Why is Mumbai abandoning its civic hospitals? #Healthcare


 

 – Rediff.com India News

By deserting public hospitals we are dismantling our public health-care system, says Dr Sanjay Nagral. | Why is Mumbai abandoning its civic hospitals?

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Why is Mumbai abandoning its civic hospitals?

May 09, 2013 10:56 IST

By deserting public hospitals we are dismantling our public health-care system, says Dr Sanjay Nagral.

The recent story of babies with heart defects dying in Mumbai’s [ Images ] civic hospitals while the procurement of a heart-lung machine was delayed is tragic and shocking.

The heart defects in these toddlers were eminently correctable by timely surgery, which not only would have saved lives but also lead to a normal quality of life.

Unlike bypass surgery, which may add a few years to life, surgery for repairing congenital heart defects can translate into a normal healthy life span. Many readers are likely to have dismissed it as yet another chapter in the now familiar media exposes on the crumbling systems in Mumbai’s public hospitals. And we will all soon if we already haven’t forgotten about these babies and their cruel fate.

Mumbai’s civic hospitals boast of some of the oldest and finest cardiac surgery departments in the country. A lot of the early pioneering works in cardiac surgery in India [ Images ] –including the earliest successful heart operations — were performed at KEM Hospital‘s cardiac surgery department. Many of us who have trained in KEM’s surgery department have been beneficiaries of this great legacy.

Even today Mumbai’s civic medical colleges and hospitals are considered amongst the best in the country, both for undergraduate and postgraduate studies. Mumbai’s civic budget for health is one of the highest in the country and the teaching hospitals get a lion’s share of this.

So why is it that the purchase of a lifesaving heart-lung machine gets delayed for so long and it takes a newspaper expose for the authorities to respond?

Is it all about bureaucracy, red tape and indifference of some officials?

It is indeed tempting to think so for this is an easy, simplistic explanation. We can then momentarily feel sad, perhaps a little outraged, rationalise it and go back to the comfort zones of our daily lives. But there is more to it.

And that bit is not about some inefficient civic official, it is about you and me.

Public hospitals in Mumbai were once the heart of health-care in the city. Except for the few super rich who would seek services in a fringe private sector a large majority of the population including the middle class were treated in these hospitals.

Check with your parents and grandparents, and they will tell you this. Over the years a burgeoning private sector started attracting larger and larger sections of the population.

Today most people including the poor seek health care in the private sector which is perceived as ‘efficient’ and of ‘better’ quality. The middle classes have largely abandoned these hospitals and even the poor seek their services only for major illnesses often after being bankrupted in the private sector. Thus, these hospitals have essentially moved out of the imagination of those who shape public opinion.

A majority of the doctors trained in these institutions seek careers abroad or in the private sector. They have largely become training grounds for nourishing the private health- care industry. And finally no bureaucrat or politician now seeks treatment in these institutions, preferring to get their treatment funded at private institutions.

At the Bhabha hospital in Bandra — one of the largest civic peripheral hospitals where I work part time as a surgeon — there is a predictable pattern to patients brought to our casualty with accidents. Those who are well to do will often be whisked away by their family and friends to nearby private hospitals, whereas the poor will continue to be treated with us.

Thus in the bomb blasts of 2006 most of the victims including those with serious injuries were transferred to private hospitals since they were from the first class compartment. In the previous year’s riots and floods we managed the victims.

Many years ago when I was at KEM I would treat a large number of friends and their family; people like you and me. Now I treat a large number of maids and drivers of friends at Bhabha, whilst I treat their employers in the private hospitals I work with.

A few years ago when a senior journalist friend chose to get himself operated at Bhabha a large number of common friends expressed surprise and even admiration for his act of ‘courage’.

In a subconscious collective act we have abandoned these institutions to those ‘others’ who inhabit a different space, who have no voice, clout or energy to fight the battle for decent health-care.

The parents of the kids fortunate to have their hearts fixed may thank the newspaper and the journalist who broke, and followed up the story. The act of getting a few private hospitals to do the pending cases is but only a temporary solution.

