Dr. Sedevi Angami
Director, CIHSR
On the 7th September, the NPRAAF raised questions of CIHSR flouting the rules of the MOU in the newspapers. These allegations are absolutely baseless, ignorant of the ground reality and factually incorrect. The people of Nagaland have trusted the CIHSR society to deliver health in the land and therefore have a right to know.
CIHSR belongs to the people of Nagaland and we are just stewards of the campus for a temporary period.
The CIHSR was conceived to meet the Healthcare needs of the state of Nagaland and North eastern region. It is currently in the process of completing 12 years of its existence. It is considered one of the best examples of a public private partnership in the country. The CIHSR society was able to revive the defunct and abandoned Referral hospital project after about 12 years of existence as a Ghost town at Diphupar village.
CIHSR is governed by a society which comprises of the Nagaland state Government, CMC Vellore and EHA. The president of the society is the Chief Secretary of Nagaland. The Governing society meets once a year and the board meets thrice a year to review all the activities of the Institute. Other officials of the state in the society are the Development commissioner, Finance commissioner, Health secretary, Principal Director Health and the DC of Dimapur. The executive director of EHA is the Chairman of the board of directors.
The role of CMC Vellore is to provide technical assistance to CIHSR to develop its technical departments, develop manpower, mentor its academic initiatives and aid its movement towards a centre of excellence. Over the years, more than 50 of CIHSR staff have been trained at CMC Vellore. CMC has also sent hundreds of its staff to teach and train the staff at Dimapur. CMC Vellore has repeatedly been awarded best employer of the year in the country. CIHSR emulates a large amount of the best practices and processes of CMC Vellore in its daily operations, selection processes and SOPs.
The state Government facilitates the process of the same. In return, CIHSR partners with the Government in implementing all its national health programmes. CIHSR seeks to strengthen the hands of the Government in its delivery of health to the people.
The role of EHA is to provide direction, accountability, technical expertise and support from its huge network of friends and experiences. CIHSR also gains by leveraging the sponsorship privilege of EHA to gain sponsorship of students at CMC Vellore. Some of the finest brains in the Christian medical world work in the EHA hospitals among the most marginalized people. Their fight for survival, experience and their immense innovations are a huge resource for CIHSR.
All three partners function beautifully, support each other and have no conflicting issues. It is an example of what an ideal partnership should be like.
Finances
Being charitable organizations, by law EHA and CMC cannot invest any funds into CIHSR. There are no shareholders in this partnership and no funds generated from CIHSR go out to any other organization or person. The board of directors are not allowed to benefit financially from any profits of CIHSR.
The state Government does not give any funds to CIHSR except for its share of specific projects or those related to specific national programmes.
CIHSR does not receive any funds for its day to day expenses and all expenses for running the institution including salaries are met from the funds generated from the hospital operations. CIHSR receives no funds from any foreign agency. All income from the operations are spent on staff salaries, charity to poor patients, outreach and further development of the institute.
CIHSR pays the best salaries in the market (apart from central Government scales) to its staff relative to the current market except for the doctors who get much less than the current market standards. All the doctors who have joined CIHSR have done so with a sense of commitment and sacrifice.
Every year, CIHSR spends over 3 crores of its income on charity and subsidizing for poor patients. Every day, patient’s bills are written off if they cannot pay for services.
As the NPRAAF has correctly pointed out, our rates are lower than the existing market rates. We charge Rs 100 per patient for new outpatient consultation. This we do without any subsidy from external sources.
Management accountability
The financial audits are done 4 times a year and presented to the financial committee and thereafter to the board of directors. CIHSR is one of the only mission hospitals in the country with a finance manual which is followed to the letter. It is also considered one of the best organizations in terms of financial management processes and accountability by the auditors. Several audits by income tax scrutinies have found CIHSR’s books and operations in order.
Internal management audits are carried on an almost daily basis. We have 10 audit teams from among our staff (almost 60 staff) doing internal audits of all our processes.
