Human rights body directs state govt, BMC to improve living conditions in M/East ward Pratip Acharya March 28, 2023 https://indianexpress.com/article/cities/mumbai/human-rights-body-directs-state-govt-bmc-to-improve-living-conditions-in-m-east-ward-8522494/ The Maharashtra State Human Rights Commission (MSHRC) has directed the state government and Brihanmumbai Municipal Corporation (BMC) to prepare a roadmap that would improve public infrastructure and existing civic amenities in the M/East ward in the eastern suburbs. “The concentration of polluting and hazardous activities, poor standards of supporting infrastructure due to lack of planning and socio-economic deprivation have resulted in high levels of mortality, morbidity and threat infectious diseases,” said the MSHRC directive.
The ward covers Govandi, Deonar, Shivaji Nagar and Cheeta Camp areas, and mainly comprises slums, LIG houses.
For Report by GBGB Andolan..
Report on Health Conditions in M-E Ward of Mumbai
Amita Bhide, D. Parthasarathy, Hussain Indorewala | December 2022
BACKGROUND
This report aims to provide an outline of the socio-economic factors and environmental
conditions in the M-E Ward of Mumbai, that are responsible for the abysmal health levels in
the Ward as highlighted over the years in various official and unofficial studies.
In March 2019, four field investigators were directed by the Maharashtra State Human
Rights Commission (MSHRC) to visit the slum areas of M-E Ward. The investigators wrote
to the MSHRC in their letter dated 1st April 2019 that “there are numerous gaps” in the
healthcare framework in the Ward and that “lack of access to quality healthcare...coupled
with lack of sanitary facilities has caused numerous health issues in the community.”
Consequently, the MSHRC assigned the NGO Ghar Bachao Ghar Banao Andolan (GBGBA)
and its member Mr. Bilal Khan to look into the matter. Mr. Bilal Khan recommended a list of
institutes who could lend their expertise and experience to conduct a study. As per the
recommendations, the MSHRC constituted a committee of three members:
1) Amita Bhide, Professor, School of Habitat Studies Tata Institute of Social Sciences ; (2) D
Parthasarathy, Professor, Department of Humanities and Social Sciences, Indian Institute of
Technology Bombay; (3) Hussain Indorewala, Asst. Professor, Kamla Raheja Vidyanidhi
Institute of Architecture and Environmental Studies.
The members were to work in coordination with the office of the Municipal Commissioner,
MCGM, and the Principal Secretary, Women and Child Welfare Department, Mantralaya.
The scope of work
as decided by the members was as follows:
a) To provide a brief overview of the nature and extent of the public health crisis and
environmental vulnerability in the M-E Ward
b) To identify the various socio-economic and socio-environmental factors responsible for
the poor health indicators of M-E Ward
c) To suggest various steps to address the urgent issues and guiding principles and directions
to improve the health and well-being of the residents of M-E Ward.
INTRODUCTION
ME Ward is an area of the city that is subjected to the most adverse environmental
conditions that have a negative impact on health. It hosts 2 state led petroleum refineries
(Bharat and Hindustan Petroleum), state-owned fertilizer factory Rashtriya Chemical and
Fertilizer, one atomic research centre and Tata power station. The presence of a
slaughterhouse which was shifted from a western suburb (Bandra), a (Deonar) dumping
ground, bio-medical waste incinerator company add to the health vulnerabilities. The
concentration of these hazardous activities make M East ward a periphery within the city
whose population is at extreme risk and vulnerable to multiple health hazards. To make
matters worse, physical and social infrastructure such as open spaces, health infrastructure
that can partially offset the debilitating impact of these polluting activities is abysmally low.
Further, these environmental hazards are imposed on a population that has
socio-economically low status and is vulnerable in other ways. A cumulation of these three
factors viz the concentration of polluting and hazardous activities, poor standards of
supportive infrastructure due to lack of planning, state neglect, and socio-economic
vulnerability result in high levels of mortality, morbidity and heightened threat of infectious
diseases.
The health indicators below substantiate the significant adverse impact of the
above factors:
● The life expectancy of people in this ward is 39 years as against the 56 years for
Mumbai and 73 years for urban Maharashtra as of 2009.(MCGM (2009). Mumbai Human Development Report 2009.p.228.)
● The annual TB report of 2017 of India reveals that Govandi is a major TB hotspot in
the city; cases in M East amount to a prevalence of 1,055 cases per 1 lakh persons
which is about 3-5 times higher than the national average. The ward also had 2,800
residents on active treatment for drug-resistant TB in 2020, the biggest cluster of
patients in the city. (Ministry of Health and Family Welfare (2017). TB India 2017. p.138.)
Dhakulkar and others in 2021 found high number of Childhood
and adolescent drug-resistant TB (DR-TB) in M=ME Ward, They observed that
patients affected by undernutrition reflected a higher probability of “unsuccessful
DR-TB treatment outcome.” (Dhakulkar, S., Das, M., Sutar, N., Oswal, V., Shah, D., Ravi, S., Vengurlekar, D., Chavan, V., Rebello, L., Meneguim, A.C. and Iyer, A., 2021. Treatment outcomes of children and adolescents receiving
drug-resistant TB treatment in a routine TB programme, Mumbai, India. Plos one, 16(2), p.e0246639)
● The Praja report on malnutrition status of 2017 reveals that the nutrition status of
children in ME Ward is very poor, ranking 3rd highest percentage of students
underweight in MCGM schools in 2018–19, and the highest number of actual
students underweight. As per the NFHS 5 data, more than 37% of children under 5
years are stunted and 25% are underweight.As per an RTI filed in April 2022 there
are more than 1900 SAM children under 5 years in M East ward of Mumbai. ( Praja (2017). Report on Status of Malnutrition in Municipal Schools in Mumbai.)
