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Are Indian Cities Equipped To Take On A Pandemic At Local Level?

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This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.

by Harshil Suresh, Milind Mhaske:

With the rising issues of climate change and the possibility of frequent COVID-19-like pandemics in the world, cities are more vulnerable to natural disasters and the rapid spread of communicable diseases. The Spanish Flu pandemic which arrived in India through the ports of Mumbai (also known as ‘Bombay Fever’), bubonic plagues in Mumbai (1896) and Surat (1994), and the floods in Mumbai (2005) and Chennai (2015) are a few examples that clearly remind us how cities are easily prone to both disease outbreaks and disasters.

One part of the solution to this lies in adopting sustainable urban planning and design measures that are proactive and enable our cities to be resilient. The other part involves creating administrative measures for city governments, which will allow them to handle any emergency speedily and effectively. The importance of empowering local government can be seen in the case of Surat and Mumbai during the plague, where decentralised administrative action allowed them to respond rapidly and contain the outbreak.

“If the state governments were to transfer the function of urban poverty alleviation to cities, it would allow them to act proactively and quickly.”

This can be further supported through examples emerging from the response to the current COVID-19 crisis in cities. These include the Municipal Corporation of Greater Mumbai (MCGM) home testing residents for symptoms and spreading awareness on preventive measures; city governments in Chennai and Bengaluru spraying disinfectants using drones; and the Cuttack Municipal Corporation (CMC) developing a home delivery system for the city. Most city governments in the country at present are contact tracing, screening, and setting up quarantine facilities.

The urban poor (including those living in slums) and the informal workforce (including migrant workers) bear the brunt of such crises in the city. At such times, the central and state governments come out with relief assistance and provision of care to the urban poor to help them cope. However, if the state governments were to transfer the function of urban poverty alleviation to cities, it would allow them to act proactively and quickly, thereby overcoming some of the key implementation challenges in deploying relief services for the poor.

Political Leadership

The coordination between the state government and city governments is crucial for effective decentralised crisis management at the local level. Strong political and executive leadership is necessary to enable city governments to respond quickly. This can only be ensured when authority lies with the commissioner, mayor, and the city councillors to make decisions for the effective management of crises in the city. In turn, this will further allow for better planning and quick action at the respective zonal, ward, and local area levels.

However, city-level political leadership is usually not seen in our country. State governments need to be supportive and empower the mayor to take responsibility for handling emergencies at the city-level. Coordinated actions taken by the executive and legislative wings under the political leadership of an empowered mayor can achieve better, decentralised management and rapid resolution of the crisis.

hands tied together with rope-restrictKey healthcare infrastructure such as hospitals, clinics, and primary healthcare centres continue to remain under the control of the state government. | Photo courtesy: Wallpaper Flare

Control over public health functions

The Twelfth Schedule of the 74th Constitutional Amendment Act specifies the function of public health to be transferred under control of city governments. However, the 2020 Urban Governance Reforms study conducted by Praja, where we work, found that most city governments out of the 21 states that were studied, do not have total control over the function. Key healthcare infrastructure such as hospitals, clinics, and primary healthcare centres continue to remain under the control of the state government. Also, a majority of health departments in cities lack human resources, including medical officers and skilled staff.

However, Mumbai is an exception. The MCGM has complete control over the public health function, and has medical colleges, municipal hospitals, dispensaries, primary healthcare centres, and ground-level outreach services such as vaccination and hygiene, at its disposal. The health department has joined other departments of MCGM to act immediately and screen people in public spaces, prepare municipal hospitals to treat patients, mark containment zones, and map risk zones. The MCGM has been able to proactively and effectively contain the spread and tackle the threat posed by COVID-19 because it has the autonomy and resources to make appropriate decisions and act upon them.

Access To Finances 

Financial resources are paramount for implementing decisions taken in the wake of disasters and disease outbreaks. This can be clearly seen in the case of Delhi, where the state government has made effective use of the financial resources they can access—such as the state GST—to bring in sweeping changes to education and healthcare facilities. This kind of action was possible because unlike city governments, state governments in the country have easier access to large financial sources.

“City governments need to have access to financial sources not only to deliver services but also to be financially equipped to tackle large scale issues.”

Praja’s urban governance study found that none of the 21 cities studied has authority to bring in new sources of revenue, and only two out of 21 cities have the authority to revise existing tax rates without depending on state government’s approval. City governments need to have access to financial sources not only to deliver services but also to be financially equipped to tackle large scale issues. They need to be authorised to be able to bring in such sources of revenue, without dependence on the state government, which is often the case. This would enable city governments to build their revenue incomes and implement actions locally.

Building The Capacity Among Stakeholders

Various stakeholders such as elected representatives, administrative officials from government bodies, the private sector, academia, media, civil society organisations (CSOs), and citizen volunteers need to coordinate and work together to build their capacity to handle crises such as floods, earthquakes, and disease outbreaks.

This may include supporting administrative tasks, such as preparing action plans in advance for better preparedness on the ground, providing emergency response training, and improving coordination with key departments such as the National Disaster Response Force, police, and others. The machinery and functionaries need to know how to act so that basic services are not disrupted as the crisis is being dealt with.

The capacity of CSOs and volunteers needs to be built such that they may be able to effectively assist city governments and support their efforts to implement local action. Targeted capacity building training sessions will help stakeholders develop the knowledge, ideas, and practical actions required to deal with crises occurring in the city, together. We also need a common knowledge-sharing platform, so that everyone involved in dealing with the crisis can access best practices and efforts that have been successful across cities.

Empowering city governments to respond to crises at the local level will not only increase the effectiveness of our response to the current pandemic but also ensure that our cities are prepared for the future.

Know more

  • Dip in to Praja’s research carried out across two years and 21 states, to understand the challenges in the implementation of the 74th amendment.
  • Read more about how cities around the world should prepare for COVID-19.

Do more

  • Praja is building a network of stakeholders across states. If you wish to be a part of the network, support the study, and/or receive regular updates about the study, write in to
  • If you’re a student who wishes to learn more about and work on urban governance issues, join the Praja Fellowship.

This article was originally published on India Development Review.


About the authors:

Harshil Suresh is a project officer in the dialogue and advocacy team of Praja Foundation. The team is currently completing ground research on the status of implementation of 74th Constitution Amendment Act, 1993 and on urban governance reforms in 28 states and one union territory. He has an MTech in Urban Development and Management from the TERI School of Advanced Studies.
Milind Mhaskeis Director, Praja Foundation. He has anchored Praja since 2010, scaling it up to make it a key player in transforming urban governance across India. Milind helped set up some of its key projects, such as report cards for ranking elected representatives and training programmes for elected representatives. He also helped launch Praja’s Delhi operations in 2014. He is a business management graduate from Mumbai University and has more than 18 years of experience in managing development sector projects.
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Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

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The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

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A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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