A manufactured crisis to justify privatisation?

Six major BMC hospitals are currently being handed over to private companies through public–private partnership (PPP) arrangements. According to the views expressed by this coalition, this move will replace free public services with paid care, hitting Mumbai’s poor and marginalised the hardest. Simultaneously, the BMC has been steadily reducing regular health staff, replacing permanent positions with outsourced and contractual workers, eroding both service quality and workers’ security.

Despite mass retirements of BMC health staff, there has been no serious effort to fill and expand regular posts. This is a deliberate strategy: weaken the public system through neglect, then hand it over to private operators under long-term contracts. The result is restricting access to free care, worsening working conditions, and compromised service quality.

Problematic record of PPPs in BMC health services

Providing details to justify their accusations, in a press release issued Monday, October 7, citizens said that over 20 PPP projects already operate within Mumbai’s municipal health system, covering ICUs, diagnostic centres, dialysis units, and entire maternity homes and hospitals. Yet there is no independent evidence that these PPP arrangements have improved quality or accountability of health services. Many PPPs have been deeply problematic but despite such experiences, new moves for privatisation continue without any comprehensive evaluation of existing projects.

A recent study of healthcare PPPs in Mumbai and Pune has revealed alarming problems:

• Outsourced ICUs are staffed with underqualified doctors, even run by homeopathy practitioners, leading to compromised patient safety and preventable deaths. One ICU contract worth several crores was cancelled after 149 deaths were exposed.
• Diagnostic centres under PPPs frequently charge patients three to fifteen times higher than public hospitals, making them inaccessible to low-income communities.
• Monitoring mechanisms are very weak, allowing non-compliance with contracts, underqualified staff, and erratic service delivery. Some PPP hospitals remain grossly underutilised despite substantial infrastructure, due to lack of full-time doctors, essential equipment, or basic services.
• Political influence pervades the contracting process, with corporators or ex-corporators floating companies or favouring bidders to secure contracts, turning healthcare provisioning into a political-business venture.

Overall, rates charged to patients under various Municipal PPPs were found to be two to twenty-five times higher than comparable public hospital rates. The study concludes that PPPs have largely become vehicles for private profit rather than instruments of public good.

The real issue: Deliberate understaffing

The push for privatisation is justified by claims of inadequate capacity in public hospitals. In reality, the BMC has created an artificial shortage through chronic understaffing of its health services. According to Praja Foundation’s 2024 report, municipal hospitals face massive vacancy rates of 46% among doctors, 26% among nurses and paramedical staff, and 42% among labour staff, with an overall vacancy level of 36% in the health department. Rather than investing in recruitment and better working conditions, the BMC is diverting resources to PPPs—benefiting private operators while bypassing public accountability.

What needs to be emphasised is that there is no shortage of doctors and health workers in Mumbai, the available pool could be readily employed and all vacant posts in BMC could be promptly filled. For example, the number of vacant medical posts in BMC is around 975, while the annual output of MBBS doctors just from government medical colleges in Mumbai is around 1200, and number of graduating MD / MS doctors from these colleges is around 1000 per year. Enough doctors, nurses and health workers are available to fill all vacant posts.

Communities, Health workers and Public health experts raise their voices

Social movements and community organisations in various parts of Mumbai, especially in bastis and informal settlements are opposing user-fee-based PPPs which will deny them life-saving care. One major example of this resistance is the movement by “Aspatal Bachao, Nijikaran Hatao Kriti Samiti” active among residents of M-East ward (Mankhurd and Govandi areas). This is a coalition of over 25 organisations who have organised a series of major protests since July, demanding a halt to the privatisation of Shatabdi Hospital and Lallubhai Compound Super-Speciality Hospital. This mobilization is a powerful, grassroots rejection of BMC’s proposal to hand over key public hospitals to private players under the deeply problematic Public-Private Partnership (PPP) model.

