Mumbai's health infrastructure remains dismal even as city struggles to contain dengue

Despite a massive annual health budget of Rs 3,312 crore for 2017-18, the Municipal Corporation of Greater Mumbai (MCGM) is not only struggling to contain the rise of dengue in the city, it has failed to even create health infrastructure to support rising population. Instead of slowing down, government data has shown that the number of dengue cases in Mumbai has grown more than 2.5 times in the last five years. [caption id=“attachment_3831319” align=“alignleft” width=“380”] Representational image. AFP[/caption] A white paper on health released by the NGO Praja Foundation recently said the number of cases of dengue in government hospitals/dispensaries has increased from 4,867 in 2012-13 to 17,771 in 2016-17, witnessing a growth of 265 percent during the period. So, what’s missing? Why is it that despite having a robust financial support, Mumbai is unable to contain the rise of a preventable disease that killed nearly 585 people over the last five years. The problem with dengue and several other diseases such as malaria that affect Mumbaikars every year seems to be multidimensional, but at the centre of it is the MCGM and its policies. How? The first important thing that the MCGM or any municipal body in the world needs to effectively ward off the spread of dengue or any other disease in a city is an actual picture of the ground situation, something, the MCGM is clearly lacking if the Status of Health in Mumbai report is to be believed. While government data puts the total number of dengue cases in Mumbai during 2016-17 to be at 17,771, according to the Praja Foundation, the number of dengue cases could actually be much higher. A survey of data, conducted by the NGO across all 24 wards of Mumbai showed that the cases of dengue actually were as high as 1,09,443. But instead of taking note of the figures and getting its act together, the MCGM accused the NGO of  “manipulating” the data. “Praja had procured the data through RTI and we are not saying that the data is wrong, but that to some extent they have manipulated it,” Rohini Kamble, chairperson of public health committee of BMC, had told The Asian Age. The Praja Foundation report highlights several other issues that might be slowing down Mumbai’s fight against dengue, prevention of the disease, timely diagnosis and offering treatment to Mumbaikars. For starters, let’s just take a look at the number of dispensaries in Mumbai. Lack of health infrastructure The city is far behind in providing balanced or ideal health infrastructure. While the E Ward in South Mumbai has six hospitals catering to a population of 3,93.286, wards like K/E, K/W, L, M/E with nearly double the population of the E ward have just one hospital. Likewise, the R/N ward with a population above 4.3 lakhs has just one hospital and four dispensaries.

Mumbai health infrastructure Create pie charts

This highlights the fact that the corporation has failed to improve the health infrastructure in the different wards as per its population, thus creating massive gaps in affordable healthcare services across the city. It has also failed in achieving the ideal number of dispensaries that the MCGM is required to have as per the National Urban Health Mission (NUHM) and National Building Code (one dispensary is required for a population of 15,000). The city has just 171 dispensaries catering to its 1.24 crore population which is less just 1/5th of the 830 dispensaries the MCGM is required to provide in the city. Goregaon, Mulund, Dahisar had the least number of dispensaries at 2, 3, 4 respectively in the entire city. All these numbers are less even compared to the recommendations of the Rindani committee report of 1977, which had suggested that there has to be one dispensary for a population of 50,000 or 1.5 km radius. How is this related to dengue, you ask? The MCGM has made it compulsory for every dispensary in the city to keep rapid test kits for timely diagnosis of the disease as part of its anti-dengue policy. This is despite the fact that rapid test kits do not provide confirmed diagnosis of the disease. ELISA (Enzyme Linked Immunosorbent Assay) or Polymerase Chain Reaction (PCR) tests are required for confirmation, which can be done only at specified labs. This, the report argues, brings two issues to the light: first, if rapid test kits don’t give confirm diagnosis what does the BMC aims to achieve from making it available at all local dispensaries? Does the MCGM health department approve medication on a probable diagnosis? Or, offers no medication to Mumbaikars who visit these dispensaries, which by the way, are already very few. The report points out that while dispensaries across Mumbai recorded 925 positive dengue cases after rapid test kits during 2016-17, the actual number of dengue cases were 1,321 during the same period. The difference is a staggering 42 percent of the cases diagnosed positive by dispensaries. What’s more? H/E ward, M/E and R/S wards had stated dengue cases in their wards were one, zero and zero respectively. However, the results of Rapid Test Kits showed the number of positive dengue cases as 20, 41 and 38 cases in these wards respectively. [caption id=“attachment_3828649” align=“alignnone” width=“825”] Ward wise data of dengue cases in Mumbai. Image credit: Praja Foundation[/caption] Though a link between health infrastructure and dengue can’t be established, the fact that three wards with poor government health infrastructure — K/E, L, and R/N — showed the highest number of dengue cases in 2016-17 at 224, 144 and 108 respectively, it is clear that Mumbai lacks even the minimum healthcare infrastructure. Also, it’s worth noting that majority of those affected by Dengue in the city, majority of the cases per thousand households fall in the age group of 18-25 years. What’s disheartening is, across the city, the number of patients seeking treatment for dengue in dispensaries has increased by 40 times from 26 in 2012-13 to 1,039 in 2016-17. Now, if these patients were able to get clearer information about the status of their own health, they would be less likely to shift to the private sector for treatment. One would have expected these issues to be highlighted by the elected municipal councillors. But according to the report, the BMC corporators were more interested in getting names of hospitals and dispensaries changed than actually questioning health policy decision in their respective wards. “Between 2012 and 2017, 90 questions were raised by corporators in both health and standing committee meetings to seek a change in the name of a hospital, maternity home or a dispensary instead of discussing issues concerning the biomedical waste, hypertension, diabetes, diarrhoea and vaccination availability in the civic-run hospitals,” the report states. Is this an honest mistake or the municipal corporation lacks any sympathy towards the health of Mumbaikars? Irrespective of the answer, these ill-thought processes are likely to be forcing Mumbaikars to spend money from their pocket.