Express Townhall: ‘Need to strengthen healthcare facilities around city… reserve space for makeshift units to come up’

We are upgrading our infrastructure. We have 16 peripheral hospitals, of which in six hospitals, we have started DNB courses. Once the six peripheral hospitals start conducting minor surgeries, the pressure on tertiary hospitals will automatically drop. We have decided to strengthen primary healthcare as well. We have around 200 dispensaries and have decided to strengthen those so that diagnostic tests can be conducted there. This will help in reducing the pressure on tertiary hospitals where people keep flocking for swab and blood testing, among others. It leads to wastage of important resources and time, which can be used for critical and moderate patients.

Sandeep Singh: Would you accept that there was neglect in upgrading these facilities, which were exposed during the pandemic?

I won’t say that it was neglected but the focus was on something else. In Mumbai, the four medical colleges are already flooded with patients, most coming from outside the city. Nearly 30-40 per cent of the patients were coming from outside. It is important to strengthen healthcare facilities in areas that are around Mumbai.

Rupsa Chakraborty: There was a plan to build another building at Kasturba Gandhi Hospital for infectious diseases. But it has been put on hold. What kind of infrastructural plans or preparations do we have to handle another possible pandemic after 10-15 years?

The Kasturba plan couldn’t take off due to some technical issues. It has not been shelved completely and in the coming months, will be taken up again. On infrastructure plans, we have realised that developing permanent facilities wouldn’t serve any purpose while handling a pandemic. The only option during a pandemic is to have the capacity to construct makeshift facilities. The city needs to reserve spaces where makeshift facilities can come up in times of crisis. These reservations need to be made in a way we reserve spaces for gardens, parks and schools. These hospitals can be put to use during pandemics otherwise it will be very difficult. Take the case of Seven Hills hospital. It was vacant hence we could use it for Covid-19. Had it been functional, it would have been difficult to get more than 200 beds. We have to reserve or develop some facilities on the lines of exhibition centres like NESCO. During off time, we can use it for commercial purposes and when needed, they can be converted into jumbo facilities.

Yogesh Naik: What are the predictions for the probable fourth wave of Covid-19?

I recently read that the fourth wave would come in June… it would be more troublesome and the death rate would be high. We had earlier decided to close jumbo facilities, however, after these predictions, we are reconsidering shutting these centres. We are taking suggestions from the task force. The prediction has been made by IIT, however, one should not get carried away by it. In New Zealand and Korea, the number of Covid-19 patients is going up, hence, we cannot relax.

Rupsa Chakraborty: Are we planning to restart four shut jumbo centres?

They will be on standby and we will go by the advice of the task force. We have prepared a list of things to be moved from these centres… the process has started, as the three upcoming hospitals will open shortly. We will not only be moving material to these three hospitals but also other hospitals that are in need of it, so that they do not have to procure.

Zeeshan Shaikh: What do you think are the changes that need to be made in our healthcare system for it to be more effective?

Strengthening primary healthcare is badly required and that is what we are trying to do. Earlier, we used to get Rs 300-400 crore for this task, of which we used to spend Rs 200 crore. Now, because of the pressure of the pandemic and persuasion, we are getting nearly Rs 2,600 crore. The challenge before us is how to use this amount effectively.

There is a need to strengthen our healthcare, especially the public healthcare system. The pandemic has made us realise that the dependence of the lower strata of society or the middle class on public hospitals is very high. While people would get their patients admitted to private hospitals, in sometime, these patients were brought back to the public hospitals during the pandemic due to the resources, doctors and medicines that the public system had. We need to further strengthen the faith in the public healthcare system by providing more facilities.

Devendra Pandey: What is your take on booster doses?

Vaccination has played a key role in controlling the spread of the virus. When the third wave hit, nearly 90 per cent of the city’s residents were fully vaccinated and its impact could be felt. There is definitely a need to ensure that booster doses are made available to a larger section of the population. We operate as per the guidelines laid down by the Union government.

Laxman Singh: Has the BMC formalised any plans what it will do with the expired vaccines that are with private hospitals?