Municipal health worker unions have also joined this movement, highlighting that outsourcing and PPPs cut down of secure employment for health workers. Contractual staff face much lower pay, total job insecurity and lack of social security. Privatisation also replaces teams of experienced regular health staff with precarious contract workers, thus affecting the quality of patient care. All unions belonging to this coalition, who represent thousands of health workers in Mumbai demand that all forms of privatisation under BMC must be halted, and that the huge number of vacancies must be filled promptly through regular recruitment, along with creation of additional posts to meet the city’s health needs. This will majorly reduce work overload on the existing BMC health staff. The vital role played by public health systems and their staff during the COVID pandemic underscores the urgency of this demand.

Public health professionals are also questioning handing over of public hospitals—built with public funds—to private players without robust evidence or accountability mechanisms. The entry of politically connected, non-medical operators undermines healthcare quality and ethics, especially in critical areas like ICUs and maternity care. What Mumbai urgently needs is a robust, publicly funded health system—not privatised services that exclude large numbers of people who are most in need.

Joint demands of the coalition

The coalition demands the BMC to retract its pernicious policy of privatisation and contractualisation, which only benefits contractors, corrupt officials and politicians. Instead BMC must now act decisively and promptly in public interest by taking the following steps:

• Immediately halt and cancel all PPP-based privatisation proposals for public hospitals and health services in Mumbai, and conduct an independent review of existing PPPs with a plan to return them to public management.
• Launch urgent recruitment drives to fill all staff vacancies—doctors, nurses, paramedics, sanitation, support staff—through regular appointments, while phasing out outsourcing.
• Develop a comprehensive plan to strengthen public health services through regular recruitment, increased budgets proportional to population needs, and improved management. This should be linked with assured, quality provision of various levels of health services and essential medicines. 
• Ensure systems for transparency and social accountability, including community-based monitoring of BMC health services and participatory governance mechanisms involving communities, civil society groups as well as health workers.

Joint Plan of Action – Aspatal Bachao Neejikaran Hatao Kruti Samiti and Unions 

– A more extensive public campaign will be launched to against privatisation of hospitals that have been tendered for PPP.

– A massive campaign will be launched in collaboration with health workers’ unions demanding full social security and rights of workers in public healthcare facilities and services. The right to health cannot be fulfilled without workers’ rights.”

– Jan sunvayi’s will be held across the city to address the current state of public health facilities and services.

– All political parties and their candidates will be asked to clarify their positions on these two issues: “transformation of public healthfavilties and services to serve people and opposition to any form of privatization of health services.” Those parties or candidates who unconditionally agree on this issue will be labeled “supporters of public health,” while those who do not will be labeled “enemies of public health,” and the public will teach them a lesson in upcoming elections.

– A massive state-level conference will be held by civil society organizations, unions and other organizations against privatisation and contractualisation of health services in Mumbai on November 30th.

We call upon every Mumbaikar to stand up and speak out today against ongoing privatisation of health services, which is a betrayal of public trust. It is surprising that existing BMC officials, who do not have any democratic mandate to take major policy decisions in the absence of an elected corporation, are trying to push through large scale privatisation of health services. Finally, the coalition stated in a press conference held today that Mumbai deserves a public health system that is equitable, transparent, accountable, and ensures that healthcare is strengthened as a public right, not being turned into a commodity for private profit.

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Samsung workers end strike but the core issue of recognition of unions’ remains

The post Citizens move to stop privatisation of Mumbai’s Public Hospitals appeared first on SabrangIndia.

The Supreme Court has come down heavily on the Gujarat government for a series of decisions regarding fire safety that appear to be contempt of court. The court also appeared flummoxed at the state government’s decision to submit its report in a sealed cover.

“What is this report in sealed cover? It is not a nuclear secret,” Justice DY Chandrachud was quoted as saying by Bar&Bench. Justice Chandrachud was hearing the case along with Justice MR Shah. The court also took umbrage to the state government’s decision to issue an executive notification that hospitals will not be required to adhere to fire safety norms till 2022.

The Bench slammed the state government, reportedly saying, “Once a mandamus is there, it cannot be overridden by an executive notification like this! You now give a carte blanche and say hospitals don’t have to adhere till 2022 and people will continue dying and be burnt…”

The Court has hearing a suo moto case concerning fire tragedies at Covid Hospitals after two cases in Rajkot and Ahmedabad. SabrangIndia had previously reported on the fire that broke out in the Intensive Care Unit (ICU) of Ahmedabad’s Shrey Hospital leading to the deaths of eight Covid-19 patients on August 6, 2020. Advocate Suhel Tirmizi, whose wife Ayesha was one of the victims, had filed a PIL demanding accountability be fixed on various state and hospital authorities. Then in November 2020, another inferno, this time at a Rajkot Covid care hospital claimed five lives.