The hospital is governed internally by an administrative committee and officers who meet every week to take decisions on all aspects of institutional functioning. There is no one man decision taken. The administrative officers are assisted by several committees for staff grievance redressal, sexual harassment, materials condemnation, patient grievance handling, academics, research and ethics, housing, hospital infection control, library, sponsorship, canteen, purchase, pharmacy, construction, quality steering, medical board, radiation safety, transfusion safety etc. This ensures that there is a widespread participation of staff in the decision making and collective ownership of the institute. Regular patient feedback is taken and every department has Key performance indicators ( KPIs) which are presented regularly.
Staff development – CIHSR aims to develop all its staff to the highest potential that God has created them to be.
At least 18 of our senior staff have had administrative training and have a very good understanding of the whole spectrum of hospital management. They in turn take leadership in various responsibilities of the hospital. There is a very transparent HR process of 360 degrees performance appraisal of its entire staff every year. The top leadership have a separate additional appraisal. There are continuous trainings throughout the year for all our staff in NABH, communications, Sharpening your internal personal skills, trauma and healing, couples seminars, professional academics, retreats and Bible studies. Our staffs are our greatest assets and therefore we invest heavily in their growth and regularly send them outside the state for various workshops, conferences and seminars. At any given point of time, some of our staff are in Vellore or some other institution, learning new skills or information to return and build up the institution. Our staffs are 478 in number with 407 of them being Naga staff and the rest from the Northeast with a small handful from Vellore and other states. We need staff from outside the state and the rest of the country to add flavour, variety and intellectual wealth to the institution. Diversity is absolutely essential for healthy growth and is one of our core values. We also have about 100 outsourced staff for security and housekeeping, almost all of whom are Nagas.
Networking
Working in Dimapur alone, we cannot expect to impact health in the region. In order to have wide ranging impact in health in the state and region, CIHSR has partnerships with NBCC, ECS in Tuensang, ABAM in Impur, the Catholic church, Berean Medical centre, Ukhrul, several NGOs, schools and colleges. We also work in very close tandem with the Government and implement all their vertical national health programmes. CIHSR initiated the Arukah network Northeast cluster to work amongst people with disabilities and partners with several NGOs in this regard.
We look actively for more partners with whom we can work and support or build their capacity so that they can in turn impact health in the state.
Community health
Our team has adopted two blocks – Dhansiripar and Medziphema to partner with the Government in developing services and capacity of health personnel. They go to these places almost everyday for regular clinics and health trainings. We also regularly visit Tenning in Peren district. We will soon be carrying out health trainings for Niuland block and Tsemenyu district.
These activities are completely financed by CIHSR and we spend about Rs. 50 lakhs a year on these activities. Some project activities are financed by research grants.
EHA with its vast experience in community health development has mentored some of our programmes and trained our staff. We aim to start a Community based rehabilitation and mental health programme soon.
Academic activities
CIHSR started the first Nursing college in the state with an initial grant from the NEC for buildings. After 7 years of functioning, today it is one of the finest in the region with almost all its staff trained from Vellore. Our nursing students get 100 percent employment and placements in various parts of the country. They are very well trained and pay some of the least fees in the country among private nursing colleges. This is still subsidized by the hospital without any help from external sources.
CIHSR runs 5 paramedical courses and has recently upgraded three of these to bachelors courses. We run 3 post graduate DNB degree courses under the National Board of examinations in Family medicine, General surgery and Internal medicine.
We run contact classes for the distance education courses in Family medicine and Community Lay leader’s health training courses under CMC Vellore and MGR University.
CMC Vellore regularly sends its students for secondary hospital exposure and training to CIHSR. We have already trained several doctors from mission hospitals in endoscopy and dermatology.
Several institutions in Nagaland and neighbouring states send their students to us for internships and elective postings.