Even worse, it strengthens the belief that such care can only be provided in the private sector. Some of the private hospitals will seize the moment to actually market themselves.

The specific reason for the delay in sanctioning the heart-lung machines could have been a slowly moving file, an indifferent official or even a lack of follow-up from the departments concerned. But each time a life-saving ventilator doesn’t work, a CT scan is not available for a young man who has fallen off a train and a young pregnant woman dies, as she is transported from hospital to hospital in ramshackle ambulances, a media story cannot correct the problem.

Unless we realise that by abandoning these hospitals we are complicit in the process of dismantling our public health-care system. Whether we like it or not, at some stage in our lives we need the services of public hospitals; what if you are knocked down on the road and carried by passersby to the nearest public facility?

The heart-lung machines have probably been temporarily procured and unlike the unfortunate ones who died, some of the kids will now live to tell the tale of the holes in their hearts. Many years later when they grow up will there still be a long queue for poor kids born with heart defects?

Their fate is inextricably linked with the value we give to the development of an efficient public health system. And that in turn will be determined by whether we relate to our civic hospitals as our own and are outraged by its inadequacies and indifference.

The holes in the babies’s hearts is currently a gap in our collective minds.

Dr Sanjay Nagral is a consultant surgeon, department of surgical gastroenterology, Jaslok Hospital and Research Centre, Mumbai. Photograph: Sahil Salvi

Dr Sanjay Nagral in Mumbai

 

Immediate Release- Stop Privatization of Health Services in Maharashtra


State Convention’s Critique of the Privatization Proposal

Do not privatize Lab. Investigations, MRI, CT scan Facilities

in Medical College Hospitals and Radiology Services in other hospitals!

This Privatization will be disastrous for the people and Public Health Services and Medical Education in Maharashtra

—————————————————————————————————————————

March 17 Mumbai

During a state level convention, at Mumbai Marathi Patrakar Sangh on 17th March 2012, wide spectrum of social organisations, health-activists, healthcare professionals across Maharashtra expressed their disapproval and anger, against the proposed privatization of certain key services in Public Hospitals in Maharashtra which is being pushed in the name of Public – Private partnership. The Convention resolved to launch a movement against the privatization of MRI, CT scan services and certain laboratory services in government run medical colleges as well as district hospitals across Maharashtra..

Jan Arogya Abhiyan (a network of civil society organisations working in the health sector in the Maharashtra since 2000) along with various mass organisations, trade unions, other civil society organizations, health sector professionals and academicians had organised this broad based state level convention to discuss the issue and to chalk out strategies and action plans.

Dr. Abhijit More a co-convenor of the Jan Arogya Abhiyan, brought attention of the convention towards Maharashtra State Government’s proposals to privatize key services in medical college hospitals and district hospitals. He said, “Two senior cabinet ministers – Minister for Medical Education and Research, Dr. Vijaykumar Gavit has floated proposal to privatize radiology services (like CT scan, MRI etc) and laboratory services in 14 Government Medical College hospitals while Minister for Public Health and Family Welfare, Shri Suresh Shetty has floated proposal to privatize radiology services in all District Hospitals, across Maharashtra. “

Speaking at the convention Dr. Abhay Shukla pointed towards larger design for privatization of the healthcare system in the state. He said, “Maharashtra State Government is planning to hand over huge sums of public money to insurance companies and large private hospitals through a flawed Private-Public Partnership (PPP) in the form of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY). This scheme involves large scale public finances being given to corporate hospitals without adequate standardization or regulation of their services, and no protection of patients rights. At the same time, the government is planning to privatise its most revenue generating units in public hospitals like radiology services and laboratory services. The Public health system, which is already neglected by the state government, will collapse in this kind of negative policy environment, leaving people completely to the mercy of profit-seeking private hospitals. These changes will adversely affect not only poor people but also the middle class, for whom private healthcare is becoming increasingly unaffordable these days.”

