ESIC IS AN AUTONOMOUS AND SELF SUSTAINING ORGANISATION

INTRODUCTION

Employees State Insurance scheme of India is an integrated social security scheme tailor to provide protection to workers in the organized sector and their dependents in the organized sector and their dependents in contingencies, such as, sickness, maternity or death and disablement due to an employment injury or occupational disease. Towards this objective the scheme of health insurance provides full medical facilities to insured the person and their dependent, as well as, cash benefit to compensate for any loss of wages or earning capacity in times of physical distress. APPLICABILITY OF THE ESI ACT: The ESI Act, (1948) applies to the following categories of factories and establishments in the implemented areas: Non-seasonal factories using power and employing ten(10) or more persons. Non-seasonal and non-power using factories and establishments employing twenty (20) or more persons. The appropriate Government State or Central is empowered to extend the provisions of the ESI Act to various classes of establishments, industrial, commercial, agricultural or otherwise in nature. Under these enabling provisions most of the State Governments have extended the ESI Act to certain specific classes of establishments, such as, shop, hotels, restaurants, cinemas, preview theatres, motor transport undertakings, news paper and advertising establishment etc., employing 20 or more persons. ORGANISATION: As provided under ESI Act, the Scheme is administered by a duly constituted corporate body called the Employees State Insurance Corporation (ESIC). It comprises members representing Central and State Governments, Employers, Employees, Parliament and the medical profession, Union Minister of Labour functions as Chairman of Corporation where as the Director General, as its chief executive, discharges the duty of running the day-to-day administration. A Standing Committee representing all stake holders is elected from the body corporate for managing the affairs of the scheme and monitoring the progress of implementation of various corporate decisions and policies etc. from time to time. The Medical Benefit Council, a statutory body advises the corporation on matters related to administration of medical benefit under the ESI scheme. INFRASTRUCTURE

The central headquarters of the Corporation is located at New Delhi. For purpose of coverage, revenue collection, extension of the scheme to new classes of establishments, implementation of the scheme in new areas, coordinations the Corporation has established Regional and Divisional Offices across the country mostly located in the state capitals. Given the huge number of beneficiaries- about 354 lakhs now the Corporation has set up a wide spread network of service outlet for prompt delivery of benefits in cash kind that includes full medical care. Medical facilities are provided through a network of 1422 ESI Dispensaries, over 2000 Panel Clinics, 307 diagnostic centers besides 144 ESI hospitals and 42 hospital annexes with over 28000 beds. For providing super-specialty medical care the Corporation has tie up arrangement with advanced medical institution in the country, both in the public and private sector. The medical benefit is administered with the active cooperation of the State Governments. The payment of cash benefit is made at the grass roots level through as many as 825 Branch Offices and Pay Offices that function under the direct control of the corporation. CONTRIBUTION The ESI Scheme is mainly financed by contributions raised from employees covered under the scheme and their employers, as a fixed percentage of wages. As of now, the rates of contribution are:I. Employees Contribution: 1.75 percent of wages II. Employers Contribution: 4.75 percent of wages Employees earning up to Rs. 50/- a day as wages are exempted from payment of their part of contribution. The State Government bear one-eighth share of expenditure on Medical Benefit within the per capita ceiling of Rs. 900/- per annum and any additional expenditure beyond the ceiling. WAGE CEILING Employees of covered units and establishments drawing wages upto Rs. 10.000/- per month come under the purview of the ESI Act, 1948 for multi-dimensional social security benefits.

