Tuesday, 13 January 2015

An Institution with a difference


An Institution with a difference[1]
One  TV commercial claimsthat “an idea can change your life”. However in case of IIHMR,the idea has gone beyond changing an individual’s life. It has changed the way the government and corporate sector both in India  and abroad have perceived the health sector and its management. The idea has changed millions of lives and is still changing many more. Today, the discipline of health and hospital management is a well-accepted reality in India but this did not happen overnight.
Let me take you threedecades back. A young medical graduate from National Medical College, Kolkata,,was looking for a post graduate degree to specialize. As luck would have it, he ends up at the Johns Hopkins School of Hygiene and Public Health (now Johns Hopkins Bloomberg School of Public Health). Rest, as they say, is a history.

At the school, he is baptized into public health and the new challenges and horizons it offered.The young man finishes his Masters in Public Health and returns to India. Almost at the same time, he loses his father. The corporate group (TCI BhorukaGroup of Institutions), which was founded by late Shri Prabhu Dayal Agarwal,setaside a corpus to establish memory of its legendary founder. Since the family has its origin in Marwar region of Rajasthan, it was expected that family will either come up -with a hospital or a community hall or somethingsimilar to it forcommemorating the contribution of Shri PD Agarwal to the society. However, the family had different ideas.
The Agarwal brotherstasked their youngest brother Dr. Ashok Agarwal, to come up with an idea which befits the stature of Shri P D Agarwal. Dr. Ashok Agarwal,equipped with his public health credentials,venturedaround the globe and within country looking for new innovative ideas. On this sojourn, he met some of the leading industrialists, academicians and practicing minds of various fields and came up with an idea of establishing an Institutewhichwill worktowards improvement ofthe health standards through better management of public health and healthcare related services.He envisaged that this improvement will be carried out through managementresearch,training, consultation and institutional networking in national and global perspectives.One of the leading public health practitioners in the country,  Prof. N.S. Deodhar was entrustedto come up with the first detailedproject report for establishing this Institute which was christened asIndian Institute of Health Management Research. On 5thOctober 1984,Society for Indian Institute for Health Management Research was established with some of the leading practitionerslike Shri V.P. Agarwal, Dr. Ram S. Tarneja, Dr. Ashok Agarwal, Mr. M.L. Mehta and Dr. Rusikesh M. Maruas the members of first management board. .
As it happens with any new idea, there was initial resistance and hardly any buyers of this idea of ‘health management’. Therefore the promoting familydecided to support most of the finances of the Institute for first few years. It was also felt that the first and foremost need of the health sector is to create a culture of evidence based decision making andtherefore research in health sector was identified as first activity of the institute. This gave IIHMR a leading edge and distinct identity from other B schools in years to come. Gradually, some of the UN agencies started giving project evaluation and other assignments to IIHMR.

After first decade of experimenting, somewhere in the mid-90s, IIHMR started establishing itself as a center of excellencefor quality research. People in the government set up as well as international academic and development sectors started accepting the value of research conducted by IIHMR. Gradually the Institute networked with prestigious universities and organizations of international and national level.  The John Hopkins University (JHU), John Hopkins Bloomberg School of Public Health (JHBSPH) also signed Memorandum of Understanding (MoU) with IIHMR in area of research, education and training. In 1998, the Institute was designated as the WHO Collaborating Centre for District Health System Based on Primary Healthcare for its excellence in health management research, training and educational programs. As a collaborating centre, the Institute works in the areas of organization and management of health system based on primary healthcare with particular emphasis on district health system in urban and rural areas and quality assurance in healthcare. Since then, IIHMR has been operating as a resource center, organizing inter-country training programs, collaborating with World Health Organization (WHO) for monitoring and evaluation and providing its expertise in health system management and research. The IIHMR also get the recognition as an Institute of Excellence by the Ministry of Health and Family Welfare, Government of India.
While making its presence known in national and international level, national and international agencies started giving more and more assignments to IIHMR.The Institute was nominated as a nodal agency in year 1994-5 for managing one of the world’s largest user fee-based rural drinking water supply, AapniYojana - a unique drinking water project launched with the support by KfWGermany.The project has benefitted 9 lakh people ensuring round the clock supply of potable water. In 2006, the IIHMR also partnered with the DFID supported multi country consortium formed for the Future Health Systems Research Program Consortium (FHSRPC), which envisages providing high quality knowledge about how health systems can improve quality of and access to basic health services for the poor. As a partner of this consortium and under a research programme titled “Future Health System: Innovations for Equity”, IIHMR in 2012 has  carried out a household survey in three districts of West Bengal to capture the data on out of pocket payments for inpatient care, travel costs, and board and lodging costs for the patients admitted in a hospital.

