1. KEY HIGHLIGHTS of The STATE of HEALTH of MUMBAI July 2016 1

2. Vital Health Statistics Since the last five years 33,442 people have died due to TB, averaging 6688 every year, a total of 19 fatalities daily in Mumbai. Dengue has gone up eight times in last five years, currently the total number of cases are 15,244. From 2014-15 to 2015-16, the number of cholera cases registered has increased seven times with 31 in 2014-15 to 207 in 2015-16 respectively. Diarrhoea has affected 118093 in Mumbai on an average in last three year. Estimated annual family income spent on hospital and medical costs in Mumbai is Rs.13,675 crores. Four councillors (Geeta Gawli, Pramod Sawant, Sandhya Yadav and Tavaji Gorule) who are members of Public Health Committee have not asked a single question on health in 2015-16; while four MLAs (Ramesh Latke, Ram Kadam, Trupti Sawant and Capt. R Tamil Selvan) have not asked a single question during Winter’14 & Budget’15 sessions. 2

3. Verbal Autopsy Study Half-hearted and callous efforts: Methodology not specified Sampling was not specified Questionnaire was not shared Duration of Verbal Autopsy conducted was not specified The report did note that 7090 deaths due to TB in 2014 according to MCGM, while TB control unit recorded 1351 death due to TB in same year. This anomaly needs to be addressed by Public Health authority. 3

4. Tuberculosis Data Since the last five years 33,442 people have died due to TB, averaging 6688 every year, a total of 19 fatalities daily in Mumbai. Males (68%) dying due to TB are over double the number of Females (32%). The highest number of cases registered in L(1422), H/E(532) and K/E(491) in the year 2015-16. Only two questions asked on TB in public health committee in last four years. Total 11 questions were asked by councillors in all committees and 14 questions were asked by MLA on TB.

5. Diarrhoea Data Diarrhoea has affected 118093 in Mumbai on an average in last three year. Deaths due to Diarrhoea, children below the age group of less than four year for 28%. Females (62%) dying due to Diarrhoea are nearly double the number of Males (38%). The highest number of cases register in L(12311), M/E(11805) and N(10239) in the year 2015-16.

6. Dengue Data Dengue has gone up eight times in last five years, currently the total number of cases are 15,244. In 2014-15, 102 people died of dengue, whereas 124 in 2015-16, showing 22% increase in number of deaths The highest number of cases register in and S(308), K/E(198) and N(155) in the year 2015-16. People have died in the productive age group of 20- 39 years due to causes that are treatable such as Dengue (38%)

7. Discrepancy in Health Surveillance System (Reporting of data) 7

8. Discrepancy in reporting system of Malaria deaths (Calendar Years 2011-2015) 8

9. Discrepancy in reporting system of TB deaths (Calendar Years 2011-2015) 9

10. Age wise Causes of Death from April 2015- December 2015 (highlight percentage) 10 Cause of death < 4 Years5-19 Years20-39 Years40-59 Years60 - AboveNot StatedTotal Malaria In (no)26272920084 In (%) 2.47.132.134.523.80.0 Tuberculosis In (no)3523612361552101804077 In (%) 0.95.830.338.125.00.0 Dengue In (no)6244726210124 In (%)4.819.437.921.016.90.0 Diabetes In (no)2451444138401885 In (%)0.10.22.723.673.40.0 Diarrhoea In (no)3511126520125 In (%)28.00.88.820.841.60.0 Hypertension In (no)9453570256903205 In (%)0.30.11.717.880.20.0 Other Cause of deaths In (no)3464151860291160227304149918 In (%)6.93.012.123.254.70.0 Total Deaths 3553179374541424932368159418

11. Citizen Survey Data Praja Foundation had commissioned Hansa Research to conduct Survey in 2016 across the city of Mumbai with a total sample size of 25,215 households. 11

12. Survey Data As per our surveys, only 34% use only government health facilities, 47% of people use only private facilities, while the rest (19%) use a combination of public and private health services. 67% families in Mumbai do not have a medical insurance in year 2016. 15% respondents reported to have spent more than 11% of their annual income on hospital/medical costs in 2016. [[ SEC E has highest occurrence of diseases per 1000 households such as Malaria (74), Dengue (14), Diabetes (45) and Hypertension (20). The productive age group (18-40 years) suffers the most. 12

13. Estimated cases per 1000 households of Diseases and Ailments across different socio-economic classes 13 Diseases and Ailments MalariaDengueDiabetesCancer 201420152016201420152016201420152016201420152016 Overall615567251415426750755 SEC A56485119812346452325 SEC B534460241314516453522 SEC C5144612417143761471052 SEC D6965842914184172518515 SEC E7775742214 5572454120

14. Deliberations by Councillors and MLAs of Mumbai 14

15. March 2012 to March 2013 * April 2013 to March 2014 * April 2014 to March 2015 * April 2015 to March 2016* Deliberations of 227 Councillors Total questions200365417412 Councillors who have not asked a single question138121108115 Deliberations of the Public Health Committee (PHC) Total questions56122123147 Councillors who have not asked a single question111244 Deliberations on health by Councillors during March’12 to March’16 *Note: Their are a total of 227 councillors of whom 36 are members of the Public Health Committee Saeeda Khan (56) has asked maximum number of questions in 2015-16. 15

16. Deliberations on health by 36 MLAs (excluding the 4 ministers) during Winter sessions 2014 and Budget 2015 4 MLAs (Ramesh Latke, Ram Kadam, Trupti Sawant and Capt. R Tamil Selvan)did not raise a single question on health. Amin Patel asked maximum number of questions on health (66). 16

17. What needs to be done Sincere efforts be carried in order to achieve Goal 3 of UN’s Sustainable Development Goals that emphasises to end epidemic of aids, tuberculosis, malaria and neglected tropical diseases, combat hepatitis, water borne disease and other communicable diseases. For more authenticity in collating TB related data, Cause of Death data needs to be refined through tools like Verbal Autopsy. Public Health Surveillance (Health Information System) needs to be immediately augmented to regularly collect health data from private and charitable health facilities along with 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. A master plan, involving working in sync to solve the issues, combined with a robust health surveillance system, micro health insurance and emphasis on primary healthcare will ensure restoration of health in Mumbai. 17

18. THANK YOU 18 Questions