Despite crores of funding from MCGM, more doctors, hospitals and other facilities, health care indices of Mumbai are poor. What ails healthcare in Mumbai? This is first part of a three-part series
The Municipal Corporation of Greater Mumbai (MCGM) is a very rich corporation. Its annual budget exceeds that of many states like Kerala, Goa, Chhattisgarh, and Jharkhand. It is probably the only Municipal Corporation in Asia to run—not one but three medical colleges, with the fourth one in the offing. It is also one of the rare government bodies, which spends a very high amount on health and medical education. At one time nearly 15% of its revenue expenditure was spent on healthcare but it has now dwindled to about 8% or so.
In absolute terms, the MCGM has presented a budget for the year 2015-16 wherein its income is Rs33,000 crore and expenditure is Rs31,000 crore. Out of this expenditure, it has allotted Rs2,552 crore for health and medical education for the total population of 1.3 crore people. The percentage works out to be nearly 8%. It has allotted a little more than Rs600 crore for primary healthcare, Rs744 crore for its peripheral hospitals, another Rs108 crore for TB (100) and Acworth leprosy (8) hospital. However, it is spending a whopping Rs1,100 crore for its three medical colleges and their hospitals and one dental college. These are tertiary care hospitals and, no doubt, some of the best medical centres in India, offering CT scans, endoscopy, laparoscopy, angiography, angioplasty, open heart surgery, neurosurgery paediatric surgery, ICUs, nephrology, dialysis, kidney transplants, all sorts of emergency services and what not!
The MCGM has a network of health services and, despite all its deficiencies, it has one of the best health services in the country- probably exceeded only by Tamil Nadu. The network consists of primary health services consisting of 174 dispensaries, 168 outreach health posts, 15 RCH health posts, and 30 maternity homes. Secondary health services comprise 18 peripheral hospitals, in addition to five speciality hospitals, namely, one ophthalmic, two ENT, one for TB and leprosy each, besides one large Infectious diseases hospital—Kasturba Hospital. Tertiary care, as mentioned above, is offered by three major teaching hospitals, which also offer complete secondary care too.
All this is ably assisted by state government hospitals like JJ hospital (a teaching hospital) and four other secondary hospitals. There are many other state and central health services and their hospitals, which cater to specific groups—their own workers. There are two Railway hospitals, a Naval Hospital, CGHS, BARC (atomic energy), ESIS scheme hospitals, and Port-Trust Hospital. These, however, are not available for the public.
Yet, the health care needs of the Mumbai population are hardly satisfied and private sector has expanded like never before. Earlier, till the year 2000, it was the small hospitals or nursing homes, which rapidly increased in number, especially in suburban areas. This was because, as is seen in the map above, public sector hospitals were concentrated in the island city till 1980.
It was during Municipal Commissioner BG Deshmukh’s time that peripheral hospitals were established in suburban areas, the number rising to 18. The total population at that time (in 70s) was around 52 lakh. But in this century, tertiary care hospitals are growing very rapidly in the private sector, due to high expectations of the people from modern technology and its affordability among the increasing percentage of Mumbaiites.
At least 30% are now covered by insurance or re-imbursement by their employers. They do not feel the pinch of steep rise in the cost of health care but the rest of the population suffers heavily as the cost rises for them, too. The private sector in Mumbai comprises of around 1500 hospitals—mostly small or big nursing Homes- but now- at least a dozen major tertiary Hospitals with all modern High tach. Facilities have sprouted in various regions of the city. The total number of beds available are 12,000 in MCGM, 8,000 in government and 21,000 under private hospitals.
The total of 41,000 beds or more fall too short for the population of 1.3 crore, with a ratio of 1 to 3,000 when the minimum ratio should be 1 to 1,000. It is strange and highly regrettable that we do not have any authentic data as to the number of (allopathic) doctors in Maharashtra and especially in Mumbai. MCGM is stuck with the figure of 80,000 doctors since the year 2002. But, if we consider that 16,000 students pass MBBS every year in Maharashtra alone, the number ought to reach one and a half lakhs by now.
Mumbai has 10% of the total population but doctors are more concentrated in this city than elsewhere. Presuming that just 15% of the doctors’ practice in Mumbai—it must be more—it still means that there are more than 22,000 doctors in Mumbai – a ratio of 1 doctor per 600 people. It could well be 1 to 500-- almost the same as for UK.
Thus, Mumbai has enough budgetary provision for health services, the corporation is spending 8% of its budget on health, there is a good network of health care centres and public sector caters to 50% of the city population, there are more than enough doctors and almost all facilities that a developed nation has. One should expect that health care indices of Mumbai should be very good at par with the developed nations. Unfortunately, it is not so.
(Dr Sadanand Nadkarni, is former Dean of Lokmanya Tilak Municipal Medical College (Sion Hospital), author of several books, a serious thinker of medical issues and hugely respected for a series of path-breaking ideas on improving the delivery of medical services to the aam aadmi. His book “Management of the Sick Healthcare System” is among the first to speak out about medical malpractice and other issues.)