● As per the MCGM records only 0.2 percent of the population has a disability in ME
Ward, which is slightly lower than the whole of Mumbai (0.24 percent). But
according to a report by Apnalaya NGO (that also works in M East ward) wherein
9972 individuals were surveyed between July 2019 and June 2020, it was found that
at least 1.3 percent of the population has some sort of disability in the ward. (Bangarwala, T (2020). Mumbai: Study finds 1.3% disabled people in M East ward. Indian Express.December 3.) The
2015 TISS Survey found this proportion to be much higher at about 4.36%
self-reported disabilities. Another report by the minority commission of 2013,
revealed that 3.5% respondents reported having a handicapped person in their home.
● TISS Survey of 2011 shows that there were 30 maternal deaths in M East ward among
3000 women surveyed in 2011. As per NFHS-5 data of 2019-20, Mumbai suburbs
records only 58% mothers having ANC check-up in the first trimester, 50% women of
age 15-49 years anemic which has remained unchanged from the NFHS 4 of 2015-16.
● ME Ward dispensary data for April 2018 shows that this Ward had the 2 nd highest (22,000) number of total patients visiting the dispensary for complaints (the highest
rank is for L ward with 27,000 cases in a year). The Ward ranks first in share of Non
Communicable Diseases (NCD) complaints with 2100 patients visiting the dispensary
in April 2018 followed by G north ward with 1800 patients and L Ward with 1450
patients. Wards of Mumbai like A, B, D, HW and even MW wards have less than 500
patients visiting dispensaries for NCDs.
● A doctoral dissertation in 2017 revealed a strong correlation between the high level of
communicable diseases and environmental hazards in the Mankhurd area of ME
Ward (Khatun, Nasima. "Establish Diseases Pattern-A Study On The Relation Between Communicable
Diseases And Environmental Determinants In The Slum Area Of Mankhurd In Mumbai,
Maharashtra." PhD diss., 2017.)
.
● Chitturu (2018) studied inadequate access to healthcare infrastructure for the elderly
population ME Ward Chitturu, Saigita. "Issues of Elderly Women: A Study of M-East Ward, Mumbai." The Indian Journal of Social Work 79, no. 1 (2018): 99-118.
.
● According to a study by Das et al 2010, ME Ward had the highest number of home
births, but had inadequate maternity hospitals to meet the need for maternity care ( Das, Sushmita, Ujwala Bapat, Neena Shah More, Latika Chordhekar, Wasundhara Joshi, and David
Osrin. "Prospective study of determinants and costs of home births in Mumbai slums." BMC
pregnancy and childbirth 10, no. 1 (2010): 1-10)
.
● Immunization coverage among children of Nomadic and De-notified Tribes ME Ward
were extremely low“only 11.5 per cent children were fully immunized while 37.2 per
cent children were partially immunized and 51.3 per cent children were
non-immunized”( Katarki, Praveenkumar, Mayank Sinha, and Vijay Raghavan. ‘Living on the Edge: Immunization
Coverage among Children of Nomadic and De-notified Tribes in the Slums of M-East Ward, ‘ Mumbai.
No. id: 8366. 2016.)
.
● Several studies have shown high rates of prevalence of COPD, allergic rhinitis, throat
and eye irritations, bronchitis, TB, chest illnesses and cardiac ailments in the ME
Ward
M-E WARD DEMOGRAPHIC PROFILE
(Pix)
FIG 1: M-E WARD ELECTORAL BLOCKS (2022) AND SLUM CLUSTERS
Source: Electoral Blocks from MCGM; Slum Clusters from SRA 2016 Survey
As a part of the Kurla Taluka, the M-Ward (before it was subdivided into two Wards) was
included within the municipal boundary of Mumbai in 1950. At that time, this area around
Trombay Hill mainly consisted of fields and plantations, a few country houses, and very few
civic amenities or transport facilities. From 1949, hutment dwellers who were evicted from
different parts of the Island City began to settle to the north of the Hill after gaining some
concessions from the authorities in the form of allotment letters to sites (being charged
Municipal rent), and later on, some basic services. This became the Janta Colony, a
settlement of 7,450 homes. (Deshpande, S.G.(1976). ‘Resettling a Squatter Settlement’, Economic and Political Weekly.)
Meanwhile, the Department of Atomic Energy (DAE) set up its
reactor in the 1950s, and residential quarters for DAE officers began to be set up in the late
1960s. 25 years later, in 1976, Janta Colony was razed just before the monsoons to build 700
lavish flats and amenities for the officers of the Department of Atomic Energy (DAE). The
residents who were displaced once again were allotted plots of half the size in an inter-tidal
swamp a few miles away. (ibid)
Nevertheless, over the decades, the residents gradually made land
and a flourishing settlement now known as Cheeta Camp.
The Janta Colony episode is emblematic of the violence and insecurity that pervades the
residents of the M-E Ward - which has since the 1970s seen numerous unplanned
resettlements without adequate services, amenities or livelihoods. In the 1970s, evictees of
the Island City were resettled in Shivaji Nagar, Bainganwadi, and Lotus Colony. Further
evictions in the 80s and 90s brought another wave of displaced households to the ward.
Since the early 2000s, many formal resettlement colonies have been built in the Ward to
rehouse squatters displaced by infrastructure projects. (2 Bhide, A. (2015) ‘Social Economic Conditions and Vulnerabilities: A Report of the Baseline Survey of
M(East) Ward, Mumbai’, Tata Institute of Social Sciences (TISS))
The land-based-incentive approach
to producing rehabilitation units has made M-E Ward not only a site for absorbing displaced
persons, but also a site for generating low-cost development rights in the form of TDR. In
other words, the poverty and vulnerability of the M-E Ward and its neighboring Wards has
become functional for real estate speculation in Mumbai, exacerbating urban inequality and
socio-economic segregation in the city.
Furthermore, the Ward has also been the site of ‘undesirable’ or hazardous land uses -
beginning with the Garbage Dump that was set up in 1927 in a mangrove swamp north of
Trombay Hill. In the 1950s and 60s, many industrial and defense installations were located
in the M Ward: a naval base, the Atomic Energy complex, Rashtriya Chemical Fertilizer
plant, Tata Thermal Power station, NTPC storage facility, Burmah Shell refinery, etc. In
1971, the Bandra abattoir was moved to its current location in Deonar. (Ibid)
Deonar also became
the site for the city’s bio-medical waste facility. These land uses and the proximity of lakhs of
people to the hazards and pollution is an important cause of its health vulnerabilities.
