Report on
The STATE of HEALTH of MUMBAI
July 2014
Supported by
FORD FOUNDATION
MADHU MEHTA FOUNDATION
1
Data from RTI
RTI (Right to Information Act) Data in this section has been collected
from (162) Municipal Dispensaries, (26) Municipal Hospitals and (4)
State Hospitals for the period April’2008 to March’2014.
RTI Data from (8) Other Government Hospitals[which include Central
Railway, Bombay Port Trust Hospital, Police Hospital (Nagpada and
Naigaon), ESIS – Worli, Mulund, Kandivali, Marol) and (12) Police
Dispensaries] has been collected for the period of April’2012 to
March’2014.
2
7650 unnecessary deaths
3
Vital Health Statistics
• 20: Nearly 20 people die daily due to TB in
Mumbai
• 46,606: Since the last 6 years 46,606 people have
died due to TB averaging 7600 every year
• 6: Case fatality rate in TB is very high with every
6th person having TB dying
• 10: Dengue has gone up 10 times in six years
• 4.5: Death due to dengue has gone up by 4.5
times in 6 years
• 69%: Diarrhoea up by 69% in six years
• 7 died due to Cholera last year
• 20%: Malaria down by 20% since last year
• 195 people died due to Malaria last year
4
Registration of Birth and Death Act 1969
• Provides for registration of births and deaths
and for matters connected.
• ‘Source of demographic data for socioeconomic planning, development of health
systems and population control’ (as per 2012
Training Manual for Civil Registration Functionaries
in India, Office of Register General of India, Ministry
of Home Affairs, Government of India).
5
Refer to Report on The STATE of HEALTH of MUMBAI (Page No.45)
6
Medical Certification of Causes of Death (MCCD)
In Maharashtra, every 10th of the month monthly reports are received at state office of Deputy
Chief Registrar of Birth and Death at Pune. The strategy they follow:
•
In the case of deaths occurred in the institutions, Head of the institution is responsible for
submission of form no.4 to the Local Registrar. Or in the case of domiciliary death attended
by any physician prior to death is responsible to submit form no.4A to the local registrar.
•
It is the duty of Registrar (in the case of Mumbai it is Executive Health Officer of MCGM), to
ask about form No.4 & 4A according to occurrence of death, while entering the death event.
•
Deputy Director is responsible for compilation, coding & analysis of data received through
MCCD
according
to
ICD
(International
Cause
of
Death)
–
10
(http://www.who.int/whosis/icd10/).
•
The entire data is coded and computerised since September 2004.
Source: http://www.maha-arogya.gov.in/programs/other/sbhivs/strategy.htm
7
Discrepancy in reporting system
of TB deaths
(Calendar Years 2010-2013)
8
Discrepancy in reporting system
of Malaria deaths
(Calendar Years 2010-2013)
9
Causes of death in Mumbai : As per cause of death certificates issued by
MCGM’s Public Health Department
Cause of
Death
2008-09
2009-10
2010-11
2011-12
2012-13
2013-14
In no. In %
In no.
In %
In no.
In %
In no.
In %
In no.
In %
In no.
In %
Malaria
353
0.4
669
0.7
1222
1.2
385
0.4
230
0.3
195
0.2
Dengue
24
0.0
64
0.1
79
0.1
52
0.1
74
0.1
108
0.1
Tuberculosis
8196
9.4
8205
8.9
9168
9.0
7041
7.8
6921
8.1
7075
8.1
Diarrhoea
430
0.5
452
0.5
597
0.6
300
0.3
245
0.3
255
0.3
Cholera
13
0.0
2
0.0
3
0.0
3
0.0
9
0.0
7
0.0
Typhoid
17
0.0
30
0.0
28
0.0
7
0.0
9
0.0
10
0.0
Diabetes
Hyper
tension
2686
3.1
2539
2.8
2951
2.9
2118
2.3
2523
2.9
2341
2.7
3669
4.2
3974
4.3
4643
4.6
3780
4.2
3974
4.6
4525
5.2
HIV / AIDS
Other Cause
of deaths
948
1.1
899
1.0
780
0.8
544
0.6
558
0.7
439
0.5
71231
81.3
75254
81.7
82098
80.8
76559 84.3
71259
83.1 71918 82.6
Total Deaths
87567
100
92088
100
101569
100
90789 100
85802
100
87027 100
During the last six years (2008-14), 8.55% of all deaths and 46,606 people have died due to
10
TB in Mumbai .
