COURSE 3: LAW AND POLICIES PERTAINING TO …2. History of Urbanisation in India When India gained independence the country’s population was a mere 350 million. Since 1947, the population

COURSE 3: LAW AND POLICIES PERTAINING TOURBANISATION

Block 3 : Other Urban Regulatory Frameworks

Unit 7 : Urban Population Management .......................... 3

Unit 8 : Urban Health and Sanitation ............................. 17

Unit 9 : Urban Poverty Management .............................. 39

National Law University, DelhiSector-14, DwarkaNew Delhi-110078

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January, 2012 © CEL, WWF-India & National Law University Delhi 2012

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UNIT 7URBAN POPULATION MANAGEMENT

Contents Page No.

1. Introduction 3

2. History of Urbanisation in India 5

3. Planning for Population Management 7

4. Challenges Posed by Increasing Urban Population 12

5. A Few Case Studies: Best Practices/Projects 13

6. Conclusion 15

7. References and Recommended Readings 15

1. Introduction

India is the second most populous country in the world, with over 1.21 billion people (2011census), more than a sixth of the world’s population1 . Already containing 17.5% of theworld’s population, India is projected to be the world’s most populous country, surpassingChina, its population reaching 1.6 billion by 2050. India occupies 2.4% of the world’s landarea and supports over 17.5% of the world’s population2 . The country has more arable landarea than any country except the US3 and more water area than any country exceptRussia, Canada and US.

As per the 2001 census, 72.2% of the population lives in about 638,000 villages4

and the remaining 27.8%5 lives in more than 5,100 towns and over 380 urbanagglomerations.6

The rapid growth of urbanisation accompanied by phenomenal increase in urban areas.Concentration of population in limited number of cities and town have accentuated theproblems of urbanisation. Urbanisation involved not only movement of population fromrural to suborn area, but it has at the same time recognised the economic, social andpolitical structure of every state.

1 India’s population ‘to be biggest’ in the planet, BBC News. 2004-08-18. Retrieved 2011-09-24.2 US Census Bureau, Demographic Internet Staff, US Census Bureau-International Data Base (IDB), Census.gov.

Retrieved 2011-09-24.3 GM Crops Around the World – an accurate pitchure, GM Freeze, Table 3.4 Rural Urban Distribution, Census of India: Census Data 2001: India at a glance-Rural-Urban Distribution. Office

of the Registrar General and Census Commissioner, India. Retrieved on 2008-11-26.5 Urban Agglomarations and Towns, Census of India: Urban Agglomerations and Towns. Office of the Registrar

General and Census Commissioner, India. Retrieved on 2008-11-26.6 Census of India. Ministry of Finance India. Retrieved 18 December 2008.

