Drawbacks of the health infrastructure

Here, hospital-ity goes for a toss
Deepa Suryanarayan

In Part II of our ongoing campaign, we take a look at the state of Mumbai's
health services

The city's health infrastructure was planned between 1950 and 1980 to cater
to a maximum of seven million people. Circa 2007 - these facilities are
being used by 13 million people. No wonder then that the civic hospitals are
always over-crowded, and the list of complaints against these hospitals is
almost endless.

The two main drawbacks of the health infrastructure - according to the BMC
Health status report, 2006 - are inadequate facilities for primary and
secondary healthcare and the lack of healthcare access to poor sections.

"There is a demand for services offered by municipal hospitals as they are
more affordable. But it is essential to increase health infrastructure and
also prioritise improvement of services at the primary level," said the
report.

As far as reports of unfriendly hospitals are concerned, authorities agree
that the heavy workload makes it difficult for doctors to give patients
their undivided attention. "All the hospitals regularly organise orientation
programmes for resident doctors so that they learn to communicate well with
the patients," said Dr Nilima Kshirsagar, Dean, KEM Hospital.

Owing to better budgetary allocation last year, and properly-planned
projects, all peripheral hospitals are undergoing OPD renovations said Seema
Malik, Chief Medical Superintendent, In-charge, 16 peripheral hospitals.
These hospitals will now have well-designed toilets, airy, well-lit waiting
areas, and even audio visuals for the patients which will tell them what to
do and whom to approach, she added.

According to city doctors, the quality of healthcare service in government
and civic hospitals is very high. "Despite our heavy workload the total time
required, from the time the patient enters the hospital, to the time he gets
treatment is very less as compared to other countries," said Dr Kshirsagar.
Such indicators are comparable to international standards, which the WHO has
appreciated. This is because, in developed countries these services would
require prior appointment and even more paper work.

The patient-bed ratio
The total bed capacity in municipal hospitals is 10,600 - which constitutes
about 28 per cent of the total hospital beds (40,000) in the city - the rest
being provided in government hospitals (23 per cent) and private hospitals
in Mumbai. According to health experts, this is an indicator of the huge gap
in provision and access to health care in the city. And the World Health
Organisation (WHO) norm is one bed for every 550 people, while the ratio for
Mumbai is one for every 3,000.

Services
Sion Hospital has a bed capacity of 1422. The annual figure of patients
treated is 800,000, while outdoor attendance is up to one million. The
indoor admission is 55,000 to 60,000 every year and up to 45,000 operations
are performed annually. At KEM, which has 1800 beds, there are 150,000
annual admissions in casualty department, and there are 155,000 out-patients
every year. Indoor admission is 85,000 and 65,000 operations are performed
yearly.

Hygiene and cleanliness
KEM sees 5,000 patients every day. "We get ten times that number of
relatives and visitors. So, there is a floating population of about 100,000
people in the hospital premises at any point of time. Cleanliness is an
issue," said Neelima Kshirsagar, dean, KEM Hospital.

"We have labour staff and cleaners who work in continuous shifts. But you
have to remember that this is a heavily visited hospital, in terms of
attendance of relatives. There is over-crowding, particularly between 4.30
and 6.30 pm. We get patients and visitors from slums like Dharavi, Labour
camp, Antop Hill and Pratikshanagar - so the profile of visitors is
different from that of say, a private hospital," said ME Yeolekar, dean,
Sion Hospital.

Infrastructure
"Peripheral hospitals are getting developed, which will reduce the heavy
workload on tertiary hospital like KEM," said Dr Malik. Sion Hospital, at
present in its diamond jubilee year, will start a new OPD building project.

"We are going in for ambience improvement, setting up a medico legal complex
and getting a cardiac cathetrisaiton laboratory," said Dr Yeolekar. In the
coming months, KEM will get equipment like neuro-navigation system, positron
emission tomography (PET) scan, computerised orthopaedic system and digital
radiograophy apart from new hospital and hostel buildings, said Dr
Kshirsagar.

Hospital staff
Sion Hospital has 4,300 employees and KEM has 4000, including doctors,
resident doctors, nurses, and labourers, while a total of 5,500 employees
work in the peripheral hospitals.

Budget
Over a quarter of the revenue expenditure of the BMC budget is spent on
public health, which amounts to Rs850 crore. Sion Hospital has a budgetary
allocation of Rs88 crore, while KEM Hospital has up to Rs400 crore which
will be given in a phased manner over the next few years. "The BMC budget
for peripheral hospitals is 155 - 200 crore for budget.

A lot of it will be used for modernisation of 16 hospitals," said Malik. She
added that almost all peripheral hospitals will receive new equipment which
are required in the coming months. Bhabha Hospital, Bandra, will get a
specialised operation theatre for total knee replacement, while Bhagwati and
Rajawadi Hospitals will receive new CT scan machines. Shatabdi Hospital,
Govandi, MT Agarwal Hospital, Mulund, and Rajawadi Hospital, Ghatkopar which
are in bad condition, will receive face lifts.


URL : http://www.dnaindia.com/report.asp?NewsID=1079608