Farishte Dilli Ke – Empowering Citizens Through Accessible and Reliable Emergency Healthcare Services

Farishte Dilli Ke (Hindi for Saviours of Delhi) uses innovative fiscal and non-fiscal incentives to encourage citizens to become Good Samaritans by helping victims of road traffic accidents, thermal burns and acid attacks without the fear of legal hassle or police enquiry. Under this scheme, the victims receive cashless treatment at any registered public or private nursing home or hospital across Delhi benefitting more than 18,919 people in the last 5 years.

Innovation Summary

Innovation Overview

In the past few decades, road accidents have emerged as one of the biggest causes of concern in the world and fatal accidents have been identified as a leading cause of deaths globally. In 2021, India was ranked first in the world for the number of deaths caused by road accidents. According to the World Bank, with just 1 percent of the world’s vehicles, India accounts for more than 11 percent of global deaths that happen from a road accident.

The impact of road crashes is disproportionately borne by the poor as most road accident victims are pedestrians, bicyclists, and motorcyclists. During the year 2016, 7375 road accidents were reported in Delhi, out of which 42.86% of the persons killed were pedestrians. Scooter/Motorcycle riders were the second most vulnerable victims constituting 35.9% of fatalities.

A large number of these deaths can be prevented if adequate treatment is provided in the “golden hour” (first hour post injury) to the victims. In 2016, the Supreme Court of India approved a set of guidelines issued by the Government of India which protected good samaritans from harassment at hospitals, police stations or courts. A Good Samaritan being any individual who, in good faith, without expectation of payment or reward and without any duty of care or special relationship, voluntarily came forward to administer immediate assistance or emergency care to a person injured in an accident, crash or emergency medical condition.

However, the implementation of these guidelines across the country remained incomplete by not accounting for the legal, financial and medical implications that followed the accident. In contrast, the Delhi Government under the leadership of Chief Minister Arvind Kejriwal came up with “Farishte Dilli Ke '' scheme in 2018 to provide an efficient solution to this booming epidemic. Through this, Delhi has taken the lead in not only developing and implementing innovative fiscal and non-fiscal incentives to encourage citizens for helping victims of accidents, but also in expanding the scope of the scheme by including victims of burns and acid attacks in its purview.

The implementation of such a scheme requires coordinated management of interventions, focused post-crash response and conjoint efforts of multiple stakeholders. Over the past five years the Delhi Government has incorporated all these to make Farishte Dilli Ke more efficient, comprehensive, and responsive to people’s actual needs.

Under the scheme, the Delhi government provides a reward of Rs. 2000 and a certificate of appreciation to the good samaritans who bring accident victims to the hospital. The accident victim can be admitted to any public or private hospital across Delhi, the government covers all medical costs of the victim and in case a hospital refuses to admit a patient, their license may be canceled. If the victim desires to change the hospital within the first 72 hours of the accident, then the government will pay for the bills at both the hospitals along with the ambulance expenses.

This citizen centric approach of the Delhi government reduces the impact on victims from lower and middle-income households by providing cashless emergency medical services. The scheme has helped over 18,919 victims of accidents, burns and acid attacks in the last 5 years.

By ensuring that every accident victim in Delhi is covered under the ambit of the scheme, and good samaritans are rewarded for their compassionate efforts, Farishte Dilli Ke guarantees equal opportunity to social security to every individual. The sustainability of the scheme in the long run is ensured by the institutionalization of the Delhi Arogya Kosh, a state level fund set up under the State Illness Assistance Fund. The Delhi Arogya Kosh formalizes cashless treatment of medico-legal victims of RTAs, burns and acid attacks as one of the four fundamental schemes under its purview, thereby ensuring a sustained flow of financial and administrative support to the Farishte Dilli Ke Scheme in the long run.

The State Illness Assistance Fund that ensures the sustainability of the scheme was set up under the National Illness Assistance Fund of the Government of India, in the first place. This implies that institutions for administrative and financial support for the creation of such a scheme already exist.

In the last ten years, road crashes have killed over 13 lakh people in India. According to the Law Commission of India, 50% of these victims died of preventable injuries and could have been saved if they had received care on time. It is high time that policies like Farishte Dilli Ke are envisioned and implemented at the national level, emergency health care services are made more accessible and supportive citizens are rewarded for their acts of kindness.

In a country where people without cars are at a greater risk of car accidents, Farishte Dilli Ke is an emblem of relief, reliable healthcare, and visionary governance.

Innovation Description

What Makes Your Project Innovative?

Farishte Dilli Ke is an innovative approach to road safety and emergency medical services as it banks on people’s ability to respond to emergency situations when they feel secured, protected and rewarded for their actions. Contrary to this, many countries enforce good Samaritan laws by initiating punitive action against bystanders who do not support the victims of road accidents. The Delhi Governments’ approach is less of threat and more of positively incentivizing the good in people.

Despite the monetary incentives for the good Samaritan, a key hurdle that disincentivised people from admitting road accident victims was the doubt around the bearing of medical expenditure. Many private healthcare facilities would earlier refuse assistance to accident victims. Under ‘Farishte Dilli Ke’, all monetary expenses of the victim are borne by the state Government, irrespective of whether the hospital is public or private, or whether the citizen belongs to Delhi or a different state.

What is the current status of your innovation?