Other Urban Regulatory Frameworks4

Table 1: Largest cities of india7

Sl. Name Census 1991 Census 2001 Calculation 2012 State/UT

1 Bombay 9 925 891 11 978 450 14 282 734 Maharashtra

2 Delhi 7 206 704 9 879 172 11 279 074 Delhi

3 Bangalore 2 908 018 4 301 326 6 386 490 Karnataka

4 Madras 3 857 529 4 343 645 4 703 195 Tamil Nadu

5 Calcutta 4 399 819 4 572 876 4 467 821 Bangla

6 Ahmadabad 2 966 312 3 520 085 4 064 518 Gujarat

7 Surat 1 498 817 2 433 835 3 927 101 Gujarat

8 Hyderabad 3 059 262 3 637 483 3 912 815 Andhra Pradesh

9 Pune 1 702 376 2 538 473 3 663 287 Maharashtra

10 Jaipur 1 518 235 2 322 575 3 416 819 Rajasthan

11 Kanpur 1 879 420 2 551 337 3 234 385 Uttar Pradesh

12 Lakhnau 1 619 115 2 185 927 2 874 489 Uttar Pradesh

13 Nagpur 1 624 752 2 052 066 2 469 427 Maharashtra

14 Patna 917 243 1 366 444 2 021 498 Bihar

15 Indore 1 091 674 1 474 968 1 972 883 Madhya Pradesh

16 Thana 803 389 1 262 551 1 936 751 Maharashtra

17 Pimpri 517 083 1 012 472 1 920 898 Maharashtra

18 Bhopal 1 062 771 1 437 354 1 917 293 Madhya Pradesh

19 Ludhiana 1 042 740 1 398 467 1 800 830 Punjab

20 Agra 891 790 1 275 134 1 769 814 Uttar Pradesh

21 Ghaziabad 542 992 968 256 1 702 985 Uttar Pradesh

22 Nashik 656 925 1 077 236 1 695 920 Maharashtra

23 Rajkot 559 407 967 476 1 606 745 Gujarat

24 Vadodara 1 046 009 1 306 227 1 602 424 Gujarat

25 Faridabad 617 717 1 055 938 1 594 224 Haryana

26 Navi Mumbai 307 724 704 002 1 533 639 Maharashtra

27 Marat 753 778 1 068 772 1 456 406 Uttar Pradesh

28 Mira Bhayandar 175 605 520 388 1 397 423 Maharashtra

29 Kalyan 1 014 557 1 193 512 1 338 643 Maharashtra

7 India: largest cities and towns and statistics of their population, World Gazetter.

Urban Population Management 5

30 Aurangabad 573 272 873 311 1 285 519 Maharashtra

31 Amritsar 708 835 966 862 1 265 766 Punjab

32 Varanasi 940 778 1 091 918 1 220 081 Uttar Pradesh

33 Sholapur 604 215 872 478 1 198 974 Maharashtra

34 Srinagar 702 478 898 440 1 188 388 Jammu & Kashmir

35 Allahabad 792 858 975 393 1 164 810 Uttar Pradesh

36 Ranchi 626 262 847 093 1 162 025 Jharkhand

37 Mysore 493 927 755 379 1 127 804 Karnataka

38 Koyampattur 816 321 930 882 1 120 462 Tamil Nadu

39 Jabalpur 764 586 932 484 1 112 215 Madhya Pradesh

40 Visakhapatnam 875 175 982 904 1 073 517 Andhra Pradesh

41 Guwahati 590 114 809 895 1 071 905 Assam

42 Jodhpur 666 279 851 051 1 048 939 Rajasthan

43 Haora 950 435 1 007 532 1 032 509 Bangla

44 Salem 499 024 696 760 1 021 893 Tamil Nadu

45 Vijayawada 701 827 851 282 1 005 452 Andhra Pradesh

46 Bhubaneswar 411 542 648 032 1 003 786 Orissa

47 Chandigarh 569 374 808 515 971 172 Chandigarh

48 Gwalior 690 765 827 026 965 851 Madhya Pradesh

49 Madurai 940 989 928 869 946 032 Tamil Nadu

50 Hubli 648 298 786 195 945 172 Karnataka

2. History of Urbanisation in IndiaWhen India gained independence the country’s population was a mere 350 million. Since1947, the population of India has more than tripled.

In 1950, India’s total fertility rate was approximately 6 (children per woman). Nonetheless,since 1952 India has worked to control its population growth. In 1983, the goal of thecountry’s National Health Policy was to have a replacement value total fertility rate of 2.1by the year 2000. That did not occur.

In 2000, the country established a new National Population Policy to stem the growth ofthe country’s population. One of the primary goals of the policy was to reduce the totalfertility rate to 2.1 by 2010. One of the steps along the path toward the goal in 2010 wasa total fertility rate of 2.6 by 2002.

As the total fertility rate in India remains at the high number of 2.8, that goal was notachieved so it is highly unlikely that the total fertility rate will be 2.1 by 2010. Thus,


India’s population will continue to grow at a rapid rate. The U.S. Census Bureau doespredict a near-replacement total fertility rate of 2.2 to be achieved in India in the year2050.

India’s high population growth results in increasingly impoverished and sub-standardconditions for growing segments of the Indian population. As of 2007, India ranked 126th

on the United Nations’ Human Development Index, which takes into account social, health,and educational conditions in a country.

Population projections for India anticipate that the country’s population will reach 1.5 to1.8 billion by 2050. While only the Population Reference Bureau has published projectionsout to 2100, they expect India’s population at the close of the twenty-first century toreach 1.853 to 2.181 billion. Thus, India is expected to become the first and only countyon the planet that will ever reach a population of more than 2 billion (recall that China’spopulation is likely to drop after reaching a peak of about 1.46 billion in 2030 and theU.S. isn’t ever likely to see a billion).

Although India has created several impressive goals to reduce its population growth rates,the India and the rest of the world has a long way to go to achieve meaningful populationcontrols in this country with a growth rate of 1.6%, representing a doubling time of under44 years.

Now the biggest challenge for urban managers lies in managing the urban population. Thegrowth of urban population in India is attributed to a large extent to migration factor,which is generally experienced in the initial stage of urbanisation. The growth of urbanisationduring pre-independence period was slow. In the earlier part of 20th centuary in 1901 thelevel of urbanisation was only 10:84% with only 25:85 million people in 1827 cities. Duringpost-independence period the growth of urbanisation was fact. In 1951,at the startingpoint of planned economic development, the level was 17:29% with 62.45 million.

Traditional rural-urban migration exists in India as villagers seek to improve opportunitiesand lifestyles. In 1991, 39 million people migrated in rural-urban patterns of which 54%were female. Caste and tribe systems complicate these population movements. Accordingto estimates 25% of the country’s poor live in urban areas and about 31% of the urbanpopulation is poor.8

Seasonal urban migration is also evident throughout India in cities like Surat where manymigrants move into the city during periods of hardship and return to their native villagesfor events such as the harvest.

Ratio of rural urban population of a country is an index of the level of industrialisationof that country. As the industries get momentum, ratio of urban population go on increasing.As India is predominantly agricultural country, ratio of urban population is less as comparedto rural population.

Census of 2001 reveals that about 27 per cent population i.e. about 28 crore people wereliving in urban areas. As against it, 74 per cent of the population i.e. 63 crore people wereliving in rural areas.

8 India’s national census of 2001.


It implies that in the economic life of India, role of industries is relatively less. In 1901,rural population was 89.0 per cent while the urban population was 11.0 per cent. In 1921rural population reduced to 88.8% and urban population increased to 11.2 per cent.

Further in 1951 rural population was 82.8 per cent and urban population was 17.2 per cent.Moreover, in 1981 rural and urban population was recorded to be 76.7% and 23.3 per centrespectively against 74.0 per cent and 26.0 per cent in 1991. The population in rural areawas 72.6 per cent while 27.4 per cent in urban areas.

The population explosion table shows that in the last 100 years, percentage of urbanpopulation in the country has increased from 11 per cent to 26 per cent. It proves thatin the economic life of India, role of cities has been increasing, but progress in thisdirection is very slow.

Compared to developed countries, number of cities and the ratio of population living inurban areas are very low. Just 26 per cent of population lives in urban areas, as against80 per cent in England, 74 per cent in USA, 72 per cent in Japan, 60 per cent in Russiaand 52 per cent in France.

