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         WHITE PAPER




          Report on
The STATE of HEALTH of MUMBAI


            Supported by




      FORD FOUNDATION
   MADHU MEHTA FOUNDATION
                 1
                           Report on the STATE of HEALTH of MUMBAI
www.praja.org

                                                 Table of Content

                                                                                                         Page
Sr. No.
                                                      Title                                               No.

   I      Foreword                                                                                         4

  II      Information on organisations Involved                                                            6

  III     Note by Healis Sekhsaria Institute for Public Health                                             7

  IV      Section A: Compressive of State of Health of Mumbai                                              8

          Section B: Data collected from Municipal Dispensaries, Municipal Hospitals and State            16
  V
          Hospitals

  VI      Section C: Questions asked by Municipal Councillors and MLAs                                    23

                                                     Tables

  1       Estimated percentage of Annual Family Income spent on hospital/medical costs                     9

  2       Whether Respondents has Medical Insurance                                                        9

  3       Estimated Citizens using Government Dispensaries/Hospital                                        9

  4       Estimated Occurrence of Diseases/Ailments for the year 2011-12                                  10

  5       Ward wise Malaria as per survey                                                                 11

  6       Ward wise Hypertension as per survey                                                            12

  7       Ward wise Tuberculosis as per survey                                                            13

  8       Ward wise Diabetes as per survey                                                                14

  9       MLA constituency wise survey                                                                    15

  10      Sensitive Diseases/Ailments as per RTI Data                                                     17

  11      Ward wise registered cases of Malaria (April 2008 to March 2012) as per RTI data                18

          Ward wise registered cases of Diarrhoea (April 2008 to March 2012) as per RTI                   19
  12
          data

          Ward wise registered cases of Hypertension (April 2008 to March 2012) as per RTI                20
  13
          data



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                                                                         Report on the STATE of HEALTH of MUMBAI
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     Ward wise registered cases of Tuberculosis (April 2008 to March 2012) as per RTI         21
14
     data

15   Ward wise registered cases of Diabetes (April 2008 to March 2012) as per RTI data        22

16   Questions asked on health by councillors (March 2012 to May 2012)                        24

17   Issues raised/Questions asked by Councillors                                             25

     Questions asked on health by MLAs during following sessions: Budget 2010,                26
18
     Monsoon 2010, Winter 2010, Budget 2011, Monsoon 2011 and Winter 2011

19   Issues raised/Questions asked by MLAs                                                    27




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                                                             Report on the STATE of HEALTH of MUMBAI
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I.      Foreword

Is Mumbai prepared to tackle its woes in health management? Our report on the state of health of Mumbai
raises several red flags. While the city’s health is a BMC concern, public health issues involve the state and the
centre as well. It calls for some policy level changes and a deep introspection by all the custodians of public
health.

The Declaration of Alma-Ata in 1978, adopted at the International Conference on Primary Health Care, and
accepted by all member countries of the World Health Organization (WHO) expressed the need for urgent action
by all governments, all health and development workers, and the world community to protect and promote
the health of all people. "Health For All" was the goal set up at this Conference.

Three decades later, we still have almost 25% of city’s population suffering from either malaria, TB, diarrhoea,
diabetes or hypertension. For a city of over 10 million populations, this is a cause for serious concern. 80% of
the city’s population is not insured at all. Less than 25% of Mumbai’s population visit municipal hospitals and
dispensaries.

To put things in perspective, the new agenda for Public Health in India includes the epidemiological transition
(rising burden of chronic non-communicable diseases), demographic transition (increasing elderly population)
and environmental changes. The causes of health inequalities lie in the social, economic and political
mechanisms that lead to social stratification according to income, education, occupation, gender and race or
ethnicity. Lack of adequate progress on these underlying social determinants of health has been acknowledged
as a glaring failure of public health.

There indeed is an urgent call for revitalizing primary health care based on the principles outlined at Alma-Ata in
1978: Universal access and coverage, equity, community participation in defining and implementing health
agendas and inter-sectoral approaches to health. These principles remain valid, but must be reinterpreted in
light of the dramatic changes in the health field during the past 30 years.

The state of health of Mumbai during the last three years has raised several red flags. From 2008-09 (taken as
base year with 100 as a denominator), the incidence of sensitive diseases in the city within the past 4 years has
almost doubled in some of the diseases.

•    Malaria has gone up to 171
•    Diarrhoea to 123
•    Dengue to 276
•    Cholera to 185
•    Hypertension to 90
•    TB to 95
•    Diabetes to 89
•    Typhoid to 91
•    Hepatitis B to 94

And these figures are after the slight improvement in 2011-12 from previous year that had shown exceptional
hike in almost all diseases, not just in Mumbai but across the country. So while BMC needs to be commended in
curtailing the growth rate of diseases from last year, it clearly is not enough. Identification of health objectives

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                                                                          Report on the STATE of HEALTH of MUMBAI
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and targets is one of the more visible strategies to direct the activities of the health sector. For instance, in the
United States, the “Healthy People 2010” offered a simple but powerful idea by providing health objectives in a
format that enables diverse groups to combine their efforts and work as a team.

Similarly, in India, we need a road map to “better health for all” that can be used by states, communities,
professional organizations and all sectors. It will also facilitate changes in resource allocation for public health
interventions and a platform for concerted inter-sectoral action, thereby enabling policy coherence. Mumbai
has perhaps the greatest allocation of funds and resources for its health agenda. Can we seriously consider some
policy level amendments and at least attempt to make Mumbai a role model for public health issues all across
India?

NITAI MEHTA

Managing Trustee, Praja Foundation




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                                                                           Report on the STATE of HEALTH of MUMBAI
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II.     Information on organisations Involved

Praja Foundation:

Founded in 1998, the PRAJA Foundation is a non-partisan voluntary organization which empowers the citizen to
participate in governance by providing knowledge and perspective. PRAJA aims to provide ways in which the
citizen can get politically active and involved beyond the ballot box, thus promoting transparency and
accountability.

PRAJA's goals are: empowering the citizens, elected representatives & government with facts and creating
instruments of change to improve the quality of life of the citizens of India. PRAJA is committed to creating a
transparent, accountable and efficient society through people's participation.

Healis -Sekhsaria Institute for Public Health (Healis):

Founded in 2004, registered under Section 25 of the Indian Companies Act, 1956 on April 29, 2005 and thus
became a separate legal entity as a Not for Profit Organization. Healis primarily works towards advancing public
health through innovative science and evidence-based policy by conduct quality research in public health and
carry forward its outcome for the benefit of the society. Healis is committed to improving the public health in
India and in other developing countries through epidemiological research. Healis is one of the few institutes that
are solely dedicated to public health research and thus a leader in this field in India. Healis works in
collaboration with leading National and International Health and Research organizations.

Hansa Research:

Hansa Research is a full service global market research agency conducting market research in 77 countries
globally with offices in India and US. It is the ONLY global market research agency headquartered in India. Under
the leadership of Mr. Ashok Das, Managing Director, Hansa Research became one of the fastest growing market
research agencies in India. It specializes in Media, Telecom, Financial Services, Consumer Products and
Technology spaces. With research offices across India and the U.S., Hansa Research’s infrastructure is
comparable to the best in the industry.

Hansa Research also has considerable experience in the space of opinion polls as it has done several studies
dealing with social, cultural and political issues in the country.




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III.    Note by Healis Sekhsaria Institute for Public Health

The principles enshrined in our Constitution, particularly in the Directives, emphasise the role of the state not
only for protecting the health and but also for improving the health of its citizens.

“Duty of the State to raise the level of nutrition and the standard of living and to improve public health.
The State shall regard the raising of the level of nutrition and the standard of living of its people and the
improvement of public health as among its primary duties........”
                                               from Part IV of Indian Constitution, Directive Principles of State Policy

Since independence, subsequent national, state and local governments have hence taken up several initiatives
to control/eradicate diseases, improve environmental sanitation, raise the standard of nutrition, control
population and improve public health. However, public health in India is beset by a vast spectrum of problems.

It is important for us to identify big problems and focus upon them. It is to be understood that a solution to a big
problem will help in improving public health in substantive manner. For public health field research, problems
that can be addressed by population-based epidemiological research have to be selected. Solutions have to be
found to a problem function through evidence-base for formulating policies that should advance public health.

Surveillance systems (health information system) play and extremely important role here; they can provide
accurate understanding of the problem. Hence, setting up strong surveillance system should be priority of the
administrator and the data process for capturing should be scientific, up-to-date and sacrosanct. Equally
importantly, the data captured should be disseminated at all levels to all stakeholders periodically and
suggestions should be actively sought through a more institutionalised manner from all (within the
administration and also from the civil society researchers).

The primary objective of any robust health information system should be to provide reliable, relevant, up-to-
date, adequate, timely and reasonably complete information for health managers at all levels (Local, State and
Central) and to researchers (NGOS, Media and Academicians) to assist planners/researchers for monitoring the
health services/state, analysing trends and making policies.

Even the Millennium Development Goals (MDG), place health at the heart of development; three of the eight
goals are directly related to health and the others have important indirect effects on health. Hence, the data
that is captured locally must be synthesised with global data for overall evaluation of evidence and for drawing
attention towards important but neglected issues. This will further strengthen the health information system.

