Why Udupi’s people don’t want their hospital handed over to NRI business tycoon
On Sunday, Chief Minister Siddaramaiah laid the foundation stone for the new hospital in Udupi town proposed to come up under the aegis of business tycoon BR Shetty, even as the past few weeks have seen strong protests against the move.
Earlier this week, a large number of people protested against the government’s decision to hand over the Government Maternity and Children Hospital to industrialist BR Shetty, an NRI businessman who has interests in healthcare, distribution, financial and food sectors, and spread across the UAE and in India. Earlier this year, he was also awarded a government contract to develop Jog Falls in Shivamogga district.
According to a fact-finding study by the Karnataka Janaarogya Chaluvali (KJC), a public health advocacy group, the hospital is well-run, and efficient and a “model” for the whole state.
Calling the entire staff from doctors to Group D employees as “inspiring”, the report notes that despite a resource crunch and living in dilapidated quarters, the staff attended to all patients with care at any time of the day and night.
They noted that not the “poor” people, but even middle class people obtained services from the hospital from a 150km radius including far-off places such as Byndoor, and Bhatkal and Karwar (both in the neighbouring Uttara Kannada district).
Contrary to the reputation for corruption that most government hospitals have, the Udupi hospital provides free service to all patients. The report also notes that the list of medicines available at the hospital have been displayed for public knowledge, and government rules for waste disposal and disease control are strictly followed.
Although Chief Minister Siddaramaiah tweeted about the proposed handover to Shetty’s business venture, protesters say that there is no need for the government to hand over a perfectly well-run hospital to a private party. They also allege that contrary to the claims of the government, the provisions of the MoU would allow BR Shetty to profit from the arrangement, turning a hospital that provides good quality health care for all, into a private hospital for all practical purposes.
A Govt Hospital in Udupi shall be handed over to Abu Dhabi-based entreprenuer BR Shetty to develop it into a multi-speciality hospital
— CM of Karnataka (@CMofKarnataka) August 24, 2016
What is the project?
The MoU is between the Department of Health and Family Welfare, Government of Karnataka, and BR Shetty, Chairman of BRS Health and Research Institute Private Limited Bengaluru. An unsigned copy is available with The News Minute.
Through the MoU, the existing 70-bed hospital on KM Marg would be demolished and upgraded to a 200-bed set-up in a new building to be constructed by BRS group.
The government would also provide land to BRS group to construct a 400-bed centre for excellence, which would provide specialized and super-specialised medical care.
Government claims
On Sunday, during the foundation ceremony, Health Minister KR Ramesh Kumar denied that the government was privatizing the hospital. He claimed that the government hospital was in poor condition, and that it would retain full control over the hospital, which would only be run by the BRS group.
However, the text of the MoU disputes this claim.
Only “universal health card holders” (BPL card holders) would be given free treatment at the government hospital, while other patients would be charged according to the government guidelines, the MoU says.
BPL card holders would be given free treatment at the centre for excellence, while the BRS group would have “complete autonomy in its functioning without any external interference”, according to the MoU.
Dr PV Bhandary, who has worked as an honorary psychiatrist at the district government hospital, argues that the conditions of the MoU smacked of a profit motive.
“If BRS group builds a 400-bed hospital and runs it like Jayadeva (hospital in Bengaluru), we have no problem. But what is the meaning of introducing a system of payment in a government hospital?” Dr Bhandary asks.
During the ceremony on Sunday, both Siddaramaiah and Minister for Health and Family Welfare Ramesh Kumar sought to deny that the hospital was being privatized.
He says that Udupi district is not new to private participation. The existing maternity hospital was built on land donated by Haji Abdullah Saheb in the 1950s. According to the Save Udupi Government Hospital Citizens Forum, a federation of organizations across the state, Abdullah donated the land with the explicit condition that it was to be used to prove free health care to citizens, especially the poor.
Hospital’s requirements
The Report by the KJC notes that although the hospital staff and administration ensure that good care both medical and otherwise (meals served by the hospital include fish curry) is provided, they do lack certain facilities.
The hospital has 70 beds which is in line with its status as a taluk hospital before Udupi district was carved out of Dakshina Kannada in 1997. “In the past 19 years, this has not been upgraded. The government has money to build a mini Vidhan Soudha here but none for upgrading it to a district hospital,” says Dr. Bhandary.
The KJC report also notes that due to the failure of the government to upgrade the number of beds, the hospital accommodates patients in the corridors instead of turning them away. Doctors told the fact-finding team that the vacancies in the sanctioned strength of doctors and nurses should be filled up, and the number of beds needed to be increased to accommodate the number of the patients. They also said they were happy to work at the hospital; all they required were good staff quarters.
Interestingly, during the event on Sunday, Ramesh Kumar said that “the public private partnership should be seen” in the context of the fact that the specialist doctors did not want to serve in rural areas even though the government was willing to pay salaries of up to Rs 1 lakh. Udupi city, where the government hospital is located, is not in the back of beyond, like some of the Primary Health Care Centres that the government handed over to private entities and later cancelled their contracts due to poor service.
“Who feels threatened by a well-run government hospital?” asks Akshila Vasan, one of the members of the KJC which prepared the report. She says that the Rajiv Gandhi Super Specialty Hospital, popularly known as the OPEC hospital, in Raichur city, was a classic example of a good government hospital destroyed by private management.
The 450-bed OPEC hospital was handed over to Apollo Hospital in June 2001 for a 10-year period ending 2001. According to a research paper on public private partnerships in the health sector, occupancy rate during this period declined from 85% to 58%.
An analysis of the payments found that on average, BPL patients paid more than APL patients. It notes that the government appointed evaluation team found that the even as an income generation model, the PPP had failed.
“The evaluation team attributes this to sub-optimal utilisation of beds, poor cash flow management, incorrect and unrealistic assumptions for designing the revenue model, weak management and weak monitoring. The evaluation team also states that in such partnership models, the private partners should be responsible for achieving service quality benchmarks and assume the risks for delays and cost overruns in the project, including issues related to human resources and efficiency in service delivery,” the research paper says.
“I don’t understand why the government wants to hand this hospital over to the private sector when its own experience with the OPEC hospital, and the PHCs, tells it that this is not a good idea,” Akhila says.
She points out that Udupi district has some of the lowest IMR and MMR rates in the state. “But the real litmus test is the toilet. In any other hospital, you can just follow your nose (because of the stink). But here, you have to ask people where it is. That’s how well-run this hospital is.”