3. Planning for Population ManagementRapid population growth in cities after exerts pressure on the existing infrastructure,housing and other basic amenities. The services required to support large concentrationof population are lagging behind the pace urbanisation. Even the infrastructure facilitiesare not proper. The growth of urban agloration created several population of ourconcentration of population, problems of planning, co-ordination and development of civicamenities. Urbanisation requires a healthy local government but it is made difficult bythe explosive problems of urban areas. The unplanned and unbalanced urban growthis leading to inter-regional imbalances, rural urban divisions, springing up of large slumsand environmental pollution. It is also leading to social tension, depletion of resources,etc. The process of urban development has been a big challenge to planners andadministration in India.

Historical measures to manage population in India

Historically, human population control has been implemented by limiting thepopulation’s birth rate, usually by government mandate, and has been undertaken asa response to factors including high or increasing levels of poverty, environmentalconcerns, religious reasons and over population. While population control can involvemeasures that improve people’s lives by giving them greater control of theirreproduction, some programmes have exposed them to exploitation.

Worldwide, the population control movement was active throughout the 1960s and1970s, driving many reproductive health and family planning programmes. In the 1980s,tension grew between population control advocates and women’s health activists whoadvanced women’s reproductive rights as part of a human rights based approach.Growing opposition to the narrow population control focus led to a significant changein population control policies in the early 1990s.

In 1952, India was the first country in the world to launch a national programme,emphasizing family planning to the extent necessary for reducing birth rates “to


stabilise the population at a level consistent with the requirement of nationaleconomy”. After 1952, sharp declines in death rates were, however, not accompaniedby a similar drop in birth rates.

In the early 1970s, then Prime Minister Mrs. Indira Gandhi had implemented a forcedsterelisation programme, but failed. Officially, men with two children or more hadto submit to sterilisation, but many unmarried young men, political opponents andignorant, poor men were also believed to have been sterilised. This programme isstill remembered and criticised in India, and is blamed for creating a public aversionto family planning which hampered Government programmes for decades.

Contraceptive usage has been rising gradually in India. In 1970, 13% of marriedwomen used modern contraceptive methods, which rose to 35% by 1997 and 48% by2009. The national family planning programme was launched in 1951, and was theworld’s first governmental population stabilisation programme. By 1996, the programmehad been estimated to have averted 168 million births.

The National Health Policy, 1983 stated that replacement levels of total fertilityrate (TFR) should be achieved by the year 2000. In 2000, a fresh policy was formulated.National Population Policy, 2000 was formulated with the aim of stabalising populationin India. It states that stabilising population is an essential requirement for promotingsustainable development with more equitable distribution. However, it is as much afunction of making reproductive health care accessible and affordable for all, as of increasing the provision and outreach of primary and secondary education, extendingbasic amenities including sanitation, safe drinking water and housing, besides empoweringwomen and enhancing their employment opportunities, and providing transport andcommunications. The National Population Policy, 2000 (NPP 2000) affirms thecommitment of government towards voluntary and informed choice and consent ofcitizens while availing of reproductive health care services, and continuation of thetarget free approach in administering family planning services. The NPP 2000 providesa policy framework for advancing goals and prioritising strategies during the nextdecade, to meet the reproductive and child health needs of the people of India, andto achieve net replacement levels (TFR) by 2010. It is based upon the need tosimultaneously address issues of child survival, maternal health, and contraception,while increasing outreach and coverage of a comprehensive package of reproductiveand child heath services by government, industry and the voluntary non-governmentsector, working in partnership.

National Population Policy 2000

Objectives

The immediate objective of the NPP 2000 is to address the unmet needs forcontraception, health care infrastructure, and health personnel, and to provideintegrated service delivery for basic reproductive and child health care.

The medium-term objective is to bring the TFR to replacement levels by 2010,through vigorous implementation of inter-sectoral operational strategies.

The longterm objective is to achieve a stable population by 2045, at a level consistentwith the requirements of sustainable economic growth, social development, andenvironmental protection.


The long and short term objectives of National Population Policy, 2000, are to addressthe unmet need for contraception, development of health care infrastructure includinghuman resources, ensure the implementation of inter-sectoral operational strategiesand achieve a stable population by 2045, at a level consistent with the requirementsof sustainable economic growth, social development and environmental protection.

For achieving population stabilisation as envisaged by National Population Policy(NPP), comprehensive strategies aimed at convergence of service delivery at thevillage level for basic health care, family planning and maternal and child healthrelated services; and empowerment of women for accessing health and nutritionservices and promotion of male participation in Family Planning are beingimplemented as components of the State Programme Implementation Plan underNational Rural Health Mission.

The following specific initiatives have been taken in pursuance of the objectives ofNPP/NRHM towards population stabilisation:-

Since 2005, the National Family Planning Insurance Scheme is under implementation· to compensate the sterilisation acceptors for failures, complications and deaths andindemnity insurance cover to doctors;

Compensation Package for Sterilisation acceptors increased in September, 2007 i.e.in Vasectomy from Rs.800/- to Rs.1500/- and· tubectomy from Rs.800/- to Rs.1000/-in public facilities and a uniform amount of Rs.1500/- in accredited private healthfacilities for all categories in all States for vasectomy in order to promote acceptanceof No Scalpel Vasectomy;

Promoting IUD 380A intensively as a spacing method because of its longevity of 10years;·

Promotion of Fixed day Fixed Place Family Planning Services round the year in healthfacilities under NRHM.·

The Prerna and Santushti strategy under which delayed marriage (after the legalage) among girls, proper spacing in the birth of their children and Public PrivatePartnership for providing family planning services are being implementedby Jansankhya Sthirata Kosh(JSK).