The immediate need of the hour for our country today is to have such a robust, up-to-date health information
system that will further complement and assist in achieving the goals of all our present and proposed
programmes on improving public health. And no part of our country is better poised to build a more perfect
health information system than Mumbai; with all our administrative resources (local, state and national) and
strong presence of civil society including businesses and range of private organisations. Mumbai can really take
the lead here and then the system can be taken to other parts of the country thus making strides in the direction
of achieving those State Directives enshrined in our Constitution on improving public health.


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                                                                             Report on the STATE of HEALTH of MUMBAI
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Dr. MANGESH PEDNEKAR, Director (Research & Development), Healis

IV.      Section A: Compressive of State of Health of Mumbai
Praja Foundation had commissioned the household survey to Hansa Research and the survey methodology
followed is as below:

•     In order to meet the desired objectives of the study, we represented the city by covering a sample from
      each of its 227 wards. Target Group for the study was :

         Both Males & Females
         18 years and above
         Belonging to that particular ward.
•     Sample quotas were set for representing gender and age groups on the basis of their split available through
      Indian Readership Study (Large scale baseline study conducted nationally by Media Research Users Council
      (MRUC) &Hansa Research group) for Mumbai Municipal Corporation Region.
•     The required information was collected through face to face interviews with the help of structured
      questionnaire.
•     In order to meet the respondent within a ward, following sampling process was followed:
         4 – 5 prominent areas in the ward were identified as the starting point
         In each starting point about 12 – 15 individuals were selected randomly and the questionnaire was
         administered with them.
•     Once the survey was completed, sample composition of age & gender was corrected to match the
      population profile using the baseline data from IRS. This helped us to make the survey findings more
      representatives in nature and ensured complete coverage.
•     The total study sample was 15,191.




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Table 1: Estimated1 percentage of Annual Family Income spent on hospital/medical costs

             In %             Amount spent from total income (in %)              Estimated Household2
            4.26                        More than 30%                                     1,13,171
            7.15                         21% to 30 %                                      1,89,946
            18.97                         11% to 20%                                      5,03,955
            38.92                          6% to 10%                                     10,33,944
            30.7                         Less than 5%                                     8,15,572
             100                             Total                                       26,56,588


More than 30% of households spend 11% or more of their annual income on hospital/medical costs.



Table 2: Whether Respondents has Medical Insurance

                                                                             In %              In no. of respondents
                Respondents have medical insurance                           20.45                    3,107
              Respondents not having medical insurance                       79.55                    12,084
                                  Total                                       100                     15,191




Table 3: Estimated Citizens using Government Dispensaries/Hospital


                                   Estimated citizens     Estimated citizens
                                                                                        No. of          Available No.
                Provisional            using Govt.            using Govt.
    Ward                                                                            Municipal/State     of Municipal
              Population 2011     Dispensary/Hospital    Dispensary/Hospital
                                                                                      Hospitals         Dispensaries
                                          (in %)             (in numbers)


    Total       1,24,32,830               24.49               30,44,800                   28                   160



Less than 25% of citizens in Mumbai use government dispensary/hospital; while the rest use private
facilities.


1
 The estimated cases percentage of people is computed out of the total sample of 15,191 households surveyed across the
city.
2
 Household computed at the rate of 4.68 people per household based on Provisional Population for 2011
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Table 4: Estimated Occurrence of Diseases/Ailments for the year 2011-12


                                                 Total Estimated          Estimated Cases Per 1000
              Diseases/Ailments
                                                      Cases                     households

                   Diabetes                          274,957                        104
                   Malaria                           392,378                        148
                 Tuberculosis                        63,227                         24
                 Hypertension                        78,635                         30
                   Cancer                            39,583                         15




In 2011-12, for every 1000 households there was atleast one malaria patient was reported in 148
households.




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Table 5: Ward wise Malaria as per survey

                                                                                                       Estimated cases per
                                     Provisional Population              Estimated3 Cases
              Ward                                                                                      1000 households
                                              2011
                                                                               2011-124                        2011-12
                A                              148,432                          4,710                            149
                B                              127,005                          11,593                           427
                C                              165,583                          3,768                            107
                D                              346,719                          8,809                            119
                E                              413,662                          27,675                           313
               F/N                             528,767                          16,507                           146
               F/S                             359,980                          8,861                            115
               G/N                             602,328                          17,310                           135
               G/S                             414,038                          21,879                           247
               H/E                             555,179                          18,945                           160
               H/W                             329,952                          18,380                           261
               K/E                             817,684                          29,283                           168
               K/W                             718,375                          18,773                           122
                L                              891,208                          29,307                           154
               M/E                             806,433                          22,435                           130
               M/W                             412,163                          8,640                            98
                N                              622,594                          19,104                           144
               P/N                             943,605                          16,574                           82
               P/S                             461,304                          16,776                           170
               R/C                             431,791                          15,823                           172
               R/N                             561,870                          11,213                           93
               R/S                             690,128                          11,355                           77
                S                              742,053                          20,692                           131
                T                              341,977                          3,749                            51


B, E & H/W ward have highest number of people suffering from Malaria. In B ward, 427 out of every
1000 households had some person suffering from Malaria.




3
    Estimated cases covers occurrences for the entire ward including cases diagnosed in public as well as private facilities.
4
    All the years (E.g. 2008-09) in this paper are financial years (E. g. April 08 to March 09).
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Table 6: Ward wise Hypertension as per survey

                                                                               Estimated cases per
                           Provisional Population      Estimated Cases
         Ward                                                                   1000 households
                                    2011
                                                           2011-12                   2011-12
          A                       148,432                   1,085                      34
          B                       127,005                   2,442                      90
          C                       165,583                   1,995                      56
          D                       346,719                   1,497                      20
          E                       413,662                   4,835                      55
         F/N                      528,767                   4,429                      39
         F/S                      359,980                   2,123                      28
         G/N                      602,328                   2,574                      20
         G/S                      414,038                   3,831                      43
         H/E                      555,179                   5,255                      44
         H/W                      329,952                   2,270                      32
         K/E                      817,684                   8,876                      51
         K/W                      718,375                   3,423                      22
          L                       891,208                   4,323                      23
         M/E                      806,433                   3,739                      22
         M/W                      412,163                    881                       10
          N                       622,594                   5,002                      38
         P/N                      943,605                   3,085                      15
         P/S                      461,304                   2,366                      24
         R/C                      431,791                   1,624                      18
         R/N                      561,870                   4,130                      34
         R/S                      690,128                   1,076                       7
          S                       742,053                   4,947                      31
          T                       341,977                    848                       12




B, C & E ward have highest number of people suffering from Hypertension. In B ward, 90 out of 1000
households had some person suffering from Hypertension.




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Table 7: Ward wise Tuberculosis as per survey

                                                                             Estimated cases per
                            Provisional Population    Estimated Cases
         Ward                                                                 1000 households
                                     2011
                                                          2011-12                  2011-12
          A                        148,432                  257                       8
          B                        127,005                 2,963                     109
          C                        165,583                  513                      15
          D                        346,719                  556                       8
          E                        413,662                 6,921                     78
         F/N                       528,767                 2,508                     22
         F/S                       359,980                 2,146                     28
         G/N                       602,328                 3,771                     29
         G/S                       414,038                 2,796                     32
         H/E                       555,179                 1,578                     13
         H/W                       329,952                 2,891                     41
         K/E                       817,684                 4,665                     27
         K/W                       718,375                 1,857                     12
          L                        891,208                 3,790                     20
         M/E                       806,433                 7,358                     43
         M/W                       412,163                 2,413                     27
          N                        622,594                 2,142                     16
         P/N                       943,605                 1,794                      9
         P/S                       461,304                 1,232                     13
         R/C                       431,791                  397                       4
         R/N                       561,870                  924                       8
         R/S                       690,128                  767                       5
          S                        742,053                 6,168                     39
          T                        341,977                 1,330                     18




B, E & M/E ward have highest number of people suffering from Tuberculosis. In B ward, 109 out of
1000 households had some person suffering from TB.




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Table 8: Ward wise Diabetes as per survey

                                                                             Estimated cases per
                            Provisional Population    Estimated Cases
         Ward                                                                 1000 households
                                     2011
                                                          2011-12                  2011-12
          A                        148,432                 4,421                     139
          B                        127,005                 1,180                     44
          C                        165,583                 2,993                     85
          D                        346,719                 6,423                     87
          E                        413,662                 12,516                    142
         F/N                       528,767                 12,112                    107
         F/S                       359,980                 6,538                     85
         G/N                       602,328                 9,640                     75
         G/S                       414,038                 7,060                     80
         H/E                       555,179                 20,214                    170
         H/W                       329,952                 10,237                    145
         K/E                       817,684                 18,241                    104
         K/W                       718,375                 14,721                    96
          L                        891,208                 24,375                    128
         M/E                       806,433                 19,833                    115
         M/W                       412,163                 7,539                     86
          N                        622,594                 15,139                    114
         P/N                       943,605                 19,820                    98
         P/S                       461,304                 5,076                     52
         R/C                       431,791                 9,291                     101
         R/N                       561,870                 11,550                    96
         R/S                       690,128                 10,927                    74
          S                        742,053                 19,281                    122
          T                        341,977                 4,815                     66




H/E, H/W & E ward have highest number of people suffering from Diabetes. In H/E ward, 170 out of
1000 households had some person suffering from Diabetes.




