Tuesday, November 29, 2016

Fixing healthcare in Mumbai

I just attended a meeting at Freedom for A Billion, where senior medical experts such as Dr. Sanjay Oak , CEO of Aga Khan Health Services, and Dr. Avinash Supe , Dean of KEM Hospital, spoke about their vision for improving healthcare for Mumbai.

Healthcare represents what economists call a wicked problem. There are many moving parts, and there's no one person who is in charge of everything. Thus, doctors will treat an ill child with diarrhea, but how do they make sure that the child does not get diarrhea again ? When he goes back to his house in the slum , how can the doctor ensure she gets clean drinking water ? Another problem is that healthcare is always a very emotionally charged issue, because it is so personal . When someone in the family falls sick, we are willing to move heaven and earth to help them get better, and it's very frustrating when we encounter road blocks because of high costs, red tape , a shortage of doctors, or poorly equipped healthcare facilities .
The truth is that while doctors can treat illness, our health is impacted by many factors which are completely beyond our control - for example, the quality of air we breathe. The big problem is that growth in Mumbai has been completely unplanned , and healthcare facilities have not been able to keep up with the needs of the exploding population.

There were lots of eye openers during the presentation. It's interesting that the problem isn't a lack of money, because the Mumbai Corporation has tons of money - it's a very rich corporation, thanks to the taxes we pay. For example, the Dean of KEM Hospital, a 2250 bed teaching hospital run by the Municipal Corporation has a budget which authorises him to spend Rs 100 Crores every year on upgrading facilities and buying state of the art medical equipment in KEM Hospital.   The problem is political interference. Even though the money is lying in the bank, politicians with vested interests will block him from spending this, because they want him to buy the equipment from their buddy. It's hard for a Dean to stick his neck out, because a few disgruntled corporators will allege that you're corrupt because you are favouring a particular vendor, when all you're trying to do is to buy the best CT scanner to be able to provide better care to your patients.

One way of fixing the problem would be to insist that all municipal corporators ( who control the corporation budget ) should be forced to take treatment only in municipal hospitals. Only when they understand the problems which a patient in a corporation hospital has to suffer through , will they become a little more empathetic . They will then be more willing to give the Dean more autonomy by treating him as a respected senior expert doctor. He needs to be able to exercise his discretionary power so he has the freedom to purchase the best equipment, using his best judgment, so that he can do his job properly.

The problem with the public health system today is that there is no accountability nor transparency . This is why no one is responsive, and the buck keeps on getting passed around from one person to another. It's much easier to do nothing, rather than try to fight politically motivated rivals, who want to take a cut of every transaction. This is why the medical equipment in these hospitals is outdated and poorly maintained , because the money lies unspent. This is one of the reasons why patients are so unhappy with public healthcare facilities . Even though the quality of medical care is very good, the level of hygiene and the ambience - the hotel facility and hospitality care provided in these hospitals - leaves a lot to be desired.

The problem is that we take a top-down approach. We need to take a bottom-up approach and think about what we can do to put patients first . The good news is that there are lots of opportunities to do so, and I'll discuss these in my next post.

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