According to the Census 2011, the M-E Ward is home to 807,720 people (see Table 1),
making it the fourth largest out of 24 Administrative Wards in Mumbai in terms of
population. (The MCGM Public Health Department estimates the current midyear population at 907,660 persons) The decadal population growth rate between 1991 - 2001 was 43.4% while
between 2001 - 2011 was 19.6%. The decadal growth rate for Mumbai as a whole during the
same two periods was 20.68% (1991-2001) and 3.87% (2001-2011) respectively. The growth
rate for suburban( Suburban Mumbai refers to the Eastern and Western Suburbs - or Greater Mumbai excluding the Island City) Mumbai between 2001-2011 was 8.29%. In other words, the population
growth rate of M-E Ward was five times greater than the Mumbai average and twice that of
the suburbs. What is more striking is that the slum population growth rate in the decade
between 2001-2011 in M-E Ward is 31.08% - meaning that the slum population in M-E Ward
grew at a greater rate than its non-slum population. The Ward has the highest percentage of
residents living in slums and the second highest number (after L Ward) of slum dwellers in
Mumbai.
TABLE 1: M-E WARD POPULATION AND SLUM POPULATION 1991-2011
M-E Ward 1991 2001 2011
Total Population 470,662 674,850 807,720
Slum Population - 523,324 685,994
Slum Population (%) - 77.5% 84.9%
Source: Census 1991, 2001 & 2011. Slum population for 2011 from MCGM Public Health Department.
TABLE 2: SPATIAL DISTRIBUTION OF NON-SLUM AND SLUM POPULATION IN DIFFERENT PARTS OF MUMBAI 2001-2011 (%)
Zone (Wards) 2011 total 2011 Non-Slum 2011 Slum
Inner Island City (A, B, C, D, E) 9.79 17.06 3.22
Outer Island City (FN, FS, GN, GS) 15.00 16.29 13.83
Near Western Suburbs (HE, HW, KE, KW) 19.59 19.93 19.28
Outer Western Suburbs(PN, PS, RS, RC, RN) 24.83 21.70 27.66
Near Eastern Suburbs (L, ME, MW, N) 22.06 15.00 28.44
Outer Eastern Suburbs (S, T) 8.72 10.01 7.56
Greater Mumbai 100 100 100
Source: Census 2011. Slum population for 2011 from MCGM Public Health Department.
The spatial distribution of slum and non-slum population in Mumbai reveals that the Near
Eastern Suburbs (consisting of L, ME,, MW and N Wards) have the largest concentration of
slums in Mumbai (see Table 2).
In 2009, the Municipal Corporation of
Greater Mumbai (MCGM) conducted a
Human Development measure for all Wards
of the city, by adopting a combination of
educational, health and income indicators. (MCGM (2009). ‘Mumbai Human Development Report’.)
As the map to the left shows, the M-E Ward
ranked lowest among all the Wards, with a
measure of 0.05 as compared to the Mumbai
average of 0.56. The Social Economic
Conditions and Vulnerabilities survey carried
out by the Tata Institute of Social Sciences in
2015 (henceforth the TISS Survey) pointed
out that the M-E Ward is a geography “that
has almost exclusive occupation of the poor”
and has emerged as an “expanded poverty
space” in the city. In comparison to city level
parameters, the parameters of M-E Ward are
substantively low - even comparable to some
of the poorest regions in the world. The poor
health indicators of M-E have to be seen from
a broader socio-economic and human
development perspective, rather than simply as a consequence of hazardous industries or
unregulated / unauthorized activities. It is therefore necessary to address the gross
inequalities and multidimensional deprivations suffered by the residents of the Ward. (MCGM (2009). ‘Mumbai Human Development Report’.)
16
DETERMINANTS OF POOR HEALTH CONDITIONS:
HOUSING, INFRASTRUCTURE & BASIC SERVICES
FIG 3: LOW-INCOME SETTLEMENT AREAS IN M-E WARD
Pix ) Source: Bhide, A. (2015) ‘Social Economic Conditions…’
a) HOUSING
Housing is an important index of stability or vulnerability since security of tenure affects
access to basic amenities and services, while housing quality tends to correlate with other
human development indicators. If one leaves out the multifamily private and government
housing and single family homes (bungalows and row-houses), the M-E Ward has a variety
of settlements that provide low-cost shelter to its predominantly poor residents. These
settlements have come up at different points in time with multiple layers of occupation -
having different conditions, different levels of acceptance by law, and varied access to
amenities and services.
Six broad areas of low-income settlements are shown in Figure 3 comprising (a) Shivaji
Nagar, (b) Bainganwadi, (c) Mankhurd, (d) Govandi, (e) Vashi Naka and (f) Cheeta Camp.
The TISS Survey conducted in 2015 noted that 40% of low-income households in M-E Ward
live in ‘fair’ housing conditions (based on criteria that includes quality of the structure,
number of rooms, water and sanitation) while 60% live in ‘average’ or ‘inadequate’
conditions. The survey indicated that better housing quality was linked to greater tenure
security and plot provisioning by the government (in the form of layouts) rather than the age
of the settlement. Nevertheless, the policy of ‘cut-off dates’ results in more layers of
vulnerabilities to settlements created post-2000 in the form of repeated evictions and lack of
basic services and amenities. (Bhide, A. (2015) ‘Social Economic Conditions…’ p. 145-147
areas of M-E Ward is 440 tenements per hectare, 4.7 times the non-slum residential density.)
TABLE 3: RESIDENTIAL DENSITY IN M-E WARD
Land use Housing Type Land Area (Ha)* Population2011 Res. Density HH/Ha
Residential 121,726 93.85
(non-slum) Individual 22.75
Apartments 127.67 121,726 93.85
Government 106.57
Chawls 2.41
Residential (slum) Slum Clusters 311.72 685,994 440.13
Total 571.12 807,720 282.85
Source: ^MCGM Public Health Department 2011; *MCGM ELU Survey 2012.
