JOIN USHaseena delivered a baby in the toilet in her home, when she was all alone, after being asked by a Bruhat Bengaluru Mahanagara Palike (BBMP) maternity hospital to come back next day as the hospital was under-staffed and over-crowded. Shamshad, in labour and bleeding, was referred to Vani Vilas hospital in the middle of the night by a BBMP hospital without providing proper assistance. Salma(all names changed) stopped going for ante-natal care check-ups as the government hospital scanning machine was out of order and she could not pay the Rs 800 for scans in private hospitals… All this when maternal and child health are priority items on the nation’s agenda and the Millennium Development Goals.
While the National Rural Health Mission has to follow the Indian Public Health Standards in terms of infrastructure, manpower, equipment and medicines, urban areas do not appear to have any standards. Added to this is the splintering of services within urban areas.
BBMP, for instance, has urban health centres (UHCs), urban family welfare centres (UFWCs), dispensaries, maternity homes and referral hospitals in its old areas. The extended BBMP area is covered by the directorate of health & family welfare. But all of these do not add up to a comprehensive population-based primary healthcare system.
Inadequate service
Inadequate primary and secondary health services result in constant referral to tertiary hospitals which are over-crowded and where waiting time is long. Hence people are forced to approach private hospitals and spend huge sums, which often land them in debt and poverty.
To bring in people’s role in monitoring health services, BBMP’s referral hospitals have boards of visitors (BoV). But these are not there for its UHCs, UFWCs and dispensaries. The state-run PHCs, CHCs and hospitals are supposed to have Arogya Raksha Samithis (ARS) with local community participation. But in most hospitals these are on paper only.
In KR Puram taluk-level hospital, an ARS was created dueto public pressure but consists only of hospital officials with no community members. BBMP standing committee members when asked to provide adequate amounts in BBMP’s budget to fill the lacunae in manpower, equipment and medicines in its healthcare institutions, opined that all the ‘unattractive’ stone hospital buildings should be demolished and replaced by ‘attractive’ multi-storeyed hospitals. What if the fancy buildings again have no doctors, equipment or medicines? A standing committee chairman was of the view that there are plenty of private super-specialty hospitals with the latest equipment which cannot be matched by the government. “Why not simply refer poor patients there and reimburse the costs with BBMP funds?” he recommended.
In the much-lauded Arogyashri scheme of Andhra Pradesh, nearly 25 per cent (Rs 3,511 crore) of its health budget of Rs 14,471 crore between 2008-12, was allocated to the scheme, depriving the already resource-starved government health network. The High Level Expert Group pointed out that programmes such as Aarogyasri are based on the ‘skewed logic of high-cost, low frequency, surgical-based interventions’ which account for less than 2 per cent of the total disease burden. Thereby the state is grossly neglecting primary and secondary healthcare which could take care of the high incidence of infectious and communicable diseases that cause maximum morbidity and mortality among BPL families.
India has averaged 8 per cent the GDP growth rate over the XI Plan period. And yet, its public spending on health has been around an abysmal 1-1.2 per cent of GDP, one of the least in the world. While the XI Plan at least aimed to increase this amount to 2-3 per cent, the Approach Paper to the XII Plan intends to increase it to only 1.58 per cent. Critics question why this should be the case if higher growth rates for the country are always justified as necessary to enable increased spending on social sector programmes?
After civil society pointed out the lacunae in Bangalore’s health services to the authorities concerned, a meeting was convened with officials and civil society members on November 30. The meeting decided to prepare a framework for a comprehensive primary health care system in urban areas which will hopefully serve as a model for adoption across the country by the Centre for providing universal health care under the urgently needed National Urban Health Mission.