AREAS COVERED The ESI Scheme is being implemented area-wise by stages. The Scheme has already been implemented in different areas in the following States/Union Territories STATES

All the States except Nagaland, Manipur, Tripura, Sikkim, Arunachal Pradesh and Mizoram. UNION TERRITORIES Delhi, Chandigarh and Pondicherry

STRUCTURE AND FUNCTIONS OF ESIC

BENEFITS PROVIDED BY ESI Medical Benefit: An insured person and his dependent family member become eligible t claim medical facilities under the E.S.I. Scheme from day one of entering insurable employment. For availing the medical facility for self or any of the declared dependents an insured person has to produce the temporary identification certificate issued by the E.S.I.C Branch Office on taking insurable employment. This temporary identity certificate is thereafter replaced with a family photo identify card that carries the photographs and other particulars of the family member and the insured person. Failure to obtain the permanent card or its non production at dispensary/hospital can result in deprivation of medical care. It is also to be born in mind that dispensary is the base point for availing medical facilities. The reference for specialist treatment of diagnostic investigations is made by the ESI dispensary itself to the concerned hospital. It is only in extreme

emergency or at odd hours when the dispensary is closed that the insured person can report at the emergency dept of an ESI hospital directly but should not fail to produce his/her photo identity card. All medicines are issued free of cost by the dispensary to which an ISP is attached. However, in case of non-availability of prescribed drugs at the hospital an insured person can purchase the medicines from local market if so advised and submit such claim to the dispensary for reimbursement. Sickness Benefit: A claim for sickness benefit can be made only on the basis of Medical Certificate issued by the authorized doctors under the Scheme. In exceptional cases alternative evidence of sickness or temporary disablement is accepted by the Corporation. 1. An insured person is required to deposit his medical certificate in the box provided at the dispensary. Or he should ensure that the certificate is presented to the branch office within 3 days of its issue. 2. He/She should fill-up claim form from sickness benefit printed on the certificate itself, when she/he goes to branch office for collecting payment or while submitting the certificate at the pay office, as the case may be. 3. Branch office staff will assist in the filing the claims if so required. In case of pay offices, Dispensary staff will assist in filing the claims. 4. If the claim is accepted, the same shall be paid immediately by the branch office and if not found eligible a regret slip will be issued in ESI-15. In case of Pay-offices the cashier visits the pay office on an appointed day and disburses the payment. Insured person can also get payments through money order if they do desire and send a written request to the Branch Office. Extended Sickness Benefit: Same procedure is to be followed as is applicable for claiming Sickness Benefit. However, in this case the insured person is supposed to appear before the medical referee when referred by the Branch Officer Manager for the purpose of confirmation of the examination for allowing Extended Sickness Benefit from 124 to 309 days. Further an insured person is required to appear before the Board for deciding the case beyond 400 days but upto a maximum period of 2 years: Temporary Disablement Benefit: 1. Procedure regarding submission or Regulation Certificate and claiming the benefit remains the same as shown above against sickness Benefit.

2. In addition, an insured person who sustains employment injury to give a notice to such injury to the employer immediately either in writing or orally and also ensure that the employer has given the accident report to the concerned Branch Office will in time in the prescribed form-16. Permanent Disablement Benefit: 1. An Insured person should submit an application for reference to the Medical Board on plain paper to the branch office manager after the termination of temporary disablement benefit. This may be done at the time of submitting the final certificate or within 12 months from the termination of temporary disablement. 2. He should ensure that he also gives his age proof to the Branch Office Manager along with the application. 3. Form B.11 (a) indicating residual incapacity will be issued by the I.M.O./I.M.I. at the time of final certificate. It is required to be submitted along with an application for appearing before a Medical Board. If it has not been obtained at the time of issue of final certificate it should be obtained at the time of applying for Medical Board. 4. The Medical Board sends its decisions to the ESIC Regional Office directly or through branch office as the case may be and the regional office issues the sanction for periodically payments of P.D.B. One copy of the sanction order is endorsed to the insured person also. After receipt of this sanction the insured person should submit the claims form in the branch office for payment of P.D.B. This payment will be made to him every month as long as he is alive. 5. In case his rate of P.D.B. is Rs.5/- per day or less an insured person can apply for lump sum communication of the payment provided that the total commuted value does not exceed Rs.3000 6. An Insured Person should apply for commutation within a period of 6 months from the date of possible option. Then only branch office manager shall be able to send the request to regional office immediately. Otherwise the insured person will be referred to the medical referee for certifying normal expectancy of life, and only after such certifying is obtained, the insured persons case will be processed for sanction of communication. 7. The original sanction order of communication is send to the insured person with a copy to the branch office. The insured person should produce the original copy at the branch office at the time of payment. Dependent Benefit:

1. Dependents of a deceased insured person should contact the branch office for claiming the dependents benefit. The claim clerk will receive them and supply them necessary forms and furnish all information needed by them. He will also assist them in filing the claim form-18 Dependents are required to submit: a) The evidence of death of the insured person having occurred due to an employment injury. b) Evidence that claimants are dependent. c) Evidence of age of claimant. d) Evidence that female dependent (widows/daughters) has/have not remarried or married after the death of an insured person. 2. These claims after scrutiny are forwarded to the regional office and the Regional Officer communicates its decision to all the persons who claim the Dependent Benefit. To those who are not found entitled, a letter in form ESIC-146 will explain why their claim has been rejected. The letter in form ESIC-147 will indicate the daily rate of benefit of each dependent. For minor dependent the information is sent through the guardian. 3. The dependents should approach the Branch Office with the letter (ESIC-147) for claiming the first payment. 4. Subsequently they can collect dependents Benefit on first of each month either in person or by money order by submitting claims in form-18 A. 5. If dependants are staying in far off places, they can opt for payment from the nearest Branch Office. The Branch Office Manager will transfer all the records to the concerned Branch Office from where payment has been desired to be made by the beneficiary. 6. At the time of claiming Dependent Benefit for the month of June and December every, the claimant should submit a declaration in form-27 duly attested by the authorities mentioned there in. Maternity Benefit: An Insured woman claiming Maternity Benefit during the employment is to submit following documents either personally or by post: a) A certificate of expected confinement form-21. Issued by an authorized doctor. b) A benefit claim in form-22 duly completed. c) In addition to above, she has also to submit a certificate of confinement in form-23 within 30 days of date of confinement.

In case of claiming payment after confinement insured women has to submit a certificate in form-23 along with the claim form in form-22. In case of miscarriage she has to submit a certificate of miscarriage along with claim in form- 22. Certificate of miscarriage has to be submitted within 30 days. Insured woman can draw Maternity Benefit on weekly basis. At the time of final payment she should submit form-28 duly completed by her employer which will be issued by the Branch Office Manager. Funeral Expenses: Claim in form 25 (A), duly attested by the competent authority as mentioned in the claim form itself, be submitted to the branch office along with the death certificate for claiming the funeral expenses on the expenses up to a maximum of Rs.2500/- is admissible. Other Benefits: a) Unemployment Allowance payable for up to 6 months to those insured persons, who face involuntary unemployment due to closure of factory/establishment, retrenchment or permanent invalidity arising out of non-employment for last 5 years. b) Old age medical care for self and spouse at a nominal contribution of Rs.120/- per annum. c) Physical rehabilitation with free supply of artificial appliances. d) Vocational rehabilitation on permanent disablement. e) Immunization, family welfare services besides pre-natal and post-natal care in respect of female beneficiaries.

EMPLOYMENT INJURY Employment Injury is the personal injury to an employee caused by an accident or by an occupational disease arising out of employment of the employee in a covered factory or establishment, and arising in the course of his employment in a covered factory or establishment. The site of the accident is immaterial and accident occurring or an occupational disease contracted even outside the territorial limits of India can result in entitlement to benefit under the ESI Act.

