BMC's failing PPP model causes unavailability of emergency services in city

Up to nine Public Private Partnership (PPP) projects the BMC had tied up with private players in the last two years have not fructified.  The projects were planned to bring in MRI/CT scan, ICU and dialysis facilities in BMC's peripheral hospitals.

BMC's plan to install an MRI machine in Rajawadi hospital has failed as Uber Ink Foundation, which was awarded the PPP contract, has not started the services. CT scan services in Kurla Bhabha hospital, Kandivali Shatabdi hospital and Mulund-based MT Agarwal hospital have not commenced. 

A plan to start ICU services in Siddartha hospital, Goregaon, with Interventional Criticare Associates, has also not seen the light of the day.  “Notices have been served to those trusts and private players which have not started services inspite of signing the PPP agreement,” said Dr Mahendra Wadiwalla, chief, peripheral hospitals, BMC.

Currently, of the 18 peripheral hospitals, functional ICUs are there only in nine hospitals. MRI/CT scan facilities are available in three and dialysis facilities in five hospitals. “Peripheral hospitals are running at a mere 30% of their functional capacity due to the failing PPP model,” said Ashwin Vyas, health committee member, BMC.

The civic body's move to privatize healthcare services has gone down the drain. There is a severe lack of essential and emergency health facilities provided by the Brihan mumbai Municipal Corporation (BMC) to the citizens. In the light of this, it has now come to fore that up to nine Public Private Partnership (PPP) projects that the BMC had entered into with private players, in the last two years, are biting dust.

BMC had allotted space to various charitable trusts and private players to run services like that of diagnostic imaging techniques – MRI and CT scan, which are life saving emergency services, Intensive Care Unit (ICU) beds and dialysis, which is crucial to salvage kidney failure patients, through the PPP model.

The PPP model entails BMC floating tenders and inviting bids from charitable trusts and private players. In the last two years, private players did come on board and assured to provide services to the BMC-run hospitals. Agreements and contracts were signed. Two years have gone by, and these agreements only remain on paper. BMC's ex-additional municipal commissioner (health) Manisha Mhaiskar had vouched by the PPP model and said that services will become operational rapidly.

The crucial MRI/CT scan, ICU or dialysis services have not started in at least nine peripheral hospitals even as the documents accessed by dna state that private players have been allotted to start the project. Apart from the three major hospitals – Sion, KEM and Nair, BMC runs eighteen peripheral hospitals across South Mumbai, eastern and western suburbs. While all the major hospitals are concentrated near South Mumbai, the peripheral hospitals in eastern and western suburbs are bereft of any infrastructure.

Defunct CT Scan/MRI Services -

The PPP project to set up MRI services in Rajawadi Hospital, which is one of the few BMC hospitals in eastern suburbs has been gathering dust. The project was allotted to Uber Ink Foundation by the BMC and has not been implemented.

Of 18 BMC's peripheral hospitals in suburbs, only three have functional MRI services. "MRI machines are functional in Kandivali Shatabdi, Govandi and RN Cooper Hospitals," said Dr Mahendra Wadiwalla, chief, BMC's peripheral hospital.

Further, PPP projects to set up CT Scan machines in Kurla Bhabha, Kandivali Shatabdi and MT Agarwal Hospital in Mulund have not seen the light of the day. The projects have been allotted to Krishna Diagnostics and Uber Ink Foundation.

Only three of eighteen peripheral hospitals – RN Cooper in Vile Parle, VN Desai in Santacruz and Rajawadi Hospital in Vidyavihar have a functional CT Scan centre.

"The rest are either PPP projects stuck in a limbo or hospitals where no services have been proposed to be set up," said a senior doctor in the BMC health administration.

According to Save Life Foundation, a health non-profit, one road accident death occurs in India every four minutes. Up to 377 persons die in India due to road accidents and fifty percent of these deaths can be averted if timely emergency care is provided. Mumbai has a population of over 1.25 crores, of which maximum persons reside in western and eastern suburbs. Over eighty lakh persons reside in the suburbs while a little over thirty lakh persons comprise of South Mumbai's population. "Most medical services of the BMC including location of premier super specialty hospitals like Sion, Nair and KEM is in South Mumbai," said a senior doctor from KEM Hospital. "Due to lack of MRI/CT scan services in suburbs, we get referrals from remote parts of suburbs in KEM. This leads to overloading of patients."