Total Fertility rate has come down from 6.0 in 1951 to 2.6 in 2008. 14 major Stateshave already reached the replacement level of fertility. 12 States have TFR between2.1 and 3.0. In the remaining nine States/UTs viz. Uttar Pradesh, Bihar; MadhyaPradesh; Rajasthan; Chhatisgarh, Jharkhand, Meghalaya, Nagaland and Dadra & NagarHaveli, the TFR is above 3.0.

NGOs are supported by the respective State Governments under NRHM to provideservice delivery in Maternal and Child Health, Family Planning, Adolescent ReproductiveHealth and Prevention and Management of RTI in addition to advocacy and awarenessgeneration, in areas which are under served or not served by Governmentinfrastructure.

India needs to work on several areas to manage its urbanisation. India also needs to starta political process where the urban issues are debated with evolution of meaningful


solutions. The National Documentation Center (NDC) that is the an agency acting as aninformation resource center, which provides an access to documentation on all aspects ofthe subjects of health, population and family welfare etc. needs to be involved in urbanpopulation management strategies. The following areas are perhaps the most important:

1) Inclusive cities - The poor and lower income groups must be brought into themainstream in cities. Regulations intended to manage densities and discourage migrationboth limit the supply of land and require many households to consume more land thanthey would choose. This drives urban sprawl and pushes up the price of land and thecost of service delivery for all. High standards for parking, coverage limits, setbacks,elevators, road widths, reservations for health centers, schools etc. (often not used)prevent the poor from choosing how much to consume of the costliest resource (urbanland) to put a roof over their heads, and comply with legal requirements. Informalityis now the only path to affordable housing for the bulk of the population in India’scities. But informality implies illegality and therefore vulnerability. While lowerincome groups pay dearly for shelter and services — they are bereft of normal propertyrights protections and their investments are thus far riskier than those of the welloff. They must instead depend on the good will of bureaucrats and politicians — tosafeguard their homes and places of business. These barriers to healthy urbanisationcome not only at a high human cost, but take a toll on productivity. Chronic informalitydiscourages the very investments in education, health and housing improvements thelower classes need to improve their own lot and contribute more to the nationaleconomy.

2) Urban governance - Meaningful reforms have to happen that enable true devolutionof power and responsibilities from the states to the local and metropolitan bodiesaccording to the 74th Amendment. This is because by 2030, India’s largest cities willbe bigger than many countries today. India’s urban governance of cities needs anover-haul. India’s current urban governance is in sharp contrast to large cities elsewherethat have empowered mayors with long tenures and clear accountability for the city’sperformance. India also needs to clearly define the relative roles of its metropolitanand municipal structures for its 20 largest metropolitan areas. With cities growingbeyond municipal boundaries, having fully formed metropolitan authorities with clearlydefined roles will be essential for the successful management of large cities in India.

3) Funding - Devolution has to be supported by more reforms in urban financing that willreduce cities’ dependence on the Center and the states and unleash internal revenuesources. Consistent with most international examples, there are several sources offunding that Indian cities could tap into, to a far greater extent than today: Monetisingland assets; higher collection of property taxes, user charges that reflect costs; debtand public-private partnerships (PPPs); and central/state government funding. However,internal funding alone will not be enough, even in large cities. A portion has to comefrom the central and state governments. Here one can use central schemes such asJNNURM and Rajiv Awas Yojana but eventually India needs to move towards a systematicformula rather than ad-hoc grants. For large cities with deep economies, this mightmean allowing them to retain 20 per cent of goods and services tax (GST) revenues. This is consistent with the 13th Central Finance Commission’s assessment that GST—a consumption-based tax that creates local incentives for growth and that is thereforewell suited for direct allocation to the third tier of government. For smaller cities,however, a better option would be to give guaranteed annual grants.


4) Planning - India needs to make urban planning a central, respected function, investingin skilled people, rigorous fact base and innovative urban form. This can be donethrough a “cascaded” planning structure in which large cities have 40-year and 20-year plans at the metropolitan level that are binding on municipal developmentplans. Central to planning in any city is the optimal allocation of space, especiallyland use and Floor Area Ratio (FAR) planning. Both should focus on linking publictransportation with zoning for affordable houses for low-income groups. These plansneed to be detailed, comprehensive and enforceable.

5) Capacity building - A real step-up in the capabilities and expertise of urban localbodies will be critical to devolution and improvement of service delivery. Reformswill have to address the development of professional managers for urban managementfunctions, who are in short supply and will be required in large numbers. Newinnovative approaches will have to be explored to tap into the expertise available inthe private and social sectors. India needs to build technical and managerial depth inits city administrations. In the Indian Civil Services, India has a benchmark for howto build a dedicated cadre for governance. India now needs to create an equivalentcadre for cities, as well as allow for lateral entry of private-sector executives.

6) Low-income housing - Affordable housing is a particularly critical concern for low-income groups — in the absence of a viable model that caters to their needs, Indiacan meet the challenge through a set of policies and incentives that will bridge thegap between price and affordability. This will enable a sustainable and economicallyviable affordable housing model for both government housing agencies and as well asprivate developers. India also needs to encourage rental housing as an option particularlyfor the poorest of the poor, who may not be able to afford a home even with theseincentives. With the 74th amendment to India’s constitution and the Jawaharlal NehruNational Urban Renewal Mission (JNNURM), India took the first steps toward urbanreforms. Going forward, the central government has to play a catalytic roleaccompanied by a supporting package of incentives. States should recognise thatstarting early on the urban transformation will give them competitive advantage,attract investment, and create jobs — getting them ahead of the curve.

