HEALTH CARE FACILTIES IN MUMBAI:-

Mumbai has Indias best public-health infrastructuresby faryet it needs to at least double its
medical personnel and health facilities to be able to serve its underserved citizens, an Indiaspend
analysis has revealed.

State and municipal hospitals are short by 26% of health-care workers and nurses and by 44% of
doctors, according to the recently released State of the Health report from Praja,an advocacy.
State medical colleges that also work as hospitals are short of lecturers by 38% and paramedical
staff by 25% says the report.

Mumbais existing health infrastructure was planned between 1950 and 1980 to cater to 5.2 and
7 million people, while the facilities are currently used by about 13 million people,said a World
Bank study.
Most of Mumbais people flock to state-run hospitals because they are affordable. For example,
an angioplasty at a government hospital costs somewhere around Rs.75,000, while a private
hospital charges between Rs 3 lakh and 3.5 lakh for the same procedure.
Mumbai has a vast supply of public and private health care services. The services range from the
super speciality, tertiary-level care hospitals to the general practitioners. The Central
Government has its own dispensaries, which are available only for their employees. Further,
there are the Employees' State Insurance Scheme (ESIS) health care services that include
hospitals and dispensaries which cater to employees in the organised sector. The various
government organisations, such as ports, railways and defence, have their own health care
services for their employees. For the general population, the Municipal Corporation of Greater
Mumbai (MCGM) provides major facilities in the public sector along with the State
Government.
GENERALLY VISITED HOSPITALS IN MUMBAI:-
Government Hospitals:
(1) M. W. Desai Municipal General Hospital, Malad (E),
(2) K. B. Bhabha Hospital, Bandra (W), and
(3) K.M.J. Phule Municipal General Hospital, Vikhroli (E).
Private Hospitals:
(1) Samarth Hospital, Vikhroli (W),
(2) Shanti Nursing Home, Bandra (W),
(3) Sanjeevani Hospital, Malad (E),
Trust-run Hospitals:
(1) Sanjeevani Chandrabhan Agrawal Charitable Trust Hospital.
(2) Mahavir Medical Research Centre
.

THE FAILURE OF PUBLIC HOSPITALS:-

In Thane, The Civic Hospital, run by the state government, has lesser beds than its sanctioned
strength, fewer by about 50. Patients spill over on to the floor, not just the 50 who may otherwise
have had a bed, but many others. The place literally stinks, bed sheets don't go to the laundry
often enough, the plates on which daily diet is served often remains with the patient for over half
a day, putrefied and smelling.

Now, on to Mumbai where one knows of many charitable hospitals which are run as corporate
businesses, built on lands provided by the state government or the civic body with the stipulation
that 10 percent of the patients treated are poor and for free or at concessional rates. The
government has never been able to enforce this contractual obligation of the hospital.

Now, back to Thane. The civic body has said that unless the Fire Officer provided a no-objection
certificate, stating that the nursing homes hospital is fire-safe, their licences to continue
operating, risks non-renewal. Running them later would run afoul of the law. One, however, has
not heard of the civic body carrying out any safety audit of its own Rajiv Gandhi Hospital or the
Civic Hospital.
In the first place, how did as many as 300 nursing homes get clearances? That is a question that
would never find an answer, though one can guess. Of course, some new stipulations can
emerge, like from the Municipal Corporation of Greater Mumbai that if a nursing home was
located in a residential building, it ought to have a separate entry. How many have complied with
this?

MCGM:-
The Public Health Department of the MCGM not only provides basic health care
facilities but also manages other aspects related to preventive and social or community
medicine. The Department is divided into zonal set-ups for administrative purposes.
There are five such zones, which cover 23 Wards (nine city Wards, eight western
suburban Wards and six eastern suburban Wards). The Deputy Municipal Commissioner
handles each zone. Each Ward has a separate Ward Office and the Ward Medical Health
Officer (MHO) heads the Public Health Department in that Ward. The Department
carries out the following activities:
Registration of births and deaths and maintenance of statistics
Regulation of places for disposal of dead
Maternity and child welfare and family welfare services, school health services
Control of communicable diseases
Food sanitation and prevention of adulteration of food
Control of trades likely to pose a health hazard
Insect and pest control
Impounding stray cattle, immunisation and licensing of dogs
Regulation of private nursing homes
 Medical relief through hospitals
Issuance of international health certificates for travelling abroad
Ambulance and hearse services
Treatment of contagious diseases
SANITATION PROBLEMS IN URBAN AREAS:-
The survey examined 1405 cities in 12 different States and found out that around 50% of these
cities dont have a proper water supply system. Even if the households have access to piped
water in around 80% of these households the average supply is less than five hours per day.
Concerning sanitation the numbers are even worse: Over 70% of the households in the analyzed
cities dont have access to toilets or a sewerage system. Almost 60% of the worlds population
who has to rely on open defacation lives in India, but this number also includes many people in
rural areas.