Pramod Nigudkar from Jan Swasthya Abhiyan-Mumbai said that privatization of health services is becoming norm even for Mumbai Municipal Corporation run hospitals. This has increased burden of fees on patients. Marginalized communities are badly affected by such moves.

Dr. Anant Phadke, co-convenor of Jan Aarogya Abhiyaan, criticized the proposed privatization of key health services. He said, “The so called Public Private Partnership has no real economic, social, managerial justification. All justifications given by health officials do not stand on merit. There is no truth in health officials’ claim that there is paucity of funds to develop modern medical facilities, forcing government to privatisation proposal. The report of of the Steering Committee on Health for the 12th FYP has clearly recommended cashless universal health care for all and not only for the poor people. Towards this end the Planning Commission is set to double the public health expenditure in India from the current 1.2% of GDP to 2.5 % of GDP during the 12th Five Year Plan. This would mean an additional budgetary availability of Central Govt. funds of more than Rs. 80,000 crores annually! This amount would be more than 10 times the additional budgetary allocation for the NRHM during the 11th Five Year Plan! Hon’ble President Pratibha Patil’s speech before Parliament on 12th March 2012 also gives ample clues in this direction. Maharashtra Government should take advantage of this situation by coming with innovative ways, schemes to strengthen public health system rather than resorting to privatisation. Apart from that, Maharashtra govt. should also increase it’s own contribution to health care from the current miserly health care expenditure 0.5% of the State Domestic Product to atleast 1.5%.”

Mr. Tukaram Sathe, President of Shasakeey Padvidhar Ksh Kiran Tantradnya Sanghatana pointed out that- “Radiology technicians were hardly taken into confidence before such proposals by Maharashtra State government. Whatever problems that may exist in the management of MRI and CT scan facilities in the medical college hospitals, must be solved by seeking active cooperation of the doctors and other staff in these centres. Privatization is no answer to these problems. The experience of the so called PPP in case of MRI and CT scan facilities in the GT hospital in Mumbai shows that only a small proportion of patients get service at government rates. Moreover, under some pretext or other, even such ‘free, subsidized ’patients are made to spend beyond the official rate. The rest have to pay at commercial rates. This will clearly increase burden on lower middle and middle class patients. Also, as a result of privatisation- Radiology, Microbiology, Pathology, Biochemistry departments in the government medical college hospitals would remain ‘Public’ only on paper; it would also damage the training of new generation of doctors.”

Mr. Sanjay Salunke of the Laboratory Technicians’ Union-Mumbai, “Public hospital labs are able to conduct many sophisticated tests. Skilled doctors and technicians are also available. There is a need for their better utilization. There should be more transparency while purchasing laboratory equipments and reagents. Concerned doctors and lab technicians should be taken into confidence while making such purchases to avoid wastage of public money. Instead of privatisation, government should focus on better management and modernization of public hospital laboratories.”

“In the 21st century health care should be regarded as human right and in most developed countries as well as in many developing countries like Sri Lanka, Thailand, Brazil, Malaysia and Venezuela the goal of Health Care for All has been achieved. In this process, the Public Health Services have played the role of leadership, of trend setting and as a back-borne for the National Health Care System. India cannot be an exception,” said Girija Gupte.

“On one hand our Prime Minister has expressed concern regarding our health system and has promised to substantially increase financial allocations to improve healthcare delivery to citizens, and Planning Commission of India is proposing to double its public health budget. The High Level Expert Group formed by the Planning Commission is recommending a system of Universal Health care for every citizen with strong emphasis on strengthening our public health system and abolition of user fees in all public hospitals. On the other hand, our learned Ministers from Maharashtra Government are considering seriously regressive steps which would weaken public hospitals, and are likely to deny health rights to large number of citizens,” said Sonya Gill from Akhil Bharatiya Janawadi Mahila Sanghatana(AIDWA).

In the light of facts and analysis presented by various speakers in the convention regarding proposed privatization key public health services, this Convention unanimously denounced the proposed privatization of above mentioned public health services and

RESOLVED TO-

1. Build a state-wide campaign to oppose proposed privatization of key health services in government run medical college hospitals and all district hospitals across Maharashtra.

