Fewer dispensaries, lack of awareness ail Mumbai’s primary health care system

Published on May 09, 2022 10:17 PM IST
The concept of the polyclinics, which will be identified as ‘Hinduhridayasamrat Balasaheb Thackeray Health Centres’, was announced in the civic budget presented in March.
The initial plan is to have 100 polyclinics and the civic body has made a provision of <span class='webrupee'>₹</span>250 crore for the capital expenditure and <span class='webrupee'>₹</span>150 crore for the revenue expenditure on this project that aims to boost the city’s healthcare at the primary level (AP)
The initial plan is to have 100 polyclinics and the civic body has made a provision of 250 crore for the capital expenditure and 150 crore for the revenue expenditure on this project that aims to boost the city’s healthcare at the primary level (AP)

Mumbai: Bano Yusuf Shaikh, a 53-year-old resident of Nehru Nagar in Sahar Village, Andheri, regularly visits the Koldongri civic dispensary about 15 minutes away from her home. She has been suffering from diabetes for the last two decades and since then avails treatment at the dispensary, where a medical officer examines her blood test reports and a pharmacist dispenses the medicines through a tiny counter.

For the tests, says Shaikh, her blood samples are collected in the dispensary and she is charged only 50 under the civic body’s Aapli Chikitsa initiative, which offers tests at subsidised rates. However, for X-rays, sonography and specialised consultations, she is referred to Vile Parle’s RN Cooper Hospital.

“It takes around 80 in an auto-rickshaw to get there,” said Shaikh, adding that last November she was referred to the hospital for acute pain in the hip and prior to that for sonography due to recurring pain in the lower abdomen. “I end up going to the Cooper Hospital at least five to six times a year. It is expensive to commute and spend all day there,” said Shaikh, who does odd jobs. “I wish the dispensary was more equipped and there were specialised doctors,” she said.

Shaikh’s suggestion might perhaps see the light of the day. Ten out of the 188 dispensaries in Mumbai have been shortlisted to be developed as polyclinics that will offer specialised care through consultants with expertise in areas like ophthalmology, orthopaedics, gynaecology and paediatrics, among others. The civic body released an expression of interest (EOI) on April 24 seeking consultants and is now waiting for responses.

“Our dispensaries are used by a large number of people, but since these dispensaries don’t have specialists, patients are often referred to the higher centres,” said Dr Daksha Shah, deputy executive health officer of Mumbai. “We are developing polyclinics to plug this gap and eventually help decongest larger civic hospitals. For now, the 10 dispensaries that will be upgraded are in the eastern and the western suburbs,” she said.

The concept of the polyclinics, which will be identified as ‘Hinduhridayasamrat Balasaheb Thackeray Health Centres’, was announced in the civic budget presented in March. The initial plan is to have 100 polyclinics and the civic body has made a provision of 250 crore for the capital expenditure and 150 crore for the revenue expenditure on this project that aims to boost the city’s healthcare at the primary level. If implemented, patients like Shaikh will benefit greatly. However, attempts to upgrade the dispensaries in the past haven’t always taken off.

SHORT OF FACILITIES

Mumbai has a three-tier civic health system. There are 188 dispensaries, 28 maternity homes and 201 health posts at the primary level, 16 peripheral hospitals at the secondary level and four medical and one dental college attached to super speciality hospitals at the tertiary level. While maternity homes purely cater to deliveries, the health posts function as outreach centres to drive awareness and conduct immunisation camps etc. The dispensaries, therefore, are the most crucial first level of care when it comes to all kinds of ailments.

As per the National Health Mission, one urban primary health centre should cater to a population of around 50,000 to 60,000 people. Going by the 2011 census, which pegs Mumbai’s population at 1,24,42,373, it translates to one dispensary for 66,182 people. Experts say that the gap is much wider in reality if one considers the current population estimates of around 20 million.

Data gathered from the civic body shows that from 160 dispensaries in 2011, the number of dispensaries has increased by a mere 17% to 188 in 2021.

“Some dispensaries have a low footfall, while some have a very high footfall due to their location,” said BMC’s executive health officer Dr Mangala Gomare. “We are looking for strategic locations to open more dispensaries and cater to a larger population,” she said.

The number of patients visiting the dispensaries had crossed 5.1 million in 2019, but the numbers fell in the subsequent years during the pandemic. Even then, the dispensaries catered to over 3.9 million and 3.3 million patients in 2020 and 2021, respectively.

Public health researcher and activist Ravi Duggal said that the lack of thought towards the betterment of the primary health system has resulted in the overcrowding of hospitals in the city. “The number of dispensaries is not just inadequate, but some of the dispensaries are better located than others. Given Mumbai’s population, it needs at least 400-500 well-staffed, and strategically located dispensaries,” he said, adding that the dispensaries and health posts should be co-located and not located separately. Besides, the dispensaries should have a minimum of two doctors, Duggal added.

QUESTIONABLE REACH

Despite the existence of dispensaries, many citizens often prefer to go to civic hospitals for simple coughs and colds. Some are even oblivious to the fact that civic dispensaries exist. Take the case of 38-year-old Manisha Sonone who works as domestic help. In March, Sonone, a resident of Aarey Colony in Goregaon, suffered from acute pain in the hip. For treatment, she preferred to visit a local homoeopath who charged 50 and gave her painkillers.

“The nearest hospital for me is the civic-run HBT Trauma Hospital in Jogeshwari but one has to spend half the day to get even the basic treatment there,” said Sonone, adding that she is not aware of the BMC dispensaries despite residing in the area for over two decades.

The closest civic dispensary for Sonone is the one at Squatters Colony in Jogeshwari east. It is about two kilometres from her home.

In 2010, the civic body had announced an ambitious plan to brand dispensaries by taking up repairs and giving them a similar look and feel. The plan never took off.

“Indeed, the plan did not materialise,” said Gomare, adding that the latest plan to upgrade dispensaries to polyclinics will not have the same fate.

“Back then, we never had a budget allocation to work on the plan. But this time, we have a budget of 400 crore, which is a considerable chunk of money assigned for working on the polyclinics,” she said.

Besides hiring specialists as consultants, the polyclinics will have a tie-up with local private diagnostics centres to conduct 139 diagnostics tests such as x-ray, MRI, CT scan, mammography etc. The civic body’s existing Aapli Chikitsa scheme includes over 130 blood tests that are offered at the dispensaries and maternity homes through a similar tie-up with a private laboratory.

“We are working out the finer details to get the plans moving for the shortlisted dispensaries,” said Gomare.

While the plan sounds promising, activist Duggal pointed out that the civic body should strengthen the health care system by upgrading the infrastructure and human resources. “Unfortunately, they are trying to strengthen by outsourcing, which is not the right way,” he said.

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