Report onThe STATE of HEALTH of MUMBAI

July 2013

Supported by

FORD FOUNDATION MADHU MEHTA FOUNDATION1

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First the Good News

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Years 2008-09 2009-10 2010-11 2011-12 2012-13Number of Malaria Cases in government dispensaries/hospitals in Mumbai

MCGM dispensaries/hospitals 21766 38336 75992 38616 18296

State hospitals 1606 1562 2457 1212 1280Other government dispensaries/hospitals Data was collected only for the period 2012-13 2363

Total Cases 23372 39898 78449 39828 21939Population/Total Cases 532 312 158 312 567

Number of Deaths due to Malaria in MumbaiTotal Deaths 353 669 1222 385 230Total Cases/Total Deaths 66 60 64 103 95

Malaria

From a high in 2010-11 of one in every 158 person suffering with Malaria in 2012-13 it was brought down

to one in every 567.

• Data as per RTI• Population taken as per census 2011 the population taken is 1,24,32,830

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But other diseases/ailments are threatening …

• Dengueo At least one in 2,555 people in Mumbai had dengue during 2012-13

• Tuberculosiso In the past 5 years, at least 40,000 people in Mumbai have died of TB

• Cholerao In the past three years (2009-2011) 8 people died of cholera in

Mumbai. In 2012-13 alone, cholera took 9 lives

are all on the rise…

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Years 2008-09 2009-10 2010-11 2011-12 2012-13Number of Dengue Cases in government dispensaries/hospitals in Mumbai

MCGM dispensaries/hospitals 649 762 1097 1759 4447

State hospitals 33 104 307 120 289Other government dispensaries/hospitals Data was collected only for the period 2012-13 131

Total Cases 682 866 1404 1879 4867Population/Total Cases 18230 14357 8855 6617 2555

Number of Deaths due to Dengue in MumbaiTotal Deaths 24 64 79 52 74Total Cases/Total Deaths 28 14 18 36 66

Dengue (as per RTI data)

One in every 18230 persons had dengue in 2008-09. Every year it has been dipping and now last year in

2012-13 one out of every 2555 person had dengue.

• Data as per RTI• Population taken as per census 2011 the population taken is 1,24,32,830

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Years 2008-09 2009-10 2010-11 2011-12 2012-13Number of Tuberculosis Cases in government dispensaries/hospitals

MCGM dispensaries/hospitals 30473 30263 34431 30016 34873

State hospitals 2101 848 1090 659 946Other government dispensaries/hospitals Data was collected only for the period 2012-13 598

Total Cases 32574 31111 35521 30675 36417Population/Total Cases 382 400 350 405 341

Number of Deaths due to Tuberculosis in MumbaiTotal Deaths 8196 8205 9168 7041 6921Total Cases/Total Deaths 4 4 4 4 5

Tuberculosis (as per RTI data)

One in every 341 persons had tuberculosis in 2012-13.

Mortality due to Tuberculosis is one in every five cases in 2012-13.

In the last five years (2008-09) 39,531 people have died in Mumbai due to TB.• Data as per RTI• Population taken as per census 2011 the population taken is 1,24,32,830

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Years 2008-09 2009-10 2010-11 2011-12 2012-13Number of Cholera Cases in government dispensaries/hospitals in Mumbai

MCGM dispensaries/hospitals 82 96 224 168 187

State hospitals 14 28 12 10 11Other government dispensaries/hospitals Data was collected only for the period 2012-13 0

Total Cases 96 124 236 178 198Population/Total Cases 129509 100265 52681 69847 62792

Number of Deaths due to Cholera in MumbaiTotal Deaths 13 2 3 3 9Total Cases/Total Deaths 7 62 79 59 22

Cholera (as per RTI data)

Compared to 129,509 cases in 2008-09 one in every 62,792 person had cholera in 2012-13.

Mortality rate was one in 7 cases in 2008-09. It improved to one in 62 in 2009-10. But has now

again dipped to one in every 22 in 2012-13.• Data as per RTI• Population taken as per census 2011 the population taken is 1,24,32,830

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Medical facilities used by citizens

31% of Mumbaikars use only government dispensary/hospital facilities.

Even in lower economic strata usage of Private & Charitable facilities is high [SEC D (65%),

SEC E (46%)].

