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In little over a decade, Mumbai will be the largest city in the developing world. It will be a symbol of the megalopolis of the twenty-first century. And, like its counterparts in the developing world, the city's future is marked by great possibility and great peril.
While there has been considerable improvement in healthcare indicators since independence, Mumbai still remains well behind most developed Indian and international cities. Healthcare infrastructure in Mumbai in terms of hospital beds per 1000 population lags behind several key peer Indian cities such as Gurgaon, Delhi, Chennai, Hyderabad and Bangalore, says a KPMG report.
Alongside the shortfalls in hospital beds, there is also a shortage of healthcare professionals, equipment and infrastructure needed at various levels in the healthcare delivery supply chain.
Healthcare delivery in Mumbai faces other important challenges. Mumbai does boast of traditionally reputed and well known general and specialty hospitals but the public healthcare facilities are burdened by the needs of an ever growing population.
This problem gets further accentuated by the specialty healthcare needs of in-migrants and citizens from other parts of Maharashtra. Although, the hospitals under Trusts have a requirement for providing 10 per cent of the capacity to the under-privileged and BPL* patients, however, this does not provide adequate solution for the masses.
New healthcare infrastructure development in Mumbai has been constrained because of high cost of real estate. The private sector finds investments in healthcare in Mumbai un-remunerative, while the government find it prohibitive in terms of capital and management demands.
The paper by KPMG covers healthcare delivery from five different facets: infrastructure capacity, accessibility, resources and productivity, disease focus and preventive measures. Healthcare in Mumbai requires a multi-pronged approach to address these aspects in the healthcare value chain to make a paradigm shift in delivery of healthcare services to the citizens of Mumbai.
The Committee has deliberated on the numerous challenges faced by the City and recommended potential solutions to deal with some of these challenges.
The various recommendations provided by the Committee are summarised as follows:
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A. |
Accessibility |
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Key concern: Affordability of healthcare solutions to economically backward sections of the City Potential solution: Social health insurance schemes for weaker sections of the society | |
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B. |
Resources & productivity |
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Key concern: Improving efficiency and productivity of existing resources Potential solutions: Proposal for centralisation of resource utilization such as under the Ambulance Service Foundation (Emergency Medical Services Model) Promote accreditation of hospital and health care facilities Developing a City wide hospital information management system | |
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C. |
Infrastructure sapacity |
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Key concern: Limited capacity and reach of hospitals and primary health care providers Potential solution: Use of Public Private Partnerships models to support infrastructure capacity addition in hospitals and primary care facilities (BOO**/DBFO***/Management Contracts/Mobile Clinics) | |
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D. |
Disease focus |
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Key concern: Mumbai has not conquered infectious diseases and is witnessing an ascent in lifestyle diseases Potential solution: Developing a sanitation and sewerage infrastructure to manage incidence of infectious disease (covered by the other Sub-committee on urban development) | |
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E. |
Preventive measures |
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Key concern: Growing shift from curative to preventive solutions to lifestyle diseases Developing a wider well being agenda through information dissemination and promoting sports and recreational facilities |
Clearly, healthcare delivery in Mumbai has a significant scope for capacity development and efficiency improvement through further public private investment in infrastructure facilities.
Many aspects of delivery of the Bombay First strategy will therefore have an important contribution to make to improve the healthcare and well-being in Mumbai. I urge the government to initiate pilot projects as examples of promoting these solutions to enable a greater acceptance of recommendations made in this paper.
Introductory note by Gustad B Daver, chairperson of the Bombay First Sub-Committee on HealthCare and Consultant Surgeon - Vascular, Thoracic and general director professional services P D Hinduja National Hospital & Medical Research Centre, Mumbai.
*Below Poverty Line
**Build, Own, Operate
***Design, Build, Finance and Operate (DBFO) Scheme