EMPLOYEES STATE INSURANCE HOSPITAL Specialist Services: This hospital caters OPD Services in General Specialties viz. General Medicine, General Surgery, Orthopedic, Gynecology, and Obstetrics, Pediatrics, Ophthalmology and ENT. Medical Officers with Post Graduate Qualification run the Pediatric and Gynecology Department. Appointment will be done in August 2008. One Dentist is also posted. The Specialties other then in OPD Service are Pathology, Anesthesia (PG Qualifies Resident Anesthetist) and Radiology (Medical Officer with PG Qualification). The hospital has a Counseling Center for HIV/AIDS with a Counselor from MDACS. A DOTS Centre is also functioning. There are no Skin, Psychiatry and Chest Department at present. Daily attendance in OPD is approximately 300 patients. OPD services are catered during working hours of 9.00 a.m. to 4.00 p.m. Emergency Services: Round the clock services are available in Casualty, Indoors, Pathology, X-Ray, and O.T. Casualty medical officers are posted in casualty along with another staff compromising staff nurse, ward boy, Sweepers, Barber etc. Medical officers are also posted in shifts for indoors. Specialists remain on call to attain any emergency either in casualty or in wards. Technicians are posited in shift duties in X-Ray and Pathology Department. The maintenance agency has provided man power round the clock to run Central AC and package unit of kitchen. Ambulance Services are available round the clock. A tie up arrangement has been made for super Specialty investigations and purchase of medicines, which are not available in the hospital. Indoor Services:

There are 300 beds distributed for different departments viz. Medicine 90, Surgery 60,Gynecology and Obstetric 60, Paediatrics 30, Orthopedics 30, Casualty 5, Pooled beds 15 and 5 beds each for Eye and ENT. Pooled beds can be utilized later for other departments to be established viz. Skin, Chest, Dental, Psychiatry, ICU/ICCU etc. The present occupancy of the hospital ranges between 180 to 190. Diagnostic Services: These services are catered through Pathology and X-Ray Department. A full time Pathologist is posted a Semi Autonalyser, Cell Counter, Centrifuge, Hot Air Oven, Incubator, Auto pipettes, Blood Storage Refrigerator are available in Pathology Department. All routine investigations are done here. Since there is no tissue processor, tissue blocks and slides are got prepared through a tie-up arrangement. X-ray Departments has won 725 MA X-Ray machines, One Portable, 60 MA Machine and One Ultrasonograph. Medical Officer with PG Qualification is looking after X-Ray Department. Both Pathology and X-Ray Department function round the clock. Operation Theatre: There are two Operation Theatre complexes in the hospital. A minor O.T. and Major O.T. as a makeshift arrangement. All major and minor Operations of all departments are done here. There are two Resident Anesthetists posted here. The equipments available are Boyles Apparatus, Suction Machine, Cardiac Monitor with Defibrillate, Pulse Oximeter, Multipara Monitor, Operating Microscope (Ophth.) etc. Number of operations performed is annexed. Kitchen: Through Kitchen diet as required for various patients is provided as per ESIC Norms. Morning breakfast, Lunch and Dinner are provided. Diet Committee makes the planning of diet. Apart from Steward, Head Cook and Cook mates, a Dietician is posted here. One Medical Officer is the in charge. CSSD: There are two High Pressure Horizontal Sterilizers in the department out of which one is working and other needs repairs. Suppliers of Sterile material is made from here to OPD, Indoor, Pathology, X-ray and other department. One Medical Officer is in charge of the department, apart from Staff Nurses and other Staff. Linen Department:

This department has a staff including Linen Keeper, Tailor and group D Employees. There is sufficient stock of blankets, bed covers/sheets, and other surgical linen. Procurement was done through PSU Textile Industry. Labour Ward: This section runs round the clock with Staff Nurses and Group D Employees. Medical Officers with PG Degree in Gynecology and Obstetrics remain on call. Deliveries conducted in the past are annexed.

