KEY HIGHLIGHTS of The STATE of HEALTH of DELHI July 2017

Source of Information – RTI Data Occurrence of diseases/ Illnesses: We collect data on certain diseases and ailments from all the government health units run by State government of Delhi and the three Municipal Corporations of Delhi. Cause of Death data: This data has been collected from the online Medical Certification of Cause of Deaths (MCCD) reports by Government of National Capital Territory of Delhi for calendar year 2014 & 2015. The data in this report pertains only to the institutional deaths. Institutional deaths refer to the deaths that happen in any government or private health unit. On an average, only 60% of the total deaths are institutional deaths in Delhi for the last 15 years i.e. from 2001 – 2015. Deliberations: The data on deliberations i.e. attendance, numbers of issues raised and the categories of issues raised pertain to the Public Health Committees(PHC) of the three corporations for the councillors and Vidhan Bhawan for MLAs. The data for PHC is collected from April 2015 to December 2016 while the data from Vidhan Bhawan is from 24th February 2015 to 15th November 2016.

Malaria data 10,025 cases of Malaria in 2015, came down to 6,063 in 2016 which is still an alarming number Institutional deaths due to Malaria increased from 160 in 2014 to 164 in 2015 Civil Line Zone had the highest number of (6,265) cases for Malaria in the last three years (26% of the total) 67 issues were raised on Malaria/ Dengue by councillors (April 2015 to December 2016) 16 issues were raised on Malaria/ Dengue by MLAs (24th February 2015 to 15th November 2016).

Dengue data Dengue was highest in the year 2015 with 25,546 cases, came down to 6,597 in 2016 which is still an alarming number Institutional deaths due to Dengue increased almost seven times from 2014 (74 deaths) to 2015 (486 deaths) The third quarter (July to September) for all the three years, had highest number of cases registered for Dengue Rohini Zone had the highest number of (8,599) cases for Dengue in the last three years (26% of the total) 67 issues were raised on Malaria/ Dengue by councillors (April 2015 to December 2016) 16 issues were raised on Malaria/ Dengue by MLAs (24th February 2015 to 15th November 2016).

Diarrhoea data On an average in last three years, 5,89,683 people have suffered from diarrhoea in Delhi Institutional deaths due to Diarrhoea increased from 2014 (146 deaths) to 2015 (157 deaths) 41% of the total diarrhoea deaths in Delhi are of children below 4 years of age The third quarter (July to September) for all the three years, had highest number of cases registered for Diarrhoea Rural Narela zone had the highest number of (3,84,401) cases for Diarrhoea in the last three years (22% of the total).

Tuberculosis data In the last three years, 2,24,473 people have suffered from Tuberculosis in Delhi Number of institutional deaths due to Tuberculosis were 4350 in 2014 and 3635 in 2015 Rohini zone had the highest number of (74,477) cases for Tuberculosis in the last three years (33% of the total) No issues were raised by the Delhi councillors (from April 2015 to December 2016) No issues were raised by MLAs (24th February 2015 to 15th November 2016).

Diabetes & Hypertension data In the last three years, 10,72,233 people have suffered from Diabetes in Delhi There were 1762 institutional deaths in 2014 which went down to 1356 in 2015 Rohini zone had the highest number of (1,85,635) cases for Diabetes in the last three years (17% of the total). There were 1962 institutional deaths in 2014 which doubled to 3890 in 2015 Rural Narela zone had the highest number of (1,87,957) cases for Hypertension in the last three years (18% of the total).

New Delhi Municipal Council Zone wise occurrence of Diseases/ Ailments in percentage from 2014 to 2016 Corporation Zone Dengue Diabetes Diarrhoea Hypertension Malaria Tuberculosis Typhoid EDMC Shahdara North 5% 10% 6% 7% 17% 8% Shahdara South 13% 9% 2% NDMC City 1% 4% 0% Rural Narela 14% 22% 18% 3% Karol Bagh Rohini 26% 12% 16% 33% 27% Sadar Paharganj Civil Lines 11% 19% SDMC Central West South Najafgarh 15% New Delhi Municipal Council  Total 100%

Citizen Survey Data Praja Foundation had commissioned Hansa Research to conduct Survey in 2017 across the city of Delhi with a total sample size of 24,301 households.

Extrapolation of occurrences of diseases/ ailments Not everyone in Delhi accesses government facilities as a result of which the data collected through RTIs will have limited representation. Hence, to understand the overall occurrence of certain diseases (Dengue and Malaria) we have extrapolated the numbers through our citizen survey. The cases of dengue as shown in the RTI data are 6,597 in government dispensaries/hospitals while according to survey data dengue cases are estimated to be 3,51,312 across Delhi which could have been treated across all facilities both government and private/charitable. Similarly the figures for Malaria through RTI data malaria cases were 6,063 while the estimates for total cases are 1,03,852.

Type of Facilities used by the citizens across different socio-economic classes, 2017

Medical Insurance across socio-economic class families with no Medical Insurance in 2017

Estimated Health Expenditure 2016-17 Annual Per Capita Income in Delhi as per GDP Rs. 3,03,073 Less 35% (accounting for savings and taxation) Rs.1,96,997 Annual Income per household = Per Capita X 5.02 Rs.9,88,927 Annual Expenditure on Health per household = 10.9% Rs. 1,07,793 Overall Household Annual Expenditure on Health = Rs. 1,07,793/- X 33,40,538 households Rs.36,009 crores (*) Gross Domestic Product as per the Economic Survey of Delhi for the year 2016-17. The directorate of Economics and statistics revised the Gross value added and the above numbers.

What needs to be done ? A centralised, robust and holistic Health-MIS (Management Information System) for all the health service providers for better policy decisions The hotspots of various diseases/ illnesses needs to be focused on while formulating and developing strategies to cope with them Despite the excruciating budget allocations on health primary health is being highly ignored. Need to invest on primary health care Elected representatives should become more engaged in the debates on public health policies, proposed legislations like Clinical Establishment Act, Health Surveillance Reports, etc.

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