Type of Facilities Overall SEC A SEC B SEC C SEC D SEC E

Only Government dispensaries / hospitals

31 26 31 31 30 48

Only Private or Charitable clinics / hospitals

62 66 62 58 65 46

Using both private and government hospitals

7 8 8 11 5 6

Total 100 100 100 100 100 100

Data as per Praja’s citizen survey 2013

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Estimated % of annual income spent on hospital/medical costs

The households spending more than 6% of annual income on hospital/medical costs are

maximum in lower socio-economic strata i.e. in SEC E (59%) followed by SEC C (56%), SEC D

(54%), SEC B (54%) and are least in SEC A (53%).

Data as per Praja’s citizen survey 2013

Amount spent from total income

(in %) In % SEC A SEC B SEC C SEC D SEC E More than 11% 17 18 18 18 15 17

6% to 10% 38 35 36 38 39 42Less than 5% 45 47 46 44 46 41

Total 100 100 100 100 100 100

Average spent from total income

(in %)

7.1 6.9 7 7.3 6.9 7.6

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Estimated cases per 1000 households

The top most strata of socio-economic class (SEC A) had more cases per 1000 households of

Malaria, Dengue, Diabetes; while for cancer SEC B had more cases per 1000 households.

Data as per Praja’s citizen survey 2013

Diseases and AilmentsTotal Estimated Cases

Overall SEC A SEC B SEC C SEC D SEC EMalaria 80 139 74 62 79 44Dengue 16 20 22 09 17 10Diabetes 49 67 45 43 49 45Cancer 06 09 11 02 06 07

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Ward-wise break up of diseases/ailments in 2012-13Ward Provisional Population 2011 Malaria Dengue Tuberculosis Diabetes Diarrhoea

A 148,432 602 342 327 1449B 127,005 99 117 756 1077C 165,583 162 120 47 1946D 346,719 112 250 413 4649E 413,662 213 748 327 2208

F/N 528,767 362 3 382 618 1547F/S 359,980 846 185 216 4259G/N 602,328 312 457 1068 3073G/S 414,038 201 178 168 4036H/E 555,179 223 1 539 220 4224H/W 329,952 170 757 168 1878K/E 817,684 831 16 1069 1770 6641K/W 718,375 308 398 1146 3011

L 891,208 512 994 1402 11967M/E 806,433 178 135 592 2565M/W 412,163 131 1 111 303 2656

N 622,594 353 1 140 579 5972P/N 943,605 104 120 155 2790P/S 461,304 56 1 58 311 949R/C 431,791 106 183 367 2633R/N 561,870 88 98 78 580R/S 690,128 230 2 613 2420 1925

S 742,053 162 1 440 586 3822T 341,977 154 246 177 3252

Municipal Hospital 12408 4441 26198 7424 19358

State Hospital 1280 289 946 728 785Government

Hospital 1736 111 593 2579 575

Total 12,432,830 21939 4867 36417 24945 99827

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Deliberations by Councillors and MLAs of Mumbai

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Deliberations on health by Councillors during March’12 to March’13

34 elected (councillors) members of the Public Health have asked only 56

questions on health in 16 meetings.

11 of them have not asked a single question.

In various committee (GBM, Ward, etc.) meetings a total of 200 questions

were raised on health by 227 councillors.

138 out of 227 have not raised a single issue on health.

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Deliberations on health by 32 (excluding 4 ministers) MLAs during Budget’12, Monsoon’12 & Winter’12 sessions

Total of 780 questions were raised of which 446 were related to Mumbai or

to Schemes/Policies on health, rest were related to other parts of the state not

having direct implication to health policies, programmes, schemes in Mumbai.

MLAs, Baldev Khosa and Milind Kamble have not asked a single question,

while Annie Shekhar, Chandrakant Handore and Kripashankar Singh have asked

only a single question on health.

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Inferences …

If the government had access to information from the non-government sector

healthcare practitioners

Private and Charitable Clinics/Dispensaries

Private and Charitable Hospitals

Private Pathological Laboratories

Government will be able to collect more robust and rich data across the city

and across demographics

Which would enable the government to create more meaningful, effective

and efficient health programme, scheme and policy

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What needs to be done

Public Health Surveillance (Health Information System) needs to be

immediately augmented

Government must establish through legislative process a mechanism to

regularly collect health data from private and charitable health facilities

Government needs to focus on primary healthcare and extend its reach and

efficiency to cater towards fulfilling needs of lowest strata of socio-economic

(SEC E) households

Tailor-made health awareness campaigns need to be designed to reach

different socio-economic classes for greater impact

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THANK YOU

Questions