All said and done, it should not be forgotten that urbanisation is an integral part of theprocess of economic growth. As in most countries, India’s towns and cities make a majorcontribution to the country’s economy. With less than 1/3 of India’s people, its urban areasgenerate over 2/3 of the country’s GDP and account for 90% of government revenues.

Fast Facts : Urbanisation in India9

Most Urbanised States : Tamil Nadu 43.9%; Maharashtra 42.4%; Gujarat 37.4%

3 out of world’s 21 mega cities : Mumbai (19 mill); Delhi (15 mill); Kolkata (14 mill)

Large Cities : 23 in 1991; 40 in 2001

Urban Pop. : 25% of 850 mill in 1992; 28% of 1,030 mill in 2002

Estimated Urban Pop. by 2017 : 500 mill

% of Urban Residents who are Poor : About 25%

Slum Population : About 41 million in 2001

Estimated Slum Pop. by 2017 : 69 mill

9 World Bank.


4. Challenges Posed by Increasing Urban PopulationUrbanisation in India has expanded rapidly as increasing numbers of people migrate totowns and cities in search of economic opportunity. Slums now account for 1/4 of all urbanhousing. In Mumbai, for instance, more than half the population lives in slums, many ofwhich are situated near employment centers in the heart of town, unlike in most otherdeveloping countries.

Meeting the needs of India’s soaring urban populations is and will therefore continue tobe a strategic policy matter. Critical issues that need to be addressed are:

♣ Poor local governance

♣ Weak finances

♣ Inappropriate planning that leads to high costs of housing and office space; in someIndian cities these costs are among the highest in the world

♣ Critical infrastructure shortages and major service deficiencies that include erraticwater and power supply, and woefully inadequate transportation systems

♣ Rapidly deteriorating environment

Challenges of Urban Society – The rapid rate of urbanisation today in India is posing arange of challenges that has to be tactfully met by urban managers. The are:

a) Planning

♣ Many urban governments lack a modern planning framework

♣ The multiplicity of local bodies obstructs efficient planning and land use

♣ Rigid master plans and restrictive zoning regulations limit the land available forbuilding, constricting cities’ abilities to grow in accordance with changing needs.

b) Housing

♣ Building regulations that limit urban density — such as floor space indexes —reduce the number of houses available, thereby pushing up property prices

♣ Outdated rent control regulations reduce the number of houses available on rent– a critical option for the poor

♣ Poor access to micro finance and mortgage finance limit the ability of low incomegroups to buy or improve their homes

♣ Policy, planning and regulation deficiencies lead to a proliferation of slums

♣ Weak finances of urban local bodies and service providers leave them unable toexpand the trunk infrastructure that housing developers need to develop newsites.


Service delivery:

♣ Most services are delivered by city governments with unclear lines of accountability

♣ There is a strong bias towards adding physical infrastructure rather than providingfinancially and environmentally sustainable services

♣ Service providers are unable to recover operations and maintenance costs and dependon the government for finance

♣ Independent regulatory authorities that set tariffs, decide on subsidies, and enforceservice quality are generally absent.

Infrastructure:

♣ Most urban bodies do not generate the revenues needed to renew infrastructure, nordo they have the creditworthiness to access capital markets for funds

♣ Urban transport planning needs to be more holistic – there is a focus on movingvehicles rather than meeting the needs of the large numbers of people who walk orride bicycles in India’s towns and cities.

Environment:

♣ The deteriorating urban environment is taking a toll on people’s health and productivityand diminishing their quality of life.

5. A Few Case Studies: Best Practices/ProjectsIn our previous units we have already read about the policies existing at national level totackle urban challenges. Let us now examine some good policies/projects designed at alocal level by different States in India.

There are many States in India that have come up with models or projects that aim atsupporting policy reforms in critical areas such as land use planning and municipal finance,as well as institutional reforms. Some such projects are as follows:

1) Karnataka Municipal Reform Project: Karnataka is one of India’s most rapidly urbanisingstates; its capital city of Bangalore is known as the Silicon Valley of India. Enormousgrowth in business opportunities, as well as rising urban populations and incomes hasled to strong demand for better infrastructure and services.

The objective of the Karnataka Municipal Reform Project for India is to help improvethe delivery of urban services through enhancing the quality of urban infrastructure,and strengthening the institutional and financial frameworks for urban services at theUrban Local Bodies (ULB) and state levels.

There are four components to the project, the first component being institutionaldevelopment; the second component is the municipal investment support; the thirdcomponent is the Bangalore development; finally, the fourth component is the projectmanagement.


The changes aimed at include:

i) a reduction in the scope of activities (Institutional Development for landmanagement and planning) and (municipal investment support); includingmodification to three of the related indicators within the results framework;

ii) re-definition of the scope of activities related to greater Bangalore seweragerelated interventions under Bangalore development component;

iii) minor re-allocation of expected loan savings across components aggregating US$3.97 million, and changes to disbursement percentages and broadened definitionsacross some of the disbursement categories; and

iv) revised disbursement projections.

2) The Third Tamil Nadu Urban Development Project (TNUDP III) – The TNUDP III aimsto help to improve civic services in the state. It aims at improving the delivery ofurban services through enhancing the quality of urban infrastructure and strengtheningthe institutional and financial framework.