Maintenance of the Buildings: The hospital building is on ground and five floors and there are 324 Staff quarters in the Premises. The maintenance at present is being done through Private Contractors. Hospital Building and Residential Quarters are undergoing special repair works. However, there is a proposal to renovate the hospital completely and provide modern facilities with Central AirConditioning. Family Welfare Activities: There is a family Welfare Section run by the State Government with a Staff of a Medical Officer, Staff Nurse, One Clerk and Group D Employees. This Department conducts Antenatal Checkups, vaccination and distribution of Contraceptives. Operative part is looked after looked after by the hospital. Composition: Person In charge: Medical Superintendent Deputy Medical Superintendent Deputy Director, Finance

The medical superintendant is directly appointed by the government. The deputy medical superintendant and the deputy director, finance is recruited from the UPSC (Union Public Service Commission) based on their qualifications. The minimum qualification for the medical superintendant is M.B.B.S degree. There is no fixed tenure for the officers. They can be transferred from one location periodically as per the requirement.

Organization chart:

COMMITTEES It has been decided to constitute committees for various purposes for smooth functioning of the hospital, ensure supply of drugs, diet, stationary and other articles and also see for implementation of new proposals to update the hospital services. Such committees will work out annual requirement on the basis of consumption of last 3 years and taking into consideration future planning and development. After sanction from the medical Superintendent limited/open tenders, as the case may be, shall be limited and finalized in consultation with accounts and approval of the medical superintendent. Emergency requirement may be fulfilled by local purchases from hospital contract for drugs and dressings and Kendriya Bhandar/NCCF for stationery and other articles. Dietary articles if required may be purchased by inviting limited tenders. Linen and liveries should be purchased from government agencies. It should be ensured by all committees that adequate stock is kept at hand before placing the orders. The committees are as follows: 1. Medical scrutiny committee: After the tender is passed this committee first checks the quality of the medicine and then it uses for the patients. This committee mainly looks after the quality of drugs and medicines supplied in the hospital. Composition: Deputy Medical Superintendent Medical Officer Purchase Representatives of 3 Departments Deputy Director Finance 2 Pharmacists

2. Tender/Purchase committees for Non-Medical equipments:

In this committee, all the suppliers get a chance to quote their price in a sealed envelope and then all the tenders are opened in front of all the committee members and the tender with lowest quotation is finalized. Composition: Deputy Medical Superintendent Medical Officer Purchase Representative of user department Joint director (Administration) / Deputy Director (Administration) Deputy Director (finance) Care taker of hospital

3. Technical Evaluation Committee for Equipments: This committee evaluates the equipments that are brought into the hospital. Composition: Deputy Medical Superintendent Medical Officer Purchase Representative of user department

4. Committee of General/Stationery Purchase: This committee looks after the stationary items that are used in the hospital. Composition: Deputy Medical Superintendent Joint director (Administration) / Deputy Director (Administration) Deputy Director (finance) Representative of nursing staff. Medical Officer Purchase.

5. Technical Committee (purchase of medical equipments): This committee purchases medical equipments like X-Ray machines, C T Scan machine, and Ultra Sound machine. Composition: Deputy medical Superintendent Specialist of concerned department Doctor (may or may not be from the same department) Medical Officer (Purchase)

Deputy Director Finance (For all committees)

6. Committee of Dietary and Grocery items: This committee looks after the food items for the patients. The quality and quantity of food items is decided by this committee. Composition: Deputy medical Superintendent Joint director (Administration) / Deputy Director (Administration) Deputy Director (finance) Dietician Store in charge

7. Committee of Linen Purchase: This committee looks after the uniforms of the patients as well as bed sheets, napkins, pillow covers. Composition: Deputy medical Superintendent Joint director (Administration) / Deputy Director (Administration) Deputy Director (finance) Representative of nursing staff Medical Officer (Purchase) Linen keeper

8. Committee of Purchases of Liveries: This committee looks after the uniforms of the staff. Every year three uniforms are provided to each staff member. Composition: Deputy medical Superintendent Joint director (Administration) / Deputy Director (Administration) Deputy Director (finance) Store Keeper

