With more than 13 million inhabitants, Mumbai is the most populous city in India. Being the commercial hub of India it continues to grow and attract thousands from all over the country. This has resulted in a spike in urban poverty and concurrently health issues generating from impoverishment. Brihan Mumbai Municipal Corporation (BMC) – the largest municipal corporation in India – is the major provider of public health care services in Mumbai. Although Mumbai has a vast public health infrastructure (BMC) comprising of three tertiary hospitals (which are also medical colleges), 16 peripheral hospitals with maternity wards, 28 maternity hospitals, 168 health posts (primary health centres situated in slum areas) and 172 dispensaries, the functionality of these health infrastructure is questionable. As many surveys point out, in Mumbai, public health agencies reach only about 30% of the urban poor. The lower rung of health care facilities are neglected and not developed according to health standards. This result in major health care establishments being utilized more than minor ones like dispensaries and maternity homes, overcrowding the upper levels of the health care system. In addition, these major health infrastructure facilities are concentrated in South Mumbai, leaving suburban populations at the mercy of private enterprises with a monopoly in these areas. Therefore, the state needs to strengthen the foundation of the health care system rather than solely concentrating resources at the higher levels of health care infrastructure. The DP should be based on the policy of universal access to health care which states that “whole populations have access to same range of health services, regardless of income levels, social status, gender, religion, and urban/rural residence. Moreover, a comprehensive range of curative, symptomatic, preventive, promotive health services should be made available at the primary, secondary and tertiary levels of health care.”

Major issues
Lack of primary healthcare facilities leading to problems at the upper level of health system: For example 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.

Need for specialty hospitals in Mumbai: TB and its various forms like MDR (multi- drug resistant) are being increasingly detected in the city. But the existing network of DOTS Centres can only provide preliminary support and are anyway resource starved. The Sewri TB Hospital which handles higher stages and complications of TB has been shown to be inadequate. Considering the public health risk of TB and MDR, another dedicated tertiary- level centre should be invested in the city. Moreover, improving the outreach and better equipping the DOTS Centres and the primary health centres for screening, detection and distribution of medications should be factored in the planning.

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.

Restricted access to private hospitals: The chunk of the services in Mumbai are provided and clustered in certain locations (D, K-West, R-Central. etc), leaving much of the population out of its ambit. Moreover, many new private hospitals are built by public-private-partnerships (PPPs) on land for public hospitals with an understanding that mandates provision of beds for weaker sections. However these agreements and the compliance of such hospitals are not available for public scrutiny. For example, Seven Hills, Andheri which promised 20% of its 1500 beds went to court with the BMC over compliance.

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 avail the private health care facilities. Also, it is noted that 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.

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