While there has been a rise of 98% in BMC’s health budget in the last seven years, from Rs 3,637 crore in 2018-19 to Rs 7,191 crore in 2024-25, vacancies in BMC Primary Healthcare Facilities (dispensaries) have increased by three times in the last decade.

Praja Foundation’s ‘Report on the Status of Health Issues in Mumbai 2024’ has found that vacancies in BMC’s primary healthcare facilities increased from 12% in 2014 to 37% in 2023 and not a single ward in Mumbai met the criteria of availability of 1 dispensary per 15,000 population, set by Urban and Regional Development Plans Formulation and Implementation (URDPFI).

There is a shortage of 525 dispensaries as per the URDPFI norms. A total of 191 municipal dispensaries are operational in the city. However, 95% of these clinics (181) are operating for only 7 hours a day. 97 of 207 Hindu Hridaysamrat Balasaheb Thackeray (HBT) clinics are functioning in the premise of existing municipal dispensary after the dispensaries close for the day, therefore, only 110 HBT clinics are operating in unique locations.

Between 2014 and 2023, the top five diseases with the highest number of registered cases in Mumbai were Diarrhoea (9,36,061), followed by Tuberculosis (3,89,803), Hypertension (3,70,795), Diabetes (3,70,081) and Dengue (1,39,892). During 2014-2022, top four causes of death were: Diabetes, Major Respiratory Diseases, Tuberculosis and Hypertension.

The report says that in 2022, 69,904 Diarrhoea cases were registered. However, Maharashtra Pollution Control Board (MPCB) report in 2022, rated Mumbai’s water quality as Good to Moderate (50-63). “While this suggests a generally acceptable standard of water in the city, the high incidence of Diarrhoea calls into question the effectiveness of water management and sanitation systems in preventing waterborne diseases in a metropolis such as Mumbai” it says.

“In 2014, total of 2,428 deaths were caused by lifestyle diseases such as diabetes which have risen by 485% to 14,207 in 2022, becoming the leading cause of death in Mumbai. This alarming trend highlights the need to follow the Urban and Regional Development Plans Formulation and Implementation (URDPFI) Guidelines set by the Ministry of Housing and Urban Affairs (MoHUA) to guide urban planning and development across cities and regions,” said Milind Mhaske, CEO of Praja Foundation.

He added that the guidelines recommend that at least 10 square metres of open space per person should be available, promoting public health, physical activity, and well-being. “However, Mumbai’s Development Plan (2014-2034) proposes only 3 square metres of open space per person, a stark shortfall that not only highlights the urgent need for more open spaces but also points to the broader issue of inadequate infrastructure to support the health and well-being of its citizens."

The report based on documents procured through RTI also finds deteriorating air quality in Mumbai. From 2019 to 2022, the city's average air quality has declined from Satisfactory (51-100 AQI) to Moderate (101-200 AQI). 33,711 deaths occurred due to 'Major Respiratory Diseases' and 'Respiratory Tuberculosis' caused 13,524 deaths  during the same period highlighting serious air pollution threat to the residents of Mumbai.

“In 2023, the air quality took a further hit as there was not even a single month where the recorded Air Quality Index (AQI) was in the Good category (0-50),” said Eknath Pawar, Associate Manager, Capacity Building, Praja Foundation.

Shreyas Chorgi, Associate Manager, Research, Praja Foundation, said that the addition of 207 HBT clinics in 2022 has been a welcome step to reduce the burden on municipal dispensaries. However, 97 of the 207 HBT clinics operate within the same premises as municipal dispensaries. Additionally, only 6% (13 out of 207) of the HBT clinics are accessible for 14 hours (7:00 AM to 10:00 PM). To better serve all areas, municipal and HBT clinics should operate for 14 hours, especially in wards with large slum populations.

With no municipal elections held  since the last three years the BMC has been operating without elected representation. As a result, the health committee has not been formed to address important health issues.

“The overall health situation highlights the need for greater citizen involvement in the city’s public health functions. The National Health Management Information System (NHMIS) must be fully operational to ensure the efficient real-time collection of health data, including information on deaths and diseases. To transform Mumbai into a world-class city and improve the health of its citizens, the BMC must prioritise access to open spaces and strengthen primary healthcare services. This approach will promote healthier lifestyles and help tackle the growing challenge of lifestyle-related diseases” added Mhaske.

Recommendations
* Data Management at Ward Level on occurrences of diseases, COD and facilities provided under various schemes should be maintained ward  wise to decentralise health management and  for  targeted interventions to handle health issues. Maintain Cause of Death data on a real-time basis. Make data accessible to all tiers of the government. Streamline duplication of data through various agencies within the BMC (such as TB cell, EPID cell, ward wise Medical Officer of Health, etc.)to ensure that uniform data for a particular disease is made available across agencies.

* Have outcome-based budget for targeted development in the overall healthcare sector of the city.

* Elected Representatives (ERs) should carry out citizen-centric deliberations in the public health committee meetings that target the existing major issues related to health in the city. Include  data-centric discussion on diseases that leading to the highest deaths in Mumbai, vacancies of medical personnel in municipal hospitals and dispensaries .

* Adopt stringent measures to achieve SDG Goals Regularly monitor performance through HMIS on the SDG indicators to meet the targets by 2030.

* Strengthen and equip dispensaries and maternity homes for preventive and primary care by including beds and equipment to provide proper care to patients to provide integrated primary care with specialist services for diseases including mental health and nutrition counselling and diagnostic services.

* Amplify medical testing for all age groups for various diseases that are prevalent in the city.