JOIN USCovid-19 may turn the tide in Mumbai's political discourse
The back-to-back waves of the Covid-19 pandemic may turn the tide in India’s political discourse vis-a-vis the health sector.
This holds true in the financial capital of Mumbai, one of the worst-affected cities of India, and the fact that the Brihanmumbai Municipal Corporation (BMC), one of the biggest and richest civic bodies, is going to polls next year.
Three Mumbai-based medical professionals - Dr Akshay Baheti, Dr Trupti Gilada and Dr Sanjay Nagral, made this point in a paper published in the British Medical Journal.
The paper discusses the Mumbai Model spearheaded by BMC Commissioner Iqbal Singh Chahal.
While Baheti is with the Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Dr Gilada is an Infectious Disease Physician, Unison Medicare and Research Center, Mumbai and Dr Nagral works with the Department of Surgical Gastroenterology, Jaslok Hospital and Research Center, Mumbai.
“The city of Mumbai, where we work, witnessed some unique phenomena in its healthcare infrastructure during the pandemic. The BMC temporarily took over 80% of private hospital beds to ensure a common admission route with strict triaging and capped rates,” the paper said.
The elite, who normally avoid engagement with public hospitals, and were always guaranteed a bed in private hospitals on the basis of expensive deposits, had to call municipal telephone lines and wait to secure a hospital bed.
This transient centralisation and regulation of healthcare facilities, routine in many countries, demonstrated visible results and was commended as the 'Mumbai model'.
A deeper look into the reasons for the success of the Mumbai model also demonstrates a more longstanding systematic investment to create a more robust public healthcare infrastructure compared to many other cities in India.
Apart from its large private medical infrastructure, Mumbai boasts of five central academic teaching hospitals, and over 20 peripheral municipal hospitals, attracting top medical trainees from across the country.
“During the pandemic, medical interns and post-graduate trainees became its strongest workforce. Importantly, unlike the central budget, health has been a relative priority in the municipal budget, accounting for 12 per cent of overall budget. This partly ensures no shortage of funds in procuring medicines or equipment for creation of larger Covid care facilities,” the paper states.
The biggest strength of the model was allowing decentralised management at the local ward level (Mumbai is divided into 24 administrative divisions called wards), with each having individual “control rooms” for the management of Covid patients, right from testing, sanitisation, home isolation, contact tracing and quarantining, and hospital admission.
The dramatic load on private healthcare in the second wave led to the middle class experiencing first-hand what it means to face a dysfunctional healthcare infrastructure and perhaps even grasp its tragic consequences, besides also understanding the crucial role of public healthcare for overall national wellbeing.
“This may translate into sustained public pressure for bringing healthcare into the mainstream political agenda. This will soon be tested in the local Mumbai Municipal elections due early next year, along with elections in a few states. In New Delhi, a local political party which has placed health and education at the centre stage for some time has managed in the past to upstage national parties and win the elections, with support both from the working class and substantial sections of the middle class,” the paper points out.
“Will Mumbai’s poorer and the middle and upper classes come together in the aftermath of Covid to force permanent changes in its public healthcare infrastructure, by altering the usual identity politics on which elections are won? This is a question that only time will answer. But if it does happen, it could also be another Mumbai model for the rest of the country to follow,” it says.