Flies Without Borders : Lessons from Chennai on Improving India's Municipal Public Health Services
India's fast-growing cities face three key challenges in improving public health outcomes. The first is the persistence of weak links in the chain -- notably, slums badly underserved with basic civic services -- that can pose public health thr...
| Main Authors: | , , , , , |
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| Format: | Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2017
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/561701505760347121/Flies-without-borders-lessons-from-Chennai-on-improving-Indias-municipal-public-health-services http://hdl.handle.net/10986/28375 |
| Summary: | India's fast-growing cities face
three key challenges in improving public health outcomes.
The first is the persistence of weak links in the chain --
notably, slums badly underserved with basic civic services
-- that can pose public health threats to all. Richer
residents corner public resources, such as water and
sanitation services, but their children's health
indicators suggest they are deeply affected by contagion
from the broader urban environment. The second challenge
relates to devolution of services to elected bodies.
Devolution works poorly for intangible and highly technical
services, such as public health, where success is measured
by the lack of (adverse) events. The third challenge is high
fragmentation of services that directly affect health
outcomes. In India, some cities have addressed these
challenges more effectively than others have. This paper
explores the management of municipal public health services
in two major Indian metropolises with sharply contrasting
health and sanitation indicators. The paper explains how
Chennai mitigates these challenges through active service
outreach to vulnerable populations, and a considered
approach to devolution that distributes responsibilities
appropriately between line agencies, technical personnel,
and elected representatives. Services in Delhi are quite
constrained. These policy lessons are pertinent to other
Indian cities and beyond. |
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