Mumbai: Despite a near-200% jump in the civic health budget over a decade, a sizeable gap has remained in the city’s primary health system. Mumbai is short of 659 public dispensaries and suffers from a 30% staff shortage in 187 existing centres, states NGO Praja Foundation’s white paper on the city’s health status, released on Tuesday.
The report said that as per the National Building Code and Urban Design Plan Formulation and Implementation, there should be one dispensary per 15,000 people.
By that parameter, the city should ideally have 858 dispensaries but merely 199 public facilities exist, including 187 in the civic set-up. None of the 24 wards, therefore, meet the population-dispensary ratio. Further, 174 of the 187 BMC dispensaries function for seven hours (9am to 4pm), while just a dozen work for 14 hours (9am to 11pm). Exacerbating the crisis is vacancies, which have grown from 10% to 30% in 2012-2021.
A WHO report published in March 2022 stated that household out-of-pocket (OOP) expenses on health services continue to push over 5.5 crore people in India into poverty annually. A guaranteed solution to reducing OOP expenditure is strengthening primary health systems by providing manpower, medicines and diagnostic services under one roof. BMC is yet to deliver the advanced polyclinics it promised. Given Covid’s disruption, the need for efficient primary health services is immediate.TimesView
“These shortages exist despite an increase of 196% in the BMC’s health budget from 2012-13 to 2022-23,” said Praja CEO Milind Mhaske. The NGO has analysed that the island city with a 27% slum population needs 133 more dispensaries, while western suburbs with 43% slum population need more 315 centres. The eastern suburbs with 51% slum population need about 211 more dispensaries. The lack of an adequate primary health system is not only pushing out-of-pocket expenses, but could have a cascading effect on Mumbai’s timeline to meet the Sustainable Development Goals (SDG) by 2030.
Yogesh Mishra of Praja added that a lion’s share of the civic health budget is being allocated to hospitals instead of primary health centres. “In the 2022-23 BMC health budget of nearly Rs 7,000 crore, just 27% went to primary healthcare facilities,” he said. “Although hospitals bear the load of secondary and tertiary healthcare, there is a need to lower the out-of-pocket expenditure burden by strengthening primary services.”
But civic officials said the budget has given a major push to primary health systems by allocating Rs 400 crores to developing 200 Hinduhridayasamrat Balasaheb Thackeray primary health centres. A senior official said these polyclinics will be complete with diagnostic and consultation services.
In the first phase, ten dispensaries have been shortlisted to be upgraded into polyclinics. Expression of interest (EOI) from agencies and individuals to offer services at these polyclinics have been floated, the official said.
Citing examples, the Praja report stated wards S (Vikhroli, Bhandup) and N (Ghatkopar, Vidyavihar) with more than 60% of the population living in slums have just eight and nine dispensaries. Densely populated wards such as K-West (Andheri-West), P-South (Goregaon), R-South (Kandivli, Charkop) and T (Mulund) have only one dispensary for more than one lakh population, the report stated, calling for urgent augmentation.
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