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Table 9: MLA constituency wise survey5

                                                            Malaria6    Hypertension    Tuberculosis    Diabetes
         MLA Name            Area                            (in %)        (in %)          (in %)        (in %)
Gopal Shetty                 Borivali                         11.3           0.1             0.2           8.8
VinodGhosalkar               Dahisar                           9.3           3.4             0.8           9.6
Pravin Darekar               Magathane                        25.7           4.2             0.8          12.0
Sardar Tara Singh            MulundAmboli                      5.1           1.2             1.8           6.6
Mangesh Sangle               Vikhroli                         18.2           6.0             3.5          13.1
Shishir Shinde               Bhandup West                     13.1           3.1             3.9          12.2
Ravindra Waikar              Jogeshwari East                   1.5           6.8             0.6          10.6
Rajhans Singh                Dindoshi                          1.5           6.8             0.6          10.6
Ramesh Singh Thakur          Kandivali East                    7.4           1.1             1.1           9.1
YogeshSagar                  Charkop                           8.0           0.4             0.0           6.0
AslamShaikh                  Malad West                        8.2           1.5             0.9           9.8
Subhash Desai                Goregaon                         17.0           2.4             1.3           5.2
Baldev Khosa                 Versova                           8.7           2.8             1.0          13.1
Ashok Jadhav                 Andheri West                     13.3           2.1             1.3           8.6
Suresh Shetty                Andheri East                     21.0           5.0             3.1          11.2
Krishnakumar Hegde           Vile Parle                       17.6           3.9             0.4          22.1
Arif Naseem Khan             Chadivali                        16.9           3.7             3.3           7.6
Ramchandra Kadam             Ghatkopar West                   13.0           2.4             1.8           9.2
Prakash Maheta               Ghatkopar East                   14.2           4.3             0.7          13.0
Abu Asim Azmi                Mankhurd                          9.8           1.0             2.7           8.6
Nawab Malik                  Anushakti Nagar                  13.0           2.2             4.3          11.5
Chandrakant Handore          Chembur                           9.8           1.0             2.7           8.6
Milind Kamble                Kurla (SC)                       15.4           2.3             2.0          12.8
Kripashankar Singh           Kalina                           15.1           4.7             1.9          14.2
Prakash Sawant               Vandre East                      26.1           3.2             4.1          14.5
Ziyauddin Sidikki            Vandre West                      26.1           3.2             4.1          14.5
Varsha Gaikwad               Dharavi (SC)                      9.7           2.5             1.6           3.1
Jagannath Shetty             SionKoliwada                     19.9           2.7             1.1           9.7
Kalidas Kolambkar            Wadala                           11.0           4.8             3.0          11.4
Nitin Sardesai               Mahim                            15.8           1.7             3.8          10.2
Sachin Ahir                  Worli                            24.7           4.3             3.2           8.0
Bala Nandgaonkar             Shivadi                          11.5           2.8             2.8           8.5
Madhukar Chavan              Byculla                          34.1           6.3             8.6          11.8
Mangal Prabhat Lodha         Malbar Hill                      11.9           2.0             0.8           8.7
Amin Amir Ali Patel          Mumbadevi                        10.7           5.6             1.5           8.5
Annie Shekhar                Colaba                           14.9           3.4             0.8          13.9

5
As per the survey data, Byculla is the worst assembly constituency, followed by Vandre East and Vandre
West; while Byculla is worst for Malaria cases.
6
 The estimated cases percentage of households suffering from the disease/ailment out of the total sample of 15,191
households surveyed across the city.
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V.      Section B: Data collected from Municipal Dispensaries, Municipal Hospitals and
        State Hospitals
The data that is compiled and presented in this section is collected through RTI from all the (160) municipal
dispensaries, (24) municipal hospitals and (4) state hospitals in Mumbai. Praja since 2008 has been meticulously
collecting this data, collating it and presenting it through media and also directly to all the stakeholders in
improving public health in the city.

The last year white paper released about the same time in 2011, emphasised a lot on the increasing trends in
occurrences of diseases/ailments, particularly, malaria. The public health department officials through various
programmes national and local vector control programmes particularly the ‘Fight the bite’ campaign acted
promptly and the data this year shows a vast reduction in malaria cases. It is very important that such strong
programmes and focussed campaigns be carried out in anticipation of any epidemic breaking out; thus
improving the overall public health in the city. Kudos to the MCGM (Municipal Corporation of Greater Mumbai)
and its officials for getting it right. We believe that these efforts need to be continued and strengthened further
for improving the public health in the city.




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Table 10: Sensitive Diseases/Ailments as per RTI7 Data
        :

                                          Sensitive Diseases/Ailments
                                           2008-09              2009-10              2010-
                                                                                         -11              2011-12
               Malaria                      23,317               39,898               78,448               39,828
              Diarrhoea                     81,321               116,295             125,999               99,839

             Hypertension                   28,337               32,469               38,388               25,518

             Tuberculosis                   31,510               29,692               32,383               29,878

               Diabetes                     23,777               23,838               22,493               21,264

               Typhoid                       8,288                4,220                6,557                7,561

              Hepatitis B                     990                  444                  547                  931

               Dengue                         682                  866                 1,403                1,879

               Cholera                         96                  124                  236                  178



Inference:

                                            2008-09 as base year8 for total cases
                            % Increase from 2008
                                           2008-09              2009-10              2010-11
                                                                                          11              2011-12
               Malaria                       100                  171                  336                   171

              Diarrhoea                      100                  143                  155                   123

          Hypertension                       100                  115                  135                   90

             Tuberculosis                    100                   94                  103                   95
              Diabetes                       100                  100                   95                   89
               Typhoid                       100                   51                   79                   91
             Hepatitis B                     100                   45                   55                   94
               Dengue                        100                  127                  206                   276
               Cholera                       100                  129                  246                   185




7
Data as per RTI received from 160 Municipal Dispensaries, 24 Municipal Hospitals and 4 State Hospitals.
8
Year 2008-09 has been taken as the base year for computing trends for occurrences of cases for the subsequent years.
           09
                                                          17
                                                                             Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 11: Ward wise9 registered cases of Malaria (April 2008 to March 2012) as per RTI data

                                               Number of cases registered as per RTI data
    Ward
                          2008-09                    2009-10                    2010-11                    2011-12
     A                      133                        664                       1,221                      1,141
     B                      274                        552                       1,147                       381
     C                      238                        426                       1,532                       330
     D                      940                       1,645                      1,774                       277
     E                      750                        756                       2,945                      1,255
    F/N                     362                       1,365                      2,073                      1,154
    F/S                    1,644                      2,991                      4,499                      1,691
    G/N                     490                       1,075                      2,088                       985
    G/S                     711                       2,149                      3,115                      1,400
    H/E                     124                        442                        804                        383
    H/W                    1,062                       817                       3,360                       595
    K/E                     747                       1,299                      3,687                      1,610
    K/W                     652                       1,100                      2,524                      1,080
     L                      376                        832                       1,718                       751
    M/E                     536                        661                        192                       1,761
    M/W                     244                        291                        622                        346
     N                      244                        880                       1,909                       620
    P/N                     67                         220                        385                        396
    P/S                     92                         150                        251                        242
    R/C                     61                         129                        334                        289
    R/N                     12                         79                         83                         114
    R/S                     101                        170                        417                        214
     S                      99                         677                       1,083                       328
     T                      45                         497                        242                        178




9
 Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from municipal/state
hospital is not taken into account for computing cases for the ward level data.
                                                            18
                                                                               Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 12: Ward wise10 registered cases of Diarrhoea (April 2008 to March 2012) as per RTI data

                                              Number of cases registered as per RTI data
     Ward
                          2008-09                   2009-10                    2010-11                    2011-12
      A                    1,213                     1,440                      1,522                      2,051
      B                    1,220                     1,654                      1,844                      1,557
      C                     944                      1,309                      2,019                      2,203
      D                    1,175                     3,579                      4,536                      5,114
      E                    5,490                     8,147                      8,201                      4,605
     F/N                   4,063                     5,796                      5,295                      2,994
     F/S                   4,424                     5,824                      7,261                      4,753
     G/N                   3,431                     4,343                      5,849                      4,464
     G/S                   6,874                     6,776                      7,252                      4,864
     H/E                   3,442                     5,697                      6,041                      3,949
     H/W                   2,657                     3,338                      3,946                      2,567
     K/E                   5,997                     7,219                      7,885                      7,066
     K/W                   3,358                     4,042                      4,023                      3,354
      L                    5,379                     11,971                     12,588                     10,592
     M/E                   1,461                     3,769                      6,108                      4,433
     M/W                   3,715                     4,763                      5,083                      3,384
      N                    3,381                     6,636                      7,869                      6,321
     P/N                   2,104                     2,861                      2,741                      3,373
     P/S                    804                      1,423                      1,062                       860
     R/C                   2,922                     2,686                      1,801                      1,850
     R/N                   1,011                     1,067                       946                        698
     R/S                   2,920                     3,972                      2,657                      1,569
      S                    2,950                     4,445                      5,242                      3,686
      T                    1,387                     1,620                      1,976                      1,845




