A Brief Overview

January 6, 2006

Meenakshi Verma  

Background:

The Municipal Corporation of Greater Mumbai (MCGM) is the largest and wealthiest civic organization in the country, and it covers an area of 434 sq km. The MCGM runs several different aspects of the city and the Municipal hospitals are one of them.  

Before discussing the Municipal hospitals in Mumbai, it is important to have an understanding of the basic health information of the city. Since the most recent report is currently being published, the following information was gathered from the 2001-2002 report. According to the 2001-2002 Health Profile published by the BMC public health department, these were the health statistics of the city:  

It is important to note that accessing data for this kind of research is often hard to find and as equally as difficult to understand. This data should be taken as an estimation based on the findings of the MCGM health profile. However, the reports essentially demonstrate with an expanding population, over 50% of people living in slums, and lack of access to proper medical services for many underprivileged communities, Mumbai’s current services are unable to meet the demand for better health care systems.  

Current hospital services provided by the City of Mumbai :

The MCGM has a complex web of services including hospitals, dispensaries, health posts, and maternity homes. In summary:

§         4 teaching hospitals

§         5 specialized hospitals

§         16 peripheral hospitals

§         28 municipal maternity homes

§         14 maternity wards attached to municipal hospitals

§         17,000+ employees  

There are approximately 40,000+ beds in the city, and MCGM runs between 10,000 and 11,000 of them. According to a report by the Bombay Community Public Trust, as many as 10 million patients are treated annually in the Out-Patient Departments (OPDs) in the MCGM hospitals. At King Edward Memorial (KEM) hospital, there are over 1.2 million people treated annually, alone. The state government has one medical college, three general hospitals and two health units with a total of 2,871 beds. There is also one hospital run by the central government. Each of the peripheral hospitals is linked to one of the four (tertiary) specialty hospitals. The health posts and the dispensaries are linked to the peripheral hospitals in their respective Wards. These health posts were established to provide convenient and easy to access locations for people seeking treatment for minor ailments that did not require a visit to the hospital. Conceptually, this complex system is quite possibly one of the most elaborate ones that exist for a city with a burgeoning population with such strains on the public health infrastructure. However, several aspects of such a large bureaucracy also prevent the care from reaching underprivileged communities in time.  

Even within this complex system, which is designed to reach the city’s residents through preventive, promotive, and curative care ends up falling short when trying to reach out to the communities that need their care the most. For example, the K-East ward, which covers Jogeshwari, Vile Parle, and Andheri is home to over 800,000 people living in low/low-middle class communities. This entire ward does not have one municipal hospital in its area. It should be noted that within 11 dispensaries, there are 9 vacancies for physicians to fill these posts. In a report by Mr. Ravi Duggal of CEHAT “The Un-Met need for Public Health Services in Mumbai, India ” , a team surveyed the health care needs of the K-East community in collaboration with the BMC found that 80-83% of people would access the municipal services if they were closer in proximity and economical. Many of people who currently access the public services in the area (dispensaries and such) often do not have a choice to go to a closer, private hospital and have to access a public facility at the risk of losing a day’s wages.  

Major Challenges:

It is clear that a wider net of bureaucracy seems to be slowing down the process of sending health care to those who need it the most. Additionally, the three major reasons cited in the research into utilization of municipal hospitals are summarized in the following three areas: lack of infrastructure, access/location, and inconvenient timings. Although the teaching hospitals and the specialized hospitals are equipped adequately, many consumers find the peripheral hospitals lacking in infrastructure and ill-equipped to handle certain serious medical cases. Once those cases are further referred to the tertiary hospitals- it can be too late. The lack of infrastructure also includes inadequate staffing of physicians, in a population where the draw of private practice is often more appealing than to work for a government hospital- with little resources and a meager salary. This is exemplified by the fact that the K-east ward currently only has 2 out of 11 doctors positions filled for such a large population.  As highlighted in the K-East ward in Mumbai, for a population who does not have a disposable income, they are forced to access private services instead of having close access to the public ones.  

Access/location is a critical aspect of utilizing public health care facilities. Without access to convenient locations, the population has to turn elsewhere for services. This in turn becomes a breeding ground for quacks or unqualified doctors to take advantage of the need of the impoverished, working communities. Finally, the aspect of inconvenient timings is a critical one as many of the people accessing public health care facilities and municipal hospitals are unable to take the kind of time from their service-sector jobs needed to travel long distances and wait in long queues to access medical services.  

Conclusion & Discussion:

Although there seem to be many problems associated with the public healthcare system, it is clear that there is an opportunity for growth. Through the proper flow of funds and allowing a certain degree of independence at the hospital level, there can be improvements in the system. If the MCGM puts a mandate on a “Healthy Mumbai”, then there will be clear benefits for a city with such a large and dynamic population. In this discussion, there should be systems designed for better accuracy in reporting, improved patient care, and quality assurance at the hospital levels. If these systems are integrated, then we can look forward to a truly “Healthy Mumbai”.  

Works cited:

Duggal, Ravi et al, “Unmet needs for Public Health Care in Mumbai India , June 2004.

Qureshi, Athar Dr., “Health Services in Mumbai”, 2002 (unconfirmed)

Personal interviews and data collection

72 Government Hospitals in Mumbai  / Navi Mumbai / Thane