Yet, from a broader planning perspective (Table 3), the residential inequities become
evident when we link demographic with land use data. As discussed above, the slum
population of M-E Ward is 685,994 and non slum population is 121,726. According to the
MCGM’s Land Use Survey of 2012, 17.26% of land in M-E Ward or 571.12 Ha is used for
residential purposes. Of the total residential area, 54% or 311.72 Ha is slums, and 45% or
259.4 Ha is non-slum residential. This means that the average residential density in slum
17
This statistic indicates not only the overcrowded conditions with slum settlements, but also
the level of disparity in terms of access to land and amenities within the Ward.
Since 2003 numerous Resettlement and Rehabilitation (R&R) colonies have been built in the
M-E Ward. A 2008 article pointed out that 32,653 units have been constructed in M-E, and a
2012 study by TISS showed the poor environmental and service conditions in these
colonies.
18 A recent report by the NGO Doctors For You showed that the occurrence of TB in
two of the R&R colonies in M-E Ward is strongly associated with the built environment of
the houses and the layout of the buildings in both the colonies.
19 Significantly, these R&R
colonies are sites for the generation of Transferable Development Rights (TDR) which
provides developers who surrender land in the Ward or build rehabilitation units with
permits to build elsewhere in the city. According to recent data (2021) obtained from the
MCGM by the authors of this report, the M-E Ward has generated 2,582,468 sqm of slum
TDR, 31,8% of the total slum TDR generated in the city - the highest by a significant margin.
b) HEALTH INFRASTRUCTURE
The public health system in Mumbai, specifically the tertiary care and even the secondary
care hospitals, are concentrated in the Island City (see Table 4). The suburbs, which
comprise a bulk of the total population and also majority of informal settlement population
of Mumbai have access to very few public secondary and tertiary health care facilities, and
the Eastern suburbs fares worse than the Western suburbs. As a result of these disparities,
people living in the Eastern suburbs are forced to either use private facilities or travel to
public health facilities in the Island City.
TABLE 4: COMPARISON OF HEALTH CARE FACILITIES IN THE ISLAND CITY AND SUBURBS
OF GREATER MUMBAI
Hospitals
Island City Western
Suburbs
Eastern
Suburbs
MCGM
Peripheral 0 8 8
Tertiary 3 1 0
19 Doctors for You (2018). ‘Studying the association between structural factors and tuberculosis in the
resettlement colonies in M-East ward, Mumbai’; see also Peehu Pardeshi et. al. "Association between
architectural parameters and burden of tuberculosis in three resettlement colonies of M-East Ward,
Mumbai, India." Cities & Health 4, no. 3 (2020): 303-320.
18 TISS M(E) Ward Project (2012). ‘An overview of Resettlement and Rehabilitation Colonies in
M(East) Ward, Mumbai’, Tata Institute of Social Sciences, Mumbai.
Specialty 5 1 0
State Government
Secondary 3 1 0
Tertiary 1 0 0
Source: MCGM
According to a 2019 response submitted by the MCGM to the MHSRC, at the primary
healthcare level, the ME Ward has 15 health posts, 9 working MCGM dispensaries, and 2
functioning maternity homes (1 with no delivery facility, only OPD service).
20 In 2020, BMC
decided to run 15 evening dispensaries through the PPP model with consultation only mode,
but none of these were opened in the M East.
21 This level of primary health care is highly
inadequate as per various urban planning and public health care norms (see Table 5 below).
The inadequate access to health care facilities particularly has adverse impacts on women,
children, and the elderly, as well as those affected by adverse environmental hazards.
While there is a serious shortage of primary health care facilities in the ME Ward, even at the
secondary healthcare level the Ward consists of only 1 peripheral hospital (Shatabdi
Hospital) and no tertiary care facilities. The nearest speciality hospital is 30 minutes away by
private mode of transport (costing about 400 rupees for a round trip).
TABLE 5: HEALTH CARE FACILITIES FOR 900,000 PERSONS AS PER VARIOUS PLANNING
NORMS*
Type Existing
ME Ward
Required
NBCI
Required
URDPFI
Municipal Dispensary** 9 60 60
Nursing Home, Maternity Center 2 9-20 9-20
Peripheral Hospitals 1 18 18
General Hospitals 0 3.6 3.6
Speciality and Super Speciality
Hospitals
0 18 18
*Estimated current population of ME Ward according to the Public Health Department is 907,660.
NBCI = National Building Code of India; URDPFI = Urban and Regional Design and Plan Formulation
Guidelines. ** The Rindani committee in 1977 recommended a norm of 1 dispensary for 50,000 population -
or 18 for 900,000 persons
21 Jyoti Shelar (2020). ‘Evening OPDs in 15 civic-run dispensaries from next week’, The Hindu.
20 Office Report submitted by MCGM to the MHSRC dt. 16/7/2019 in response to Suo-motu Case no.
MAS/1027/13/16/2019.
It is clear from the above that public health services and facilities are highly inadequate in
the ME Ward. It is also important to note that these facilities are not evenly distributed. The
2015 TISS Survey indicated that while Shivaji Nagar and Cheeta Camp have different levels
of health facilities (although inadequate), Mankhurd and Bainganwadi have no dispensaries
or maternity care facilities. This means that public health services are not spread evenly
through the different areas of the ward.
In terms of health seeking behavior with respect to different illnesses, the TISS Survey
showed that while 75% of households sought treatment from private services in case of
minor illnesses, only 36% sought treatment from the private health sector in case of major
illnesses.