The Institute is also a partner in Health of the Urban Poor (HUP) project consortium, which aims to improve the delivery of a comprehensive package of maternal, child health and nutrition interventions, including promotion of water supply, sanitation and hygiene services in urban communities. The project,in partnership with Population Foundation of India and support of United States Agency for International Development, is being implemented in Rajasthan and Chhattisgarh since September 2010.The IIHMR, with the support of Global Alliance for Improved Nutrition (GAIN), is also involved in a food fortification programme to reduce the prevalence of micronutrient deficiencies in the State of Rajasthan, especially iron deficiency, Vitamin A and D deficiency which will have far reaching implications in solving long standing problem of anemia in the population particularly women and children since 2011. The project makes available fortified wheat flour, oil, milk and pulses through both the open market and government distribution channels including Public Distribution System and other public funded programs such as the Integrated Child and Development Scheme and Mid-Day Meal programs. A Project Management Unit has been operational for over a year now at IIHMR for the implementation of the project.
As days passed, IIHMR had made its presence felt in other countries also. From 2003, the Institute has been actively involved in Afghanistan in association with John Hopkins School of Public Health in terms of providing technical support for monitoring and evaluation, acting as the Third Party Evaluator for the delivery of health services, capacity building of Afghan nationals for managing health services, and formulating health research policy. The activities never looked back in Afghanistan and now the IIHMR is one of the most respected academic institutions in the country providing technical assistance to Ministry of Public Health and beyond.IIHMR in close consultation with(JHUin 2004 developed a balanced scorecard for monitoring health services in Afghanistan. The Ministry of Public Health (MoPH) was so impressed with the balanced scorecard for health sector that it decided to adoptthe same for hospital sector as well in the year 2006. IIHMR also initiated Afghanistan Mortality Survey (AMS),with support from USAID and ICF Macro, USA in whole Afghanistan. It was a unique, largest and first of its kind large scale nationwide survey that has provided the latest health status information of the country. It provided information on various demographic indicators related to mortality and fertility of the country, with special emphasis on maternal and child mortality apart from data on the socio-economic situation of the population. The MoPH also mandated IIHMR to help Afghan National Institute of Public Health to develop a research policy and strategy. IIHMR, in 2009, has also signed a MoU with Afghanistan Center for Training and Development (ACTD), one of the leading NGOs in Afghanistan, a registered non-profit, non-political and non-governmental organization working for development and transformation of the civil society in Afghanistan, to further strengthen research, training, and consultancy services in health management areas in Afghanistan.
While doing research and interacting with various stakeholdersof health sector, it was realized that one of the weaknesses of the health system islack of managerial insights among itshealth managers. Since all those who are responsible for managing health sector wereprimarily clinicians, expecting them to transform as efficient managers when they get promoted as districtlevel officers was unfair. Therefore,as a second activity IIHMRtook upon itself to work with people who are already a part of the health system to buildtheir skills in managerialaspects of the healthcare. A series of managerial healthcare programs were launched to fill the gap in this important sector. The key focused areas of these programs included: leadership and strategic management, policy analysis and formulation, project/program management, human resource management, logistics and supply management, monitoring and evaluation, etc.
The next breakthrough in IIHMR life came in 1995 when the Management Board of IIHMR approved the idea of starting a 2 year Post GraduationProgram in Hospital and Healthcare Management. Afterpreparation of aboutone year, the program was launched in July 1996 at Jaipur with 23 young graduates from all disciplineslike medicine, arts,science, and commerce. This was the first revolutionary step in opening up the managerial course. Almost two decades down the lane, this Post Graduate Program has helped IIHMR in establishing itself as a brand both asnational and international level.As the course picked up so did demand for these graduates. On campus jobs and placement of these graduates encouraged themanagement to increase the intake from 60 to 120 at Jaipur campus.Later, keeping  in view the demand of pharmaceutical industry  (allied health sector), Post Graduate Diploma in Pharmaceutical Management waslaunched.  In 2010, the School of Rural Management was established at Jaipur campus to cater the need of rural development sector.  Today IIHMR as an institutionhas a critical mass of about 2,000 graduates from its various campuses working across the globe in improving health sector functioning and taking it forward.
The IIHMR society, in 2004, opened its second campus in Bangalore to cater the growing need of management in health sector of southern part of India.IHMR Bangalore initially started with one year Post Graduate Programme for doctors and allied sciences graduates. However, from 2010, the IHMR-Bangalore started running two years AICTE approvedPost Graduate Diploma in Hospital and Health Management. The Institute has successfully rolled out seven batches of students enrolled for its earlier one year PGPHM program and two batches of two year programme. Besides teaching, the institute has a very strong and sound research wing wherein various research projects and studies pertaining to the health policies, projects, systems and management are carried out.The Institute has also been actively involved in providing wide range of consultancy services to existing and upcoming hospitals since its beginning. The Institute also conducts various Management Development Programs on all the facets of management and its application in health sectorfor the professionals of medical and health care.
In 2007, the IIHMR society and itsManagement Board took another step and decided to establish a campus at Delhi with the prime focus on national and international health and with an aim to play a major role in promoting and conducting research in policy analysis and formulation, strategy development and effective implementation of policies. The International Institute of Health Management Research Delhi was launched in 2008. The first AICTE approved Post-graduate Diploma on Hospital and Health Management began in July 2008 with 60 students.Considering the growing application of information technology, the Institute also launched a specific course on Healthcare IT in 2010. Research has been forte of IIHMR Delhi and the Institute is developing centers of excellence in three areas, namely, non-communicable diseases, health and environment, and management of national programme. Needless to say, during the short span of four years, IIHMR Delhi has carved a niche for itself in the field of research, training and academics.