10
  1) Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from
municipal/state hospital is not taken into account for computing cases for the ward level data.
2) Estimated cases for Diarrhoea are not computed as our survey was structured to capture data of atleast one occurrence
of a disease in a household. And, in case of diseases like diarrhoea, cold, cough there is high probability of multiple
occurrences in any household. Hence it would be difficult to estimate an ‘accurate’ number of probable cases for diarrhoea.
                                                            19
                                                                               Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 13: Ward wise11 registered cases of Hypertension (April 2008 to March 2012) as per RTI data

                                         Number of cases registered as per RTI data
     Ward
                      2008-09                 2009-10                2010-11                 2011-12
      A                2,562                   1,369                  1,338                   1,076
      B                 436                     750                   1,353                    913
      C                 641                     653                    599                     381
      D                 532                     949                    686                     225
      E                 866                    1,213                  1,154                   1,270
     F/N                575                     972                   1,234                    407
     F/S               2,649                   3,868                  3,586                   1,305
     G/N                341                     548                    746                     548
     G/S               1,681                   3,241                  2,198                   1,970
     H/E                443                     625                    844                    1,004
     H/W                639                     306                    496                     456
     K/E               1,319                   1,715                  2,241                   1,592
     K/W                693                      -                     174                    1,122
      L                 251                     502                    580                     644
     M/E                379                     142                    392                     563
     M/W                321                     529                    709                     611
      N                 50                      41                     24                      132
     P/N                405                     172                    282                     254
     P/S                49                      132                    155                     100
     R/C                915                     839                    890                     992
     R/N                62                      94                     249                     297
     R/S                679                     184                    201                     287
      S                 75                      214                    308                     316
      T                 75                      160                    176                     370




11
 Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from
municipal/state hospital is not taken into account for computing cases for the ward level data.
                                                    20
                                                                     Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 14: Ward wise12 registered cases of Tuberculosis (April 2008 to March 2012) as per RTI data

                                         Number of cases registered as per RTI data
     Ward
                      2008-09                 2009-10                2010-11                 2011-12
      A                 292                     438                    461                     348
      B                 100                     155                    160                     130
      C                 156                     133                    131                     106
      D                 378                     265                    246                     259
      E                 592                     516                    417                     704
     F/N                858                    1,274                  1,332                   1,581
     F/S                577                     573                    600                     116
     G/N                714                     404                    417                     561
     G/S                276                     221                    361                     235
     H/E                444                     503                    518                     594
     H/W                275                     250                    226                     365
     K/E               2,048                   1,391                  1,164                   1,703
     K/W                395                     260                    240                     360
      L                 760                    1,118                  1,118                   1,037
     M/E                146                     67                     147                     152
     M/W                181                     200                    218                     166
      N                 120                     96                     65                      133
     P/N                187                     124                    96                      135
     P/S                71                      65                     69                      31
     R/C                129                     111                    137                     167
     R/N                123                     128                    86                      281
     R/S                542                     765                    572                     472
      S                 417                     671                   1,551                    315
      T                 334                     393                    191                     236




12
 Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from
municipal/state hospital is not taken into account for computing cases for the ward level data.
                                                    21
                                                                     Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 15: Ward wise13 registered cases of Diabetes (April 2008 to March 2012) as per RTI data

                                         Number of cases registered as per RTI data
     Ward
                      2008-09               2009-10                  2010-11                 2011-12
      A                 39                     28                       46                     191
      B                 189                   165                       464                    818
      C                 89                     66                       29                     47
      D                  2                      -                        -                     80
      E                 156                    80                       212                    669
     F/N                292                   878                       938                    136
     F/S                10                     80                       24                     81
     G/N                16                     73                       105                    18
     G/S                131                   291                       492                    625
     H/E                65                     68                       71                     63
     H/W                142                   207                       167                    125
     K/E                385                   597                       613                    747
     K/W                246                   136                       301                    471
      L                 93                    164                       189                    369
     M/E                231                    89                       242                    266
     M/W                180                   240                       273                    217
      N                 12                     10                       24                     144
     P/N                25                     10                       21                     77
     P/S                27                     42                       98                     88
     R/C                111                   159                       127                    250
     R/N                18                      7                       11                     140
     R/S                87                     72                       50                     196
      S                 42                     45                       53                     184
      T                  5                     21                       16                     187




13
 Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from
municipal/state hospital is not taken into account for computing cases for the ward level data.
                                                    22
                                                                     Report on the STATE of HEALTH of MUMBAI
www.praja.org




VI.   Section C: Questions asked by Municipal Councillors and MLAs




                                        23
                                                     Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 16: Questions asked on health by councillors (March 2012 to May 2012)

                                                                               Health
  Ward                    Councillors Name                 Political Party                   Total question
                                                                              question
  F/N       LalitaYadav*                                       INC               1                  1
  F/N       ManojkumarSansare                                  IND               1                  2
  F/S       NandkishorVichare                                   SS               1                  2
  F/S       Sanjay Ambole                                       SS               1                  2
  G/N       Sudhir Jadhav                                      MNS               1                  7
  G/S       MansiDalvi*                                         SS               1                  2
  G/S       Ratna Mahale                                       NCP               1                  3
  G/S       Sunil Ahir                                         NCP               1                  3
  H/E       Krishna Parkar                                     BJP               1                  3
  H/E       Pooja Mahadeshwar                                   SS               1                  2
  H/E       SnehalShinde*                                      MNS               1                  1
  K/E       ManishaPanchal*                                     SS               2                  4
  K/W       AmeetSatam                                         BJP               1                  3
  K/W       Dilip Patel*                                       BJP               1                  6
  K/W       YashodharPhanse                                     SS               2                 11
   L        Anuradha Pednekar*                                  SS               3                  8
   L        DilipLande                                         MNS               1                 10
   L        Saeeda Khan*                                       NCP               6                  6
  M/E       ReshmaNevrekar*                                     SP               1                  3
  M/W       Vandana Sable                                      INC               1                  5
   N        Bharti Bawadane*                                    SS               1                  6
  P/N       Kamarjaha Siddiqi                                  INC               1                  2
  P/N       ParminderBhamra*                                   INC               1                  1
  P/N       VinodShelar                                        BJP               1                  4
  P/S       PramilaShinde*                                      SS               2                  2
  R/C       Chetan Kadam                                       MNS               2                  3
  R/C       SandhyaDoshi                                       NCP               1                  5
  R/N       Hansaben Desai                                      SS               1                  2
  R/N       Prakash Darekar                                    MNS               1                  5
  R/N       Sheetal Ashok Mhatre                               INC               1                  4
  R/N       Sheetal Mukesh Mhatre*                              SS               2                  2
  R/S       SunitaYadav*                                       BJP               1                  1
   T        NandakumarVaity*                                   NCP               1                  3
            194 Councillors have not asked a single
  City                                                                            0               279
            question on health
  City      227 Councillors                                                      45               403


Note - (*) This councillors are members in Health committee which has total of 35 members out of which only
14 members have asked questions on Health.
                                                     24
                                                                     Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 17: Issues raised/Questions asked by Councillors

                                   Issues                                 Question asked
Epidemic/Sensitive Diseases                                                      4
Equipments                                                                       1
Health Related Issues                                                            2
Human Resources                                                                  9
Infrastructure                                                                   10
Maternity homes / Primary Health Centre(PHC)                                      3
Mortality rate                                                                   1
Scam/Corruption                                                                  1
Schemes / Policies in Health                                                     11
Treatment/Medicine                                                               3
Total                                                                            45




                                                 25
                                                         Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 18: Questions asked on health by MLAs14 during following sessions: Budget 2010, Monsoon
2010, Winter 2010, Budget 2011, Monsoon 2011 and Winter 2011

                                                                       Health   Total    Health   Total
Name of MLA                     Political                             Question Question Question Question
                                Party       Area                        2010    2010      2011    2011
Gopal Shetty                    BJP         Borivali                    14          190          13          134
VinodGhosalkar                  SS          Dahisar                     20          270          31          347
PravinDarekar                   MNS         Magathane                    5          31            0           7
Sardar Singh                    BJP         MulundAmboli                14          202          13          137
Mangesh Sangle                  MNS         Vikhroli                    18          261          39          345
ShishirShinde                   MNS         Bhandup West                69         1144          63          960
RavindraWaikar                  SS          Jogeshwari East              1          20            1           8
Rajhans Singh                   INC         Dindoshi                     1          15            0           2
Ramesh Thakur                   INC         Kandivali East              32          371          31          349
YogeshSagar                     BJP         Charkop                     13          201          15          180
AslamShaikh                     INC         Malad West                   6          78            9          87
Subhash Desai                   SS          Goregaon                     3          55            2          17
BaldevKhosa                     INC         Versova                      6          51            4          37
Ashok Jadhav                    INC         Andheri West                13          177          12          172
KrishnakumarHegde               INC         Vile Parle                  35          480          40          472
Ramchandra Kadam                MNS         Ghatkopar West              34          764          53          771
Prakash Maheta                  BJP         Ghatkopar East               3          69            3          34
Abu Azmi                        SP          MankhurdShivaji Nagar       14          177           5          41
Nawab Malik                     NCP         Anushakti Nagar             27          419          30          322
ChandrakantHandore              INC         Chembur                     38          522           7          338
MilindKamble                    NCP         Kurla (SC)                   5          99            9          126
Kripashankar Singh              INC         Kalina                      42          708          42          566
Prakash Sawant                  SS          Vandre East                  5          75            3          50
ZiyauddinSidikki                INC         Vandre West                 12          261          31          441
Jagannath Shetty                INC         SionKoliwada                 9          127          17          218
KalidasKolambkar                INC         Wadala                      50          788          32          740
NitinSardesai                   MNS         Mahim                       49          620          55          610
BalaNandgaonkar                 MNS         Shivadi                     10          224          31          375
MadhukarChavan                  INC         Byculla                     72         1102          29          695
MangalLodha                     BJP         Malbar Hill                 49          732          20          552
Amin Patel                      INC         Mumbadevi                   37          506          43          504
Annie Shekhar                   INC         Colaba                       0          20            2          28
Total                                                                   706        10759         685        9665

