Coronavirus: BBMP, prioritise public health

City municipal budgets attract little attention at the best of times, much less now when the world is preoccupied with a deadly pandemic. But the pandemic is precisely the reason local budgets and local action become important. Public health is a major responsibility of every municipality and it is distressing to see BBMP allocate a meagre Rs 131.78 crore under this head out of the total outlay of Rs 10,899 crore in its budget for 2020-21. It is unfortunate that BBMP has missed the opportunity of according due priority to this crucial sector at this critical juncture. In fact, COVID-19 does not figure in its budget except for a brief mention about a contribution of Rs 49.5 crore to the Chief Minister’s Relief Fund.

Public health is fundamental to the prevention of disease and promotion of health, with linkages to other sectors. At the core of addressing its issues is the scientific discipline of epidemiology. The BBMP has either been unable to appreciate the epidemiological challenges we are facing or it has chosen to ignore them. How then do you explain its decision to pay a paltry amount of Rs 33,600 per month to the epidemiologists it intends to recruit. No wonder, four of them who were employed with the civic body quit their posts.

Epidemiology is the study of disease in populations. It investigates outbreaks of diseases and tries to identify the risk factors of zoonotic (transmitted from animal to human) diseases in human and animal populations. COVID-19 only underlines the importance of this discipline. True, research on such issues requires huge resources and scientific manpower which are beyond the reach of local governments. But cities have their own role to play in the prevention and the spread of a disease.

Under the law, public health is an obligatory function of the local government. The Karnataka Municipal Corporations Act devotes an entire chapter to ‘Prevention of Diseases.’ It is mandatory on the part of the municipal corporation to notify dangerous diseases and undertake preventive measures such as disinfection of buildings and articles. It can order closure of places of public entertainment and destruction of birds and animals causing danger to human health. It has a duty to regulate slaughterhouses, public markets and places for washing and bathing of animals.

While the corporation and other government agencies may be working overtime to control the disease currently, it is important that they pay adequate attention to public health issues during normal times. Matters like cleaning of streets and drains, waste management, water quality, maintenance of public toilets and sanitation, considered routine functions, are crucial for the health and safety of the people.

A broad analysis of the BBMP budget reveals that the priorities for expenditure are lopsided. While health accounts for a mere 1.2% of the budget, infrastructure items like roads, flyovers, subways, stormwater drain development and other construction works claim 49%. It’s interesting to note that the amount earmarked for the Mayor’s discretionary fund -- Rs 150 crore -- exceeds the provision for health (Rs 131 crore). Add to that the discretionary funds of the Deputy Mayor, Chairman of the Taxation and Finance Committee and the Leader of the Ruling Party and the total rises to a whopping Rs 325 crore (3% of the budget).

It is not my intention to undertake a detailed review of the budget here but to draw attention to the reality that the impact of COVID-19 will last not just for the next few months but for the next couple of years. This is the opportune time for BBMP to establish a primary healthcare system for Bengaluru. Unfortunately, in India, unlike in rural areas, urban primary healthcare has been ignored for long. In 2013, a National Urban Health Mission was created with the intention of addressing the special health needs of the urban population, but it was slow in taking off and hardly made any impact. The National Health Policy of 2017 speaks about moving from token intervention to assured intervention to organise primary healthcare to cover the entire urban population. Such interventions should deal with matters such as vector-borne diseases (mosquitoes and malaria), respiratory diseases, water-borne diseases, air and water pollution, road accidents and trauma.

This is also the time to initiate measures for a comprehensive clean-up of the city. This would include a plan for systematic cleaning of stormwater drains and to prevent entry of sewage into the lakes which, in turn, would help rejuvenate the water bodies, keeping the streets and public places free from filth and squalor and regular cleaning of public markets, especially meat and fish markets.

I strongly suggest that BBMP set up an Urban Primary Healthcare Centre and draw up a plan for short-term and long-term care, especially keeping in view the needs of the vulnerable sections of the population, including migrant labourers. This would no doubt require adequate resources and professional manpower, which the civic body lacks. To begin with, funds can be pooled from within the BBMP budget. It would be a great gesture on the part of the Mayor to give up 50% of the discretionary funds at his disposal and persuade his other privileged colleagues to follow suit for a bigger cause. Some proposed schemes like the construction of Kempegowda welcome arches can be deferred. Thus, about Rs 250 crore can be sourced internally which can be used as seed fund to start the primary healthcare centre. More money can be mobilised through government grants and from external sources.

BBMP should work in coordination with other agencies like BWSSB, Pollution Control Board, professional bodies and the community to create a model urban healthcare system for the technology hub of India.

(The writer is a former Chief Secretary, Govt of Karnataka)