22 This pattern was also captured by the 2009 Mumbai Human Development
Report
23 which pointed out that choice of private or public healthcare has much to do with
household incomes and therefore affordability of health services, despite the general
perception that private services offer better quality healthcare. This means that the MCGM
needs to urgently upgrade primary healthcare provision in the ME Ward, using the electoral
blocks as a spatial unit - ensuring that each of the 15 blocks consists of at least 4 municipal
dispensaries and 1-2 maternity care centers. Furthermore, the Ward itself needs at least 3-4
general hospitals.
c) BASIC SERVICES
The Census 2011 reported that 42% of households in Mumbai do not have access to a toilet
within the premises. Of these households, close to 95% of households rely on public /
community toilets. In other words, apart from the striking disparity of basic sanitary services
at the city level, this data reveals the extent to which the numbers, locations, and quality of
public and community provided toilets are crucial from the perspective of access and
availability of sanitation services. The Swachh Bharat Mission with its focus on toilet
construction prescribes a minimum of 1 toilet seat per 100-400 males and 100-200 females -
yet the Census indicates that there is 1 public toilet seat per 752 males and 1,820 females in
Mumbai.
24
The situation of the ME Ward is extreme. The 2015 TISS Survey shows that among the low
income settlements in the Ward, 55% use community / group toilets while 33% use private or
paid toilets. Once again, the disparity within the Ward is significant. In Vashi Naka, 88.5% of
24 Census 2011; Praja (2021). ‘Report on Status of Civic Issues in Mumbai’
23 MCGM (2009). ‘Mumbai Human Development Report’
22 Bhide, A. (2015) ‘Social Economic Conditions…’ p.66
households use community / group toilets, while in Cheeta Camp 31.3% depend on them.
Table 6 below provides details of this disparity within the settlements of the Ward.
TABLE 6: ME WARD - PERCENTAGE DISTRIBUTION OF HOUSEHOLDS BY TYPE OF TOILET
BY AREA
Area Toilet
Inside
House
Communit
y / Group
Toilets
Private
Paid Toilet
Open
Defecation
Other
Vashi Naka 3.2 88.5 6.0 4.2 0.2
Baiganwadi 7.9 59.1 34.3 1.2 0.8
Govandi 3.6 54.8 40.1 3.15 1.5
Shivaji Nagar 18.5 53.6 22.2 2.6 6.9
Mankhurd 2.1 50.3 45.1 6.8 0.8
Cheeta Camp 16.9 31.3 53.6 0.2 3.3
ME Ward total 8.0 54.9 35.3 3.5 2.1
Source: Bhide, A. (2015) ‘Social Economic Conditions…’ p.137
The type of toilets and policies facilitating a certain kind of sanitation system have a direct
impact on human rights issues. Sanitation technology that involve pit latrines and septic
tanks require manual cleaning in the absence of mechanized equipment. A report by Praja
released in 2021 noted that in Mumbai, only 28% of toilets were connected to the sewer
system, out of which ME Ward fares the worst - only 3% of public toilets in ME Ward are
connected to a piped sewerage network. This means that the very low coverage of the piped
sewerage network in ME Ward is a matter of serious concern from the perspective of public
health as well as human rights.
Governance issues also affect the availability, maintenance, and access to toilets, as public
participation in toilet infrastructure is seen to play a role in these, several localities in ME
Ward (Biswas et al 202)
25
. Hence beyond just providing toilets, attention to governance
issues is required to put in place appropriate arrangements.
In terms of access to water, the 2015 TISS Survey shows that 44% of households use the
public tap for water, and 13% purchase water from private sources. Only 28% of households
have a personal water connection. Furthermore, in settlements like Baiganwadi and
25 Biswas, Rathin, Kavi Arya, and Shankar Deshpande. "More toilet infrastructures do not nullify open
defecation: a perspective from squatter settlements in megacity Mumbai." Applied Water Science 10,
no. 4 (2020): 1-9
Shivajinagar, more than 20% households purchase drinking water from private sources. The
reliance on private supply is a significant expense - households in Baiganwadi and
Shivajinagar incur a median expense of Rs 400 and Rs. 500 respectively. On average,
households in the ME Ward invest half an hour each day for fetching water.
26
Several studies have pointed out that differences in access to basic services are determined
by the legal nature of the slum settlements and that the conditions and access to amenities
are somewhat better in rehabilitated settlements and buildings as opposed to informal
settlements
27
. These particularly affect water, sanitation, hygiene and health conditions.
A report by NAGAR in 2014 showed that the number of MCGM sanitation workers for M
East and other wards with large population size is woefully inadequate whereas smaller
wards with middle class and elite populations tend to have a larger municipal workforce.
DETERMINANTS OF POOR HEALTH CONDITIONS: SOCIAL
ECONOMIC FACTORS
a) LIVELIHOODS
As discussed above, a majority of urban poor residents rely on private health services for
minor illnesses, and for major illnesses, including those that require hospitalization, people
tend to choose government hospitals even where there may be a preference for private health
care. Besides, a significant number of people in ME Ward (about 30%) do not choose to
undergo hospitalization even when they need to.
28 Lack of finances is the main reason for not
seeking treatment - and data on household expenditure reveals that healthcare is one of the
highest expenses incurred by households. It is plain that low incomes combined with lack of
affordable healthcare facilities have produced the public health crisis in the ME Ward.
The median income for Greater Mumbai was shown to be Rs. 20,000 according to a World
Bank paper published in the year 2010.
29 In contrast, the median household income for the
ME Ward as per the 2015 TISS Survey was found to be only Rs.8,000. Nearly 23% of the
households in ME Ward reported a monthly income below Rs. 5,000. Furthermore, nearly
49% of households need to borrow money during health and other emergencies, further
stressing low-income households (see Table 7).
30 As the Survey notes:
30 Bhide, A. (2015) ‘Social Economic Conditions…’ p.xvi
29 Clarke Annez, P., Bertaud, A., Patel, B., & Phatak, V. K. (2010). Working with the market: a new
approach to reducing urban slums in India. World Bank Policy Research Working Paper, (5475).