Two significant orders by the Gujarat HC

Following this, the Gujarat High Court had passed two significant orders. On December 15, 2020, while passing orders in a batch of Public Interest Litigations (PIL) in connection with the Shrey Hospital fire case, the Gujarat High Court had made a series of pertinent observations and passed orders that are bound to have a far-reaching impact.

The court ordered the State of Gujarat “to enact a consolidated Code/Act/Guidelines for fire safety requirement for clinical establishments/hospitals of all kinds setting out minimum standards of fire safety standards to be maintained by clinical establishments/ hospitals such as across the State of Gujarat.” It also directed the state government “to frame rules and guidelines for fire safety in ICU wards of the hospitals.”

It further ordered all respondent authorities “to comply with the provisions of Gujarat Fire Prevention and Life Safety Measures Act, 2013 strictly in clinical establishments such as Hospital/Nursing Homes/ School buildings of the city of Ahmedabad.”

Significantly, it also directed respondent authorities “to make mandatory installation of sprinkles and a fire extinguisher in every room/ward of every Hospital/Nursing Home irrespective of its height with a view to protect lives of innocent and infirm patients who are not capable of escaping any disaster in case of emergency situations.”

Then on February 26, 2021, the court ordered that all Municipal Corporations mentioned in the PIL be served notice. It further ordered, “We direct all the Municipal Corporations to place on C/WPPIL/118/2020 ORDER record by way of an affidavit, a list of all the high rise buildings

-15 metres and 18 metres in height, special buildings, schools, hospitals, industries and factories within the jurisdictional limits of all the Municipal Corporations :

a. Which have a valid and subsisting No Objection Certificate with regard to the Fire Prevention and Protection Systems in the State of Gujarat ;

AND b. Which do not have a valid and subsisting No Objection Certificate with regard to the Fire Prevention and Protection Systems in the State of Gujarat”

The Court had ordered, “Ahmedabad Municipal Corporation is directed to place on record by way of an affidavit, the details of all the private hospitals which have not complied with the directions issued in Paragraph No. 23(14) of our earlier Order dated 15.12.2020” and that it was “directed to place on record the photocopies of the No Objection Certificates issued to all the hospitals located within the jurisdictional limits of Ahmedabad Municipal Corporation signed and certified by the Competent Authority within a period of 10 days from the date of the receipt of this order. One set of such photocopies shall also be furnished to the party-in-person.”

Specifically, when it came to reopening the Shrey Hospital, the court had on February 26, 2021 ordered, “The Ahmedabad Municipal Corporation is directed not to remove or open the seals applied at the premises of the Shrey Hospital without the permission of this Court and shall not permit the Management to once again start with the functioning of the Hospital without the permission of this Court.”

The case in the Supreme Court

Following the Rajkot fire at the Uday Shivananda Hospital the SC took suo moto cognizance, and in the case titled, In Re: Proper Treatment of COVID-19 Patients and Dignified Handling of Dead Bodies in the Hospitals, etc., asked the government via an order passed on December 9, 2020, to submit a report comprising data from all states on fire safety audits carried out in hospitals.

Meanwhile, little changed on the ground as yet another fire broke out in the ICU of the Bharuch Welfare Hospital in May this year, killing 18 people. Meanwhile, the Gujarat government issued an executive notification that gave a virtual carte blanche to hospitals by allowing them to function without adhering to fire safety norms till June 2022, and that no action will be taken against them till then. Given the number of lives lost and the direct involvement of the highest court in the country, this notification showcased the Gujarat government’s impunity.

Bar&Bench quoted Justice Shah as saying, “40 hospitals in Gujarat were held liable and they came to High Court. Later, government order was that no action should be taken against hospitals for violation of fire safety. Such an order is a contempt of this court.”

The case has been adjourned for two weeks.

