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No Room For Complacency

No Room For Complacency

On the side-lines of releasing the country’s first sero-survey pertaining to COVID-19 this 12 June, the main takeaway from the media briefing by the Director General of Indian Council of Medical Research, as reported in our mainstream newspapers, is that India is not in community transmission stage of the novel coronavirus.

Is that good news? Wait.

Further, India’s COVID-19 cases per lakh population being the lowest in the world and the number of patients recovering exceeding the number of active COVID cases (rate of recovery at 49.21 per cent) is also commendable.

Nonetheless, the crucial findings of the said survey undertaken in May this year that COVID incidents are higher in urban slums ought to serve as a wake-up call.

India’s health scenario has been facing several challenges and the COVID-19 pandemic has compounded the situation. Yes, a large proportion of our population is susceptible to infections. It has been debated several times that urban India is nothing but a concrete jungle of slums, high-rise buildings and unplanned colonies without basic amenities. Such informal settlements within cities, with inadequate housing and miserable living conditions, are overcrowded. Being the only type of settlement affordable-cum-accessible for the poor in many cities, living conditions are harsh and even unimaginable.

According to Census 2011, out of 4041 statutory towns, there were 2613 slum reported towns in the country. Total slum populations residing in these slums was a whopping 65.49 million out of which 22.53 million are living in notified slums. It roughly translates to about 22.4 percent of the total population of slum reporting cities/towns and 17.4% of total urban population of all the States and Union Territories. Mumbai has the highest proportion of slum-dwelling households (41.3%) as well as the highest slum population followed by Kolkata and Chennai at nearly 30% and 29% respectively. Delhi and Bengaluru have 15% and 9% of its households in slums respectively.

Not long ago, a study to examine the learners’ achievement level of slum children in the government schools and privately run unrecognised schools in Delhi found that primarily the slums were bereft of necessary physical and civic amenities with no schooling or poor schooling facilities. Slum children faced special problems in the form of child abuse, danger of infections due to unhygienic slum conditions. Most of the children did not receive any academic assistance and help from their families. The neighbourhood schools had poor infrastructure and were overcrowded. The socio-economic backwardness was further exacerbated by the poor quality teachers who were not trained to deal with the learners who came from temporary settlements having poor physical facilities. But what emerged was that the parents’ of slum children wanted their children to break the vicious circle of educational backwardness and obtain higher education.

Assessments have shown that if tens of thousands poor Indians migrating to urban centres in search of work, park on vacant land, there are corrupt middlemen who allow them to raise structures with impunity. In this manner, slowly but steadily slums begin to mushroom across cities. Well such unauthorised structures getting transformed into vote banks is another story.

For people living in squatter settlements and slums, using common sanitation facilities and collecting water puts avoidable stress and strain on women and children. Further, unhealthy living conditions due to lack of basic services, overflowing open sewers, uncontrolled dumping of waste, polluted environments, unhygienic community toilets etc., can adversely impact the health of slum dwellers.

Notably, the risk of any disease in a locality is affected by both personal factors, such as diet and genetic constitution, and factors in the local environment like faecal contamination, vectors of disease and pollution.

True, interpersonal and economic factors play a significant role in influencing mental health of every individual and slum dwellers are no exception.  Are slums dwellers more susceptible to health problems including mental issues? Are they diagnosed so as to receive timely treatment? What are the type of mental and general health challenges that slum dwellers seem to face has been revealed in a survey of about 1200 households and 3700 people in Bengaluru which comprised of more than three fourth (70.4%) of the population who were below the poverty line. Only one third had a regular job and the average daily income was about Rs 350/- and Rs 170/- in men and women respectively. Notably, the prevalence of hypertension (35.5%), diabetes (16.6%) and anaemia (70.9%) was high in the screened slum population. Almost half of the children under the age of five years were stunted. The study concluded that most of the people were screened for the first time and were unaware of their health issues prior to the medical check-up.

Not long ago, researchers in Mumbai, as reported in  Lancet, identified some patients in the city with a virulent strain of tuberculosis that was resistant to all known treatments. While Government health officials attributed the same to private medical practitioners prescribing inappropriate drugs, on the other side, it was argued that long waiting periods in government run facilities coupled with rude treatment and stigma associated with TB impelled many infected patients to avoid government TB programmes and seek relief from private doctors.

Since about one in six Indian lives in an urban slum with unsanitary conditions should reasonable dwelling units be constructed in distant suburbs?  At a macro level, the Pradhan Mantri Awas Yojana gives Central Assistance to States/UTs in for providing all-weather pucca houses with basic civic infrastructure including water, sanitation, sewerage, road, electricity etc., to all eligible urban households including slum dwellers by 2022. Swachh Bharat Mission - Urban is designed at making urban India free from open defecation and achieving 100% scientific management of municipal solid waste in all statutory towns of the country.

To keep COVID-19 at bay in urban slums, it is important to step up effective surveillance and containment strategies, literally on a war footing with public private participation. Besides emphasising about the importance of personal and environmental cleanliness, such informal settlements need to be helped with soap, masks and water. With no vaccine at hand social distancing and hygiene ought to be maintained at all costs. The writing on the wall is clear: there can be no room for any complacency.

(Published on 15th June 2020, Volume XXXII, Issue 25)