Red tape wraps around NHM goals in Bengaluru PHCs

Bengaluru: The administrative tussle between the Bruhat Bengaluru Mahanagara Palike (BBMP) and the state health department, over the control of 51 health centres, is hindering the effective implementation of the National Health Mission (NHM), which is crucial for providing quality healthcare to the city’s poor.

In 2020, during the first Covid wave, the civic body was given control of 35 urban primary health centres (UPHCs), 14 PHCs and dispensaries, and two community health centres (CHCs). These facilities, located in 63 BBMP wards on the city’s periphery, were under the purview of the Health and Family Welfare Department.

UPHCs are particularly useful for the urban poor in the city, offering them affordable and accessible healthcare. On July 13, 2020, a government order designated the BBMP as the managing authority for the health centres in the 63 wards to ensure better monitoring and supervision, without changing the staff composition.

The aim was to streamline the reporting of COVID-19 cases and deaths within BBMP limits and to avoid overlaps. However, the absence of direct control by the BBMP has led to a decline in patient services, particularly in the implementation of programmes under the NHM, at these PHCs.

The civic body already managed 85 PHCs, 27 maternity homes, and six referral hospitals in 135 wards located in the city’s core. These 118 health centres continue to function under the supervision of the BBMP’s health department. The state health and family welfare department plays no role.

Two years later, another government order dated May 6, 2022, directed the BBMP to return the health centers in the 63 peripheral wards, citing poor implementation of NHM programs as one of the reasons. But two years and many meetings later, the handover is yet to materialize.

While the BBMP monitors and supervises programs at these health centres, financial decisions such as salary payments and the allocation of regular staff — including medical officers, doctors, lab technicians, and staff nurses — are managed through the zilla panchayat. The district health officer signs off on the salaries to be paid to regular staff, but contract workers and support staff are employed and paid by the BBMP.

Additionally, procurement of medical supplies and drugs for these health centres comes from the BBMP Special Commissioner (Health). Challenges remain with the timely assessment of drug requirement and submission of indent.

This dual administration is causing issues in the implementation of the NHM programs and challenges with medicine and equipment procurement, several health department officials said on the condition of anonymity.

“The PHCs in the periphery should have been handed back to us as per the government order,” they echoed.

“The BBMP does not have the structure of programme officers to implement the several NHM programmes the way the state health department does. This is why NHM programmes don’t do well in BBMP PHCs as compared to PHCs in other districts,” said Health and Family Welfare Commissioner D Randeep. 

BBMP Chief Health Officer Dr Syed Sirajuddin Madni admitted that while the NHM implementation has had a slow start in the BBMP PHCs, they have begun the process of appointing program officers for the NHM. 

Sources in the health department are positive that the situation would be much better if the operations were integrated and full control of these health centres in the periphery was handed back to the district health officers. 

However, the BBMP does not share the sentiment.

Separate health commissionerate?

BBMP Special Commissioner (Health) Suralkar Vikas Kishore noted that the creation of a Bengaluru health commissionerate would ease these administrative hurdles.

“We are proposing the formation of the Bengaluru health commissionerate to supervise all the health institutions that come under the BBMP limits. Primary and maternal health will be funded by the BBMP, secondary and tertiary care will be funded by the state government but supervised by the health commissionerate,” he said, adding that medical colleges will have the BBMP health commissioner as one of the directors.

The BBMP recently submitted this file to the health department. Deputy Chief Minister D K Shivakumar and Health Minister Dinesh Gundu Rao are scheduled to meet soon to discuss the proposal.

“I haven’t seen the proposal yet. They want to run all the health facilities within their limits by themselves. I understand if they want to take over all PHCs but I am not too sure if they can take everything else because that is not their core competence. We will see how to sort this out,” Rao said. 

Unofficially, health department sources believe that the BBMP should take over all PHCs but shouldn’t interfere with the secondary and tertiary levels of healthcare.