-profit hospitals in

the data have built-in cashless payment mechanisms for hospitalisation cases for which they

have tie-ups with the insurance companies. More and more middle and upper class people in

the city are getting some form of medical insurance as costs of medical care has increased in

recent years.

Medical tourism

Medical Tourism has been a new advent in all the large hospitals in the last few years.

It is a new mechanism for generating revenue where foreign patients are pulled in to get their

surgeries done in India at cheaper rates. As in many countries, medical care is either

expensive like in the United States or there is a long waiting time like in the NHS in UK. The

easiest option is to travel to India and get surgeries done where all private tertiary hospitals

have opened their doors for such patients. Twenty two of the listed non-profit hospitals in

Delhi i.e those at the tertiary level are listed as involved with medical tourism

(http://www.indianconsultancy.com/medicaltourism/).

Elaborate packages that include, surgeries, hospital stay, pick ups and drops, travel to

different parts of the country are part of this newer form of tourism. The details are handled

in partnership with management companies who enrol hospitals in their panel and invite

patients from other countries to get surgery procedures done in India. Their websites give a

comprehensive list of panel hospitals and doctors enrolled with them with list of procedures,

facilities and services available (http:/fwww.longfieldmanagement.com). Chairman of Max

Health Care one of the leading actors in the hospital industry today says, "India has a

booming economy and is a dream place for investment. Patients come from different

countries as patients and leave as customers".

Cost of Services

The rates of three tertiary level non-profit hospitals and one tertiary for-profit hospital

in Delhi showed that the rates of some common procedures are lower in the non-profit

hospitals when compared to for-profit hospitals but the difference is not significant

188

Table 7.14 - Costs of some common procedures in three non-profits and a for-profit corporate hospital

Procedures Trust I (2004) Trust II (2004) Trust ill (2004) For-profit Hospital (2004)

Caesarean section 2,000 5,850- 7,475 5,750-ll,SOO 7,700-25,800 Cataract Removal 4,500 4,500- 6,500 6,500-20,000 8,400-28,000 Coronary N.A. 29,700-98,900 Angioplasty Appendicectomy 17,000 (package) 2,970- 4,290 4750-9500 6;500-21,500

$6VI'l~: S'G.&.~ c,tJJ'\tJi~c,ttzd riC.I"'H, 1-Do~

All tertiary non-profits hospitals have graded beds from Super Deluxe Suite, Suite,

Deluxe, Private, Semi-private, Economy, Day Care, and Critical Care. Costs vary across

these wards. Some have more categories while others have broad categories of economy

which is subsidised, semi-private and private rooms (Table 7.15).

Table 7.15- Cost of bed in some non-profit hospitals, 2008

Cost of bed (includes diet and nursing charges)

Type of bed Mata Sir Holy Jaipur Escorts Chan nan Ganga Family Golden De vi Ram

Economy/General 500 subsidised 1000 3000 ward

Economy ward (3 600 900 1200 4000 beds)

Semi-Paying 1100 1800 1500 1800 Private 1600 3100 2500 2000 Nursing Home 1600 3900 - 3000 Deluxe Room 2300 5000 - 4000 9000 Suite 3500 7850 - 5000 12000

So&Jru : t:.·Ja !u 2-Dc ~-o

Non-profits at the tertiary levels are unable to keep costs lower unlike the secondary

level non-profits that provide fewer services and keep costs relatively lower.

Cross Subsidies

It is important to note here that the Government has made it mandatory for private

hospitals which have acquired land from the State at subsidised rates to provide 20 percent of

in-patient and 40 percent of out-patient services free of cost to patients from the poorer

sections of society. This has riot been complied with by most of these hospitals and from time

to time they are pulled up by the government. Recently a directive was passed by the Delhi

High Court, regarding provision of free medical care by private hospitals in Delhi based on

the conditionalities by the government, the Delhi government has set up a group to look into

189

the complaints of poor patients turned away by these hospitals. The Director, DHS said, "We

have selected five members and soon we will publish their phone numbers and contact details

so that anybody can contact them". Besides a member from the medical department, a

member will be present from the Delhi Development Authority (DDA) and Land and

Development Office (The Statesman, Feb. lih 2006). This sector has received a lot of m~dia

attention in recent times due to non-fulfilment of conditionalities.