Union Representative

DEPARTMENTS Medical ii. Surgery iii. Gynaecology iv. Orthopaedics v. ENT (Eyes ,Nose and Throat) vi. Ophthalmic vii. Psychiatrist viii. Pathology and X-Ray ix. Anesthesia Medical Care The hospital takes care of its patients in three different ways. They are: 1. Primary care 2. Secondary care 3. Tertiary care Primary care: The doctors (Insured Medical Practitioners) give the primary treatment to the patients at the various dispensaries of ESI Hospital . They examine them by holding check ups and treat them for minor injuries. Secondary care: The IMPs at their dispensaries diagnose the severity of the disease and accordingly advise them for further treatment in the ESI hospital. The patients are advised to visit the hospital for blood testing, urine and stool testing, and other prescribed tests such as Ultra sound Sonography, Ecocardio gram (ECG), Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scan and thereby provide the reports to the patients for their further treatment. Tertiary care: The tertiary care includes the super specialty treatment which is given by the doctors to their patients. Any major surgery or a transplant which has to be performed on the patient comes

under this category. The tertiary facilities given in this case includes the knee joint replacement, the hip joint replacement and such other replacements or transplants. Budget Planning For the smooth functioning of the hospital there has to be smooth flow of funds for the various expenditures for the purchase of drugs, medical and non medical equipments, food for the in house patients and also for improving the infrastructure and administrative affairs of the hospital. For this purpose, the budget is sanctioned every year by the central government. The budget allocated by the government for the fiscal year 08-09 is 25 crores. However, the Deputy Director, Finance has proposed a budget of 52 crores. The funds allocated for the medicines and treatment of the insured employees is the collective Contribution of the employers (4.75%) and the employees (1.75%). The budget can be invariably sanctioned by the Deputy Director, Finance as and when there arises a requisition for drugs, medical/non medical equipments, stationeries, groceries, etc. Purchase of materials The ESI Hospital purchases drugs, equipments (medical/non medical), diet, stationery & printing, linen & liveries as per the requirements of various departments. The committees responsible for the purchase of their respective materials, meet as per their need in the presence of the Deputy Medical Superintendent and Deputy Director , Finance and Medical Officer Purchase to take collective decisions regarding the floating of the tenders. These tender notices can be given as global or local tender notice. Sealed bids are invited and finally the committees meet up again for finalizing the quotations. The least biding parties are selected for the purchase of their required materials. Purchase of drugs: Purchase of drugs and dressings is done under the E.S.I. Corporation centralized rate contract no.130 for additional drugs. A copy of the Centralized rate contract for additional drugs finalized for supply of drugs and dressings under the ESI Scheme in the country is sent to the director general of E.S.I. Corporation (ESIS-ALL STATES AND Medical superintendent ESIC Model Hospitals). All the medicines, drugs, dressings come under the rate contract. Purchase of equipments (Medical/non medical): For the purpose of purchase of equipments the hospital has a committee known as technical committee. This committee looks after the purchase of the medical as well as non medical

equipments. They often meet as and when the need arises and decides upon the further actions to be taken regarding the purchase of the materials. The purchase of the equipments usually occurs due to the following reasons: 1. Purchase against the contamination 2. Purchase of new equipment. Procedure for purchase of equipments:

Advertisement is given in news papers in the form of tenders with specifications. The tender with the lowest quotation which meets the requirements and standards is then finalized. After the finalization of the tender, order is passed to that particular agency. The supply of the material is done within 3-4 days (for emergency within 24 hours) The hospital receives the equipments and checks for the quality of the material supplied. After the quality checking of the material, it is approved for installation. As and when the installation is finished payment is made (90% of the payment is made before the supply and the remaining 10% is done after the installation )

