Hardly smart about urban health care

Despite the renewed policy focus on cities, the pandemic has exposed the weaknesses in handling a public emergency

The novel coronavirus pandemic has largely been an urban crisis so far, with megacities such as Delhi, Mumbai, Bengaluru and Chennai accounting for most of the COVID-19 positive cases. Indian cities are not only facing a public health crisis but also a larger emergency of economic issues and livelihoods. A high percentage of urban residents have lost employment during the lockdown and continue to face an uncertain future. So, are Indian cities equipped to deal with the pandemic and its aftermath?

Still an urban dream

Over the last decade-and-a-half, cities have started receiving more policy attention from the government, with dedicated national-level programmes on urban development. The ‘Smart Cities Mission’, a flagship programme of the Narendra Modi-led National Democratic Alliance (NDA) government, completed five years, in June 2020. The Mission had sought to make 100 selected cities “smart”, primarily through an “Area-Based Development” model under which a small portion of the city would be upgraded by retrofitting or redevelopment.

Five years after its launch, the enthusiasm regarding Smart Cities seems to have waned. While “smart cities” and “bullet trains” were buzzwords in the initial years of the first term of the NDA government, over the last few years there has hardly been any mention about them by the top political leadership. Many of the projects undertaken under the ‘Smart Cities Mission’ are behind schedule. According to the Ministry of Housing and Urban Affairs, of the 5,151 smart city projects across the 100 cities, while around 4,700 projects have been tendered, only 1,638 projects have been completed. In terms of expenditure, of the total investment of ₹2,05,018 crore, only projects worth ₹26,700 crore have been completed. Hence, the idea of completely transforming India’s derelict cities into “smart cities” within five years now seems a pipe dream.

A blind spot

Most of these Smart Cities are now reeling under the devastation caused by COVID-19. Some cities have been using the Integrated Command and Control Centres created under the ‘Smart Cities Mission’ as “war rooms” for monitoring real time data regarding the spread of the virus. However, tackling the larger public health and economic fallout remains a more difficult challenge.

In fact, the ‘Smart Cities Mission’ has given short shrift to basic services such as public health. An analysis of the smart city projects under the Mission shows that only 69 of over 5,000 projects undertaken under the Mission were for health infrastructure. These projects are for an estimated cost of ₹2,112 crore, amounting to just around one per cent of the total mission cost. Hence, public health seems to be a major blind spot in India’s smart city dreams.

While one could argue that health infrastructure is not a core element of a “smart” city, the ‘Smart Cities Mission’ was never focused merely on technology; it had the stated aim of improving the quality of life of urban residents. Further, public health is an essential local government function in India’s constitutional scheme. As per the 12th Schedule of the Constitution, introduced by the 74th Amendment, “public health” is one of the 18 functions that are to be devolved to the municipalities. However, public health infrastructure of cities has often been neglected over the years and new programmes such as the ‘Smart Cities Mission’ have further driven local governments away from their core responsibilities.

Strengthening local capacities

The COVID-19 crisis has exposed the weaknesses in the institutional and human capacity of Indian cities to handle a public health emergency. Despite the renewed policy focus on cities, India’s urban local bodies continue to be financially and administratively weak and heavily understaffed. There is also high level of vacancy of Accredited Social Health Activist (ASHA) workers, the frontline public health workers carrying out contact tracing, in urban areas, especially in COVID-19 hotspot cities such as Mumbai.

The relative success of Kerala in containing the pandemic has shown how a decentralised political and administrative system with strong local governments and high investment in local public health care can be effective. In the absence of such participative local government institutions, authorities in some cities have roped in resident welfare associations to monitor COVID-19 cases. In this process, resident welfare associations have become emboldened and are often imposing draconian rules as they exercise a form of private authoritarianism in their neighbourhoods.

To tackle the COVID-19 crisis, it is important to strengthen local government capacities, invest heavily in urban public health systems, and promote programmes that improve the livelihoods of urban vulnerable communities. The ‘Smart Cities Mission’, with its skewed priorities and parallel governance structures of Special Purpose Vehicles, offers little hope in this regard. Instead, programmes such as the National Urban Livelihoods Mission and National Urban Health Mission, which have lately received limited focus and resources, need to be strengthened.

Think jobs too

Further, it is time to consider the introduction of a national urban employment guarantee programme that assures jobs for urban residents and strengthens the capacities of urban local bodies. Kerala has been running such a scheme since 2010 and States such as Odisha, Himachal Pradesh and Jharkhand have also recently launched similar initiatives in the wake of the COVID-19 crisis. As Indian cities face an unprecedented challenge, it is important to get the priorities of urban development right and invest in programmes that improve the health and livelihoods of its residents.

Mathew Idiculla is a lawyer and researcher on urban issues, and a consultant with the Centre for Law & Policy Research, Bengaluru