We look forward to foraying into larger states using technology for efficiency, says Naresh Jain, CEO, Ziqitza Health Care Limited in an interview with Kartik Sharma of Elets News Network (ENN)
Please provide the overview of the operations of Ziqitza Health Care Limited (ZHL) in brief?
ZHL has broadly two different business verticals that include private business and government business. The private business is known by the brand 108, which is the original business that we started in 2004 that we scaled up gradually with time. Currently, we have about 110 ambulances under the brand 108, wherein users call on 108. Once the call is received in the call centre in that region, the closest ambulance is identified by the global positioning system (GPS) tracking and software installed at the call centre and immediately dispatched to pick up and drop the patient the hospital of his/her choice, since the patient pays for the services delivered by the ambulance. We actually follow the pay-per-use model, wherein the user pays as and when he/she use the service. There are no subscription fees or any other charges, only the transport fee. Currently, we are in parts of Kerala, Mumbai and some parts of East India where we have 108 ambulance stations. The other part of our business is government business, wherein we enter into a contract with state government through a publicprivate partnership (PPP) model, wherein we provide these ambulance services to the entire state or whichever region the government calls for the tender. The government pays us on behalf of the public based on the service parameters and various other deliverables that are decided before the tender process is commenced. Currently, our 108 model is present in Odisha, Punjab and parts of Bihar; we are covering only one district in Bihar with 10 ambulances and we have also won the tender for Jharkhand state wherein we will be rolling out 329 ambulances in the next three to six months under the same 108 programme. Going forward, we expect a lot of contested footage by various state government and we would bid based on the parameters specified in the tender documents. As and when more opportunities come, we will take it up for expansion.
Emergency services have emerged as the lifeline for the people unable to get the vehicle on time. Please comment.
This is a very high-impact project for various state governments, as the public uses these services directly and public benefits from such services, particularly in the absence of similar services during a real medical emergency. People have started realising its benefits, especially in rural India where access to good medical facilities is not available. In rural areas, people need to travel to various districts, headquarters where district hospitals are located and state capitals where adequate medical facilities are available. Therefore, the requirement of this ambulance service is all the more acute and needed in rural India, compared to the urban areas. With the growing usage of this serviceÂ amongst people, 108 ambulance services have got more popular. With credibility built over the period of time, people now consider such services as a reliable service by the government. As it gets more popular, the usage of the ambulance services will increase across India. Because of the popularity of these services and achievement of projections in just three years in Odisha, the government has decided to add additional 25 per cent of more ambulances in its fourth year.
Will you consider Odisha as a successful case study of ZHL?
I would not say just a successful case study for ZHL, but for the entire 108 model. These ambulances are available in all the other states and very few states are now not covered by this service. Moreover, the remaining few states are also now contemplating to adopt this request for proposal (RFP). I assume in next one year, all states should be covered by these services, as it becomes easy for the state governments to implement an existing model followed in different states.
What would you like to say on the emphasis by Prime Minister Narendra Modi on the usage of 108 services for any medical emergency?
Since the new government took over in the centre about two years back, there has been a renewed focus on healthcare, especially e-channels, in both rural and urban areas. However, the focus has been more on rural areas. A lot of projects are now being privatised on the PPP model basis, to the extent that not only ambulance services, but even diagnosis centres are being looked at for privatisation. There is entire renewed focus and emphasis on the PPP model, wherein service standards and delivery standards are set upfront and the government has to just do monitoringÂ to ensure services are delivered as per the agreed-upon parameters. We will see more healthcare services being provided under this model.
What strategic measures have been taken by ZHL to keep itself competitive and better to gain access to more areas?
By looking at the growth of 108 services in India over last seven to eight years, one will realise that only ZHL and GVK EMRI were providing emergency services until recently. There have been one or two entrants in this sector. When this sector opened up, we were very clear that we will only go into those states that have a tender-driven process of awarding contracts. Unfortunately, because this service is considered emergency and the state governments were in hurry to implement these services, they have signed memorandums of understanding (MOUs) with GVK EMRI. As a result, we were not in all the places where GVK EMRI had gone and signed the MOUs. Due to various developments and various judgments of both high court and apex court, 108 services have also started going through tender services in many states over last one-and-ahalf and two years. As and when the other states open up, where there are already existing MOUs signed up, we would look up at those opportunities based on whether the concerned tender has been structured in terms of clarity, impossibility and transparency.
From the perspective of a service provider, what basic challenges you confront and how you overcome them?