2. Raise these critical issues with Chief Minister, Public Health and Family Welfare Minister, Medical Education and Research Minister, any other Minister from the state of Maharashtra, Members of Legislative Assembly, Members of Parliament, senior health officials and convince them to withdraw this proposal.

3. Reach out to wide spectrum of stakeholders like current and past medical college students, medical professors, nurses, technicians and other public health staff to get their support to stop privatization of public health services in Maharashtra.

4. Raise awareness amongst general public, academicians, Panchayat Raj representatives, other social organisations, networks and media about grave outcomes of privatization of public health services and need to reverse the process.

5. Work out proposals to improve public health services without privatization by using various innovative ways and increased utilization of resources; and put forward these proposals as constructive alternative measures during dialogue with health officials and concerned Ministers.

issued by—-
Jan Aarogya Abhiyan, JAA- Maharashtra, Jan Swasthya Abhiyan- Mumbai, (apanalaya build, ccdt, icor, , RFTI, sneha, vacha, yuva,) Laboratory Technicians’ Union-Mumbai, Shasakeey Padvidhar Ksh Kiran Tantradnya Sanghatana, Jagrut Kamgar Manch, Akhil Bharatiya Janawadi Mahila Sanghatana (AIDWA), Maharashtra Sarva Shramik Mahasangh, Ghar Bhanao Ghar Bachao Andolan, Justice and Peace Commission, Nirmaan-Mumbai, Institute for Community Organisation Research, Movement for Peace and Justice, Jan Shoshit Andolan, Indian School of Social Sciences , Nurses Federation Maharashtra, Nurses and Para medical staff Union , Asha- Workers Association, Vacha, Majlis, Media Action Group,Women Research and Action Group (WRAG) ,Special Cell for Women

Maharashtra State Level Convention on

‘No’ to privatization of Public Hospitals

‘Yes’ to Strengthening, Improving Public Hospitals

17th March 2012, at Mumbai Marathi Patrakar Sangh

—————————————————————————————————–

RESOLUTION

—————————————————————————————————–

In the light of facts and analysis presented by various speakers in the convention regarding proposed privatization of certain radiological services in 14 government run medical college hospitals and district hospitals in Maharashtra, as well as laboratory services in government medical college hospitals; this Convention has come to the unanimous conclusion that from the point of view of the people, this proposal of so called ‘Public Private Partnership ‘ has no real economic, social, managerial justification. The justifications put forth by the votaries of this so called ‘Public Private Partnership ‘are misleading. Firstly, since the Planning Commission has announced a quantum jump for health care during the 12th FYP, there would not be now paucity of funds for buying the necessary equipments for the Public Hospitals. Secondly, thanks to tele-radiology, experts in Public Hospitals in bigger cities can prepare reports of x-ray films taken in other places. Thirdly, Health Dept. in Maharashtra canmaintain functionality of modern hospital machinery and equipments and retain expert-doctors in Public Hospitals by learning from the successful examples like Command Hospitals, Bhabha Hospital etc. This ‘Public Private Partnership ‘ on the contrary, would have grave consequences like weakening of public health system, denial of access to healthcare to the poor and middle class people.These departments in the government medical college hospitals would remain ‘Public’ only on paper; greatly damaging the training of new generation of doctors. This Convention unanimously denounces thisproposed so called ‘Public Private Partnership’ and

RESOLVES TO-

1. Build a state-wide campaign to oppose proposed privatization of MRI and CT scan facilities and laboratory services in Government run medical colleges, and of radiological services in district hospitals across Maharashtra.

2. Raise these critical issues with Chief Minister, Public Health and Family Welfare Minister, Medical Education and Research Minister, Members of Legislative Assembly, Members of Parliament, senior health officials and convince them to withdraw this proposal.

3. Reach out to wide spectrum of stakeholders like current and past medical college students, medical professors, nurses, technicians and other public health staff to get their support to stop privatization of public health services in Maharashtra.