The Project consists of two complementary components:

Component 1)- Provide support for management improvements and institutionalchanges, including provision of goods, technical assistance, workshops and staff trainingto support the implementation and sustainability of urban policy reforms, organisationalperformance and urban services delivery.

Component 2)- Aim at developing sustainable urban investments such as water supply,waste water collection, solid waste management, storm water drains, roads andcommon facilities such as transportation networks, and sanitation facilities, based ondemand driven investment plans developed by Urban Local Bodies (ULBs).

3) Andhra Pardesh Urban Reform and Municipal Services Project - The objective of theAndhra Pradesh (AP) Municipal Development Project for India is to help improve urbanservices in AP, and the capacity of urban local bodies (ULBs) of AP to sustain andexpand urban services.

The project consists of three technical assistance and one investment components:

1) state level policy and institutional development support aims at improving thestate’s policy and institutional framework to support service delivery and capacitybuilding by ULBs;

2) municipal capacity enhancement aims at enhancing the financial and technicalcapacity and operating systems of all ULBs (currently 126);

3) urban infrastructure investment to finance sustainable, high-priority investmentsidentified by ULBs to improve urban services or operational efficiency. To beeligible, ULBs need adequate financial capacity to sustainably finance and operatethe facilities and an adequate and feasible plan to improve their financial andmanagement capacity; and

4) project management technical assistance aims at ensuring the quality of subprojectpreparation, implementation and monitoring.


6. ConclusionUrbanisation is not a side effect of economic growth; it is an integral part of the process.As in most countries, India’s urban areas make a major contribution to the country’seconomy. Indian cities contribute to about 2/3 of the economic output, host a growingshare of the population and are the main recipients of FDI and the originators of innovationand technology and over the next two decades are projected to have an increase ofpopulation from 282 million to 590 million people. India’s towns and cities haveexpanded rapidly as increasing numbers migrate to towns and cities in search of economicopportunity.

Hence accompanying India’s rapid economic growth will be a fundamental shift in termsof a massive urban transformation, possibly the largest national urban transformation ofthe 21st century. This would pose unprecedented challenges to India’s growing cities andtowns in providing housing and infrastructure (water, sewerage, transportation, etc.), andaddressing slums. Already, slums now account for about 26% of all urban population incities. In Mumbai, more than half the population lives in slums, many of which are situatednear employment centers in the heart of town, unlike in most other cities in developingcountries. This would also entail massive capital investment needs in urban infrastructureIndia, as highlighted by various Finance Commissions and expert bodies. For instance, theReport on Indian Urban Infrastructure and Services by the High Powered Expert Committee(HPEC) on urban projects an investment requirement of over US$ 870 billion over the next20 year period. Similarly a Mckinsey study on Indian urbanisation projects an investmentneed of US$ 1.2 trillion over a similar period. Meeting the needs of India’s soaring urbanpopulations is and will continue to be a strategic policy matter for various national, stateand city governments. Promoting an efficient urbanisation process in India will require aset of policies that will deal with land policies and basic needs, connective infrastructureand specific interventions. India also needs well managed cities with high qualityservices. Water supply and sanitation, urban transport and urban drainage are key localservices to ensure the quality of living and sustained growth. Sustained energy supply,and affordable serviced land are services that are essential for the development of theeconomy.

7. References and Recommended ReadingsGovernment of India and United Nations Development Programme, 2002, Successful

Governance Initiatives and Best Practices: Experiences from Indian States, PlanningCommission, GoI and Human DevelopmentResource Centre, UNDP.

International Institute for Population Sciences (IIPS), 1995, National Family Health SurveyIndia – 1992-93, National and various State Reports, Mumbai.

International Institute for Population Sciences (IIPS) and ORC Macro, 2000, National FamilyHealth Survey India - 1998-99, National and various State Reports, Mumbai.

Mahbub ul Haq Human Development Centre, Various Years, Human Development in SouthAsia, Oxford University Press, Karachi.


Misra, Rajiv, Rachel Chatterjee, Sujatha Rao, 2003, India Health Report, Oxford UniversityPress, New Delhi.

Prabhu, K. Seeta, and R. Sudarshan, 2002, Reforming India’s Social Sector: Poverty Nutrition,Health and Education.

Social Science Press, New Delhi.

Sen, Abhijit and Himanshu, 2004, ‘Poverty and Inequality in India’, Economic and PoliticalWeekly, 39(38).

Sen, Amartya, 1999, ‘Health in Development’, Bulletin of the World Health Organisation,WHO, Geneva, 77(8).


UNIT 8URBAN HEALTH AND SANITATION

Contents Page No.

1. Introduction 17

2. Policies Pertaining to Public Health and Sanitation 18

3. Schemes on Health and Sanitation 21

4. Priority Areas in Health and Sanitation 24

5. Role of Education and Health Services 35


1. IntroductionThe urban population in India is expected to increase to more than 550 million by 2030.Currently, a sizable proportion of the population in most Indian cities lives in slum areas.The urban poor often face health threats that closely resemble the risk faced in ruralareas .They can adopt pattern of health seeking behaviour that are hardly distinguishablefrom those of rural villages and the health services to which the urban poor have accesscan be little better in terms of quality than those located in rural areas.