28 Bhide, A. (2015) ‘Social Economic Conditions…’ p.xvii
27 Anand, Ankit, Annu Baranwal, Emma Van Rij, and Nobhojit Roy. "Water, sanitation and hygiene
conditions in rehabilitated and non-rehabilitated slums of m-ward Mumbai, India." In Proceedings of
the 3rd International Green Health Conference, pp. 1-9. 2015
26 Bhide, A. (2015) ‘Social Economic Conditions…’ p.130
“The ME Ward…has, since the 1970s, emerged as a part of the city where the poor
found economic opportunities in the ancillaries of the industries located in the
ward…In the last decade, thousands of slum families displaced by various
infrastructure projects have been rehabilitated in the ward. This displacement has
not just meant loss of homes, but also livelihoods, as they are resettled in areas with
little or no connectivity to livelihood opportunities. The ME Ward has, thus, emerged
as an extended poverty space.”
Unsurprisingly, casual employment in the informal sector is the main employment category
in the ward (47%), followed by self employment (32%). From the perspective of work
participation, only 7% of women are a part of the workforce, which is much worse than the
already low urban workforce participation of women at 11.88% and Mumbai average of 16%.
It is clear that in addition to the general levels of deprivation in the Ward, disadvantaged
social groups fare much worse on many social indicators in the Ward as compared to city or
national averages. Occupational hazards, especially among the waste pickers and waste
loaders are also observed to be more in the ME Ward with “higher prevalence of
injury/accident, skin disease, respiratory disease, eye disease and musculoskeletal disorders
and high prevalence rate of low back pain, shoulder pain and hip/thigh pain in past 12
months. Almost 75% of them reported eye related problems; two-thirds had breathlessness
and 42 per cent workers reported injuries”
31
TABLE 7: ME WARD - SUFFICIENCY OF HOUSEHOLD INCOME IN DIFFERENT AREAS
Vashi
Naka
Baiga
nwadi
Govan
di
Shivaj
i
Nagar
Mank
hurd
Cheet
a
Camp
Avera
ge
Income meets all
requirements, plus
savings
37.3 32.6 44.7 41.6 37.1 42.4 38.6
Income meets basic
requirements, have to
borrow during
emergencies
44.5 55.1 45.0 47.5 50.6 44.6 48.7
Income insufficient to
meet basic requirements
11.8 7.8 6.7 7.1 0.2 5.6 7.9
No income, depend on
others
1.5 0.8 1.3 0.8 0.7 4.0 1.3
Data NA 4.9 3.6 2.2 3.0 3.4 4.3 3.5
31 Salve, Pradeep, and Dhananjay W. Bansod. "Occupational morbidity among municipal solid waste
loaders in Mumbai." Social Science Spectrum 2, no. 3 (2017): 195-202
Source: Bhide, A. (2015) ‘Social Economic Conditions…’ p.53
b) NUTRITION
Among all the Wards in Mumbai, the ME Ward has the highest infant mortality rate of 66.5%
(twice the average of Maharashtra) and a high level of malnourishment among children
below 6 years of age. The 2015 TISS Survey, which carried out an anthropometric survey of
children and their mothers, reported that 45% of children under 5 are stunted and 35% are
underweight. The proportion of children severely undernourished is quite high - with a
quarter of children severely stunted and 14% severely underweight, and one-fifth wasted.
In terms of women’s health, it was found that 58% of women had normal Body Mass Index
(BMI), 20% have a BMI of less than 18.5 (underweight) and 23% overweight or obese. The
survey found that 59% of households consume only two meals a day, and foods such as fish,
meat, eggs and fruit are consumed by less than 10% households each day.
In terms of access to food through the Public Distribution System (PDS), the survey found
that one-sixth of households did not have a ration card - and among those that possess one,
less than 50% use it to buy food grains.
Other summary conclusions from the survey point out that the coverage by anganwadis is
“woefully inadequate” (government norms prescribe one anganwadi for 250 households).
Additionally, since the number of government schools in the Ward are insufficient, students
do not get the mid-day meals that are provided; instead students have to depend on private
schools that do not provide nutritional supplements, and significantly increase the
educational expenses of households.
32
DETERMINANTS OF POOR HEALTH CONDITIONS:
ENVIRONMENTAL HAZARDS AND VULNERABILITIES
The ME Ward consists of multiple factories, industries and municipal service areas: oil
refineries, power generators, fertilizer plants, an abattoir, the city’s largest landfill site, etc.
This concentration of highly polluting land use is in close proximity to dense urban
settlements, making the Ward extremely vulnerable to pollutants and health hazards. This is
reflected in numerous studies measuring nitrogen dioxide (NO2), sulfur dioxide (SO2), and
Carbon Monoxide (CO) levels. Pointing out that the ward has consistently high levels of
32 Bhide, A. (2015) ‘Social Economic Conditions…’ p.xix
gaseous air pollutants, the recently released Climate Action Plan for Mumbai (MCAP) notes
that NO2 is a major pollutant in Mumbai, concentrated near the Tata Thermal Power Plant,
refineries in Trombay and the Deonar landfill site. Similarly, a concentration of CO can be
found in the eastern suburbs, mainly caused by the landfill and burning of waste at the site
and other places. The MCAP concludes that the ME is among the four Wards most exposed
to air pollution in Mumbai.
33
After a major fire broke out in the landfill site in 2016, a study by SAFAR showed that the
concentration of suspended particles in Deonar was eight times the permissible limit, and
PM10 levels went “as high as 788ug/ m3 as against a safety limit of 100ug/m3 between 8am
and 9am; and 718 ug/m3 between 7am and 8am on January 29.”
34 Another study by
researchers at IIT Bombay among others published in 2016 pointed out that the
concentration of Suspended particulate matter (SPM) in Maravali in ME Ward was almost 5
times higher than the standards of national ambient air quality.
35 Illegal dumping of
construction waste is another contributor to air pollution in the ward, causing, among other
health hazards, respiratory morbidity, as evidenced by a study carried out by the KEM
hospital.
36 Exposure to air pollution has been linked to a number of respiratory and other
illnesses, perhaps a key factor in the low life expectancy of 39 years in the Ward. Air
pollution is also linked to high traffic volumes in nearby areas of ME Ward, caused by
vehicular emissions.