manual cleaning of open drain

It is a common sight in Indian cities to have open channels carrying waste water along the streets
which is not only aesthetically questionable but also poses a threat to the health of the people
living in those areas. The open channels, regularly clogged by solid waste material that is
dumped in the streets, often have to be cleaned by hand. But even if there is a sewerage system
in most cities the water is carried to nearby rivers or lakes and enters them without any treatment
what causes heavy pollution of these water bodies. Even in Maharashtra which is one of the
richest States in India and where the megacity of Mumbai is located less than 20 cities of 249
have a sewage treatment works.
slum in Hyderabad
The roots of the bad sanitation situation in India can be found in the colonial area which was
characterized by inequitable access to sanitation and the failure or disinterest to manage urban
growth with the subsequent spread of illegal settlements and slums. But also independent India
has not been able to improve the situation, especially for the poor who often are not able to put
enough pressure on governments and demand better living conditions. There are huge public
funds in India and several programmes to improve the basic infrastructure but policies are often
driven by private interests with the result that mainly the upper and middle class profit from
sanitation services provided by the state.
Toilet in a slum
The Minister for Rural Development Jairam Ramesh recently said that sanitation is the biggest
blot on the human development portfolio in India. The sanitation situation is disastrous (India
Environmental Portal). In the past much more money was spent on water supply whereas
sanitation was neglected. More public funding was needed to deal with the problem. Hopefully
awareness is the first step towards improvement

URBAN WATER AND SANITATION FOR THE POOR:-

The city development planning and judicious resource allocation in most of the cities in South
Asian countries is a big challenge. Among the basic amenities, water and sanitation remained the
core concern that lead to health problems, livelihood losses and an impediment to economic
growth. Given the population growth and rapid migration from rural to urban areas, the cities are
swelling at an unprecedented rate, while resources are limited in terms of land, water, forest and
basic amenities.
The cities in South Asia have grown rapidly in terms of their population sizes, but not
proportionately in terms of quality of urban services and facilities. When we take example of
India; in term of services, no Indian city provides water 24/7, only half the population has access
to safe drinking water, and less than a third has access to sanitation.

The land prices have gone up; the poor are confronted with affordability of shelter, which
ultimately forces them to live in unauthorized localities, which we generally call slums or
unauthorized colonies. They in one way are synonymous to No-mans Land, and survive on
the mercy of local authorities (e.g. municipality) to recognize them (in their city planning
process) or throw them out overnight, for a new project or township. These colonies are
extremely unhygienic, filth ridden and are ones nightmare to live. There, you will not find basic
services and civic amenities, and in case someone gets that, is a different story altogether.
DRAINAGE AND SEWAGE SYSTEM:-
A recent study showed that sewerage systems typically reduce diarrhea incidence by about 30%
or perhaps as much as 60% when starting sanitation conditions are very poor. But in many
contexts, sewerage might be less cost effective and less sustainable than onsite alternatives.[2]
Another study also showed that urban sanitation can have an impact on diarrheal disease, even
without measures to promote hygiene behavior.[3] In this regard, the presence of efficient
drainage and sewerage system is a major factor in the prevention of spread of waterborne
diseases in major cities. As per the census 2011, at country level, there is no drainage facility in
48.9% households, while 33% households have only open drainage system.[4] National Family
health Survey-3 (2005-2006) reported that 52.8% of the households in urban areas have
improved sanitation which means that their flush or pour toilet latrine connected to piped sewer
or septic or other systems, while 41% of the households still have no latrine within household
premises, with 24.2% of them depending on public latrine and other 16.8% practising open
defecation. Besides, more than 28% of the urban population lives in slum areas. In Bangalore,
Karnataka, only half of 52 towns were served by a sewerage system, while in Hyderabad,
Andhra Pradesh, 86 of 124 towns had neither sewerage systems nor running water. The bulk of
sewage treatment capacity exists in the metropolitan cities, with 40% of wastewater generation.
The cities of Delhi and Mumbai generate some 17% of all the sewage in the country.[5]