Strengths of the Institute
The tremendous growth of the Institute lies in the core strengths of operational model which it has evolved and adopted across the branches of IIHMR. The Institute doesn’t follow any traditional hierarchy of operational structure. Rather, it believes in a flat structure, wherein every faculty has uniform, transparent and direct access to the management. This operational model ensures that the creativity and innovations of the faculties get a positive environment to grow, which constitutes one more aspect of IIHMR strengths. Having flat structure restricts unnecessary inhibition of creativity and encourages the faculties to share and experiment with their own ideas and innovation.
Added to this, the strong willingness and openness of the management towards exploring and encouraging innovations and ideas further plays a critical role. The Institute has been fortunate enough to have dynamic Governing and Management Board who were never been bounded by traditional thinking. The same has been the case with the Directors of IIHMR, which includestowering personalities like Prof Rameshwar Sharma, Dr. G. Giridhar, Prof. Rushikesh M. Maru and Dr. S.D Gupta.       

What we have been able to do in 3 decades?
The learning made in last three decades has been phenomenal. IIHMR has been successful in making a distinct image in health sector as one of the pioneers in health management sector. With the students of its Post-graduate Diploma in Hospital and Health Management spread across the country and working in various hospitals and healthcare organization at various levels, the IIHMR continues to enhance the health system with workforce who are steadily making a change in the system with their managerial knowledge and skills. The high quality research and projects both national and international level is ensuring that critical and significant inputs are provided at the policy level which will further strengthen the health system of the country. Though a long way to go, yet IIHMR strives to achieve its mission of improving the standards of health of people through high quality management research, education and capacity development of health professionals.
What makes IIHMR unique?
Expertise on management aspects of healthcare sector, which IIHMR has gained from its rich experience of research, teaching and training over the last three decades, makes IIHMR unique. The open culture of interaction, an apt mix of experienced and young faculties, encouragement for innovations and exploring ideas adds stimulating environment for Institute and individual growth and further makes IIHMR unique. Another prime driver of our research is that we engaged in research that has direct program implications and enhances program delivery and efficiency.
Where are we going?
We are committed to make IIHMR a world class learning Centre in health management and allied research. We are launching new programs in Health Informatics at our Delhi campus Masters of Public Health (joint degree with Johns Hopkins) and other programs are in the offing at other campuses. 
We are opening a full Institute at Kolkata in 2014 and we have plans to goFar-East, Middle East and East Coast of Africa in the years to come. As always we will be expanding our network and adding more partners locally, regionally and globally. We are very excited about the challenges that health sector offers and are geared to meet them heads on. We are convinced that this millennium belongs to us and we have to make sure that agenda is India centric in the years and decades to come. 

References:
§  IIHMR Jaipur 25 years: Health Management Journey towards Excellence
§  IIHMR Jaipur27th State Institute Report, 2012
§  IIHMR Delhi: State of Institute Report (2008-2012)


[1] L. P. Singh, Director – International Institute of Health Management Research – Delhi (IIHMR-D), Email:lps@iihmr.org, Ph: +91 11 3041 8908

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