37 Anand and Phuleria (2021) show that exposure to indoor air pollution
due to traffic pollution is high in the Deonar area of ME Ward.
38 Dey, Pal and Chattopadhyay
(2018) link air pollution in the ME Ward to a high number of premature deaths caused by
cardiovascular diseases, and further state that the disease and mortality burden is
particularly high among women and infants.
39 Chronic obstructive pulmonary disease is seen
to be very high in Deonar due to exposure to pollutant PM10 and results in significant health
39 Dey, Sudeshna, Soumya Pal, and Aparajita Chattopadhyay. "Burden of Air Pollution on Premature
Deaths: A Time-Series Case Study Based on Mumbai, India." In PAA 2018 Annual Meeting. PAA,
2018.
38 Anand, Abhay, and Harish C. Phuleria. "Modeling indoor exposure to PM2. 5 and black carbon in
densely populated urban slums." Building and Environment 200 (2021): 107940
37 Air Quality Assessment, Emission Inventory & Source Apportionment Study for Mumbai City, CPCB
and NEERI, 2010
36
‘Highest pollution levels in Chembur, Deonar, Mahul: Mumbai Climate Action Plan data’ Hindustan
Times (2021)
35 Kumar, A., Gupta, I., Brandt, J., Kumar, R., Dikshit, A. K., & Patil, R. S. (2016). Air quality mapping
using GIS and economic evaluation of health impact for Mumbai city, India. Journal of the Air &
Waste Management Association, 66(5), 470-481.
34 Badri Chatterjee (2016) ‘Pollutant particles near Deonar were 8 times more than permissible limit’,
Hindustan Times
33 WRI+MCGM (2021).Mumbai Climate Action Plan, p.59-62
costs for the population.
40 Maximum population exposure to SO2 and NO2 is also observed
in Deonar according to this study.
The vulnerability assessment report of the MCAP highlights that the ME Ward is most
vulnerable to heat stress in Mumbai, with over 38% of its population exposed to a surface
temperature of greater than 35°C. The type of roofing materials, surfaces that radiate heat,
and industrial areas contribute to Land Surface Temperature (LST) and Wards such as ME
that have higher concentration of slum settlements and industrial land uses have higher LST.
This, combined with low level of basic services and amenities intensifies the risk to the
population. The ME Ward, the MCAP shows, also has the highest percentage of households
(45%) that depend on polluting cooking fuels such as firewood, cow dung, coal, kerosene, etc.
Furthermore, the Ward also has the lowest population (25%) having access to a mass-transit
station - Monorail, Metro and Suburban Rail - and a flood shelter within 1km (31.5%). This
combination of multiple levels of deprivation in terms of lack of basic services, lack of
essential infrastructure, insufficient health and educational amenities, poor housing
conditions, low incomes, inadequate nutrition, as well as proximity to highly polluting and
hazardous activities are responsible for the public health crisis as well as environmental
vulnerability in the ME Ward.
41
Sherly et al (2015) have observed that ME Ward is one of two wards in Mumbai that have
actually become more vulnerable in the last few years, and that the risk is higher for this
ward due to rapid increase in population size and density, female population, SC / ST
population, and proportion of non-workers. Several of the localities in E Ward are identified
as being affected by multiple vulnerabilities to different kinds of social, environmental,
infrastructural, and other risks. Air pollution levels in this ward induced higher levels of
morbidity and mortality.
CONCLUSION AND RECOMMENDATIONS
The ME Ward has emerged as a geographic region that is expected to accommodate the
features of the city that are considered undesirable: polluting industries and municipal
services, as well as the city’s displaced populations. Since the early 2000s, many formal
resettlement colonies have been built in the Ward to rehouse squatters displaced by
41 WRI+MCGM (2021). Climate and Air Pollution Risks and Vulnerability Assessment for Mumbai,
India. p66-69.
40 Kumar, Awkash, Indrani Gupta, Jørgen Brandt, Rakesh Kumar, Anil Kumar Dikshit, and Rashmi S.
Patil. "Air quality mapping using GIS and economic evaluation of health impact for Mumbai city,
India." Journal of the Air & Waste Management Association 66, no. 5 (2016): 470-481.
infrastructure projects. Physical and social infrastructure such as open spaces, health
infrastructure that can partially offset the debilitating impact of these polluting activities -
that are already deficient in the ward - are being compromised in these large resettlements.
Further, the Ward consists of a very large population that is livelihood insecure, has some of
the highest levels of housing poverty, as well as being exposed to multiple environmental
hazards. The cumulation of these three factors viz the concentration of polluting and
hazardous activities, poor standards of supportive infrastructure due to lack of planning and
socio-economic deprivation have resulted in high levels of mortality, morbidity and threat of
infectious diseases. In addition to these chronic problems, thesefactors also make the
inhabitants of the Ward extremely vulnerable to sudden and unanticipated disruptions and
disasters such as extreme weather events, industrial accidents, epidemic outbreaks, etc.
Nevertheless, the issues highlighted in this report have to be seen from a broader
socio-economic and human development perspective, rather than simply as a consequence of
specific hazardous industries or the prevalence of unregulated/unauthorized activities. It is
therefore necessary to undertake a public-sector-led, multi-dimensional and
inter-institutional approach to address the gross inequalities and deprivations suffered by
the residents of the Ward.
RECOMMENDATIONS:
A] HEALTH AND NUTRITION
1. Urban Planning for Human Development: It is imperative first to re-orient the
planning system of the city as a whole to be based on human development as opposed
to urban renewal - as is the norm today. Such a method would imply that both
public-sector attention and investment would be based on an assessment of
inadequacy (both quantity and quality) of infrastructure and services.
2. Remove social-infrastructural deficiencies: The M-E Ward has the lowest
Human Development Index in the city, comparable to some of the poorest regions of
the world. Therefore, as discussed above, the deficiencies of availability and access in
health, educational, cultural infrastructure as well as needs of affordable shelter and
mobility need to be addressed.