Purchase of raw materials: The purchase of the raw materials for the kitchen is managed by the committee of Dietary and Grocery items. This committee meets up to decide upon yearly purchase of the raw materials. In meetings, the dietician and the along with other members involved decide upon the quality of the raw materials to be purchased. Once the specifications are decided upon, the committee members float the tenders in the newspapers stating the required specifications. The tender is passed for the supplier whose quotation is the lowest. And after the complete quality checking and approval form the dietician the payment is done. Kitchen department The kitchen department comprises of 6 persons working in a general shift from 9 am 5 p.m out of which 3 persons work as cook, assistant cook, 1 Dietician & 1 Assistant Dietician . The raw materials & the food grains is purchased for the 15 days & is brought from the tender in Vashi. This contract is maintained for 1 year & it keeps on changing according to the need. The rate of entire meal for per patient is Rs. 17.95 paise/day & Rs. 38.86 paise/monthly. Thus the entire budget of the meal comes at around 1 lakh 42,000 monthly.

There is a provision of a refrigerator for storing the food items & the store room in case of an emergency. The Diet Sheet is prepared one day in advance according to the patients need & the scaling is done by the Dietician for proper measurement of nutrition in the food. The meal comprises of: BREAKFAST- 1 Glass of Milk, 2 Bananas; LUNCH/ DINNER- As per prescribed & it consists of 1 vegetable which could be repeated twice a week for sedimentary workers. The following terminology is used for the diet sheet as mentioned below: AD - FULL DIET LD - LIGHT DIET MD/BMD - MILK & SUGAR ADD - DIABETIC VEG -DIET AFD - PEDIATRIC DIET ( SMALL) BFD - NON VEG FULL DIET BMD - BUTTER MILK DIET BREAD - 60 GRMS - 2 SLICES/ PATIENT MILK - 70 ML MILK IS CUT FOR MAKING TEA

Training In order to avoid hindrance in the smooth functioning of the hospital, conducts training for his staffs. These training are mostly for improving the behavioral aspects of his staffs and nurses. The staffs and nurses who are employed in the hospital are underprivileged. Thus they tend to aggravate at times while serving their patients. This will in turn escalate a sense of dissatisfaction among the patients. Thus to instill a sense of tranquility within these class III and class IV employees, he holds training where he advocate about means by which patients can be served and satisfied. The staff tends to believe in spirituality. And hence he explains the sacredness involved in helping and serving people by way of treating them. There are no external training conducted as of now. But, they have future plans to give external training in technical as well as behavioral areas. Common problems These training are mostly for improving the behavioral aspects of his staffs and nurses. The staffs and nurses who are employed in the hospital are underprivileged. Thus, they tend to aggravate at times while serving their patients. This will lead to unsatisfied customers. Thus to calm these

people he holds training where he preach about satisfying one patient also, will satisfy god. And if a patient is not served properly or not attended proper manner will be punished by god. Nevertheless, he also believes that there is no organization which doesnt have problems. Even in this hospital there are certain problems which do occur among the patients, the staffs, the nurses and the doctors. The common problems, which occur among them, are as follows: Patients

There are no equipments for major surgery viz. angioplasty, heart operations, and kidney transplantations available in the hospital. The outgoing patients have to wait for long hours for the doctors which in turn results in hypertension and anxiety among them. The doctors being from the state government tends to become proud and arrogant at times with the patients. Due to their arrogant behavior they at times delay or avoid operating the patients.

No doctors for lifestyle diseases like depression and heart ailments. Over-crowded wards No proper laundry facilities provided for nurses and staffs Adequate number of uniforms not provided to them with no proper stitching facilities provided. Canteen is not in a proper hygienic condition with very few seating arrangement. Confusion in the minds of the state government staffs after the takeover of the corporation as to whose policies to follow.

Staffs

Doctors

Doctors are less in numbers hence; they have to attend more patients at a time. No adequate equipments available for super specialty treatment. The state government doctors have a fear of losing their jobs due to the takeover of corporation.