14
 Only 32 out of 36 MLAs representing Mumbai are shown in the table as the other four MLAs being ministers cannot ask
questions.
                                                        26
                                                                          Report on the STATE of HEALTH of MUMBAI
www.praja.org

Table 19: Issues raised/Questions asked by MLAs

                                Issues                           2010              2011
Bio Medical Waste                                                  7                 0
Epidemic/Sensitive Diseases                                       154               58
Epidemic/Sensitive State Hospital                                 21                 0
Equipments                                                        51                 3
Health Education/Institute                                        42                48
Maternity homes / Primary Health Centre(PHC)                       6                23
Quacks                                                            12                10
Health Service Related                                             3                 3
Health Related Issues                                             18                17
Human Resource                                                    118               112
Infrastructure                                                    45                75
Mortality Rate                                                    53                101
Private Health Service                                            12                 5
Schemes / Policies in Health                                      109               202
Treatment/Medicine                                                55                28
                                  Total                           706               685




                                                  27
                                                       Report on the STATE of HEALTH of MUMBAI

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Health White Paper 2012

  • 1. www.praja.org WHITE PAPER Report on The STATE of HEALTH of MUMBAI Supported by FORD FOUNDATION MADHU MEHTA FOUNDATION 1 Report on the STATE of HEALTH of MUMBAI
  • 2. www.praja.org Table of Content Page Sr. No. Title No. I Foreword 4 II Information on organisations Involved 6 III Note by Healis Sekhsaria Institute for Public Health 7 IV Section A: Compressive of State of Health of Mumbai 8 Section B: Data collected from Municipal Dispensaries, Municipal Hospitals and State 16 V Hospitals VI Section C: Questions asked by Municipal Councillors and MLAs 23 Tables 1 Estimated percentage of Annual Family Income spent on hospital/medical costs 9 2 Whether Respondents has Medical Insurance 9 3 Estimated Citizens using Government Dispensaries/Hospital 9 4 Estimated Occurrence of Diseases/Ailments for the year 2011-12 10 5 Ward wise Malaria as per survey 11 6 Ward wise Hypertension as per survey 12 7 Ward wise Tuberculosis as per survey 13 8 Ward wise Diabetes as per survey 14 9 MLA constituency wise survey 15 10 Sensitive Diseases/Ailments as per RTI Data 17 11 Ward wise registered cases of Malaria (April 2008 to March 2012) as per RTI data 18 Ward wise registered cases of Diarrhoea (April 2008 to March 2012) as per RTI 19 12 data Ward wise registered cases of Hypertension (April 2008 to March 2012) as per RTI 20 13 data 2 Report on the STATE of HEALTH of MUMBAI
  • 3. www.praja.org Ward wise registered cases of Tuberculosis (April 2008 to March 2012) as per RTI 21 14 data 15 Ward wise registered cases of Diabetes (April 2008 to March 2012) as per RTI data 22 16 Questions asked on health by councillors (March 2012 to May 2012) 24 17 Issues raised/Questions asked by Councillors 25 Questions asked on health by MLAs during following sessions: Budget 2010, 26 18 Monsoon 2010, Winter 2010, Budget 2011, Monsoon 2011 and Winter 2011 19 Issues raised/Questions asked by MLAs 27 3 Report on the STATE of HEALTH of MUMBAI
  • 4. www.praja.org I. Foreword Is Mumbai prepared to tackle its woes in health management? Our report on the state of health of Mumbai raises several red flags. While the city’s health is a BMC concern, public health issues involve the state and the centre as well. It calls for some policy level changes and a deep introspection by all the custodians of public health. The Declaration of Alma-Ata in 1978, adopted at the International Conference on Primary Health Care, and accepted by all member countries of the World Health Organization (WHO) expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. "Health For All" was the goal set up at this Conference. Three decades later, we still have almost 25% of city’s population suffering from either malaria, TB, diarrhoea, diabetes or hypertension. For a city of over 10 million populations, this is a cause for serious concern. 80% of the city’s population is not insured at all. Less than 25% of Mumbai’s population visit municipal hospitals and dispensaries. To put things in perspective, the new agenda for Public Health in India includes the epidemiological transition (rising burden of chronic non-communicable diseases), demographic transition (increasing elderly population) and environmental changes. The causes of health inequalities lie in the social, economic and political mechanisms that lead to social stratification according to income, education, occupation, gender and race or ethnicity. Lack of adequate progress on these underlying social determinants of health has been acknowledged as a glaring failure of public health. There indeed is an urgent call for revitalizing primary health care based on the principles outlined at Alma-Ata in 1978: Universal access and coverage, equity, community participation in defining and implementing health agendas and inter-sectoral approaches to health. These principles remain valid, but must be reinterpreted in light of the dramatic changes in the health field during the past 30 years. The state of health of Mumbai during the last three years has raised several red flags. From 2008-09 (taken as base year with 100 as a denominator), the incidence of sensitive diseases in the city within the past 4 years has almost doubled in some of the diseases. • Malaria has gone up to 171 • Diarrhoea to 123 • Dengue to 276 • Cholera to 185 • Hypertension to 90 • TB to 95 • Diabetes to 89 • Typhoid to 91 • Hepatitis B to 94 And these figures are after the slight improvement in 2011-12 from previous year that had shown exceptional hike in almost all diseases, not just in Mumbai but across the country. So while BMC needs to be commended in curtailing the growth rate of diseases from last year, it clearly is not enough. Identification of health objectives 4 Report on the STATE of HEALTH of MUMBAI
  • 5. www.praja.org and targets is one of the more visible strategies to direct the activities of the health sector. For instance, in the United States, the “Healthy People 2010” offered a simple but powerful idea by providing health objectives in a format that enables diverse groups to combine their efforts and work as a team. Similarly, in India, we need a road map to “better health for all” that can be used by states, communities, professional organizations and all sectors. It will also facilitate changes in resource allocation for public health interventions and a platform for concerted inter-sectoral action, thereby enabling policy coherence. Mumbai has perhaps the greatest allocation of funds and resources for its health agenda. Can we seriously consider some policy level amendments and at least attempt to make Mumbai a role model for public health issues all across India? NITAI MEHTA Managing Trustee, Praja Foundation 5 Report on the STATE of HEALTH of MUMBAI