3. Utilize available vacant land: To that end, the existing vacant land in the M-E
Ward must be prioritized for social infrastructure and amenities. The MCGM Existing
Land Use (ELU) survey of 2012 showed that 155.7 Hectares of land is vacant in the
Ward.
4. Nutrition: Establishing ICDS Centres and Budgetary Allocations: To
address malnourishment, it is necessary that the ICDS norms for anganwadis are
realized (1 anganwadi per 250 households) and sufficiently funded to ensure coverage
of all children of the age group 0-6 years as well as that of young girls and women.
5. Address gaps in primary health infrastructure: The public health
infrastructure gaps (based on various planning norms) for Municipal dispensaries,
Maternity hospitals, and general hospitals needs to be addressed urgently. While the
NUHM standard of one dispensary per 10,000 persons is desirable, the current
provision is well short of the Rindani Committee’s recommendation of 1 dispensary
for 50,000 persons. Similarly, Urban Health Centres (UHCs) provide the first level of
healthcare, and referral to hospitals when necessary. The NUHM norms prescribe
one UHC per 50,000 to 60,000 persons - which must be provided in the Ward.
6. Increase the Number of Maternity Homes: The M-E Ward reports the highest
cases of infant mortality and maternal mortality in the city. As per various planning
norms, there must be at least one maternity home for every 45,000 persons - and
these must be located in different localities (minimally one per Electoral Ward) to
ensure access.
7. Upgrade existing health infrastructure: Some health facilities in the M-E Ward
are undergoing repair or reconstruction, and some others have been proposed. These
facilities need to be made operational at the earliest.
8. Budgetary allocations for healthcare: Healthcare budgets be utilized and
possibly expanded to ensure that all healthcare facilities are functional and equipped,
and to ensure that programs and schemes for healthcare provision reach all the
residents of the Ward. The linkages between primary, secondary and tertiary
healthcare need to be understood to ensure that either primary or higher levels of
healthcare are not underutilized or overburdened.
9. Quality of healthcare: Apart from availability and allocations for healthcare, it is
imperative that quality of public health services are of high quality, that can set the
benchmark for both service delivery as well as affordability for the health sector as a
whole. Public healthcare today is known for long queues, ill-treatment of patients and
understaffed and under-equipped facilities. Instead, it ought to be transformed into
the first resort for all citizens rather than the last resort for the poor.
10.Emphasis on public provision: Based on an understanding of the livelihood
conditions and income levels of the inhabitants of the Ward, the Public Private
Partnership mode of providing infrastructure (both construction as well as operation)
is highly ineffective and therefore unacceptable. These have to be adequately
provisioned as affordable and reliable public services, and private facilities ought to
only be considered as supplementary.
B] LIVELIHOODS
11. Livelihoods: Setting up ITIs and other training institutions towards
expanding the MSME sector: a concerted focus on skill training and workforce
participation in the M-E Ward will go a long way in improving the employability and
income levels in the Ward. This could be done by setting up new ITIs or formalizing
existing training institutions.
12. Livelihoods: Strengthening Self Help Groups (SHGs), setting up Aadhar
Kendras: the M-E Ward has about 700 SHGs that provide a platform for training,
employment, and experience sharing for workers. Strengthening efforts that enhance
quality, viability, efficiency of work and marketability of products would go a long
way in improving the capacities and household incomes. Initiatives such as setting up
of Aadhar Kendras to stock products made by women SHG workers and provide
services requiring skills such as plumbing, carpentry, tailoring, etc. can benefit both
women and youth in the Ward.
13. Livelihoods: Support for women workers: Women’s low workforce
participation in the labor market is a serious concern but this conceals the unpaid
housework and childcare that is culturally and socially normalized as ‘women’s work.’
A program to set up community care centers, worker cooperatives at the
neighborhood level for household and neighbourhood services, as well as providing
credit and other support to women owned and managed enterprises will help
improve women’s work participation, self-regulation and state regulation of working
conditions and wages, as well as ensure that care work is dignified and adequately
compensated.
C] ENVIRONMENTAL VULNERABILITIES
14. Expand Resilience Spaces: The M-E Ward needs to plan for and provide
‘resilience spaces’ in the form of socio-cultural facilities (marriage halls, sports
facilities, municipal schools, maidans, cultural centers, etc.) that are vital for
community life, but are also invaluable during emergencies and disasters (epidemics,
floods, heatwaves, etc).
15. Undertake upgradation of resettlement colonies: resettlement colonies built
around the city, most of them in M-E Ward, have been built without regard to
planning norms or supporting infrastructure. Each one of these ‘colonies’
accommodate tens of thousands of people, who have to rely on the already
overstressed facilities in the Ward. The poor planning and design of these colonies
have also been linked to the spread of infectious diseases among residents. Therefore
a detailed post-occupancy study of these colonies need to be carried out, the level of
service provision assessed, and a planned upgradation and retrofit program carried
out to ensure acceptable standards of quality of life for inhabitants for every one of
these neighborhoods.
16. Upgradation of slum settlements, ensure basic service norms: Close to 85%
of the population of the M-E Ward lives in slums. The MCGM - which is is mandated
by law to provide basic services and facilities in slums - must prepare detailed local
area upgradation plans for every settlement, and to ensure provision of services as
per the following norms: 1 public toilet seat for every 50 persons; water supply of
minimum 90 liters / head / day; universal coverage of the sewerage network; 1
primary school for every 5,000 persons; 1 anganwadi per 250 households; 1
dispensary / health post for every 50,000 persons; public transport access within
walking distance; and paved roads and street lights at every 30 meters along the
pathway.
17. Planned decommissioning of hazardous land uses: the MCGM and various
relevant authorities must work out a plan to gradually close down or move out
hazardous and polluting activities from the Ward such as the landfill, petroleum
refineries, fertilizer plant, abattoir and biomedical waste facility. It is imperative that
the livelihood implications of shutting down each of these facilities be assessed, that
these are not undertaken in a heavy handed way, and the livelihoods be rehabilitated
through government programs before these facilities are phased / moved out.