The primary objective of providing free treatment to the poor patients has, however,

not been achieved. The Public Accounts Committee under the Ministry of Urban

Development brought out a report on 'Allotment of Land to private Hospitals and

Dispensaries' by the DDA in 2005. According to the report, till2003, DDA had allotted land

to 65 social or charitable institutions for construction of 53 hospitals and 12 dispensaries

urider Rules 5 and 20 of Nazul Rules. The allotments were made at concessional premium

and ground rent fixed by the Union Ministry of Urban Development from time to·time and at

rates fixed by the DDA in consultation with the Ministry. This has been subject to the

condition that the institution shall serve as a general public hospital with at least 25 per cent

of total indoor beds reserved for free treatment to indigent patients and that it would provide

free treatment toAO per cent patients in the outdoor department. More recently corporate for­

profits hospitals have also received free land from the government and they have to fulfil a

similar condition of providing free services (GOI, 2005).

There have been several committees and audit reviews to probe in to this fulfilment of

allotment conditionalities. The records of allotment of land to 42 hospitals and dispensaries

revealed various irregularities and shortcomings in both the allotment of land and in

enforcement of the terms of allotment which defeated or undermined the very purpose of

allotment of land to such organisations at concessional rates (Twelfth Report of Public

Accounts Committee, 2003). The print media, especially the daily newspapers have in the last

couple of years been reporting of aberrations in the contractual arrangements between the

DDA and the Societies. Various hospitals have been listed for not fulfilling conditionalities

but no collective effort has been taken by the government to check on these institu~ions.

A high level commission (Qureshi Committee) set up by the Government of NCT of

Delhi in 2000 to study private hospitals in Delhi gives insights into the complexity of

understanding the status of the not-for-profit hospitals as the older trusts have undergone

considerable changes (Government of NCT of Delhi, 2001 ). Many of these institutions were

190

given land at concessional rates by the government. The enquiry was commissioned to cover

all aspects of functioning of these hospitals that included management and administration,

costs of care, whether conditionalities are being fulfilled and percentage of poor patients are

getting treated free of cost and conditions of workers in these hospitals. The study showed

that several hospitals in Delhi had been given land almost free of charge. It revealed that the

existing free treatment facilities extended by charitable and other hospitals, who had been

allotted land on concessional terms is extremely low. Number of hospitals said that they

could not comply with the conditions of providing free treatment as it affected the financial

viability of the hospitals. They argued that the cost of medicines and medical consumables

were very high and it was not possible to provide totally free services to even 10-15 percent

of in-patients. DDA felt that there was a need for transferring those registered as 'trust' or

under 'companies act' to 'society' to claim land from DDA. There have been certain

contradictions and aberrations in this regard by some hospitals as claimed by DDA (GOI,

2002). Four detailed case studies were carried out with four hospitals that were allotted rates

at concessional rates but had violated the original purpose. The study was difficult and

majority of the hospitals did not comply to the questionnaire while the ones who did give ·

information were not completely open thus proving that conditionalities were not being

fulfilled. But the private sector perceives it very differently and does not see it as an

aberration.

There are different methods that institutions seem to have adapted when it comes to

provisioning of some proportion of free and/or subsidised services. For out-patient, in most of

the institutions there are separate timings or days for general and private out-patient

departments. The general OPD caters to the poor and nominal charges are levied from the

patients. The general is free and/or subsidised for patients who cannot afford to pay. Some of

the OPDs provide free treatment .to a proportion of patients ranging from 10 to 15 percent. In

smaller institutions cost of care is less than the tertiary institutions. Consultations for OPD

services cost less and more free and subsidised services are available unlike institutions with

over 50 or 100 beds.

For in-patient services most institutions have graded bed facilities ranging from

economy ward to a single private room. 26 institutions reported that 10-15 % free beds are

kept aside for poor patients. Only 5 directly responded that there were no free beds. In most

cases the services are not 'free' in its true sense. If the bed is free, patients are paying for

medicines, equipments, part of surgery costs etc. therefore, the costs are subsidised to a

191

certain extent but not. free. One institution said that they provide only free emergency

services. One eye hospital said that they tried to annually keep 50 percent surgeries free. In

some hospitals there are social work departments and patients who cannot afford have to be

screened by the social worker and gain approval as a genuine case. Another tertiary mission

hospital keeps 70 percent of its beds subsidised and 30 percent are for paid patients.

Community Outreach Services

Community outreach programmes is a characteristic of many not-for-profit hospitals.

Many institutions extend certain services by going to the community and providing services

through camps and so on. Many have some tie-ups with the government

St Stephen's has a community centre in an urban resettlement in Delhi. Venu hospital

has 6 s_atellite hospitals in and around Delhi. Moolchand has several charitable clinics and

also runs a soup kitchen. Amongst those who provide community outreach services in some

form are Sant Parmanand, St. Stephens, Sitararri Bhartia, Gujarmal Modi, Sir Ganga Ram,

Holy Family, Venu Eye, SCEH, Jeevodaya, Leprosy Mission, TB Centre, Brahma Shakti.