We have advised private hospitals to use our facilities to give administer doses before they expire. Some hospitals have come on board and are using our facility. Some private hospitals are seeking exchange of vaccines. We have asked the state government for advice, as it has asked us not to exchange vaccines. It has asked us to wait for further direction… The quantity of expired vaccines is not huge, but it is a precious commodity, so we have also asked the Union government about the disposal mechanism – whether these vials should be returned to the manufacturing company or disposed. In a day or two, we might get a response.

Zeeshan Shaikh: Currently, BMC is spending 15 per cent of its budget on health. Do you think this is enough and is the infrastructure creation sustainable?

There are two things. If we build facilities in one go, it is difficult to maintain. However, if the facilities are developed in phases, then there will be sustainability. In addition, we are also looking for a partnership. We have four medical colleges, with staff and doctors. But if we rope in the private sector in opening a fifth medical college, that option would help us make it sustainable. So far expense is concerned, last year we spent 12 per cent of the total allocation on health. This year, it is 15 per cent.

Sanjana Bhalerao: As the Covid-19 waves ebbed, Mumbai reported steady numbers but it has never reported zero cases or cases in single digit, like other metro cities like Delhi.

This is because Mumbai’s survival depends on the migrant population. It sees migration from across the globe, other parts of India. We are not aware if they are carrying any infection. These numbers are under control if you compare it with other cities like Delhi, Bengaluru and Chennai. As far as Delhi is concerned, the number increased leaps and bounds, even by 10,000 per day. But in Mumbai, the growth has been steady except for a few exceptions. Our system is strong… a positive case is followed by contact tracing, then testing and quarantine. We were enforcing this strictly. Thus, the further spread was under check unlike other parts of India. Every city was struggling for oxygen supply. But we never struggled in Mumbai, except for a few incidents.

Laxman Singh: The BJP has questioned the expenditure made on creating Covid-19 facilities and alleged misappropriation of money.

We were anticipating these types of allegations. However, we have documented all the expenditures. We have maintained records and followed all procedures. All guidelines have been followed while taking up these projects.

Pallavi Smart: Whenever the government announced any relaxation, its last priority seemed to be schools because of which children suffered immeasurably. Why was BMC so hesitant in allowing schools to open?

Parents had conveyed to us that they felt that children would be more susceptible to the second wave, due to which we started developing pediatric wards at jumbo centers. Fortunately, the percentage of children admitted was less than average. I personally feel that their resistance power is good because when we conducted sero survey on children, we found 51 per cent had antibodies. That way children are not very vulnerable but because of the advice given to us by medical professionals, we had to create facilities for them and shut schools for more than a year.

During the third wave also, it was proposed that we should put the city under lockdown. I was the only person who was batting for economic activities to go on. We had facilities, enough beds. I suggested that when we exceed the 50 per cent occupancy of available beds, only then should we consider lockdown.

Yogesh Naik: How prepared is the BMC for election?

We are completely ready for elections, even if elections are to begin in March. If the Election Commission (EC) declares tomorrow that we have to conduct an election in 35-40 days, the system is ready.

Yogesh Naik: What is your estimate? When would they roughly declare the election?

It is difficult to comment. I was of the opinion that the actual poll will be conducted in April. I have not read the Supreme Court judgment but it might have mentioned that it should be completed before May 31, when municipal corporation elections are due. Now, the ball is in the court of the EC. The government has no role to play… unless they come out with some ordinance, which may change many things. But as of now, elections can be held in April or May, because again in Mumbai, monsoon will bring other challenges.

Mohamed Thaver: There is always a discussion that BMC has become too big to run Mumbai efficiently. What is your perspective?

I am not in favour of dividing BMC in parts. The strength of BMC is in a united body. If we divide it further, it would be difficult to manage, it would be more confusing and coordination would be much more difficult. Dependency will increase in such a structure. For example, suppose your pipeline bursts in Mumbai and south Mumbai is suffering. The Mulund in-charge won’t bother repairing that pipeline. An integrated body is required to manage a city like Mumbai.