  • 6. www.praja.org II. Information on organisations Involved Praja Foundation: Founded in 1998, the PRAJA Foundation is a non-partisan voluntary organization which empowers the citizen to participate in governance by providing knowledge and perspective. PRAJA aims to provide ways in which the citizen can get politically active and involved beyond the ballot box, thus promoting transparency and accountability. PRAJA's goals are: empowering the citizens, elected representatives & government with facts and creating instruments of change to improve the quality of life of the citizens of India. PRAJA is committed to creating a transparent, accountable and efficient society through people's participation. Healis -Sekhsaria Institute for Public Health (Healis): Founded in 2004, registered under Section 25 of the Indian Companies Act, 1956 on April 29, 2005 and thus became a separate legal entity as a Not for Profit Organization. Healis primarily works towards advancing public health through innovative science and evidence-based policy by conduct quality research in public health and carry forward its outcome for the benefit of the society. Healis is committed to improving the public health in India and in other developing countries through epidemiological research. Healis is one of the few institutes that are solely dedicated to public health research and thus a leader in this field in India. Healis works in collaboration with leading National and International Health and Research organizations. Hansa Research: Hansa Research is a full service global market research agency conducting market research in 77 countries globally with offices in India and US. It is the ONLY global market research agency headquartered in India. Under the leadership of Mr. Ashok Das, Managing Director, Hansa Research became one of the fastest growing market research agencies in India. It specializes in Media, Telecom, Financial Services, Consumer Products and Technology spaces. With research offices across India and the U.S., Hansa Research’s infrastructure is comparable to the best in the industry. Hansa Research also has considerable experience in the space of opinion polls as it has done several studies dealing with social, cultural and political issues in the country. 6 Report on the STATE of HEALTH of MUMBAI
  • 7. www.praja.org III. Note by Healis Sekhsaria Institute for Public Health The principles enshrined in our Constitution, particularly in the Directives, emphasise the role of the state not only for protecting the health and but also for improving the health of its citizens. “Duty of the State to raise the level of nutrition and the standard of living and to improve public health. The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties........” from Part IV of Indian Constitution, Directive Principles of State Policy Since independence, subsequent national, state and local governments have hence taken up several initiatives to control/eradicate diseases, improve environmental sanitation, raise the standard of nutrition, control population and improve public health. However, public health in India is beset by a vast spectrum of problems. It is important for us to identify big problems and focus upon them. It is to be understood that a solution to a big problem will help in improving public health in substantive manner. For public health field research, problems that can be addressed by population-based epidemiological research have to be selected. Solutions have to be found to a problem function through evidence-base for formulating policies that should advance public health. Surveillance systems (health information system) play and extremely important role here; they can provide accurate understanding of the problem. Hence, setting up strong surveillance system should be priority of the administrator and the data process for capturing should be scientific, up-to-date and sacrosanct. Equally importantly, the data captured should be disseminated at all levels to all stakeholders periodically and suggestions should be actively sought through a more institutionalised manner from all (within the administration and also from the civil society researchers). The primary objective of any robust health information system should be to provide reliable, relevant, up-to- date, adequate, timely and reasonably complete information for health managers at all levels (Local, State and Central) and to researchers (NGOS, Media and Academicians) to assist planners/researchers for monitoring the health services/state, analysing trends and making policies. Even the Millennium Development Goals (MDG), place health at the heart of development; three of the eight goals are directly related to health and the others have important indirect effects on health. Hence, the data that is captured locally must be synthesised with global data for overall evaluation of evidence and for drawing attention towards important but neglected issues. This will further strengthen the health information system. The immediate need of the hour for our country today is to have such a robust, up-to-date health information system that will further complement and assist in achieving the goals of all our present and proposed programmes on improving public health. And no part of our country is better poised to build a more perfect health information system than Mumbai; with all our administrative resources (local, state and national) and strong presence of civil society including businesses and range of private organisations. Mumbai can really take the lead here and then the system can be taken to other parts of the country thus making strides in the direction of achieving those State Directives enshrined in our Constitution on improving public health. 7 Report on the STATE of HEALTH of MUMBAI
  • 8. www.praja.org Dr. MANGESH PEDNEKAR, Director (Research & Development), Healis IV. Section A: Compressive of State of Health of Mumbai Praja Foundation had commissioned the household survey to Hansa Research and the survey methodology followed is as below: • In order to meet the desired objectives of the study, we represented the city by covering a sample from each of its 227 wards. Target Group for the study was : Both Males & Females 18 years and above Belonging to that particular ward. • Sample quotas were set for representing gender and age groups on the basis of their split available through Indian Readership Study (Large scale baseline study conducted nationally by Media Research Users Council (MRUC) &Hansa Research group) for Mumbai Municipal Corporation Region. • The required information was collected through face to face interviews with the help of structured questionnaire. • In order to meet the respondent within a ward, following sampling process was followed: 4 – 5 prominent areas in the ward were identified as the starting point In each starting point about 12 – 15 individuals were selected randomly and the questionnaire was administered with them. • Once the survey was completed, sample composition of age & gender was corrected to match the population profile using the baseline data from IRS. This helped us to make the survey findings more representatives in nature and ensured complete coverage. • The total study sample was 15,191. 8 Report on the STATE of HEALTH of MUMBAI
  • 9. www.praja.org Table 1: Estimated1 percentage of Annual Family Income spent on hospital/medical costs In % Amount spent from total income (in %) Estimated Household2 4.26 More than 30% 1,13,171 7.15 21% to 30 % 1,89,946 18.97 11% to 20% 5,03,955 38.92 6% to 10% 10,33,944 30.7 Less than 5% 8,15,572 100 Total 26,56,588 More than 30% of households spend 11% or more of their annual income on hospital/medical costs. Table 2: Whether Respondents has Medical Insurance In % In no. of respondents Respondents have medical insurance 20.45 3,107 Respondents not having medical insurance 79.55 12,084 Total 100 15,191 Table 3: Estimated Citizens using Government Dispensaries/Hospital Estimated citizens Estimated citizens No. of Available No. Provisional using Govt. using Govt. Ward Municipal/State of Municipal Population 2011 Dispensary/Hospital Dispensary/Hospital Hospitals Dispensaries (in %) (in numbers) Total 1,24,32,830 24.49 30,44,800 28 160 Less than 25% of citizens in Mumbai use government dispensary/hospital; while the rest use private facilities. 1 The estimated cases percentage of people is computed out of the total sample of 15,191 households surveyed across the city. 2 Household computed at the rate of 4.68 people per household based on Provisional Population for 2011 9 Report on the STATE of HEALTH of MUMBAI
  • 10. www.praja.org Table 4: Estimated Occurrence of Diseases/Ailments for the year 2011-12 Total Estimated Estimated Cases Per 1000 Diseases/Ailments Cases households Diabetes 274,957 104 Malaria 392,378 148 Tuberculosis 63,227 24 Hypertension 78,635 30 Cancer 39,583 15 In 2011-12, for every 1000 households there was atleast one malaria patient was reported in 148 households. 10 Report on the STATE of HEALTH of MUMBAI