While the mission societies initiated outreach servic'es much before institutions were set up,

the community component later became an integral part of their work. For other institutions,

the community component has been added later as part of the institution's non-profit

character.

Partnership between state and NGOs at the primary level has been discussed before

that is prominent with respect to the National Health Programmes. These also extend to

institutions at the secondary and tertiary level. Partnership with the Directorate of Family

Welfare, Delhi, is seen with the establishment of Family Welfare Centres in some of these

hospitals to provide family planning services (hospital staff and family planning products are

. by the government). 21 NGOs have family welfare centres providing family welfare services

including immunisation. Out of these 21, 8 are non-profit hospitals at the secondary and

tertiary level. Other programme based partnerships between hospitals and the government are

also prevalent. These are seen in Tuberculosis programmes (St. Stephen's, New Delhi TB

Centre) and National Blindness Control Programme (SCEH, Yenu, Sunderlal Jain). Holy

Family has its community outreach programme where the mobile vans are provided by the

Delhi Government.

192

"Pre-requisites for any PPP is a combination of communication, consultation, coordination and collaboration. We do partner with the government in the blindness programme. The Delhi Government has allocated Mobile Health Clinics in 12 slums and immunisation programmes are run in the hospital and slums as part of the community outreach programme. MCH Care, health education, home visits, counselling, pulse polio programme and polio surveys, referral to Government centres for treatment can also be part of this scheme to ensure a successful PPP initiative." (Holy Family, Director)

Constraints of partnership with the government at the pnmary level have been

discussed previously. Even at the other levels there are similar issues raised where hospitals

feel restricted by collaborating with government and feel that it creates more obstacles in the

functioning due to administrative delays by the government. This also shows the lack of

patience with state structUres and bureaucracy.

We have a nursing school that was getting some funds from the government but there were lot of administrative delays from the government side so we told them we will manage ourselves. Our Community Health Department has been existing for a long time. We were managing it on our own initially but now we have the Delhi government's support who provide us with the vehicle, driver and medicines. (Holy Family)

"Government subsidies .... nothing as such .... The government used to give some funds every year but there was lot of administrative work and bureaucratic delays to even get that little money. Few years back we told them that we don't want it anymore. But to keep some links we have partnered with the National Blindness Control Programme. "(SCEH, Senior Administrator)

Human Resources in Hospitals

A trust or a society hospital can have teaching schools for nurses and paramedicals.

Some of the bigger trust hospitals have nursing schools or other paramedic training courses

within the institution. Among these are Holy Family, St Stephens, Tirath Ram Shah,

Moolchand, Batra Hospital, Venu Eye Hospital, Ganga Ram provides post graduate teaching

whilst SCEH.has training courses for doctors.

"The nurses have to sign a two year bond with the hospital after they pass out from our nursing school. We have a two year diploma course in lab technology and a 2 yr diploma in X-ray technology. "(Senior Administrator, non-profit hospital)

"We have rapidly grown as an institution and it has been a struggle. Struggle to keep human resources, get funding, ... its has been easy to maintain the six satellite hospiials as lot of it is being taken care by the community .... community participation has been important and has been channelised to maintain these institulions. Every family pays around five rupees a month as a pool. But it is difficult to maintain a tertiary institute, to keep up with technology, to harness human resources and retain them. " (Director, non-profit hospital)

193

In the questionnaire survey, very few hospitals responded to the question on

percentage of permanent and contractual workers at the time of establishment and at present.

But it was evident from the few that responded that the number of contractual workers and

consultants had increased over a period of time. Permanent workers have come down

drastically in the last decade. To keep workers in a contractual basis helps in cutting costs by

keeping salaries low and not having to provide any social security. In a study of 68 nursing

homes in Delhi, found that these private institutions had difficulty in getting trained nurses

and therefore many of them relied on poorly or untrained persons {Nanda and Barn, 1993).

Doctors too have increasingly taken the role of consultants where they have more than

one working place. Some hospitals rely mostly on consultants while others rely on doctors on

the pay roll and few consultants. Most of the senior doctors who have retired from a public

institute are the consultants in the non-profits. The rest are either salaried and/or part

consultants.

This chapter provided the characteristic of the present non-profit hospitals in Delhi.

One can say that non-profit hospitals are heterogeneous in their structure, role and functions

as there is no common characteristic other than them being non-profits by definition. It is

assumed that they would behave in a certain way but this brings forth the complex character.

this sector has assumed. They are of varying sizes, varied services, and vary in the proportion

of free services that they offer.

The next chapter attempts to understand the supply and demand factors that have had

an impact on non-profit hospitals and have led to their transformation.

194