Treatment of wastewater is one of the important steps to prevent contamination of urban

underground water.[6] Because of unpredictable growth and regional shortage of water, urban
areas may be monitored with semi-centralized supply and treatment system of wastewater.[7]
The change from centralized to semi-centralized supply and treatment systems will minimize the
grave discrepancy between the rapid urban growth and the provision of supply and treatment
infrastructure.[8] A case study from India showed that converting the existing open wastewater
collection drains on the roadsides, as decentralized networks of covered drains, and converting
the large open drains on the outskirts of suburban areas that carry wastewater to agricultural
fields is 70% cheaper compared to conventional collection and treatment systems.[9]

National Urban Health Mission is a welcome step and recent development which will be
launched with focus on slum areas and other urban poor.[10] At the state level, there would be a
State Urban Health Programme Committee, at the district level, a District Urban Health
Committee, and at the city level, a Health and Sanitation Planning Committee. At the ward slum
level, there will be a Slum Cluster Health and Water and Sanitation Committee. Involvement of
local community in planning, implementation, and monitoring of sanitation activities,
development of cost-effective and efficient methods and its delivery system to improve the
sanitation for rapidly growing urban population, involvement of NGOs, local leaders, and other
stakeholders, adequate financing, and political commitment are the requisite areas to be
considered to improve the sanitation status in urban areas.
CLEANLINESS IN PUBLIC PLACES IN MUMBAI:-
The Essential Elements:

Any strategy for a cleaner Mumbai needs to have the following elements:

Addressing the problem of Littering

o Daily cleaning of the streets and public places (preferably night cleaning with,

o Adequate number of street litter bins at regular intervals

o An effective system of penal action against littering, spitting etc

Addressing the problem of Garbage

o Adequate arrangements for the chain of collection, storage and transport of garbage
generated by households and commercial establishments in a sanitary manner in closed
containers and vehicles

o Incentives and penalties to ensure segregation at source and arrangements for separate
chains for collection

Addressing the problem of Other Types of Waste

o Arrangements for separate chains of collection and transport of demolition wastes, silt from
storm-water drains, debris, bio-medical and hazardous wastes

Addressing the problem of open defecation

o Adequate number of public/community toilet seats for its residential and floating
population

An effective system of penal action against open defecation

Initiatives undertaken in the Recent Past :-

o The Dattak Vasti Yojana for achieving cleanliness in the slum areas through financial
assistance to Community Based Organizations (CBOs) which currently covers % of slum
areas.

o A programme of construction of community / public, Pay & Use toilets in slums (with
the help of the World Bank) and other areas.

o Involvement of Advance Locality Management Groups (neighbourhood residents

groups) for promoting segregation of waste at source and vermi-composting in the premises
of housing societies and residential colonies.
o Supporting N.G.Os. to set up de-centralized Waste Management Projects (composting
and bio-methanation) to serve as demonstration projects on municipal plots.

o Supporting waste segregation activities of N.G.Os. working with rag-pickers by

providing sites, vehicles etc.

o Setting up a system of biomedical waste (BMW) collection, transport, treatment and

disposal.

Besides the above initiatives, efforts were also made to set up large scale Wasteto-
Energy Plants, through private operators at the dumping sites, which did not bear fruit
due to reasons beyond the control of the M.C.G.M. such as certain decisions by the
Maharashtra Electricity Regulatory Commission (MERC) and the Ministry of Non-
Conventional Energy Sources (MNES), all the other initiatives have achieved varying
degrees of success.

THE ROADBLOCK FOR A CLEANER MUMBAI:-

Resistance to Change
o A large workforce and unions of workers who resist necessary measures such as night
sweeping, outsourcing, mechanization etc.

o Entrenched lobbies of contractors engaged in the business of transport of solid waste

who operate at various levels and stall any move to bring about radical changes in the nature
of contracts for collection and transport of solid waste.

o Resistance to any move to introduce user charges for waste collection and transport
services on the basis of the polluter pays principle to be able to expand, upgrade and
modernize the solid waste management services and practices.