4. Raise awareness amongst general public, academicians, Panchayat Raj representatives, other social organisations, networks and media about grave outcomes of privatization of public health services and need to reverse the process.

5. Work out proposals to improve public health services without privatization by using various innovative methods and increased utilization of resources; and put forward these proposals as constructive alternative measures during dialogue with health officials and concerned Ministers.

Jan Aarogya Abhiyan, JAA- Maharashtra, Jan Swasthya Abhiyan- Mumbai, (apanalaya build, ccdt, icor, , RFTI, sneha, vacha, yuva,) Laboratory Technicians’ Union-Mumbai, Shasakeey Padvidhar Ksh Kiran Tantradnya Sanghatana, Jagrut Kamgar Manch, Akhil Bharatiya Janawadi Mahila Sanghatana (AIDWA), Maharashtra Sarva Shramik Mahasangh, Ghar Bhanao Ghar Bachao Andolan, Justice and Peace Commission, Nirmaan-Mumbai, Institute for Community Organisation Research, Movement for Peace and Justice, Jan Shoshit Andolan, Indian School of Social Sciences , Nurses Federation Maharashtra, Nurses and Para medical staff Union , Asha- Workers Association, Vacha, Majlis, Media Action Group,Women Research and Action Group (WRAG) ,Special Cell for Women

State Convention’s Critique of the Privatization Proposal

Do not privatize Lab. Investigations, MRI, CT scan Facilities

in Medical College Hospitals and Radiology Services in other hospitals!

This Privatization will be disastrous for the people and Public Health Services and Medical Education in Maharashtra

In the name of Public Private Partnership, in all the 14 Govt. Medical Colleges hospitals in Maharashtra the Maharashtra Govt has, decided to

1) Privatize MRI and CT scan facilities

2) Hand over part of it’s pathology laboratories to private companies

3) Privatize radiological services in Rural Hospitals and District Hospitals.

Thus these private companies who will use the premises of these Medical Colleges hospitals, and other govt. hospitals to give services at govt. rates to certain categories of the people like those below a certain level of annual income of say Rs. 1 lakh and the rest would be charged commercial rates There is no real economic, technical, managerial rationale for this decision and it will be disastrous for the Public Health Services and Medical Education in Maharashtra.

The justification given by the concerned authorities for this step is misleading-

Justification no. 1 – Paucity of funds with the Health Dept to develop modern facilities

Reality – The report of of the Steering Committee on Health for the 12th FYP has clearly recommended cashless universal health care for all and not only for the poor people. Towards this end the Planning Commission is set to double the public health expenditure in India from the current 1.2% of GDP to 2.5 % of GDP during the 12th Five Year Plan. This would mean an additional budgetary availability of Central Govt. funds of more than Rs. 80,000 crores annually. This amount would be more than 10 times the additional budgetary allocation for the NRHM during the 11th Five Year Plan! There would be thus no financial constraints in providing free health care services including MRI and CT scan services and modern pathological investigations in the government college hospitals. The Maharashtra govt. will have to prepare a proper plan and submit it to the Central Govt. to obtain these funds. Secondly, the Maharashtra govt. should also increase it’s own contribution to health care from the current miserly health care expenditure 0.5% of the State Domestic Product to atleast 1.5%.

Justification no. 2: This is not privatization but Public Private Partnership (PPP) which will make available benefits of the latest technology to the poor people

Reality – The experience of the so called PPP in case of MRI and CT scan facilities in the GT hospital in Mumbai shows that only a small proportion of patients get service at government rates. The rest have to pay commercial rates. Moreover, under some pretext or other, even such ‘free, subsidized ’patients are made to spend beyond the official rate. Secondly the people from lower middle class, middle class background currently pay much less at the govt. hospitals compared to the commercial rates. But now they will have to pay at the commercial rate. In a city like Mumbai majority of the families who barely manage to make two ends meet have a yearly income more than Rs. 100,000 and they will have to pay at commercial rates. As mentioned above, the govt. would have enough money for health care during the 12th FYP to make available all essential health care free of charge for all patients visiting Public Health Facilities. Instead of withdrawing user fees at the point of service, as per the recommendations of the High Level Expert Group (HLEG), appointed by the Planning Commission, the Maharastra govt. is going in the opposite direction.

