Jan Swasthya Abhiyan strongly objects to the new Mumbai Development Draft Plan 2034 for not addressingthe issue of Health sector in a holistic manner . Mumbai, although being the country’s economic capital is lagging far behind in providing basic health care needs to its citizens.
Social amenities and infrastructure are the basic requirement of urban life and its adequacy and accessibility are improtant contributors in the upgradation and enrichment of quality of urban life , which is primary objective of any planned effort. But the Mumbai Development Report surprisingly, washes its hand off by stating that ‘ Scope of the DP is confined to fulfilling spatial requirements of equitable access to social and physical infrastructure,and that larger sectoral goals not within its purview.
It is surprising that despite a process of 6 years of consultations with various stakeholders the DP does not include any recommendations by the health groups.
The various stakeholder consultations had recommended that Dispensaries should be the basis of eradicating the shortfall of the medical services in the city.Maternity homes should be developed into maternity and maternity and child welfare centers and Expansion of existing hospitals with addition of a certain number of minimum of maternity and child health services.
But nothing is reflected in the Draft DP document, infact it does not even look health as a thematic issue.
The DP does not even mention the Rindani Committee Report which was guiding document for the Mumbai DP Plan, The Report examined and made recommendations regarding the policy for expansion of existing hospitals, maternity homes and dispensaries and locations of the new institutions to be developed in different parts of greater Mumbai. It scrutinized the development Plan proposals in respect of medical relief and modified them wherever necessary and to laydown the basis of priority of implementation.
The Committee had made recommendation of location of the medical facilities on the basis of the impoverishment in these areas as opposed to the density of the population in a certain area. This was a choice made as most of the illnesses would have their points of origins in areas with lower
socioeconomic status. The Mumbai DP plan has totally ignored it..
The Mumbai DP Plan allocation for health amenities has given 0.38 sq m per capita (UDPFI: 0.83 sq m to 1.28 sq m per capita). Earlier, much of the land was separately marked for civic or government -run facilities this category does not exist in the new plan, ignoring all those who can’t afford private healthcare.
The table below clearly indicates the above statement
Lack of primary healthcare facilities -There are only 168 health-Posts in the Mumbai with population of nearly 1,50,00,000 i.e. 1 per 92,592 persons which is highly inadequate especially in wards with large populations which have large number of vulnerable groups like slum dwellers, migrants, minorities, etc. (such as M-East, L). These wards have the worst health and human development indices with the lowest number of facilities per population.
Non-equitable spatial distribution of healthcare amenities: Along with primary healthcare in Mumbai, looking at the spatial distribution of hospitals providing secondary and tertiary care, there is a clear disparity. The part of the city having about 28% of the population has 62% of the public beds and 49% of the private beds,whereas, the majority of the population in the Eastern and Western suburbs have inadequate beds. Therefore, there is a need to incorporate this skewed availability of health services in the development plan of Mumbai to ensure that more healthcare services are made available to the suburbs.
The DP has no clear earmarking of reservations for public health services and specifically primary, secondary and tertiary
Privatization of health care: About 70% of the city depends upon private health care; the disintegrating lower rung health care in the city is pushing the poor to availthe private health care facilities. The various DP reservations that have developed under accommodation reservation almost invariably turn out to private developments inaccessible to the poor, thereby suggesting the institutionalized privatization of health care.
The issue of health is incomplete unless its related and linked to various social determinants, water, sanitation , solid waste management .
In The DP there are no plans for Storm Water Management and no reference to Chitale Committee Report.
Mumbai’s demand for water is 4600 MLD however considered DP demand is 4000MLD. Has the demand reduced by 600 MLD in the base year itself.?
There is No reference of any sewage treatment Plant. Total solid waste generated is 10060 metric tonnes per day as against 7800 metric tonnes per day considered by DP . Has SW reduced by 2260 MTPD in the base year itself. ?
It is very strange that the DP Plan is using the National Building Code of India (NBCI) for commercial establishing but refuses do so for health According to the National Building Code of India (NBCI) the facilities available in Mumbai should be as follows–
The NHM (National Health Mission) proposes the creation of one UHC (Urban Health Centres) per 60,000 population. Ensuring need based distribution of centres as well adequate personnel is important to meet the objectives of the NHM.Accordingly, there should be around 250 UHC against the presently existing, the DP document completely ignores it. It does not give any provision to operationalise the infrastructure as laid down in the NHM
Especially looking at the vulnerable sections and health issues , The Maharashtra State Action Plan for the Welfare of Persons with Disabilities (2001) stresses on the need of primary health centres equipped to handle concerns related to disability and where people with disability can receive medical treatment.It also stresses on the need of a super-speciality-treatment that should be provided through the state resource centre. The DP document completely silent on the issue .Draft DP does not cover issues specific to Children Welfare and Women users in Mumbai and is
completely a technocratic exercise.
Jan Swasthya Abhiyan (JSA ) Mumbai demands –
- Cancelthe use of accommodation reservations and incentive FSI in the DP
- Build Public Health Facilities as per NBCI quantity norms ( dispensaries, urban health centers maternity homes, general hospitals )
- Address problem of uneven development by building more facilities in suburbs
- Enforce complaince in charitable and private hospitals to the BPT Act that mandates 20% of beds for lower income group.
- The Planning needs to be in consonance with National Health Mission standards.
- The Development Plan must work with Health Department to improve health care in City, the approach must be to development for improvement of public health with clear target and objectives.
- The deadline of accepting objections and suggestions for the Mumbai Development , Plan April 24th2015, be extended by two months as its is going to affect lievs fof more than 12.5 million people and the the process of Consultation workshops should be held ward wise for -– Elected Representatives , Issue Wise Stakeholder and – Planning Sector wise .
( Jan Swasthya Abhiyan , Mumbai is a movement to establish health and equitable development as top priorities through comprehensive primary health care and action on the social determinants of health This Statement is an outcome of a JSA meeting on Mumbai Development Plan on 7Th April , World Health day,2015 )