Lack of Coordination amongst various agencies

o Lack of proper coordination in waste management activities between M.C.G.M and

other organizations who own/occupy large layouts such as the railways, the Mumbai port
trust, MHADA etc.

o A large informal sector consisting of rag-pickers, raddi-wallahs, scrap dealers and

waste, recyclers whose role needs to be recognized and who need to be made an integral part
of the overall system of solid waste management by a suitable method of compulsory
registration/licensing and concessions to promote waste recycling activities.

o Different departments and agencies responsible for removal of garbage, cleaning of

storm water drains, regulation of hawkers, regulation of slaughter of animals and sale and
pest control respectively resulting in divided and diffused accountability.

Apathy to the Problem

o A very large and growing slum population (65% of the total population) living in
congested areas, most of which have poor drainage, practically no sanitation whether in
terms of sewerage lines, sanitary toilet seats or regular conservancy services resulting in open
nallas and open plots serving as sewers and garbage dumps both household and
commercial.
o The NIMBY syndrome and the lack of appreciation about the dire necessity of
obtaining sites urgently for setting up waste processing facilities and sanitary land fill sites.

The Tough Decisions Required:-

The political establishment has to be prevailed upon to take some bold decisions such as:

Banning the use of plastic / Stern enforcement of regulations for the manufacture and
use of plastic

Involvement of the police in nuisance detection and enforcement

Dealing firmly with employee unions who oppose changes which are required in the
interests of economy and efficiency and do not involve any loss of wages or retrenchment of
existing employees.
 Making land available at the earliest for developing sanitary landfill sites and making
finances available for developing waste management infrastructure.
SWACHH BHARAT ABHIYAN:-
The Swachh Bharat Mission (SBM) emanates from the vision of the
Government articulated in the address of The President of India in his address to the
Joint Session of Parliament on 9th June 2014:
We must not tolerate the indignity of homes without toilets
and public spaces littered with garbage. For ensuring
hygiene, waste management and sanitation across the
nation, a Swachh Bharat Mission will be launched. This
will be our tribute to Mahatma Gandhi on his 150th birth
anniversary to be celebrated in the year 2019
SBM is being implemented by the Ministry of Urban Development (M/o UD) and by
the Ministry of Drinking Water and Sanitation (M/o DWS) for urban and rural areas
respectively.

MISSION OBJECTIVES:-

1. Eradication of Manual Scavenging

2. Modern and Scientific Municipal Solid Waste Management
3. To effect behavioral change regarding healthy sanitation practices
4. Generate awareness about sanitation and its linkage with public health
5. Capacity Augmentation for ULBs
6. To create an enabling environment for private sector participation in Capex
(capital expenditure) and Opex (operation and maintenance)
7.Elimination of open defecation
SWACHH BHARAT ON NATIONAL LEVEL:-
A National Advisory and Review Committee (NARC) headed
by the Secretary, M/o UD, and comprising representatives of relevant line
ministries will be notified by the M/o UD. NARC will meet as per the
requirements, but will meet at least once in three months. The functions of
NARC will be:
i. Overall monitoring and supervision of SBM (Urban)
ii. Advise the States / UTs to explore avenues for innovative resource
mobilization of private financing and leveraging land for PPP in
sanitation projects.
iii. Approve installments and release of installment of funds for states /
UTs by Central Government under the mission.
iv. Develop and modify performance matrix and criteria for the release of
performance grants to States / UTs as specified in paragraph 10.3.3.
v. Monitor outcomes and performance of projects sanctioned under SBM
(Urban)
vi. NARC may delegate, as it considers appropriate, some of the functions
within prescribed limits, to the National Mission Director (NMD) of the
SBM National Mission Directorate to ensure speedy implementation of
the mission
vii. Any other issue which may be referred to it by the Government
SWACHH BHARAT ON STATE LEVEL:-
A High Powered Committee (HPC) under the chairpersonship
of the States Chief Secretary, and with members drawn from concerned
departments (including a MoUD representative) shall be responsible for the
management of SBM (Urban) at the State / UT level. The functions of the
SLMRC will include:
i. Preparation, approval, and online publishing of the State Sanitation
Strategy (SSS) for the respective state and City Sanitation Plan (CSP)
for all cities covered under SBM (Urban), if not already done.
ii. Finalisation of the Concept Note on the Urban Sanitation Situation
before submission to the SBM National Mission Directorate
iii. Empanel consultants of repute and experience for:
a. Preparation of DPRs under SBM
b. Conducting independent review and monitoring during execution of
projects
iv. Empanel reputed Institutes like IITs, NITs, State Technical Universities
etc. for appraisal of DPRs.
v. Sanction projects relating to Solid Waste Management recommended
by the ULBs.