  • 11. www.praja.org Table 5: Ward wise Malaria as per survey Estimated cases per Provisional Population Estimated3 Cases Ward 1000 households 2011 2011-124 2011-12 A 148,432 4,710 149 B 127,005 11,593 427 C 165,583 3,768 107 D 346,719 8,809 119 E 413,662 27,675 313 F/N 528,767 16,507 146 F/S 359,980 8,861 115 G/N 602,328 17,310 135 G/S 414,038 21,879 247 H/E 555,179 18,945 160 H/W 329,952 18,380 261 K/E 817,684 29,283 168 K/W 718,375 18,773 122 L 891,208 29,307 154 M/E 806,433 22,435 130 M/W 412,163 8,640 98 N 622,594 19,104 144 P/N 943,605 16,574 82 P/S 461,304 16,776 170 R/C 431,791 15,823 172 R/N 561,870 11,213 93 R/S 690,128 11,355 77 S 742,053 20,692 131 T 341,977 3,749 51 B, E & H/W ward have highest number of people suffering from Malaria. In B ward, 427 out of every 1000 households had some person suffering from Malaria. 3 Estimated cases covers occurrences for the entire ward including cases diagnosed in public as well as private facilities. 4 All the years (E.g. 2008-09) in this paper are financial years (E. g. April 08 to March 09). 11 Report on the STATE of HEALTH of MUMBAI
  • 12. www.praja.org Table 6: Ward wise Hypertension as per survey Estimated cases per Provisional Population Estimated Cases Ward 1000 households 2011 2011-12 2011-12 A 148,432 1,085 34 B 127,005 2,442 90 C 165,583 1,995 56 D 346,719 1,497 20 E 413,662 4,835 55 F/N 528,767 4,429 39 F/S 359,980 2,123 28 G/N 602,328 2,574 20 G/S 414,038 3,831 43 H/E 555,179 5,255 44 H/W 329,952 2,270 32 K/E 817,684 8,876 51 K/W 718,375 3,423 22 L 891,208 4,323 23 M/E 806,433 3,739 22 M/W 412,163 881 10 N 622,594 5,002 38 P/N 943,605 3,085 15 P/S 461,304 2,366 24 R/C 431,791 1,624 18 R/N 561,870 4,130 34 R/S 690,128 1,076 7 S 742,053 4,947 31 T 341,977 848 12 B, C & E ward have highest number of people suffering from Hypertension. In B ward, 90 out of 1000 households had some person suffering from Hypertension. 12 Report on the STATE of HEALTH of MUMBAI
  • 13. www.praja.org Table 7: Ward wise Tuberculosis as per survey Estimated cases per Provisional Population Estimated Cases Ward 1000 households 2011 2011-12 2011-12 A 148,432 257 8 B 127,005 2,963 109 C 165,583 513 15 D 346,719 556 8 E 413,662 6,921 78 F/N 528,767 2,508 22 F/S 359,980 2,146 28 G/N 602,328 3,771 29 G/S 414,038 2,796 32 H/E 555,179 1,578 13 H/W 329,952 2,891 41 K/E 817,684 4,665 27 K/W 718,375 1,857 12 L 891,208 3,790 20 M/E 806,433 7,358 43 M/W 412,163 2,413 27 N 622,594 2,142 16 P/N 943,605 1,794 9 P/S 461,304 1,232 13 R/C 431,791 397 4 R/N 561,870 924 8 R/S 690,128 767 5 S 742,053 6,168 39 T 341,977 1,330 18 B, E & M/E ward have highest number of people suffering from Tuberculosis. In B ward, 109 out of 1000 households had some person suffering from TB. 13 Report on the STATE of HEALTH of MUMBAI
  • 14. www.praja.org Table 8: Ward wise Diabetes as per survey Estimated cases per Provisional Population Estimated Cases Ward 1000 households 2011 2011-12 2011-12 A 148,432 4,421 139 B 127,005 1,180 44 C 165,583 2,993 85 D 346,719 6,423 87 E 413,662 12,516 142 F/N 528,767 12,112 107 F/S 359,980 6,538 85 G/N 602,328 9,640 75 G/S 414,038 7,060 80 H/E 555,179 20,214 170 H/W 329,952 10,237 145 K/E 817,684 18,241 104 K/W 718,375 14,721 96 L 891,208 24,375 128 M/E 806,433 19,833 115 M/W 412,163 7,539 86 N 622,594 15,139 114 P/N 943,605 19,820 98 P/S 461,304 5,076 52 R/C 431,791 9,291 101 R/N 561,870 11,550 96 R/S 690,128 10,927 74 S 742,053 19,281 122 T 341,977 4,815 66 H/E, H/W & E ward have highest number of people suffering from Diabetes. In H/E ward, 170 out of 1000 households had some person suffering from Diabetes. 14 Report on the STATE of HEALTH of MUMBAI
  • 15. www.praja.org Table 9: MLA constituency wise survey5 Malaria6 Hypertension Tuberculosis Diabetes MLA Name Area (in %) (in %) (in %) (in %) Gopal Shetty Borivali 11.3 0.1 0.2 8.8 VinodGhosalkar Dahisar 9.3 3.4 0.8 9.6 Pravin Darekar Magathane 25.7 4.2 0.8 12.0 Sardar Tara Singh MulundAmboli 5.1 1.2 1.8 6.6 Mangesh Sangle Vikhroli 18.2 6.0 3.5 13.1 Shishir Shinde Bhandup West 13.1 3.1 3.9 12.2 Ravindra Waikar Jogeshwari East 1.5 6.8 0.6 10.6 Rajhans Singh Dindoshi 1.5 6.8 0.6 10.6 Ramesh Singh Thakur Kandivali East 7.4 1.1 1.1 9.1 YogeshSagar Charkop 8.0 0.4 0.0 6.0 AslamShaikh Malad West 8.2 1.5 0.9 9.8 Subhash Desai Goregaon 17.0 2.4 1.3 5.2 Baldev Khosa Versova 8.7 2.8 1.0 13.1 Ashok Jadhav Andheri West 13.3 2.1 1.3 8.6 Suresh Shetty Andheri East 21.0 5.0 3.1 11.2 Krishnakumar Hegde Vile Parle 17.6 3.9 0.4 22.1 Arif Naseem Khan Chadivali 16.9 3.7 3.3 7.6 Ramchandra Kadam Ghatkopar West 13.0 2.4 1.8 9.2 Prakash Maheta Ghatkopar East 14.2 4.3 0.7 13.0 Abu Asim Azmi Mankhurd 9.8 1.0 2.7 8.6 Nawab Malik Anushakti Nagar 13.0 2.2 4.3 11.5 Chandrakant Handore Chembur 9.8 1.0 2.7 8.6 Milind Kamble Kurla (SC) 15.4 2.3 2.0 12.8 Kripashankar Singh Kalina 15.1 4.7 1.9 14.2 Prakash Sawant Vandre East 26.1 3.2 4.1 14.5 Ziyauddin Sidikki Vandre West 26.1 3.2 4.1 14.5 Varsha Gaikwad Dharavi (SC) 9.7 2.5 1.6 3.1 Jagannath Shetty SionKoliwada 19.9 2.7 1.1 9.7 Kalidas Kolambkar Wadala 11.0 4.8 3.0 11.4 Nitin Sardesai Mahim 15.8 1.7 3.8 10.2 Sachin Ahir Worli 24.7 4.3 3.2 8.0 Bala Nandgaonkar Shivadi 11.5 2.8 2.8 8.5 Madhukar Chavan Byculla 34.1 6.3 8.6 11.8 Mangal Prabhat Lodha Malbar Hill 11.9 2.0 0.8 8.7 Amin Amir Ali Patel Mumbadevi 10.7 5.6 1.5 8.5 Annie Shekhar Colaba 14.9 3.4 0.8 13.9 5 As per the survey data, Byculla is the worst assembly constituency, followed by Vandre East and Vandre West; while Byculla is worst for Malaria cases. 6 The estimated cases percentage of households suffering from the disease/ailment out of the total sample of 15,191 households surveyed across the city. 15 Report on the STATE of HEALTH of MUMBAI
  • 16. www.praja.org V. Section B: Data collected from Municipal Dispensaries, Municipal Hospitals and State Hospitals The data that is compiled and presented in this section is collected through RTI from all the (160) municipal dispensaries, (24) municipal hospitals and (4) state hospitals in Mumbai. Praja since 2008 has been meticulously collecting this data, collating it and presenting it through media and also directly to all the stakeholders in improving public health in the city. The last year white paper released about the same time in 2011, emphasised a lot on the increasing trends in occurrences of diseases/ailments, particularly, malaria. The public health department officials through various programmes national and local vector control programmes particularly the ‘Fight the bite’ campaign acted promptly and the data this year shows a vast reduction in malaria cases. It is very important that such strong programmes and focussed campaigns be carried out in anticipation of any epidemic breaking out; thus improving the overall public health in the city. Kudos to the MCGM (Municipal Corporation of Greater Mumbai) and its officials for getting it right. We believe that these efforts need to be continued and strengthened further for improving the public health in the city. 16 Report on the STATE of HEALTH of MUMBAI
  • 17. www.praja.org Table 10: Sensitive Diseases/Ailments as per RTI7 Data : Sensitive Diseases/Ailments 2008-09 2009-10 2010- -11 2011-12 Malaria 23,317 39,898 78,448 39,828 Diarrhoea 81,321 116,295 125,999 99,839 Hypertension 28,337 32,469 38,388 25,518 Tuberculosis 31,510 29,692 32,383 29,878 Diabetes 23,777 23,838 22,493 21,264 Typhoid 8,288 4,220 6,557 7,561 Hepatitis B 990 444 547 931 Dengue 682 866 1,403 1,879 Cholera 96 124 236 178 Inference: 2008-09 as base year8 for total cases % Increase from 2008 2008-09 2009-10 2010-11 11 2011-12 Malaria 100 171 336 171 Diarrhoea 100 143 155 123 Hypertension 100 115 135 90 Tuberculosis 100 94 103 95 Diabetes 100 100 95 89 Typhoid 100 51 79 91 Hepatitis B 100 45 55 94 Dengue 100 127 206 276 Cholera 100 129 246 185 7 Data as per RTI received from 160 Municipal Dispensaries, 24 Municipal Hospitals and 4 State Hospitals. 8 Year 2008-09 has been taken as the base year for computing trends for occurrences of cases for the subsequent years. 09 17 Report on the STATE of HEALTH of MUMBAI
  • 18. www.praja.org Table 11: Ward wise9 registered cases of Malaria (April 2008 to March 2012) as per RTI data Number of cases registered as per RTI data Ward 2008-09 2009-10 2010-11 2011-12 A 133 664 1,221 1,141 B 274 552 1,147 381 C 238 426 1,532 330 D 940 1,645 1,774 277 E 750 756 2,945 1,255 F/N 362 1,365 2,073 1,154 F/S 1,644 2,991 4,499 1,691 G/N 490 1,075 2,088 985 G/S 711 2,149 3,115 1,400 H/E 124 442 804 383 H/W 1,062 817 3,360 595 K/E 747 1,299 3,687 1,610 K/W 652 1,100 2,524 1,080 L 376 832 1,718 751 M/E 536 661 192 1,761 M/W 244 291 622 346 N 244 880 1,909 620 P/N 67 220 385 396 P/S 92 150 251 242 R/C 61 129 334 289 R/N 12 79 83 114 R/S 101 170 417 214 S 99 677 1,083 328 T 45 497 242 178 9 Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from municipal/state hospital is not taken into account for computing cases for the ward level data. 18 Report on the STATE of HEALTH of MUMBAI