It has been the general experience that after privatization of Public Health Services/ facilities, the private parties violate many of the terms of agreement; there being hardly any adequate mechanism to effectively monitor and ensure the observance of free/subsidized care to the poor, ordinary citizens.

Justification no. 3: Inability to get, retain expert doctors, radiologists in govt. sector.

Reality – This is not exactly true. Hospitals in the govt. sector like the Command Hospitals, the BHABHA hospital in Mumbai, AIIMS in Delhi have been able to retain expert doctors by offering good salaries and good working environment. Why can’t other govt. hospitals learn from them? If there is no corruption, baburaj, many expert doctors would like to work in govt. hospitals, turning away fromlucrative (but unethical) options in the private sector. The political and health bureaucracy has to set personal example of commitment to clean, competent work in Public Hospitals.

In case of CT scan and MRI, expert radiologists stationed in bigger cities can, with the help of extensive use of tele-radiology, do the reporting of the x-ray films taken at places like Nanded, Ambejogai. Anyway no private company will be able to depute full time qualified radiologist in all medical college hospitals, especially in places like Ambejogai, Nanded. They will also use tele-radiology. Thus unavailability of expert radiologists to report MRI and CT scan in these fourteen medical college hospitals cannot be the reason for privatization of these facilities.

Medical college hospitals are meant to train new generation of doctors. This can not be done without hands on practical training of using CT and MRI machines and modern machines/ equipments in laboratories. Private companies would not allow trainee doctors to use their machines. These departments in the government medical college hospitals would remain ‘Public’ only on paper; greatly damaging the training of new generation of doctors.

In case of atleast District Hospitals, radiologists can be hired on a part time basis as qualified radiologists are available in all district places in India. Secondly expert radiologists stationed in some of the district towns can, with the help of use of tele-radiology, do the reporting of the x-ray films taken at smaller district hospitals.

Justification no. 4: Frequent breakdown of machinery, irregular supplies of spare parts, chemicals

Reality – It is not as if good maintenance is not possible in Public Sector. In high tech areas if institutions like ISRO, Atomic Power Plants, Meteorology dept, Radio and television can function effectively, if such examples are there in the health care field also, why can’t Maharashtra govt. achieve this? Her again, there is a question of providing leadership to take on whatever challenges that exist in the functioning of the Public Hospitals.

Whatever problems that may exist in the management of MRI and CT scan facilities in the medical college hospitals, must be solved by seeking active cooperation of the doctors and other staff in these centres. Privatization is no answer to these problems. Public Health Services currently account for a small proportion of health care in India and it is not possible to achieve the goal of health care for all as envisaged by the HLEG report mentioned above if there is further whittling down of Public Health Services.

Need for a proper public debate

This step of the Health Dept in the direction of privatization is contrary to the recommendations in the report of the High Level Expert Group (HLEG) appointed by the Planning Commission(with initiative from the Prime Minister’s office) with the mandate to suggest a ‘blue print’ for achieving by 2020, the goal of Universal Access to Health Care (UAHC). The HLEG has recommended abolition of all user fees in all public health services.[*] In the 21st century health care should be regarded as human right and in most developed countries as well as in many developing countries like Sri Lanka,Thailand, Brazil, Malaysia and Venezuela the goal of Health Care for All has been achieved. In this process, the Public Health Services have played the role of leadership, of trend setting and as a back-borne for the National Health Care System. India cannot be an exception.

In any case, such a major decisions should not be carried out without a proper public debate as this decision would adversely affect millions of patients and medical education in Maharashtra.

[*] The Executive Summary of this report is available at http://www.phfi.org/images/what_we_do/HLEG-UHC_Exec_Summary_Dec_2011_1.pdf.

 

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