Shortage of staff (in%) in MCGM's dispensaries/hospitals and
State hospitals as of March 2014
11
Data from Household Survey
Praja Foundation had commissioned the household
survey to Hansa Research and the survey was conducted
in March-April 2014 across the city of Mumbai with a
total sample size of 22,580 households.
12
Facilities used by the citizens across different socio-economic
classes
Year
Overall
SEC A
SEC B
SEC C
SEC D SEC E
Only Govt. dispensaries/
hospitals
2013
31
26
31
31
30
48
2014
34
28
29
29
36
47
Only Private or Charitable
clinics/ hospitals
2013
62
66
62
58
65
46
2014
56
68
63
56
54
46
Using both private and govt.
Hospitals
2013
7
8
8
11
5
6
2014
10
4
8
15
10
8
• In 2014, there has been a 3% rise in Mumbaikars using only government
dispensary/hospital facilities; while there has been a 6% decrease in citizens who used
only non-government facilities, compared to year 2013.
• In 2013, 62% citizens used only Private or Charitable clinics/ hospitals; this has come
down to 56% in year 2014.
13
Annual Family Income spent on hospital/medical costs across
socio-economic classes
Amount
In %
SEC A
spent from
total income
(in %)
2013 2014 2013 2014
More than
17 13 18 16
11%
6% to 10%
Less than 5%
38
32
35
36
45 55 47 48
100 100 100 100
Total
Average
spent from
7.1
total income
(in %)
7.9
6.9
8.4
SEC B
SEC C
SEC D
SEC E
2013
2014
2013
2014
2013
2014
2013
2014
18
15
18
13
15
12
17
10
36
36
38
35
39
27
42
30
52 46
100 100
61
100
41
100
60
100
8.1
7.6
7.6
7.3
46 49 44
100 100 100
7
8.3
7.3
6.9
On an average, households spent 7.1 % of their total income on hospital/medical costs
in 2013 and 7.9% of total income on hospital/medical costs in 2014.
14
Estimated cases per 1000 households of Diseases and Ailments
•
•
•
Malaria
Dengue
Diabetes
Cancer
Diseases &
Ailments
2013
2014
2013
2014
2013
2014
2013
2014
Overall
80
61
16
25
49
42
6
7
SEC A
139
56
20
19
67
34
9
3
SEC B
74
53
22
24
45
51
11
5
SEC C
62
51
9
24
43
37
2
10
SEC D
79
69
17
29
49
41
6
8
SEC E
44
77
10
22
45
55
7
4
On an average, 80 households out of every 1000 in 2013 and 61 households out of every 1000 in
2014 had a member suffering from Malaria.
While there was a drastic decrease in cases reported from the upper economic strata (SEC A), the
decrease in cases reported in SEC D was less pronounced.
On the other hand, there was a sharp increase in Malaria cases reported from the lower economic
strata - SEC E.
15
Deliberations by Councillors and MLAs
of Mumbai
16
Deliberations on health by Councillors during
March’12 to March’14
March 2012 to March April 2013 to March
2013 *
2014 *
Total questions on Health
Councillors who have not asked
a single question
Total questions in Public Health
Committee
Public Health Committee
members who never asked a
single question
200
365
138
121
56
122
11
12
Praja
Impact
Note: Their are a total of 227 councillors of whom 34 are members of the Public Health Committee
Eight councillors who have been members of the Public Health Committee have
never asked a single question on health in last two years (Sushama Salunkhe, Snehal
Shinde, Ujjwala Modak, Dilshad Azmi, Prashant Kadam, Rupesh Waingankar, Avinash,
Sawant, Nandakumar Vaity).
17
Deliberations on health by 32 (excluding 4 ministers) MLAs
during Budget, Monsoon & Winter sessions of 2012 and 2013
• Two MLAs (Chandrakant Handore & Annie Shekhar) did not raise
a single question on health.
• While two (Baldev Khosa & Kripashankar Singh) others just
asked one question on health.
18
What needs to be done
•
Study of TB related deaths in Mumbai that focuses on the challenges faced by patients
in accessing the health care system should be initiated.
•
Public Health Surveillance (Health Information System) needs to be immediately
augmented to regularly collect health data from private and charitable health facilities
alongwith 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 socioeconomic classes for greater impact.
19
THANK YOU
Questions
20