To be updated with order copy.

Related:

Guj HC slams state gov’t for lax attitude to fire safety
Gujarat: 18 Covid patients killed in Bharuch hospital fire!
Shrey Hospital Fire: Guj HC bats for greater accountability
SC takes suo moto cognisance of Rajkot Covid Hospital fire
Shrey Hospital Fire: Four months on, no evidence yet!
8 killed in Ahmedabad Covid-19 Hospital Fire
Another fatal inferno in Gujarat Covid hospital!

The post Guj gov’t faces heat for submitting report on fire safety in hospitals to SC in sealed cover appeared first on SabrangIndia.

Even though restrictions imposed in Kashmir since the abrogation of Article 370 have been relaxed, the streets of continue to be occupied by the government forces who have established barricades and checkpoints after every 300 to 500 metres. These checkpoints are not only affecting normal people but are pushing patients to the wall.

Being confined to their homes for the past 14 days in the valley, many patients and doctors aren’t able to reach the clinics and hospitals. As a result, several doctors have started attending to the patients at their home.

One such case is of Dr Sajad (name changed). He is the only doctor within a radius 4 kms, and has been receiving patients at his home. Initially, the flow of patients was low, but as the news has spread, people have been turning up in large numbers.

Sajad believes that people should not be restricted from reaching the hospitals in case of a medical emergency. Right now, because of the curfew, people have no means of reaching the hospitals even in case of an emergency.

On the occasion of Eid-ul-Adha on August 12, which most people of Kashmir celebrated under an extreme lockdown, Dr. Sajad received many cases of food poisoning at his home. There were many whose condition were so bad that he had to install a drip and have them stay at his own home to monitor them.

“I came across many people who didn’t have money, so I decided to do their treatment without any charges. They are my own people. I have kept the doors open for the people so that they know that they can knock at my door in the middle of the night,” he said.

The day when people across the world were celebrating Eid, Sajad received a few pellet victims, some of them had pellets in their eyelids and on their back, fired at by the government forces. “There were kids as young as 9 years old. I tried my best to help them out. I would treat that sort of emergency,” Sajad said.

Most pellet victims who receive minor injuries try to avoid going to the hospital and instead get them treated or removed locally which he believes is not a very good idea. “People go to local sources because the government is on the lookout for these people in the hospitals and if found, they could be detained. Due to this fear of detention, they avoid going to the hospitals,” he says.

Previously in 2016, there have been cases where pellets victims were stopped by the government forces on their way to the hospitals and were beaten up and detained.

Dr. Sajad says that it is dangerous to remove pellets at local medical shops that aren’t well equipped to do the job, it can lead to serious infections.

“There are many people who lost their eye sight by refusing to go to the hospitals due to the fear of detention. Their eye sight could have been saved if they would have received treatment on time,” he said. But there are no other options left for these people.

Apart from pellet victims, other patients have started showing up at Sajad’s home too. Due to the intensified restrictions on August 15, more and more people approached him as all the main entrances were blocked by the government forces.

One of the patients had Herpes Zoster. Herpes zoster is a viral infection that occurs with reactivation of varicella-zoster virus. It is usually a painful but self-limited dermatomal rash, which requires treatment by antiviral medications within 72 hours of symptom onset.

“It is a very painful condition. The atient’s companions were crying as they were helpless and were unable to get any medical assistance,” recalls Sajad.

Despite having a staff of six people at a government Primary Health Centre, where Sajad is posted, only he and one of his male colleagues have able to reach there since August 5.

After working at the health centre for almost 8 hours, Sajad remains on duty even after coming home. On an average, he attends to about 75 patients at his home everyday and provides free treatment to them.

While talking about the situation of the hospital, he said, “Right now our hospitals aren’t fully prepared to face any sort of emergencies, there is no proper backup of medicines and other important supplies.”

“We try our best to help people including acute cases or people with different sorts of injuries. But when things are more complicated, we refer them to the main hospital. But now, even in the referral case , they face a lot of problems because ambulances are also being stopped,” he said.

First published in Newsclick.

Disclaimer: The views expressed in this article are the writer’s own, and do not necessarily represent the views of the Indian Writers’ Forum.
 

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