We follow the MOU guidelines of minimum 50% seat reservation for students from Nagaland in our academic courses. Invariably by default the students from Nagaland exceed this number. Generally we have an observer from the state Government to ensure that this rule is followed strictly. Our interview process follows the CMC Vellore method, is very strict and impossible to be manipulated since it is all blinded and coded. No recommendations or nepotism is allowed and not feasible. Students get in by merit alone.
Services
CIHSR runs a 200 bedded hospital secondary and mid level tertiary hospital with almost all the specialties.
We run a Cancer centre with radiotherapy which is supervised and mentored by CMC Vellore. Teams from CMC Vellore regularly visit CIHSR to guide the development of the centre.
We have a dedicated ICU, NICU, very busy Hemodialysis unit, Cosmetology unit, 24 x7 emergency service, Endoscopy centre, Lithotripsy machine and a state of the art Laboratory with strict quality assurance programme with CMC Vellore.
We run a special school for children with special needs. Our staffs regularly go out to train schools, churches and NGOs in relating to people with learning difficulties.
We have a palliative care team which goes every week to houses to provide home based care to those who are terminally ill or cannot come to the hospital. This is run by a family physician. This programme is also completely funded by CIHSR with no external grants.
We provide subsidized healthcare to several of our partner organizations.
60% of our patients are from Nagaland. 40% of our patients come from neighbouring Assam. This has been decreasing of late due to change in train timings, bad roads in Dimapur, high cost of transport and possibly emerging facilities in Assam. Many of them also suffer being robbed in Dimapur.
Staff welfare
We have a very vibrant staff welfare committee which works hard to foster fellowship and community in the campus by several activities. To avoid tribalism, we do not allow any tribal unions on the campus and have encouraged competitions to include all tribes eg if an Ao song is to be sung or a Sema dance performed, it should be done by a mixture of tribes and not a single tribe.
We run a music academy on campus whereby our staff, staff children and students learn Guitar, Cello, Ukelele, violin, Piano and vocals.
Our staffs contribute regularly from their monthly salaries to poor CIHSR students scholarship funds, and for scholarships to neighbouring schools.
The way ahead
We would like to have an Integrated centre for disability and are currently working towards acquiring funds for the same.
We are working towards a regional paramedical institute with several paramedical allied health courses.
We would like to start a medical college. However this is a very heavy investment and we cannot do so with our meagre earnings. It will require at least an investment of Rs 200 crores and about 130 faculty of high technical calibre with a passion to teach students. If the Government facilitates the process of acquiring funds from the central government, we may be able to achieve this goal in about 5-7 years from now. This is because the process of acquiring funds would take at least over 1 year and the buildings 3 years and then recruitment at least a year subsequently if all goes well without obstacles.
CMC Vellore which is currently one of the top institutions in the country is willing to mentor the process of becoming a medical college.
Calling us a commercial institution is doing a great disservice for the scores of staff who have given up much more lucrative job opportunities to be able to be of service to the people of the state. If you really want to see what the meaning of “commercial” is – just take a train to Guwahati or fly to Delhi and you will know commercial corporate health in its true sense.
There are still more opportunities to be of service to the poor. Concessions are only one way of providing this. We do detailed socioeconomic assessment of many of our poor patients. The Chapel committee gives free food coupons to those who do not have anything to eat. Some of our staff bring food from their homes for poor patients. Some poor abandoned patients have stayed in the hospital for several months and everything taken care of by the staff. Abandoned children and babies have been taken care of for months by our staff till they could be taken care of by other agencies. We have a core team of trainers who are currently in the process of training other institutions and organizations in income generating skills. This goes beyond medicine into addressing the social determinants of health.
I would invite anybody who is interested in seeing what CIHSR is, to come and see for themselves. I would invite them to actually partner with us in taking responsibility for the health of the people. Anybody can criticize and point out faults. What we need are actual workers on the ground who will give their sweat and hands for the health of our people.
God who brought us thus far will help us to achieve our goal of health for all in Nagaland.
