August 2018

Smart Planning for Smart Cities: Transforming Healthcare in Urban Landscape

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Dr Tejaswi NaikOur urban planning needs to get aggressive to ensure scope for adequate physical exercise for our population. From seamless transit, which ensures an adequate step count daily, to offices and buildings designed to avoid long term sitting, a vision needs to be set in place to prevent diseases like diabetes and obesity becoming an epidemic, says Dr Tejaswi Naik, Director-Budget, Government of Madhya Pradesh, in an exclusive interview to Souvik Goswami of Elets News Network (ENN).

Q What is the mandate of your department?

We manage the finances of the State, keeping a tab on the income, expenditure, debt and liabilities while guiding the Government on fiscal matters and presenting the facts before the House as and when asked for.

Q You have worked extensively in the health domain as the Collector of Barwani district. What challenges have you observed to improve the State’s healthcare sector and how can these challenges be addressed?

Madhya Pradesh’s HDI/health parameters have shown a considerable jump in last few years. But still, a Herculean effort, which is focused in nature, is required to correct the scenario which is historical, socio-economic as well as geographical in nature.

It has been 10 years at least since the flagship schemes like NRHM, JNNURM, MGNREGS have been implemented. It is now time to do an impact assessment and do course-correction wherever required.

While implementing the schemes at the grassroots level, this gap was thoroughly felt, though one could also appreciate the huge stride ahead taken by these schemes.

It is here that one notices gap (the slips) between the cup and the lip. For, we have carried out the implementation part for the past few years, but still we are not there in the parameters where we wanted to be. We may claim to have put on ground subcentres and ambulances and stuff on ground as per the norms, but are yet to achieve the actual figures that matter, let’s say, an acceptable rate of MMR, 100% institutional delivery and immunisation. And this is not the Health Department’s domain alone. This final push requires a multidepartmental convergence.

Barwani was and remains to be one of the toughest areas to bring about a change as it is placed with one of the highest IMRs nationally, low immunisation levels, abysmal institutional delivery rate, equally troubling malnutrition prevalence, compounded by the ritualistic seasonal migration and a tough terrain.

One should realise that one has to work incrementally and according to a plan if one has to bring about the change in the above parameters. It can’t happen overnight. Morale building amongst the field staff and quick achievable targets were identified to start with as part of a larger plan. Immunisation saturation in an area where families were missing for half the year and each lived atop a hillock required innovation like Green Commando and a lot of back office planning.

The results have encouraged the district to be aggressive in the newly launched Aspirational district programme, which touches upon the achievement of all the above parameters but in a specific time frame.

Again, one has to bear in mind results don’t come overnight and efforts need to be built upon incrementally to reach there. Hence, aspirational programme gave the districts an opportunity to focus on key parameters and try and achieve them.

Thanks to the KPIs, it is now easy to reach out to even the last field personnel in the chain when talking about ORS or Zinc usage or importance of breastfeeding within an hour of birth. But still a much more concerted effort is required to bring about that veritable change. This is where technology can be handy.

Q How Madhya Pradesh’s healthcare sector is experiencing transformation, leveraging technology and innovation?

Madha Pradesh was a pioneer in having a statewide family database called Samagra. This was supposed to be helpful in pushing social sector schemes. In Barwani we used it to push health benefits to Sardar Sarovar affected families in a proactive manner. During the period of rehabilitation, Green Commandos were deployed to check upon each individual across 70+ villages. The result was health data of 18,000+ case sheets.

This pilot showed us that when the same is implemented at the district level, with the help of technology, we can pre-empt many emergency situations i.e. likelihood of caesarian in a particular case and possibility of requirement of particular blood group.

Also, the seasonal migration which was the root cause of most of the problems where the family missed out on almost all the social benefits by the State, could be checked if the family could be tracked to the final location where it relocates for labour and the same benefits extended there, from polio drops to scholarship to children. We tried a very basic version of this with our labourers in Gujarat, especially in bringing back the body in case of accidental deaths which otherwise would have caused loss of all earnings. This was done by maintaining village Samagra rosters where the family had to write down the destination and a contact number in case administration had to reach out in case of emergency. But the same could be done with a simple ERP at district level which maintains all data of a family including health data. The Government reaching out in real time becomes a reality then.

The same too can be used in cancer prevention which easily converts a middle class family to a below poverty line one, sapping them of all their life savings in the treatment of a member. This happens in spite of Government schemes being available because of the flawed approach. The family avails the Government help mostly in the last or last but one stage when the prognosis is almost foregone and much money has already been expended. For better prognosis, diseases like cancer need to be pre- empted with aggressive, proactive screening of direct blood relatives of known patients and schemes extended to them. This is possible with the use of a database like Samagra where families with incidence of cancer can be marked up for probable cases. This will help in directing the Government resources where it actually matters in not just curing the individual but also in preventing the economic collapse of the family.

Q You have played an important role in Bhopal’s smart city journey, as Commissioner of Bhopal Municipal Corporation previously, and smart healthcare is an integral part of smart cities. In this context, how important is town planning considering importance of healthcare delivery in the urban ecosystem?

The world is witnessing an acute rise in the heights and weights of its population over the last 100 years. With the benefits of improved health, it has also brought to fore the ‘hidden costs’ of the same — obesity, diabetes and respiratory disorders to name a few (not necessarily in that order). Culprit for the above is improved technology, mobility being the hero as well as the villain and our own worldview as to what is good for us and what is bad, is equally at fault.

Somebody, who may have watched the movie “Wall E” in 2008 with its obese technology-slave human characters, would have treated it entirely as a sci-fi movie. Not today. For over the last 10 years, technology has made many parts of it look very much possible.

With more than two-third of the population of the globe going to be in the urban setup by 2050 and half already living, urban planning becomes very critical. And to know that, it is the cities that has health problem as above mentioned in abounds, it becomes all the more important.

City planning has mostly been carcentric, rather bordering on car-philic/ car crazy over the last one century since the inception of automobiles on large scale. The blind assumption of car for everybody is at the centre of it which, as it turns out, is a very unsustainable model and wrong aspiration to cultivate. The whole of GenX and most of Millenials have been brought up on such dreams. The latter, mostly in absence of exposure to a seamless mass transit system, a major part of Millennial, live in the cities affording them a decent transit and last mile connectivity such as ‘Paid bike sharing’. Add to this the idea of a ‘Walkable city’ in place of a car-centric one, should be the holy grail when it comes down to negating effects of lack of exercise and long sitting hours.

Our urban planning needs to get aggressive in ensuring adequate exercise to our population. From seamless transit, which ensures an adequate step count daily, to offices and buildings designed to avoid longterm sitting, a vision needs to be set in place to prevent diseases like diabetes and obesity becoming an epidemic.

Compulsory grounds and playcourts need to be encouraged in the city landscape, more than viewing them as a mere formality that they are now. Transiting for work can be checked through planned accommodation near place of work (the daily average commute in Pune and Bengaluru is minimum two hours). Technology can also ensure decentralisation of offices to tier-2 cities so that the ‘commute’ problem can be addressed.

In not going for the above, the opportunity cost is that of the mental health and its obvious effect on social health in general. From suicidal depression to aggressive mass shootings, one can trace the origins in the disturbance of the physical and mental well-being.

A ‘Happy city’ would be one which negates such possibilities with a vision in its urban planning. That is the change, I believe, we will have to look forward to, no matter how biblical it looks in practice.

 

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