1. Report on The STATE of HEALTH of MUMBAI July 2014 Supported by FORD FOUNDATION MADHU MEHTA FOUNDATION 1

2. RTI (Right to Information Act) Data in this section has been collected from (162) Municipal Dispensaries, (26) Municipal Hospitals and (4) State Hospitals for the period April’2008 to March’2014. RTI Data from (8) Other Government Hospitals[which include Central Railway, Bombay Port Trust Hospital, Police Hospital (Nagpada and Naigaon), ESIS – Worli, Mulund, Kandivali, Marol) and (12) Police Dispensaries] has been collected for the period of April’2012 to March’2014. 2 Data from RTI

3. 7650 unnecessary deaths 3

4. Vital Health Statistics 20: Nearly 20 people die daily due to TB in Mumbai 46,606: Since the last 6 years 46,606 people have died due to TB averaging 7600 every year 6: Case fatality rate in TB is very high with every 6 th person having TB dying 10: Dengue has gone up 10 times in six years 4.5: Death due to dengue has gone up by 4.5 times in 6 years 69%: Diarrhoea up by 69% in six years 7 died due to Cholera last year 20%: Malaria down by 20% since last year 195 people died due to Malaria last year 4

5. Registration of Birth and Death Act 1969 Provides for registration of births and deaths and for matters connected. ‘Source of demographic data for socio- economic planning, development of health systems and population control’ (as per 2012 Training Manual for Civil Registration Functionaries in India, Office of Register General of India, Ministry of Home Affairs, Government of India). 5

6. 6 Refer to Report on The STATE of HEALTH of MUMBAI (Page No.45)

7. Medical Certification of Causes of Death (MCCD) In Maharashtra, every 10 th of the month monthly reports are received at state office of Deputy Chief Registrar of Birth and Death at Pune. The strategy they follow: In the case of deaths occurred in the institutions, Head of the institution is responsible for submission of form no.4 to the Local Registrar. Or in the case of domiciliary death attended by any physician prior to death is responsible to submit form no.4A to the local registrar. It is the duty of Registrar (in the case of Mumbai it is Executive Health Officer of MCGM), to ask about form No.4 & 4A according to occurrence of death, while entering the death event. Deputy Director is responsible for compilation, coding & analysis of data received through MCCD according to ICD (International Cause of Death) – 10 (http://www.who.int/whosis/icd10/).http://www.who.int/whosis/icd10/ The entire data is coded and computerised since September 2004. Source: http://www.maha-arogya.gov.in/programs/other/sbhivs/strategy.htmhttp://www.maha-arogya.gov.in/programs/other/sbhivs/strategy.htm 7

8. Discrepancy in reporting system of TB deaths (Calendar Years 2010-2013) 8

9. Discrepancy in reporting system of Malaria deaths (Calendar Years 2010-2013) 9

10. Causes of death in Mumbai : As per cause of death certificates issued by MCGM’s Public Health Department Cause of Death 2008-092009-102010-112011-122012-13 2013-14 In no.In %In no.In %In no.In %In no.In %In no.In % In no. In % Malaria 3530.46690.712221.23850.42300.3 195 0.2 Dengue 240.0640.1790.1520.1740.1 108 0.1 Tuberculosis 81969.482058.991689.070417.869218.1 7075 8.1 Diarrhoea 4300.54520.55970.63000.32450.3 255 0.3 Cholera 130.02 3 3 9 7 Typhoid 170.0300.0280.07 9 10 0.0 Diabetes 26863.125392.829512.921182.325232.9 2341 2.7 Hyper tension 36694.239744.346434.637804.239744.6 4525 5.2 HIV / AIDS 9481.18991.07800.85440.65580.7 439 0.5 Other Cause of deaths 7123181.37525481.78209880.87655984.37125983.1 71918 82.6 Total Deaths 87567100920881001015691009078910085802100 87027 100 During the last six years (2008-14), 8.55% of all deaths and 46,606 people have died due to TB in Mumbai. 10