Today the urban settings of the wealthy nations were largely associated with opportunity,accumulation of wealth and better health than their rural counterparts. In the twenty-firstcentury, demographic changes, globalisation and climate change are having importanthealth consequences on wealthy nations and especially on low- and middle-income countries.The increasing concentration of poverty and significant inequalities between urbanneighbourhoods and the physical and social environments in cities are important determinantsof population health. It is important to identify the priority problems and outline solutionsthat can generate and sustain healthy urban environments.

As per the statistics compiled by UN, if urbanisation continues at the present rate in India,the 46% of total population will live in urban areas by 2030. While JNURM is beginning totackle urban infrastructure issues, urban health issues need immediate attention, especiallyin the context of urban poor. Another interlinked issue is urban sanitation.

Sanitation is defined as safe disposal of human excreta including its safe confinementtreatment disposal and associated hygiene practices. Sanitation is also depends on otherelements like environmental sanitation along with the management of drinking watersupply. The urban growth lead to an increase in the pollution levels and exposes populationto serious environmental health hazards. Environmental pollution in urban areas is associatedwith excessive morbidity and mortality. Overcrowding and inadequate housing contributeto pollution related diseases such as respiratory diseases, acute water borne diseases,tuberculosis, meningitis and various other diseases. The solid waste generation in citieshas increased from 6 million tonnes (mts) in 1947 to 48 mts in 1997 and is expected toincrease to 300 mts by 2047. The average waste collection in Indian cities is, however, 72per cent. Till recently medical wastes were also deposited and mixed with municipal wastecollection. Monitoring of the urban environment in selected cities in recent years by theCentral Pollution Control Board (CPCB) has identified 24 critically polluted areas in thecountry (10th Five Year Plan).


2. Policies Pertaining to Public Health and SanitationBy 2001, India’s urban population had reached 286 million (the second largest nationalurban population in the world) and projections suggest it will have reached 358 millionby 2011. India also has among the world’s largest urban population with below poverty lineincomes and the world’s largest population living in slums. In 2004–2005, 80.8 millionurban dwellers (25.6 per cent) were below the poverty line and the largest concentrationsof urban poor populations were in Maharashtra (14.6 million), Uttar Pradesh (11.7 million)and Madhya Pradesh (7.4 million), and Tamil Nadu, Karnataka and Andhra Pradesh (eachwith between 6–6.9 million). This is also likely to be an underestimate, for reasonsdiscussed later. The 2001 census recorded 42.6 million people living in slums but, asdiscussed above, this too is likely to be an underestimate.

Until recently, urban health and sanitation was not the main focus of public healthpolicies, since the majority of the population lived in rural areas. It was often assumedthat the heavy concentration of health facilities and personnel in urban areas, particularlyin the private sector, would automatically take care of the increasing urban population andits health needs.

♣ During the Fifth Plan (1974-79), policy-makers started to address health alongsideother development programs. The Minimum Needs Programme (MNP) promised toaddress all this but became an instrument through which only health infrastructurein the rural areas was to be expanded and further strengthened. It called for integrationof peripheral staff of vertical programmes but the population control programmes gotfurther impetus during the Emergency (1975-77) and most of the basic health workersgot sucked into the family planning programmes.

♣ The Chaddha Committee Report (1963), the Kartar Singh Committee Report onMultipurpose Workers (1974) and the Srivastava Committee Report on Medical Educationand Support Manpower (1975) remained focused on giving recommendations on howthe health cadres at the primary level should be distributed. With the widespreaddisillusionment with vertical programmes worldwide and the need to provide universalhealth services came the Primary Health Care Declaration at Alma Ata in 1978, whichIndia was a signatory to.

♣ The Sixth Plan (1980-84) was influenced by two policy documents: the Alma AtaDeclaration and the ICMR/ICSSR report on ‘Health for All by 2000’. The ICMR/ICSSRReport (1980) was in fact a move towards articulating a national health policy thatwas thought of as an important step to realise the Alma Ata Declaration. It wasrealised that one had to redefine and rearticulate and get back into track an integratedand comprehensive health system that policy-makers had wavered from. It reiteratedthe need to integrate the development of the health system with the overall plansof socio-economic and political change. The National Health Policy, 1983 attemptedto incorporate all these. Provision of universal, comprehensive primary health serviceswas its goal.

♣ The Seventh Plan (1985-90) restated that the rural health programmes and the three-tier health services system need to be strengthened and that the government had tomake up for the deficiencies in personnel, equipment and facilities.

Urban Health and Sanitation 19

♣ The Eighth Plan (1992-97) distinctly encouraged private initiatives, private hospitals,clinics and suitable returns from tax incentives. With the beginning of structuraladjustment programmes and cuts in social sectors, excessive importance was given tovertical programmes such as those for the control of AIDS, tuberculosis, polio andmalaria funded by multilateral agencies with specified objectives and conditions attached.

♣ Both the Ninth (1997-2002) and the Tenth Five-Year Plans (2002-2007) start with adismal picture of the health services infrastructure and go on to say that it isimportant to invest more on building good primary-level care and referral services.

Even courts on various occasions have declared in unequivocal terms that maintenance ofhealth, preservation of sanitation falls within the purview of Article 21 of the Constitutionas it adversely affects the life of the citizen and it amounts to slow poisoning and reducingthe life of the citizen because of the hazards created, if not checked. The court have alsodeclared that it is a primary, mandatory and obligatory duty of the municipal corporations/councils to remove rubbish, filth, night soil or any noxious or offensive matter. ThePollution Boards and its officers have a basic duty under the Environment (Protection) Act,1986 to stop unauthorised movement and/or disposal of the waste. They are also empoweredto take action against erring industries and persons. In Virendar Gaur v. State of Haryanaand in many other cases, the Supreme Court has time and again declared that right to lifeunder Article 21 encompasses right to live with human dignity, quality of life and decentenvironment. Thus, pollution free environment and proper sanitary condition in cities andtowns, without which life cannot be enjoyed, is an integral facet of right to life.1

It is obvious that effective policies for poverty reduction depend on the availability of gooddata on who is poor and the nature of their deprivation. The data are needed not onlyfor national populations but also for states, rural and urban populations and cities. Manycomparisons of health-related deprivation are made between rural and urban areas, butfar less attention has been given to identifying the range of health-related deprivationwithin urban populations.

