KEY HIGHLIGHTS of The STATE of HEALTH of MUMBAI July 2017

Vital Statistics

Tuberculosis Data TB hotspots — L (Kurla-1254 cases), H/E (Santacruz-659 cases) and R/S (Kandivli-493 cases) are the worst affected wards in 2016-17 An estimated 32,862 people have died due to TB in the last 5 years (April’12 to March’17) 18 people have died daily due to tuberculosis in last 5 years (April’12 to March’17)

Directly Observed Treatment, Short Course (DOTS) data This indicates inefficiency of DOTS and the need for corrective measures. Defaulters from DOTS programme increased by 10% in last five years (Jan’12 to December’16.

Dengue Data Dengue has gone up 265% in last five years (April’12 to March’17). Dengue hotspots in 2016-17 K/E (224 cases), L (144 cases) and R/N (108 cases). Estimated dengue deaths have doubled from 77 cases in 2012-13 to 148 cases in 2016-17

Dengue diagnosis: Rapid test kit 40 times rise (from 26 to 1039 cases) in dengue cases at dispensary level from FY 2012-13 to FY 2016-17. All the dispensaries are equipped with Rapid kits for dengue diagnosis However, zero dengue cases were reported from K/W, M/E, R/S and T ward

Registration of Births and Deaths (RBD) RBD is important for any robust scientific study for morbidity and mortality. Executive Health Officer of Mumbai is the legal registrar and the causes of deaths are certified by the ward-level MHO (Medical Health Officer). This data was maintained in MCGM’s SAP (System Applications Protocol) till December’15. Data-sets were available for various causes by age, gender and area distributions for analysis and monitoring. In a positive step for central data collation, since January’16, the platform for maintaining the data was shifted to the Government of India set-up under the Civil Registration System (CRS). However data-sets for various causes, etc. is now not available and the system is now only serving the purpose of generating certificates of birth and date but serves no purpose for a study or monitoring of morbidity and mortality patterns. This under-serves the purpose of RBD.

Extrapolation of cause of death Praja has had access to the causes of death data for Mumbai through RTI since April’08. Hence to understand what could be the pattern of causes and age-wise distribution we have with the help of Hansa Cequity create a prediction model for research purpose and to identify and monitor causes of mortality in the city. The predicted data is for 15 months from January 2016 to March 2017. Autoregressive Integrated Moving Average (ARIMA) model was used to predict the number of deaths, causes and age-wise distribution in various wards for the 15 month period. Through ARIMA we could achieve 95.5% accuracy for death data. E.g. the only data that the Public Health department has access in the ‘new’ CRS system is the total no. of deaths. For 2016, this was 84,265 while the predicted data through ARIMA shows 85,329.

Citizen Survey Data Praja Foundation had commissioned Hansa Research to conduct Survey in 2017 across the city of Mumbai with a total sample size of 20,317 households.

Survey Data The cases of dengue as shown in the RTI data are 17,771 in government dispensaries/hospitals while according to survey data dengue cases are estimated to be 1,09,443 across which could have been treated across all facilities both government and private/charitable. Similarly the figures for Malaria through RTI data malaria cases were 11,607 while the estimates for total cases are 90,703. Only 33% use only government health facilities 71% families in Mumbai do not have a medical insurance in year 2017.

Estimated Health Expenditure 2016-17 Annual Per Capita Income in Mumbai Rs. 2,96,208* Less 25% (accounting for savings and taxation) Rs. 2,22,156 Annual Income per household = Per Capita X 4.58 Rs. 10,17,474 Annual Expenditure on Health per household as per citizen survey = 7.8% Rs.79,363 Overall Household Annual Expenditure on Health = Rs. 79,363/- X 2,830,000 (households) Rs.22,460 crores (*) Gross value added as per the Economic Survey of Maharashtra for 2016-17 the year. The directorate of Economics and statistics revised the Gross value added and the above numbers.

Deliberation by Elected Representatives Projected Municipal budget on Health for 2017-18 is 3,312 crores, which is in proximity to the overall TMC budget Rs. 3,390 crores. Clearly money is not the issue. While; Councillors in public health committee did not raise a single question on diarrhoea in last four years (2013-14 to 2016-17) Only four issues were raised by Public Health committee members on tuberculosis from the year 2014-15 to 2016-17 Municipal councillors asked only 45 questions in the past five years (2012-13 to 2016-17) on TB in all committee meetings, compared to 68 questions on naming/renaming of hospitals/health centres/cemeteries in the same period.

What needs to be done We need to augment our Primary Healthcare Mechanism With all its resources its imperative that a ‘world-class’ city like Mumbai should have a robust and holistic Health-MIS (Management Information System) A good initiative such as Civil Registration System (CRS) needs to create an appropriate mechanism to serve its purpose of providing robust data for scientific study of mortality and morbidity patterns We need to create an Open data mechanism for information on Health parameters to be made available on an e-platform where raw data sets are made available for research purposes A master plan: involving working in sync to solve the issues, combined with a robust health surveillance system, and emphasis on primary healthcare will ensure restoration of health in Mumbai.

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