Mumbai: The Brihanmumbai Municipal Corporation (BMC), India’s richest civic body, has decided to focus on improving its health infrastructure after Mumbai spent much of 2020 under the spotlight as one of India’s worst Covid-19 hotspots.
The BMC says work on Mumbai’s hospitals will be one of its primary focus areas in the financial year 2021-22, and it intends to take up on priority several planned healthcare infrastructure works that were pushed back in the current fiscal due to the Covid-19 pandemic. Improving and expanding Mumbai’s hospitals will be another important focus area.
To this end, the BMC has allocated about 12 per cent of its budget — Rs 4,728.53 crore of Rs 39,038.83 crore — to the health sector, a ratio similar to the last few years. The BMC had Wednesday presented its budget for 2021-22, which saw a 16.74 per cent jump over last year.
However, the BMC’s record at spending this budget in creating and upgrading health infrastructure has been lacklustre — it set aside Rs 29,971.66 crore for the sector in its budgets from 2010-11 to 2019-20, but about 30 per cent was unspent.
Suresh Kakani, additional municipal commissioner of the BMC, said: “There has been a lag in what was budgeted and what was spent the last few years, but it would not be fair for me to comment on it as I wasn’t with the civic body at the time.
“However, we have planned better this year and I have personally scrutinised the plans. We have budgeted for works which can begin in the upcoming fiscal. At best, there might be a 10-20 per cent difference in the amount budgeted and the amount actually spent, but definitely not more than that.”
Covid hit Mumbai hard
Mumbai recorded its first Covid case on 11 March 2020, and soon became a hotspot. The city has so far recorded 3,09,631 cases and 11,366 deaths due to the novel coronavirus.
Existing health infrastructure in Mumbai proved woefully inadequate as patients scrambled for beds, and the BMC had to ramp up hospital bed capacity on war footing.
In his budget speech, Municipal Commissioner Iqbal Singh Chahal said, “From March 2020 the whole healthcare service sector of MCGM (Municipal Corporation of Greater Mumbai, as the BMC is formally known) is busy in managing the Covid-19 pandemic.”
Chahal went on to explain: “Establishing six Jumbo Centres (makeshift hospitals) and rejuvenation of Seven Hills Hospital has resulted in additional 9,133 beds and about 791 beds for intensive care. Procuring ventilators, multipara monitors, dialysis machines, PPE kits, masks, sanitisers, beds for ICU, special oxygen tanks, dura cylinders etc. was done in a phenomenal short time on war footing.”
Rise in revenue expenditure
For the first time in over 10 years, the BMC is likely to end up spending more than what it originally budgeted for on the healthcare sector in the current fiscal — it revised its allocation to Rs 5,226.17 crore from the original estimate of Rs 4,260.24 crore.
But much of this increase is on account of revenue expenditure, which is now likely to be Rs 4,445.48 crore, instead of the original budget estimate of Rs 3,211.27 crore. The capital expenditure, meanwhile, is expected to be much lower at Rs 780.69 crore, compared to the estimated Rs 1,039.07 crore.
Capital expenditure refers to the money spent on acquiring, creating, upgrading and maintaining physical assets, and is how expenses on infrastructure are gauged. The amount spent on salaries, pensions, administrative expenses, interest and so on is termed as revenue expenditure, which is more or less the fixed outgoing of any entity.
The revenue expenditure shot up as the BMC had to hire additional doctors, healthcare workers, nurses, and arrange for their accommodation and other logistics. Overall too, the BMC’s revenue expenditure this fiscal is likely to be Rs 20,264.58 crore, higher than the originally estimated Rs 19,096.74 crore.
Commissioner Chahal said: “Manpower of senior and junior doctors, staff nurses, patient care attendants required for circumventing corona(virus) pandemic was hired on contractual basis. In the lockdown situation, health care workers and doctors were accommodated in various hotels. Accommodating the doctors and paramedical staff in hotels and looking after their dining was a mammoth task which was accomplished although there were a lot of difficulties.”
According to the BMC, there were several Covid and lockdown-specific moves that weighed on revenue expenditure. These include ex-gratia of Rs 50 lakh to the families of civic employees who succumbed to Covid; paying Rs 300 per day to all BMC staff to meet day-to-day expenses in the lockdown and semi-lockdown situations (amounting to Rs 417 crore till 31 December 2020); and hiring of buses from the state road transport corporation to enable its employees as well as the general public to commute.
Chahal said the BMC made attempts to curtail revenue expenditure other than what was required to battle the pandemic.
BMC’s additional municipal commissioner Kakani added: “The Jumbo makeshift hospitals set up for Covid patients were not permanent investments and the amount had to be booked under revenue expenditure.”
Plans based on Covid lessons
As the BMC hurried to create Covid infrastructure and secure manpower, planned healthcare infrastructure projects in the sector were stalled. These include redevelopment of hospitals such as Borivali’s Bhagwati Hospital, Bandra’s Bhabha Hospital and Sion Hospital.
Kakani said the main focus for 2021-22 will now be healthcare infrastructure development — constructing some new hospitals and completing pending capacity augmentation works. It has included at least nine such works in its list of 28 “prestigious projects” for the upcoming fiscal.
The BMC has also proposed five new works, which include two new hospitals, new buildings in two existing hospitals and addition of hostel facilities at another major hospital.
To achieve this, it has planned a capital expenditure of Rs 1,206.14 crore, an over 50 per cent increase over the revised estimate of Rs 780.69 crore for the current year.
The civic body has also proposed to upgrade six peripheral hospitals to provide minimum essential super speciality services, advanced diagnostic facilities and reduce the transfer of patients to major hospitals as much as possible to reduce their load. While dealing with the pandemic, several of the city’s peripheral hospitals were either partially or fully operating as Covid facilities.
Kakani said one of the main lessons from Covid is to use available resources judiciously and ensure that happens in a smooth manner. The BMC, thus, plans to create a ward-level plan to map diseases. If the incidence of a particular disease is higher in a certain ward, the civic body will allocate resources accordingly.
Similarly, the BMC plans to create a network between major hospitals for them to share resources and specialties. “A particular hospital might have strong orthopaedic facilities, but may not have adequate resources for some other speciality. They can bank on another civic hospital for the same to ensure minimum inconvenience to patients,” Kakani said.
Past record on infrastructure works
The BMC’s actual capital expenditure in the health sector over 10 years was just Rs 2,649.45 crore, or under 10 per cent of the total health budgets from 2010-11 to 2019-20.
The budgeted capital expenditure for these 10 years was Rs 6,382.52 crore, or 21 per cent of the total health budget, while the rest was estimated revenue expenditure.
Sayli Udas Mankikar, senior fellow at the Observer Research Foundation who works on governance and urban policy, called the BMC’s fund utilisation over the last decade a “classic case of bad planning”.
“If a large part of the budget is going to be diverted to administration costs, then our primary healthcare will never get developed… Ideally, a municipal corporation should only focus on primary healthcare and tertiary should be looked at by another entity. Somewhere we have to really think about what Covid did to us,” Mankikar said.