Defunct ICU Services -

For a population of close to 1.25 crore Mumbaikars, over eighty lakh of which reside in eastern and western suburbs, not more than hundred Intensive Care Unit (ICU) beds are available. The PPP project to construct an ICU unit in BMC's peripheral Siddartha Hospital in Goregaon which was handed over to private-run Interventional Criticare Associates after a tendering process has not take off even after two years. Of eighteen peripheral hospitals, only nine hospitals have ICU services with up to a hundred beds in all.

Defunct Dialysis Services -

The demand and supply gap is huge. Up to 15,000 patients suffering from end-stage kidney disease who are unable to get a transplant are on dialysis. Currently there are only 44 operational dialysis beds in BMC-run peripheral hospitals - Rajawadi, Govandi Shatabdi. Kandivali Shatabdi, Siddartha and MW Desai. Four proposed PPP services allotted to Peer Makhdoom Sahib Trust in VN Desai Hospital at Santacruz East, Veera Desai Shwetambar Murti Pujak Jain Sangh at RN Cooper Hospital in Vile Parle, Surana Charitable Trust at Maa Hospital in Chembur and Jito Foundation at MT Agarwal Hospital in Mulund West have not been started since the past two years, even after BMC has signed agreements with the aforementioned private providers. Most of patients have no option but to visit private dialysis centres which may cost them up to Rs 1,200 per cycle. Every week patients need up to three cycles of dialysis. In BMC-run centres they may get the same service between Rs 300-400 per cycle.

Official Speak -

On being questioned about BMC's failing PPP model which has led the set-up to run at only thirty percent of it's existing potential capacity, Dr Mahendra Wadiwalla, chief, BMC's peripheral hospitals said that inspite of signing agreements, service providers had not come on board to start CT Scan/MRI, dialysis and ICU services. "Those private players that are not coming forward to start services or are non-functional have been issued notices. We will disempanel them and cancel the contracts," said Dr Wadiwalla.

Dr Suhasini Nagda, director, medical education and major hospitals said, "I am unaware as to in which hospitals are PPP services non-functional or defunct. After referring to the list appropriate action can be instituted."

BMC's corporator and health committee member Ashwin Vyas said, "PPP model is a mere eyewash. Upto 70% of services allotted under the model are lying defunct. BMC should speed up action to clean the system."

In 2014, up to 500 road accidents occurred in Mumbai where persons died. According to Save Life Foundation, 377 persons die everyday in road accidents in India.

In 50% of road accidents cases, death could have been averted if timely medical emergency services were provided to the patients within the golden hour

What is Golden Hour?

In emergency medicine, the golden hour (also known as golden time) refers to a time period lasting for one hour, or less, following traumatic injury being sustained by a casualty or medical emergency, during which there is the highest likelihood that prompt medical treatment will prevent death.

Often, patients being taken to BMC hospitals, mostly accident related cases, miss the golden hour in the process of being ferried from peripheral hospitals (that have no facilities) to bigger public hospitals in South Mumbai

Paltry BMC services in the peripheral hospitals -

Peripheral Hospitals – 18

Functional ICUs in 9 hospitals – running at 50 percent of it's capacity

Functional MRI in 3 hospitals – running at 16 percent of it's capacity

Functional CT Scan in 3 hospitals – running at 16 percent of it's capacity

Functional Dialysis in 5 hospitals – running at 27 percent of it's capacity


BMC's Non-operational PPP services in the city

Hospital Place Defunct Services Trust/Private Player

VN Desai Santacruz East Dialysis Peer Makhdoom Sahib Trust

RN Cooper Vile Parle West Dialysis Veera Desai Shwetabar Murti Pujak Jain Sangh

Diwaliben Mehta (Maa) Chembur Dialysis Surana Charitable Trust

MT Agarwal Mulund West Dialysis Jito Foundation

Siddharth Goregaon ICU Interventional Criticare Associates

BA Ambedkar Kandivali West CT Scan Krishna Diagnostics

MT Agarwal Mulund West CT Scan Uber Ink Foundation

KB Bhabha Kurla CT Scan Uber Ink Foundation

Rajawadi Vidyavihar MRI Uber Ink Foundation