Every region has its own set of challenges. In Jharkhand, our concern would be the quality of road infrastructure, as ambulances need good road to travel and reach the hospital. It becomes a challenge to pick up a patient and drop them toÂ the closest hospital in rural areas. Therefore, we see a set of challenge in Jharkhand. On the other hand in Odisha, telecom connectivity in some areas is absent, which becomes a problem as the entire 108 service is provided by a network link through telecom infrastructure to a call centre. In the absence of telecom infrastructure in certain pockets, it becomes difficult for us to monitor the movement of ambulances and provide ambulances in the shortest possible time. Additionally, it becomes a bit difficult for users to connect with us at our call centre in the absence of appropriate telecom infrastructure. In Odisha, the other issue would also be high expectation from the service by the public. If for some reason, we donât reach on time, people can get angry and engage in rioting and mob violence, as seen in the past. Such issues are not present in Punjab, which has has good infrastructure, road infrastructure, telecom connectivity, good awareness of the services, good healthcare infrastructure, etc. At the end, the common point is how the state governments interact with you on a day-to-day basis. If the RFP and agreements are very clear, then the entire process goes smoothly. However, in cases where RFP and agreements are not clear, one can face challenges in terms of day-to-day coordination of work with the state governments.
ZHL has worked more with comparatively less-developed states, such as Jharkhand and Odisha. So, how ZHL plans to work in states larger in terms of area, such as Rajasthan, Madhya Pradesh, etc.?
Madhya Pradesh has come up with a tender very recently and we have been identified as the lowest bidder. We are awaiting the formal signing of the contract, which will happen in next three to six months. Yes, theÂ challenges there would be different, as Madhya Pradesh is a very large state. The state plans to have around 600 108 ambulances and about 735 102 ambulances. However, the best part was that the tender was very open, transparent, clear and enforceable to the maximum. Because the state has the experience of running this service for the last five to seven years, the administration is aware of the service and the kind of technology involved. The administration was very clear what to expect from the operators coming in for the bid. Additionally, it did not have any unreasonable conditions which would dissuade an operator from bidding. Once we get in there, we would realise the magnitude of the real challenges. However, we have done thorough mapping of the state and have identified a couple of challenges. However, we do have experience in serving in large states, such as Rajasthan, where we operated for three years from 2010 to 2013. We have also operated in Kerala from 2010 to 2012. We look forward to getting into Madhya Pradesh in next three to six months. The larger states, such as Karnataka, Tamil Nadu, etc., are going to come out with new tenders in next one or two years, so hopefully we would be would be able to meet challenges in larger states.
What is your take on using technology in such emergency services that cater to common man?
I would say information technology (IT) is the backbone of the ambulance services. It is the IT infrastructure that drives this entire network of such ambulance services. Though ambulance services were available even earlier in India, they were available on a standalone basis. Then none knew how to reach and call ambulances. Itâs only because of IT and telecom infrastructures that people are aware of these services.Â Currently, people are aware of short code digits to call ambulances and because of the IT infrastructure the call centre can identify the location of the caller and immediately dispatch ambulances. The movement of the ambulance from pickup to the hospital is monitored in the call centre to ensure no misuse of government facilities. Proper monitoring is conducted through the data captured on GPS equipment, which cannot be captured without technology. Therefore, technology has made delivery and monitoring of services much more convenient and possible in comparison to earlier times. The government by bringing in technology usage can actually monitor services in a better manner and ensure funds being deployed are used properly.
Technology has made delivery and monitoring of services much more convenient and possible in comparison to earlier times
With more PPP model being implemented in government services, what is your take on PPP and what are the key responsibilities of both private and government players to ensure efficiency and success?
Actually, everything depends on how well the project has been understood by people who are framing the policies and tenders. If the understanding is not clear, then you probably run the risk of drafting an agreement or an RFP that has no relevance for the actual ground position. Therefore, the understanding of what to expect and how to monitor need to be clear. Because expectations will be there,Â if the monitoring is not possible then you actually end up paying for those expectations that are not being met at the government end. The drafting and the way the entire project is conceived and implemented are very important for the success of the PPP model. The state government should realise that it is better to work with a private operator with clear guidelines and understanding of the project, deliverables and boundaries in which both the partners should operate and not unnecessarily indulge in putting roadblocks for the delivery of services due to lack of clarity on some issue or other. If the operator is clear and is able to deliver, roadblocks should not be erected. Any tender-driven process that does not rely on L1 parameter can be easily misused. As the market has become competitive with so many players around, those days of unviable price quoting is far and few, unless there are huge projects where we have a limited number of bidders. However, itâs very easy to break up such projects into a smaller size to encourage more communities to come forward and bid for competition.
We are focused upon creating a footprint in the pre-medical hospital care and emergency services. We are working very actively with various state governments to ensure these kinds of ambulance services are taken up in states in a proper manner. We do provide some kind of assistance in terms of how our projects are doing in Odisha and sharing of best practices of various states, such as Odisha and Punjab. Madhya Pradesh has taken inputs from various states to come up with a consolidated document. We look forward to working with various state governments if they are very clear of what they want, how the document is framed and general attitude of the government in terms of how they handle PPP projects.