  • 19. www.praja.org Table 12: Ward wise10 registered cases of Diarrhoea (April 2008 to March 2012) as per RTI data Number of cases registered as per RTI data Ward 2008-09 2009-10 2010-11 2011-12 A 1,213 1,440 1,522 2,051 B 1,220 1,654 1,844 1,557 C 944 1,309 2,019 2,203 D 1,175 3,579 4,536 5,114 E 5,490 8,147 8,201 4,605 F/N 4,063 5,796 5,295 2,994 F/S 4,424 5,824 7,261 4,753 G/N 3,431 4,343 5,849 4,464 G/S 6,874 6,776 7,252 4,864 H/E 3,442 5,697 6,041 3,949 H/W 2,657 3,338 3,946 2,567 K/E 5,997 7,219 7,885 7,066 K/W 3,358 4,042 4,023 3,354 L 5,379 11,971 12,588 10,592 M/E 1,461 3,769 6,108 4,433 M/W 3,715 4,763 5,083 3,384 N 3,381 6,636 7,869 6,321 P/N 2,104 2,861 2,741 3,373 P/S 804 1,423 1,062 860 R/C 2,922 2,686 1,801 1,850 R/N 1,011 1,067 946 698 R/S 2,920 3,972 2,657 1,569 S 2,950 4,445 5,242 3,686 T 1,387 1,620 1,976 1,845 10 1) Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from municipal/state hospital is not taken into account for computing cases for the ward level data. 2) Estimated cases for Diarrhoea are not computed as our survey was structured to capture data of atleast one occurrence of a disease in a household. And, in case of diseases like diarrhoea, cold, cough there is high probability of multiple occurrences in any household. Hence it would be difficult to estimate an ‘accurate’ number of probable cases for diarrhoea. 19 Report on the STATE of HEALTH of MUMBAI
  • 20. www.praja.org Table 13: Ward wise11 registered cases of Hypertension (April 2008 to March 2012) as per RTI data Number of cases registered as per RTI data Ward 2008-09 2009-10 2010-11 2011-12 A 2,562 1,369 1,338 1,076 B 436 750 1,353 913 C 641 653 599 381 D 532 949 686 225 E 866 1,213 1,154 1,270 F/N 575 972 1,234 407 F/S 2,649 3,868 3,586 1,305 G/N 341 548 746 548 G/S 1,681 3,241 2,198 1,970 H/E 443 625 844 1,004 H/W 639 306 496 456 K/E 1,319 1,715 2,241 1,592 K/W 693 - 174 1,122 L 251 502 580 644 M/E 379 142 392 563 M/W 321 529 709 611 N 50 41 24 132 P/N 405 172 282 254 P/S 49 132 155 100 R/C 915 839 890 992 R/N 62 94 249 297 R/S 679 184 201 287 S 75 214 308 316 T 75 160 176 370 11 Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from municipal/state hospital is not taken into account for computing cases for the ward level data. 20 Report on the STATE of HEALTH of MUMBAI
  • 21. www.praja.org Table 14: Ward wise12 registered cases of Tuberculosis (April 2008 to March 2012) as per RTI data Number of cases registered as per RTI data Ward 2008-09 2009-10 2010-11 2011-12 A 292 438 461 348 B 100 155 160 130 C 156 133 131 106 D 378 265 246 259 E 592 516 417 704 F/N 858 1,274 1,332 1,581 F/S 577 573 600 116 G/N 714 404 417 561 G/S 276 221 361 235 H/E 444 503 518 594 H/W 275 250 226 365 K/E 2,048 1,391 1,164 1,703 K/W 395 260 240 360 L 760 1,118 1,118 1,037 M/E 146 67 147 152 M/W 181 200 218 166 N 120 96 65 133 P/N 187 124 96 135 P/S 71 65 69 31 R/C 129 111 137 167 R/N 123 128 86 281 R/S 542 765 572 472 S 417 671 1,551 315 T 334 393 191 236 12 Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from municipal/state hospital is not taken into account for computing cases for the ward level data. 21 Report on the STATE of HEALTH of MUMBAI
  • 22. www.praja.org Table 15: Ward wise13 registered cases of Diabetes (April 2008 to March 2012) as per RTI data Number of cases registered as per RTI data Ward 2008-09 2009-10 2010-11 2011-12 A 39 28 46 191 B 189 165 464 818 C 89 66 29 47 D 2 - - 80 E 156 80 212 669 F/N 292 878 938 136 F/S 10 80 24 81 G/N 16 73 105 18 G/S 131 291 492 625 H/E 65 68 71 63 H/W 142 207 167 125 K/E 385 597 613 747 K/W 246 136 301 471 L 93 164 189 369 M/E 231 89 242 266 M/W 180 240 273 217 N 12 10 24 144 P/N 25 10 21 77 P/S 27 42 98 88 R/C 111 159 127 250 R/N 18 7 11 140 R/S 87 72 50 196 S 42 45 53 184 T 5 21 16 187 13 Data of cases registered is only from the related municipal dispensaries in the particular wards. Data from municipal/state hospital is not taken into account for computing cases for the ward level data. 22 Report on the STATE of HEALTH of MUMBAI
  • 23. www.praja.org VI. Section C: Questions asked by Municipal Councillors and MLAs 23 Report on the STATE of HEALTH of MUMBAI
  • 24. www.praja.org Table 16: Questions asked on health by councillors (March 2012 to May 2012) Health Ward Councillors Name Political Party Total question question F/N LalitaYadav* INC 1 1 F/N ManojkumarSansare IND 1 2 F/S NandkishorVichare SS 1 2 F/S Sanjay Ambole SS 1 2 G/N Sudhir Jadhav MNS 1 7 G/S MansiDalvi* SS 1 2 G/S Ratna Mahale NCP 1 3 G/S Sunil Ahir NCP 1 3 H/E Krishna Parkar BJP 1 3 H/E Pooja Mahadeshwar SS 1 2 H/E SnehalShinde* MNS 1 1 K/E ManishaPanchal* SS 2 4 K/W AmeetSatam BJP 1 3 K/W Dilip Patel* BJP 1 6 K/W YashodharPhanse SS 2 11 L Anuradha Pednekar* SS 3 8 L DilipLande MNS 1 10 L Saeeda Khan* NCP 6 6 M/E ReshmaNevrekar* SP 1 3 M/W Vandana Sable INC 1 5 N Bharti Bawadane* SS 1 6 P/N Kamarjaha Siddiqi INC 1 2 P/N ParminderBhamra* INC 1 1 P/N VinodShelar BJP 1 4 P/S PramilaShinde* SS 2 2 R/C Chetan Kadam MNS 2 3 R/C SandhyaDoshi NCP 1 5 R/N Hansaben Desai SS 1 2 R/N Prakash Darekar MNS 1 5 R/N Sheetal Ashok Mhatre INC 1 4 R/N Sheetal Mukesh Mhatre* SS 2 2 R/S SunitaYadav* BJP 1 1 T NandakumarVaity* NCP 1 3 194 Councillors have not asked a single City 0 279 question on health City 227 Councillors 45 403 Note - (*) This councillors are members in Health committee which has total of 35 members out of which only 14 members have asked questions on Health. 24 Report on the STATE of HEALTH of MUMBAI
  • 25. www.praja.org Table 17: Issues raised/Questions asked by Councillors Issues Question asked Epidemic/Sensitive Diseases 4 Equipments 1 Health Related Issues 2 Human Resources 9 Infrastructure 10 Maternity homes / Primary Health Centre(PHC) 3 Mortality rate 1 Scam/Corruption 1 Schemes / Policies in Health 11 Treatment/Medicine 3 Total 45 25 Report on the STATE of HEALTH of MUMBAI
  • 26. www.praja.org Table 18: Questions asked on health by MLAs14 during following sessions: Budget 2010, Monsoon 2010, Winter 2010, Budget 2011, Monsoon 2011 and Winter 2011 Health Total Health Total Name of MLA Political Question Question Question Question Party Area 2010 2010 2011 2011 Gopal Shetty BJP Borivali 14 190 13 134 VinodGhosalkar SS Dahisar 20 270 31 347 PravinDarekar MNS Magathane 5 31 0 7 Sardar Singh BJP MulundAmboli 14 202 13 137 Mangesh Sangle MNS Vikhroli 18 261 39 345 ShishirShinde MNS Bhandup West 69 1144 63 960 RavindraWaikar SS Jogeshwari East 1 20 1 8 Rajhans Singh INC Dindoshi 1 15 0 2 Ramesh Thakur INC Kandivali East 32 371 31 349 YogeshSagar BJP Charkop 13 201 15 180 AslamShaikh INC Malad West 6 78 9 87 Subhash Desai SS Goregaon 3 55 2 17 BaldevKhosa INC Versova 6 51 4 37 Ashok Jadhav INC Andheri West 13 177 12 172 KrishnakumarHegde INC Vile Parle 35 480 40 472 Ramchandra Kadam MNS Ghatkopar West 34 764 53 771 Prakash Maheta BJP Ghatkopar East 3 69 3 34 Abu Azmi SP MankhurdShivaji Nagar 14 177 5 41 Nawab Malik NCP Anushakti Nagar 27 419 30 322 ChandrakantHandore INC Chembur 38 522 7 338 MilindKamble NCP Kurla (SC) 5 99 9 126 Kripashankar Singh INC Kalina 42 708 42 566 Prakash Sawant SS Vandre East 5 75 3 50 ZiyauddinSidikki INC Vandre West 12 261 31 441 Jagannath Shetty INC SionKoliwada 9 127 17 218 KalidasKolambkar INC Wadala 50 788 32 740 NitinSardesai MNS Mahim 49 620 55 610 BalaNandgaonkar MNS Shivadi 10 224 31 375 MadhukarChavan INC Byculla 72 1102 29 695 MangalLodha BJP Malbar Hill 49 732 20 552 Amin Patel INC Mumbadevi 37 506 43 504 Annie Shekhar INC Colaba 0 20 2 28 Total 706 10759 685 9665 14 Only 32 out of 36 MLAs representing Mumbai are shown in the table as the other four MLAs being ministers cannot ask questions. 26 Report on the STATE of HEALTH of MUMBAI
  • 27. www.praja.org Table 19: Issues raised/Questions asked by MLAs Issues 2010 2011 Bio Medical Waste 7 0 Epidemic/Sensitive Diseases 154 58 Epidemic/Sensitive State Hospital 21 0 Equipments 51 3 Health Education/Institute 42 48 Maternity homes / Primary Health Centre(PHC) 6 23 Quacks 12 10 Health Service Related 3 3 Health Related Issues 18 17 Human Resource 118 112 Infrastructure 45 75 Mortality Rate 53 101 Private Health Service 12 5 Schemes / Policies in Health 109 202 Treatment/Medicine 55 28 Total 706 685 27 Report on the STATE of HEALTH of MUMBAI