At the date of the submission the scheme has already been implemented for over five years and successfully being continued across Delhi.

Key learnings from the program include lack of awareness and sensitisation around the provisions of the scheme. A significant percentage of by-standers still do not know about the existence of the policy and their rights at the healthcare facility. We are currently working on creating awareness by means of print and radio ads, mandatory notifications in all emergency healthcare facilities, etc. to ensure that people are aware and able to exercise their rights.

At the same time, the success of the program lies in the fact that many citizens have refused the monetary reward citing the invaluable feeling they experienced by doing the virtuous act of saving someone’s life. This helps us in planning other programs where the support of active citizens and first respondents is required for greater impact especially post the Covid19 pandemic.

Innovation Development

Collaborations & Partnerships

A partnership between the transport and health department, Delhi Police and numerous public and private hospitals and healthcare providers, Farishte Dilli Ke is a holistic approach to emergency health care and road safety.

Delhi Police respects the rights of Good Samaritans by protecting them from legal hassles, all medical institutions, hospitals and maternity homes have ensured seamless and cashless delivery of quality treatment to victims at the earliest.

Users, Stakeholders & Beneficiaries

The beneficiaries of this scheme are Victims of Road Accidents, burns and acid attacks and citizens who come forward to save them as Good Samaritans. The scheme covers all accidents that occur in Delhi and is applicable irrespective of the residential status or income of the victim. This has led to benefitting more than 18,919 people between 2018-2022. Also, the majority of private hospitals welcomed the initiative reiterating the value of saving lives over profit making.

Innovation Reflections

Results, Outcomes & Impacts

The direct impact of the Farishte Dilli Ke Scheme is currently measured in terms of the number of people who received cashless emergency medical services via the Delhi Arogya Kosh. Between 2018 to June 2022, more than 18,919 people have been benefited and numerous others rewarded for being good Samaritans.

The injuries and accidents covered under the scheme are not often under the control of human actions. Therefore, even though the overall aim of the government is to reduce road traffic accidents and fatalities, it is also imperative that more and more people are made aware of schemes like Farishte Dilli Ke aiming to increase the number of beneficiaries rationally.

In the past five years, many citizens have also refused the monetary reward citing the invaluable feeling they experienced by doing the virtuous act of saving someone’s life. This shows the level of compassion that is essential for building and driving self-sustaining communities.

Challenges and Failures

Lack of awareness about the scheme amongst the target population. The government responded to this through awareness campaigns, print and radio ads, mandatory notifications in all emergency healthcare facilities, etc. to ensure that more people availed the scheme and are able to exercise their rights.
Even though this scheme provides protection from legal scrutiny, the past experiences of a large number of people before this have been otherwise. This means that along with awareness programs, the new experiences of people under the scheme is what will allow them to rebuild trust in the system.
The scheme is dependent on private hospitals to provide quality care which is hindered when the admirative process leads to delay in reimbursements to private hospitals. To resolve this, it is important that the concerns and feedback of private stakeholders is incorporated and a shared sense of responsibility and understanding of the challenges is built between the two.

Conditions for Success

The scheme is dependent on coordination and collaboration between the department of health, public and private hospitals, associated health professionals and civil servants who run these institutions. The success of the scheme therefore depends on the amount of trust, credibility and reliance offered by each of these stakeholders to each other and to the public as a whole.
Lower income groups constitute the majority of beneficiaries and are often mistreated at private hospitals. While the government has appointed nodal officers in private hospitals to ensure accountability, the equitable implementation of the scheme requires attitudinal shift and sensitisation of private healthcare providers.
High budgetary allocation in the realm of health expenditure, and willingness at the level of the executive leadership.
Increased awareness and vigilance amongst citizens would ensure that they are equipped with the knowledge of their rights and avail the scheme when required.

Replication

The scheme has not been exactly replicated in other places but after the implementation and subsequent favorable outcomes, the Ministry of Road, Transport and Highways of the Government of India (MoRTH) has started strengthening its Good Samaritan Law and placed increased attention to its promotion, awareness creation and efficient implementation.

For instance, in October 2020 the MoRTH came up with a proposal for all states to nominate individuals for good Samaritan awards. In October 2021, with the aim to motivate people, the MoRTH came up with a scheme to provide a financial reward of INR 5000 for good Samaritans and subsequent National Level Awards worth INR 1,00,000.

For states to adapt schemes like Farishte Dilli Ke can and replicate its sustained and efficient implementation, there will be high dependency on efficient interdepartmental collaboration, shared sense of commitment to and from the citizens and most importantly sustained high budgetary allocation to Healthcare.

Lessons Learned

Operation and Implementation - Initially, when patients went to the nearest hospital, they were allowed to transfer to government hospitals from government hospitals but transfer to and from private hospitals in case of lack of available facilities was prohibited. This restricted the victims to avail benefits of the scheme. Channeling this feedback, the Delhi government made prompt changes in the scheme provisions and allowed such transfers within 72 hours of the incident.

Policy outlook - Promotion, awareness and sensitisation are key drivers of public policy reforms. In the past five years, the lack of awareness amongst the general public and lack of sensitivity amongst stakeholders have been majority responsible for slowing down the wheels of impact of Farishte Dilli Ke. Therefore, as the initiative moves into its 6th year of implementation, awareness generation and sensitisation efforts should be the priorities for its success.

🇮🇳