By constructing a string of state-funded fully-equipped super-speciality hospitals, West Bengal is marking a paradigm shift in the imagination and delivery of healthcare in the country; discusses Pradip Chatterjee
"Rich or not
We all have got
Chances in lifetime
To live quite sublime
More rich people become richer
And the majority poor more poorer
It's not how much money brings boost
But having enjoyed life not its cost
Healthy body makes an active mind
Once sick can't make good things rewind
Beware of taking too much of everything
Good health is wealth and the best thing."
Penned by Marvin Brato Sr, this poem succinctly reminds the world of the importance of good health – a reality that pervades human life, anywhere at any time. With a swiftly multiplying population, India has had an often difficult equation with the vagaries of illness and public health. Yet, over the decades, much has conditioned health systems and consequently, human preparedness to overcome unexpected bumps. A microcosm of this evolution in healthcare – from an uncertain past of vaidyas and high mortality to a cocooned present of established hospitals with round-the-clock care – can be found in West Bengal. The medical landscape of this historic land of abounding population today paints a proud picture of flourishing facilities and unhindered accessibility.
Over the past few years, the Bengal government has successfully exploited a range of resources to build more advanced health infrastructure, and also apprise people about good health and ways to remain fit. A host of new initiatives have also come flowing with the goal of strengthening universal health coverage, a foremost political pledge hailed by the Mamata Banerjee-led TMC government. One of her important decisions was to set up 42 super-speciality hospitals across the state, taking tertiary healthcare to the so forth unserved hinterlands.
This much-discussed project of constructing super-speciality hospitals took promising flight and added promise to the state's healthcare service delivery mechanism, while the idea of state-funded super-speciality hospitals opened a new chapter in our country's healthcare. This is primarily because no other state has, so far, propounded such an ambitious project of constructing over 40 super-speciality hospitals within a span of five years – dismantling the comfortable monopoly enjoyed by a few private providers.
The health sector in India witnessed rapid reforms following the economic reforms of 1991. It was initially falsely assumed that the reforms would trickle down to benefit the masses. But, contradictorily, the opening of markets witnessed rapid expansion of the private sector, which is largely unregulated and favours the moneyed. Nonetheless, the Bengal government, prodded by Chief Minister Mamata Banerjee, forced accountability on private hospitals by promulgating a regulatory authority, the West Bengal Clinical Establishment Regulatory Commission.
In India, though people are entitled to receive free health services under universal health coverage, there is immense discrepancy in the quality of treatment available in urban and rural areas. Rural areas are largely plagued by infrastructural inadequacies, shortage of doctors, low literacy levels, lack of communication, etc. Due to this apparent paralysis in the health service delivery mechanism, people with heavy pockets turned towards the private sector while the poor were left diseased and without money, access or even hopes of progress towards better health.
The government set out to establish hospitals that match private standards of providing quality healthcare across various districts. Banerjee herself was actively engaged in mulling over the various possibilities on how the government can independently establish super-speciality hospitals to provide care without cost. Significantly, almost all super-speciality hospitals have been constructed in rural areas so that people aren't compelled to visit only medical colleges in Kolkata. At the forefront, Banerjee laid enormous stress on building quality infrastructure to ensure superlative treatment.
All the new super-speciality hospitals are equipped with modern technology and the general wards too are working well. But in some cases, a scarcity of specialist doctors, paramedics and medical technicians is creating hindrance in everyday operations. Thus, professor-doctors from nearby medical colleges are often roped in to these super-speciality clinics.
In many of these new super-speciality hospitals, equipment and machines are more advanced than those in the city's medical colleges. But specialist doctors and non-medical staffers tend to remain distant from these hospitals as many prefer visiting private clinics. This remains a major shortcoming as no scheme can perform to its full capacity in the absence of ground-level service workers dedicated to the cause.
Several new hospitals have also been established in previously Maoist-infested areas and this obscurity in location has also discouraged medical practitioners from serving without hesitation. Specialist doctors across medical colleges in the state sometimes have to conduct video conferences to attend to patients waiting in far-off districts. Due to this reluctance, a number of advanced equipment sits unused.
According to sources in the state health department, around 2,000 out of the 3,453 sanctioned posts for specialist doctors are vacant and more than 1,000 of the 5,835 approved posts for medical professionals need filling. The government has already made it mandatory for postgraduate medical students to serve three years at a district hospital. Around 70-80 doctors qualify postgraduation and proceed to become specialists.
The shortage of doctors is not a Bengal-centric problem and can be witnessed across India with several debates urging the Medical Council of India (MCI) to increase the number of seats in medical institutions. The state government creates infrastructure while MCI sanctions seats after an assessment. To tide over the crisis of doctor unavailability, the Bengal government is now constructing more than nine medical colleges across the state.
Since 2011, when Bengal witnessed a historic change of guard, much has unfolded in the state, particularly in its hinterlands that today do not seem as distant or diseased. The erstwhile Left government did little to alleviate the state's health services with pitiable budgetary allocations that brought insignificant change. Bengal's budget allocation in health has shot up from Rs 682 crore in 2011 to Rs 9,552.70 crore in the current fiscal, clearly reflecting the government's motivation to uplift this sector. Earlier, district and sub-divisional hospitals were ill-equipped and serious ailments were almost always transferred to medical colleges in the city or in bigger districts.
Today, 41 super-speciality hospitals are already operational across the state while one hospital, which is coming up in the Belda area of West Midnapore, is likely to be inaugurated by the Chief Minister later this year. Each hospital has been constructed at an approximate cost of Rs 10 crore.
Out of the 42, 13 sit on plots of various existing health centres in districts while the rest have been constructed on premises of either district or sub-divisional hospitals. In a few other places, hospitals have been set up a little away from sub-divisional or district hospitals.
Sanghamitra Ghosh, health secretary of the state, said: "It is not true that specialist doctors are reluctant to go to super-speciality hospitals. The construction of a large number of such super-speciality hospitals is a huge task. The work is in progress and we are constantly trying to tag more doctors to super-speciality hospitals. We are also constantly upgrading these hospitals which are all very well-equipped. Patience is key as the project is massive and time-consuming but promises fruits that will touch many lives."