Medicines Glut in ECHS – needs resolution

A post on social media highlighting the serious shortages of medicines at an ECHS (Ex-Servicemen Contributory Health Scheme) facility has thrown up widespread similarities of medicines shortages in ECHS facilities and polyclinics across the country; a widespread malaise that needs to be addressed. The post on social media, reads “ECHS Palampur (District Kangra in Himachal Pradesh) does NOT have 70% of medicines required. Ex-servicemen (ESM) left high and dry. Reason – there is universal financial cap on spending by ECHS without taking into account how many thousands of ESM are dependent on which ECHS. Kangra District perhaps has the highest number of ESM, serving and sacrifices made in wars. Policy for funding ECHS needs serious introspection”.

Some of the reactions to the above post included:-

1.  “All ECHS in hill areas are in similar state, including Dehradun where ESM are facing same problem”.
   “SIMILAR is the story at Gurgaon ECHS outlet near Shishpal Vihar. You do not get even essential medicines for months together. Glaucoma Eye Medicines is one important example, so one may lose eyesight, does it concern MD ECHS, Oh NO, Base Hospital is responsible.
   Every month need to visit three to four times to find out if Medicines have come, on phone it is always yes and on arrival ‘NO’. I am told all over other ECHS are in a similar boat at least in DELHI dependent on Base Hospital”.
2.  “Same problems with HALDWANI ECHS. I did not get any medicine this month. For the past six months practically no medicines. Actually since March no medicines”.
3.  “I, as ex OIC KRISHNSGIRI ensured nobody should go without medicines in whatever the way like beg borrow steal….”.
4.  “Something wrong somewhere….OIC Polyclinic and dependant ECHS Centre have to rise to the occasion. Dependency dictates the Type of Polyclinic and corresponding funding including medicines. In-spite of capping, one can bid for additional funds vested with SEMO (Senior-most Executive Medical Officer). Moreover, there is five times increase in monthly funds available with OIC Polyclinic to buy emergent requirements of medicines from local empanelled chemists”.
5.  “There is something wrong somewhere. Even Dehradun ECHS has no Insulin Vedaglyptin Septaglptin essential drugs for blood sugar. No redressal by anyone in authority. LUMP IT is the attitude. SAD”.
   “Some of our OsIC Polyclinic are hesitant to place demand for LP (local purchase). They simply surrender the monthly monetary limit just to please Station Commander / SEMO/ Administrative Commandant …… ignoring urgency, emergency and essentially of patient. I being OIC Polyclinic of non-military station in hill area for 8 yrs had seen all these issues. However, no station commander ever interfered once I convinced them the situation. Poly Clinics in hills are worst sufferer”.
6. Policy be made where ECHS members are allowed to buy non-available medicines from the local market on reimbursement basis. NA from medical store should be basis of these purchases by the individual. There is no extra cost involved and if need be certain civil medical stores be empanelled and reimbursement made to them directly by ECHS authorities without involvement of patients”.
   Interestingly, the post on 70% shortages of medicines at ECHS Palampur evoked the following response from the MD ECHS:

•  Comments not based on facts. Government has authorized local chemist. No shortage of funds for medicines. Station Commander has to empanel chemist.
•  Any ESM having problems with medicines can contact him (MD ECHS).
•  We have done all provisions.
•  ESM have right to demand legitimate medicines.

Closer examination of the above indicates while all provisions may have been made, their execution on ground is ludicrously wanting. The game of ping-pong is ongoing between the OIC ECHS Polyclinic and the Station Commander ? SEMO not empanelling chemists but the suckers are the widows and ESM running from pillar to post, for medicines, denied same and forced to buy them from the civil on their own expense. Are the OIC ECHS Polyclinic exerting themselves and why should a former OIC KRISHNSGIRI say he had to “beg, borrow, steal” to provide medicines? Why are essential drugs for blood sugar not available in ECHS Dehradun? Why are essentials like Glaucoma Eye Medicines not available at ECHS Gurgaon, forcing widows and ESM to travel for the same to Base Hospital, Delhi Cantonment time and again, only to be disappointed? In case the problem is local Station Commander possibly constrained by the SEMO, as indicated by some, why is it so when it is being stated there is no dearth of funds for medicines? Why should the SEMO figure as a roadblock if there is no dearth of funds and chemists are empanelled from where medicines not stocked by ECHS can be taken by patients when permitted by the ECHS?

No doubt the MD ECHS means well by saying “Any ESM having problems with medicines can contact him (MD ECHS)”, probably the Adjutant General may offer similarly, besides the complaint box of the COAS is always there, but all these are impractical measures with some 60,000 Army personnel turning ESM annually and medicine shortages as seen above. Besides, do we expect widows to contact the MD for these reasons and by what mode? Therefore, institutionalizing medicines to ESM and widows and streamlining the system focusing on the following is essential:-

• OIC ECHS outlets and Poly Clinics must perform, rather than giving lame excuses – some of them are obviously not doing so as seen from the above narrative. MD ECHS needs to institute regular digital reporting about: one, medicines unavailable / denied to patients; two, permission accorded for taking medicines from empanelled chemists; three, details of additional funds demanded, as applicable, from Station Commander / SEMO, its processing and acceptance / denial.
• The Adjutant General and Director General Medical Services (Army) needs to similarly monitor that: one, all concerned Station Commanders have empanelled chemists and their names are displayed at the ECHS outlet at the place where ESM register for medicines / treatment; two, all ECHC outlets and Poly Clinics in non-military stations have no dearth of medicines for widows and ESM; three, demands of additional funds by OIC ECHS denied by Station Commander / SEMO and reasons thereof.

Lodging of FIRs and their processing by civil police is being done on the internet in most parts of the country today. There is no reason why digital monitoring of the disbursement of medicines to ESM and widows cannot be monitored digitally and enforced. The aim should be that either the ECHS outlet gives the ESM or widow the prescribed medicine or gives them permission to take the same from an empanelled chemist, with ECHS directly paying the cost to the empanelled chemist. It doesn’t need to be reiterated that welfare is a command function and welfare in the Army includes the welfare of ESM, with widows taking precedence over everyone else. The question of course is will the Army hierarchy find time to heed the above? With the CSD canteens demanding stocks based on average present strength of serving officers only, most veterans are automatically denied the facility with stocks vanishing within two-three days of arrival. Let us at least give them the medicines which are authorized to them commencing 2018.

Prakash Katoch

Prakash Katoch is third generation army officer hailing from Himachal Pradesh. He is former Lieutenant General from Special Forces and post-retirement has published over 2100 articles on international affairs, geopolitics, military, security, technical and topical issues besides authoring two books. He is active in seminars at both national and international levels.