The massive tragedy at AMRI Hospital in Kolkata is an example of why diatribes against foreign investment can be deadly. India?s health sector is a classic example, notes a WHO report, as to why foreign investment is crucial, yet missing.
The rules mimic those for government-run institutions, thereby making it prohibitively expensive to set up a private hospital. As a result, despite 100% FDI having been allowed in the sector for nearly a decade, there has been no foreign investment in this space.
Barring a few good chains, the sector has been taken over by institutions that short-change every possible urban regulation to make a profit. A 2008 WHO report says, ?It is primarily domestic factors that are specific to the hospital business that have limited the extent of FDI in India?s hospitals.?
The report says the biggest of these is the prohibitive cost of land in cities, which with the construction cost exceeds 50% of the cost of setting up a medical facility. ?The single most important constraint is the high cost involved in setting up hospitals, the long gestation period of such investment, and the relatively low returns,? the report said.
The report cites a survey saying construction requires an estimated R50 lakh per bed, which works out to R100 crore for a 200-bed hospital. To recover these costs, the hospital will either charge very heavily or cut corners.
From the table here (an illustrative list of investments in hospitals in urban areas) the ratio of profit after tax (PAT) to operating income is either negative or barely positive ?notwithstanding some of these being well-established players?.
In the absence of established players, municipal by-laws dictate building rules especially for institutional one that are more than four-storeyed, says PK Deb, additional chief secretary (urban development) in the Rajasthan government. While central and state rules largely prescribe how much land a hospital needs, it doesn?t specify the number of doctors or nurses it needs to have, nor describe if they need to be trained in handling emergencies.
Urban policies & the right to city in India: Critics For an Indian Administrative Service officer, being posted to a city service was till recently an early end to a promising career. The lack of supposed clout in an urban centre and a work order that basically comprised directing an army of ?safai karamcharis? kept the best assiduously out of the cities.
As a result, when urbanisation in India took off, the lack of trained officials to handle city issues became a drawback. One of the targets of JNNURM is to develop a municipal cadre within a short span of time to cover this shortage.
The rapidly emerging literature on urban issues would also be critically important to devise guidelines that serve the cause of urban policies.
?Urban Policies and the Right to the City in India?, a collection of 16 essays developed as a reference point for urban policy planners and anyone interested in city issues, was published by Unesco last week. It is posited as an articulation of the Right to the City concept under the rubric of a Unesco and UN-Habitat project that pushes for making cities more responsive to the needs of all sections, especially the poor.
Since Indian city fathers broadly understand development as the construction of a block of buildings and a ribbon of road around it, the publication shows the huge gaps we need to cover.
But despite the excellent intention, the quality of the essays fluctuates enormously. Those that are iffy suffer from categorising the issues as a ?we versus them? conflict, while some are absurd assumptions categorising the public healthcare system in urban India in the 1980s as centres for ?obtaining excellent healthcare free of cost?.
There are three sections to the compendium throughout which the authors argue that Indian cities are making sporadic progress to include migrants and therefore the vulnerable sections into the urban mosaic. The first section looks at the panoply of rights in the urban scheme of things, the second examines issues like informal sector, migration, land and also subjects like gender, caste and religion. The third explores the access to urban services.
The book has problems at two levels. The most exciting work in urban areas is happening in the sub-million towns and the peri-urban areas, the areas where the population exceeds 5,000 people and goes up to 1,00,000. These, according to the Indian Institute for Human Settlements, accounts for 35% of the country?s population in 2011 and is the fastest expanding region.
The mega cities, instead, have a very limited ability to turn things around, due to the gridlock of low funds, poor planning and weaker implementation of often progressive laws. For instance, one could go blue in the face urging public housing for those relocated from slums, but short of demolishing existing housing colonies the options are areas like Bawana in Delhi that will cost a R30 metro ride for a labourer to reach an industrial area like Mayapuri. The degree of freedom for the remaining ones in the 13 cities league (Mckinsey data) is also progressively limited. So the study would have had more impact if it went down to the new burgeoning centres instead.
The other issue is the bias ? without a demonstrated logic ? against most infrastructure development. The fact that a metro project is expensive is no argument against its necessity. No expenditure manual at the Centre or states has made the argument that cities will have to live with fewer buses as funds have been diverted for metro projects.
The study?s analysis of the role of the informal sector in an urban area is impressive, but here it has the advantage of a series of seminal works that has gone in ahead. But in this context it is interesting why it refrains from taking on the Rajiv Awaas Yojana which talks of a slum-free India (the usual UN caution?).
It is also difficult to understand why technological innovations like UID or digitisation of land records are bad with an almost divine faith in the ability of municipal bodies to administer all benefits simply because they are ?decentralised?.
