Bengaluru’s pursuit of a health commissioner amid Covid crisis

While many PHCs and maternity homes in the city are well-maintained, their focus is limited and this brings down the quality of service, said a health activist who has worked with the marginalised.

Bengaluru: With the Covid scare gripping Bengaluru yet again, discussion on the city’s health infrastructure has gained the limelight. While the previous Covid waves had exposed the gaps in administration and a need for better infrastructure, has the government learnt from them?

Well the city might be able to address Covid better but there are many other bigger problems that need to be addressed, experts opined. From a need for more facilities to accessibility for the urban poor, there is a lot more to be done, they said.

Considering the need to better handle the situation, the Bruhat Bengaluru Mahanagara Palike (BBMP) in the 2023-24 budget had announced that the city will get a dedicated health commissioner who would coordinate with the various departments. However, the idea is yet to be implemented.

“We have discussed this with the Health Minister and a decision will be taken at the high level,” said BBMP Chief Commissioner Tushar Girinath.

“The administration tends to look at the health infrastructure in urban areas, especially in cities like Bengaluru, with a bias. Considering the huge number of private facilities available in the city, they do not focus on improving the government facilities and as a result, while accessibility is not a problem, affordability becomes a problem,” said Dr Devadasan N, adjunct faculty at the Institute of Public Health. 

While many Primary Health Centres (PHCs) and maternity homes in the city are well-maintained, their focus is limited and this brings down the quality of service, said a health activist who has worked with the marginalised. 

“In many cases, the facilities focus more on maternal and child care. Sometimes, the focus shifts to dengue and seasonal flu. However, we have to go beyond it and look at comprehensive health care. There is much more to it than just handling communicable diseases and maternal care. For instance, we all know that non-communicable diseases such as diabetes, and hypertension are on the rise. None of our facilities address these problems effectively,” the activist pointed out. 

Echoing the opinion, Dr Devadasan pointed out that most of the health officers in the BBMP are focused on sanitation and waste management.

“I personally feel that the PHCs should be handed over to the health department since they need to be handled by experienced healthcare providers,” he said. 

The flaws also exist because the healthcare in the city is divided among three government entities– the BBMP, the health department, and the medical education department. 

“The approach is highly fragmented and hence there are coordination issues. Many times, people directly knock on the doors of tertiary care centres since they are not sure if the PHCs will be able to treat them given that the coordination between primary care and tertiary care is poor. This leaves the tertiary care centre crowded and as a result, those who genuinely need tertiary care may find it difficult to access it,” said Dr Sylvia Karpagam, a public health professional.

She added that the timings of many primary care centres also make them useless for the workers in the unorganised sectors.

“Many of these centres close down by evening. However, the daily wage workers cannot afford to skip work to visit the clinic since they depend on the day’s earnings to make ends meet. The PHCs should be accessible at the time of their convenience otherwise it will force the workers to visit private facilities that are not affordable” she said. 

However, Bengaluru also poses unique challenges owing to the huge population and the influx of people from across the country. While techies and other workers who end up in the city can afford to visit private healthcare facilities, there is a need to address the needs of migrant workers. 

“It is high time that we come up with a strategy to address the needs of migrant workers. Given that we have limited resources, many times the government facilities refuse treatment to outsiders. We have to learn to see them as patients who need care,” Dr Devadasan said. 

Dr Karpagam added that in many cases these workers lose the benefits of the social security schemes and are left unguided on how they can access healthcare facilities. 

Issues to be addressed 

* Improve the number of healthcare facilities considering the huge population

* Run the primary healthcare facilities round the clock to meet the needs of those in the unorganised sectors. 

* Shift focus from maternal care and communicable disease to handling comprehensive healthcare

* Chalk out a strategy to provide healthcare facilities to migrant workers

Health dept scanning proposals

Sources from the health department said that multiple proposals are being discussed to improve the healthcare services in the city. Many of the discussions were also centred around improving coordination among the various departments and assigning responsibility to each of them.

The department is also gathering data on the footfall at various PHCs and the timings at which patients arrive to decide if they should be open round the clock.

“In many areas, the PHCs hardly have any patients after 2 pm. Hence, we have to determine the local needs and fix the timings. We are collecting data on the footfall to decide if the timings have to be changed,” a senior official from the Health Department said.