11. Shortage of staff (in%) in MCGM's dispensaries/hospitals and State hospitals as of March 2014 11

12. Praja Foundation had commissioned the household survey to Hansa Research and the survey was conducted in March-April 2014 across the city of Mumbai with a total sample size of 22,580 households. 12 Data from Household Survey

13. Facilities used by the citizens across different socio-economic classes YearOverallSEC ASEC BSEC CSEC DSEC E Only Govt. dispensaries/ hospitals 2013312631 3048 2014342829 3647 Only Private or Charitable clinics/ hospitals 2013626662586546 2014566863565446 Using both private and govt. Hospitals 20137881156 2014104815108 In 2014, there has been a 3% rise in Mumbaikars using only government dispensary/hospital facilities; while there has been a 6% decrease in citizens who used only non-government facilities, compared to year 2013. In 2013, 62% citizens used only Private or Charitable clinics/ hospitals; this has come down to 56% in year 2014. 13

14. Annual Family Income spent on hospital/medical costs across socio-economic classes Amount spent from total income (in %) In %SEC ASEC BSEC CSEC DSEC E 201320142013201420132014201320142013201420132014 More than 11% 171318161815181315121710 6% to 10% 38323536 383539274230 Less than 5% 455547484649445246614160 Total 100 Average spent from total income (in %) 7.17.96.98.478.37.38.16.97.6 7.3 On an average, households spent 7.1 % of their total income on hospital/medical costs in 2013 and 7.9% of total income on hospital/medical costs in 2014. 14

15. Estimated cases per 1000 households of Diseases and Ailments Diseases & Ailments Malaria Dengue Diabetes Cancer 20132014201320142013201420132014 Overall80611625494267 SEC A139562019673493 SEC B745322244551115 SEC C62519244337210 SEC D79691729494168 SEC E44771022455574 On an average, 80 households out of every 1000 in 2013 and 61 households out of every 1000 in 2014 had a member suffering from Malaria. While there was a drastic decrease in cases reported from the upper economic strata (SEC A), the decrease in cases reported in SEC D was less pronounced. On the other hand, there was a sharp increase in Malaria cases reported from the lower economic strata - SEC E. 15

16. Deliberations by Councillors and MLAs of Mumbai 16

17. Deliberations on health by Councillors during March’12 to March’14 Note: Their are a total of 227 councillors of whom 34 are members of the Public Health Committee Eight councillors who have been members of the Public Health Committee have never asked a single question on health in last two years (Sushama Salunkhe, Snehal Shinde, Ujjwala Modak, Dilshad Azmi, Prashant Kadam, Rupesh Waingankar, Avinash, Sawant, Nandakumar Vaity). 17 March 2012 to March 2013 * April 2013 to March 2014 * Total questions on Health200365 Councillors who have not asked a single question138121 Total questions in Public Health Committee56122 Public Health Committee members who never asked a single question1112 Praja Impact

18. Deliberations on health by 32 (excluding 4 ministers) MLAs during Budget, Monsoon & Winter sessions of 2012 and 2013 Two MLAs (Chandrakant Handore & Annie Shekhar) did not raise a single question on health. While two (Baldev Khosa & Kripashankar Singh) others just asked one question on health. 18

19. What needs to be done Study of TB related deaths in Mumbai that focuses on the challenges faced by patients in accessing the health care system should be initiated. Public Health Surveillance (Health Information System) needs to be immediately augmented to regularly collect health data from private and charitable health facilities alongwith data from public health facilities. And this data should be available for research on an open e-platform where raw data sets are made available. Elected representatives should become more engaged in the debates on public health policies, proposed legislations like Clinical Establishment Act, Health Surveillance Reports, etc. Government needs to focus on primary healthcare and extend its reach and efficiency to cater towards fulfilling needs of lowest strata of socio-economic (SEC D and E) households. Tailor-made health awareness campaigns need to be designed to reach different socio- economic classes for greater impact. 19

20. THANK YOU 20 Questions