BMC - NGO - Citizen meeting on January 19, 2006- 5pm

Agenda:  What are the specific public health issues that hamper access to healthcare for the underprivileged? What can the BMC do to address some of these issues in a systematic manner?

3:30 pm at the Karmayog office.
5:00 pm at BMC with Mr. S. Ratho, Addl Mun Comm
(at the Conference Room in BMC Annexe Bldg, 3rd floor, opp CST, Fort)

Below is a brief overview of the Public Health System in Mumbai. Please review it and contact Meenakshi Verma (verma.meenakshi@...) with any questions/concerns/additions.

Information for BMC- NGO Council Meeting Jan 19, 2006

1.) How is public health defined?

Public Health is a complex and dynamic system that explores health in a holistic manner. WHO (World Health Organization) defines it as a state of complete physical, mental, and social wellness, and not merely the absence of disease. Mumbai attracts people from all over the country, and thus faces common public health issues related to sprawl and a public health system which is unable to cope with the growing population. Although public health is multi-dimensional, it can be divided into the following categories for the purposes of this meeting.

Public Health Care System (Municipal):

o           Hospitals

o           Dispensaries

o           Maternity homes

o           Health posts

2.) Can you give some background information?

According to the 2001 census, India’s urban population currently accounts for almost 30% of the population (approximately 285 million). Maharashtra is one of the most urbanized states in the country with more than 42% of the population living in cities and towns[1]. The population and the amount of urban poor are rapidly increasing and contributing to a significant strain on resources. In Mumbai, a city of approximately 16 million people, over 50% of the population lives in the slums. These slum populations compromise health care over the need for food, shelter and clothing. The underprivileged population in Mumbai is most likely to seek health care services provided by the BMC, and most likely to be unsatisfied with quality of services they receive.

3.) How is Mumbai’s public health system set up?

Conceptually, the right ideas exist in the framework of the BMC’s 3-tier public health system. The BMC the largest Municipal Corporation in India, is the major provider of public health-care services at Mumbai. It has got a network of three Teaching Hospitals, 14 Municipal General Hospitals, 26 Maternity Homes across Mumbai (BMC, 2000). Apart from that there are 185 Municipal Dispensaries and 176 Health Posts to provide outpatient care services and promote public health activities in the city. In addition, the state government has one medical college hospital, 3 general hospitals and 2 health units, all have a capacity of 2,871 beds (Duggal, 2004).

4.) What are the major problems with such an elaborate public health system?

There are several issues that plague our public health system:

1.)    Geography: The majority of the 3^rd tier hospitals are located on the town side of Mumbai, where the city is now expanding further north and east. This leads to overcrowding in hospitals such as Sion hospital, which is the first place all trauma, emergency, and accident cases are sent. This creates an enormous burden on the staff there and they are unable to address the demand.

Recommendations:

a.       Create guidelines for addressing the health needs of the largely expanding population

b.      Identify key areas where there are enormous gaps between population and amount of services

2.)    Quality: Due to the overcrowding, lack of updated equipment, and proper hiring of staff, the quality of care at BMC run health services is not meeting the minimum quality standards of public health. When a daily wage earner travels to a hospital (which is about 3+ hours travel time) and then has to wait 4 more hours for care, during which he is treated badly, he is not going to want to give up his daily wages next time to access public services. Next time, he will seek care elsewhere.

Recommendations:

a.       Conduct an assessment of the quality of services

b.      Introduce quality assurance methods

c.       Get citizens involved in the decision-making process

3.)    Lack of Coordination: There is a severe lack of coordination within the 3 tier public health system of Mumbai. Since people are not aware of the services being offered by health posts, people from the community are most likely to go to a nearby hospital rather than a dispensary or a health post. If there were a proper referral system within the BMC’s public health system, there would not be such a burdening the in the major hospitals, and thus an improvement in care.

Recommendations:

a.       Critically analyze the different tiers of the system and identify the gaps

b.      Using citizen and NGO groups help pilot test some methods to improve coordination within the existing system.

Though there are many, many other complicating factors in the quest for primary health care in Mumbai, these issues are the most poignant and most likely to be the right first steps toward creating any type of sustainable change within the system. For those who will be attending the meeting, it would be great if you could send me your thoughts/recommendations on these issues and suggest other strategies for improving the system.

Thank you,

Meenakshi Verma, MPH

Reminders for the meeting:

1. If there is a list of demands already made to the Government in the past, please bring copies.

2. If there is a list of NGOs, institutions, medical practitioners in this field, please bring it.

3. If there is a list of info needed from BMC or the Government, please bring that.

4. Please come with concrete suggestions or requests -- instead of merely complaints.
Voicing complaints does not lead to action; Voicing requests does.

5. If you are willing to be in the core group to take things forward after the meeting, please inform.

This is an initiative under the BMC-NGO MOU regarding involvement of civil society in policies, procedures, awareness creation, monitoring, feedback, etc.

RSVP: email back or phone Atul at Karmayog on 22000478 / 22013535