How to Reduce Cost in Rural Hospitals: Presented at the IFRS Meeting by Dr. R.R. Tongaonkar

With Dr. R.R. Tongaonkar’s permission, Dr. J. Gnanaraj has summarized his presentation.


Dr. RR Tongaonkar is a legendary rural surgeon working in a remote area called Dondaicha in Dhule district of Maharashtra. He is the past president of the Association Rural Surgeons of India and International Federation of Rural Surgeons of India. These are the excerpts from his speech at the various international conferences of rural surgery at Ifakara in Tanzania and Eruwa in Nigeria.


India is a rapidly developing economy and many corporate are seeing India as a potential area for investment. However the reality is that our per capita GNP is $500 while it is well over $20,000 in the developed countries. Forty percent of Indians are below the poverty line and over 400 million in our country have no access to even primary surgical care.

The accesses to the available surgical facilities are complicated by the meager transport facilities.

transporting to facilities

Once the patients reach the hospital affordability is a very significant factor. Dr. Tongaonkar shares the charges at his rural hospital and compares it with the costs at Pune where he underwent surgery about 10 years earlier.

price comparison
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Dr. Tongaonkar shared his secret about being a legendary lovable rural surgeon.

A. Begin slowly and add gradually: When this happens there is no stress on the rural surgeon. Ethical practices are possible with as little investigations as possible and greater reliance on clinical examinations.

B. Keep the cost of anesthesia down: As many surgeries as possible are carried out under local and spinal anesthesia which are less expensive and low-cost specially designed equipment like the low-cost Newmon ventilator is used for general anesthesia along with industrial oxygen.

cheaper anesthesia

C. Low-cost Engineering innovations: These are essential to keep the costs down of the rural surgical facility. Rural surgeons with engineering background like Dr. Awojobi from Nigeria were inspired by Dr. Tongaonkar.

cheaper ways to combat energy

D. Specifically trained local staff: The locally trained staff are excellent in their work and although they might be considered unqualified by their urban counterparts or legal experts they are capable of high quality work.

E. Allowing relatives to stay and cook: The relatives are capable of providing better food and their presence with the patients make them happier and the relatives could be trained to be part of the health care process.

F. The surgeon as a service engineer: Often the most educated and the person with capability of understanding how things work in the team is the surgeon. Hence he needs to be involved in maintenance of the equipment and needs to make a special effort to learn.

maintenance of equipment by doctors

G. Specific directed investigations save lot of money: These include procedures like FNAC and diagnostic laparoscopies.

H. Having all investigations and treatment under one roof helps: This would save a lot of money for the patients.

I. Innovations to cut costs: Some innovations can make dramatic differences in cost. For instance the mosquito net cloth is similar to the commercial Prolene mesh and could be used for hernia surgery.

innovate new things

J. Learning modern methods are possible at low costs: Here the innovativeness of the rural surgeons comes to the forefront.

under one roof

It is important to be contentment as it is the greed of the surgeon that inflates the cost of surgical treatment. By doing ethical practice we might think that we lose money but it is compensated by increased turnover or workload.

gnanaraj Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.


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  1. Posted Jul 2016 at 5:41 pm | Permalink

    Very inspiring !

  2. Posted Jul 2016 at 5:42 pm | Permalink

    Lots of great ideas. Can you please upload a video of your hospital, so we can get a virtual tour of your facility ?

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