Mumbai saw a growth in malaria and dengue cases between 2013 and 2018, much above what the Brihanmumbai Municipal Corporation reported, going by the ‘State of Health in Mumbai report’ released by Praja Foundation on Thursday.
The foundation works in the field of research on various civic issues and comes out with annual reports on each of them. Its health report focuses on public health infrastructure in the city and analyses data from the government as well as non-government sources accessed through the Right to Information Act. Praja had commissioned a survey through its partner, Hansa Research, and 20,078 households were surveyed.
As per the BMC records, the number of dengue cases in the city went up to 14,345 in 2017-18 from 7261 in 2013-14. In 2017-18, number of malaria cases in government hospitals and dispensaries was reportedly at 11,163. However, Praja’s independent survey on dengue, malaria throws up even more serious results. This data has pegged the figures at 1,15,268 for malaria and 1,21,775 for dengue in 2017-18. “An important point to consider here is that the data is on disease prevalence, for instance, malaria patients who have availed of government facilities, and does not include patients who did not go to such a facility. Hence, to get an estimate of cases for malaria and dengue, we have extrapolated them through our household survey,” said Tristan Briganza of Praja Foundation.
Similarly, according to data from the government, TB cases rose to 55,130 in 2017-2018 from 41,479 in 2013-2014. In 2017-2018, the worst affected wards with TB partients were L (Kurla), H-East (Santacruz) and S (Bhandup).
Lack of insurance
The survey also states that 76% of Mumbai residents do not have medical insurance, making medical care more expensive for lower socioeconomic households. The estimated annual expenditure on health per household has increased to 9.1% in 2016-2017 from 8.4% in 2014-2015. The estimated overall expenditure for health is ₹24,766 crore per year.
Praja’s Yogesh Mishra said, “We have various insurance schemes which would reduce medical expenses, but there is no awareness. For those belonging to the lower economic strata of society, hefty medical bills would make them bankrupt.”
“Mumbai is very rich in Registration of Births and Deaths data. In January 2016, the civil registration system was set up for central data collection, but the system only serves the purpose of generating birth and death certificates and serves no purpose for monitoring mortality patterns,” said Milind Mahske, Project Director of Praja, said.
‘Huge dropout’
A serious discrepancy in the number of hospitals and dispensaries in certain wards throughout the city show a huge dropout of tuberculosis, malaria and dengue patients from government hospitals. There is especially a vacuum in the number of dispensaries that are sanctioned as compared to how many are available per ward.
P-South ward has over 4 lakh residents with only two dispensaries available to them when the average requirement as per the National Urban Health Mission and NBC is 31. With over 29 dispensaries short, the annual family income spent is around 11%. M-East has over 8 lakh residents with one government hospital when there should be 54, making each family spend up to 12% of their annual income on their health. In such wards the patients would have to go to expensive private hospitals, it said. “We need to augment our primary healthcare mechanism. A city like Mumbai should have a robust health management information system. Creating open data to the public would show us where we stand and which policies are being framed by the government in our welfare,” said Nitai Mehta, Managing Trustee, Praja.
The foundation also analyses the performance of elected representatives on this front. Out of the 435 questions presented to the public health committee in 2017-2018, 12 questions were asked only on naming or renaming hospitals, with just one relating to malaria and dengue and two on tuberculosis.