Estimates as to the proportion of the urban population in India that faces deprivation canbe drawn from three different data sets. The first is based on expenditure on consumptiongoods, from which a poverty line is derived. Official statistics suggest that around 24 percent of India’s urban population was poor in 2001, with an expenditure on consumptiongoods below the poverty line of Rs 454 per month.2 Estimates for 2004–2005, with somerevisions in the methodology for setting the poverty line, suggested 25.7 per cent.3 Butthere are worries that the poverty line is set too low in relation to the costs of non-foodneeds in many urban areas, especially in successful cities where the costs of non-foodneeds are particularly high.

The second is based on housing conditions (e.g. the proportion living or not living inslums). But this depends on accurate and complete surveys. Official statistics on theproportion of the population living in slums are known to be inaccurate for many citiesin India because they do not include unaccounted for and unrecognised informal settlements

1 Solid Waste Management—An Indian Legal Profile by Prof. Satish. C. Sastri.2 GOI (2001), “Poverty estimates for 1999– 2000”, Planning Commission, New Delhi, accessed 31 December 2010.

at http://www. planningcommission.gov.in/ hindi/reports/articles/ncsxna/ index.php?repts=ar_pvrty.htm.3 Government of India (2009), “Report of the expert group to review the methodology for estimation of poverty”,

Planning Commission, New Delhi.


and people residing in poor quality housing in inner-city areas, on construction sites, inurban fringe areas and on pavements. For instance, a study in Indore showed that therewere 438 officially recognised slums but a process of mapping found an additional 101slums. Official statistics suggest that of Indore’s 1.5 million inhabitants in 2001, 261,000lived in slums (17.7 per cent of Indore’s population). If a more realistic estimate of theslum population of the city is considered, including the population in the additional 101slums, more than 40 per cent of Indore’s population lives in slums/urban poor settlements.4

In Delhi, the 2001 census estimated an urban slum population of 1.85 million, which was18.7 per cent of Delhi’s urban population. But if full account is taken of unauthorisedsettlements, including jhuggi jhodpi clusters (squatter settlements), slum-designated areas(slums recognised by the government, many of which are in the walled city), unauthorisedcolonies and jhuggi jhodpi resettlement colonies (squatter resettlement colonies), theseare estimated to have a population of 9.84 million in 2011 and thus represent more thanhalf of Delhi’s total population, which is estimated to be 19 million in 2011.5 A further100,000 people are homeless and reside on pavements, under bridges and by the roadside;many are rickshaw pullers and casual workers.6

Thus, any statistic on slum population for a city or state has to be viewed with caution,as it may only include settlements that have been officially classified as “slums” or“notified slums”. As a large proportion of low-income urban clusters are informal or“illegal”, they are not part of official slum lists and hence are often not part of the publicauthorities’ mandate to provide basic services such as drainage, water, sanitation andhealth care. According to National Sample Survey 58th Round (2002), 49.4 per cent of slumswere non-notified.

Another reason for the undercount of India’s slum population was that in the 2001 census,data on slums were only collected for urban centers with 50,000+ inhabitants; the totalslum population in India would be higher if the census had covered all urban centers. Datafrom the 2001 census showed that many urban centers in India had more than one-quarterof their population in slums, including some with more than 40 per cent and a few withmore than one-half.

The third set of estimates on urban deprivation in India is based on a wealth indexconstructed from data in the National Family Health Survey 2005–2006. This allows theurban population to be classified according to their wealth, based on an index thatincludes consideration of 33 assets and housing characteristics.7 This allows comparisonsbetween the poorest quartile of the population calculated using this wealth index and therest of the population.

4 Taneja, S and S Agarwal (2004), Situational Analysis for Guiding USAID/EHP India’s Technical Assistance Effortsin Indore, Madhya Pradesh, India, Environmental Health Project Activity Report 133, Washington DC.

5 Government of National Capital Territory of Delhi (2006), Economic Survey of Delhi 2005–2006, PlanningDepartment, page 364; also Bhan, Gautam (2009), “This is no longer the city I once knew; evictions, the urbanpoor and the right to the city in Millennial Delhi”, Environment and Urbanization Vol 21, No 1, April, pages 127–142.

6 Agarwal, S, A Srivastava, B Choudhary and S Kaushik (2007), State of Urban Health in Delhi, Ministry of Healthand Family Welfare, Government of India and Urban Health Resource Centre, Delhi, page 14.

7 These include a range of housing characteristics (including electrification, type of windows, drinking watersource, type of toilet facility, flooring, roofing and exterior walls materials, cooking fuel, house ownership)and a range of assets (including ownership of a mattress, chair, cot/ bed, table, electric fan, radio, television,sewing machine, mobile or other phone, computer, fridge, watch or clock, bicycle or motorcycle).


Identifying the India Poor

In May 2011, the India’s cabinet approved a proposal for a survey to identify peopleliving below the poverty line, which also redefines what constitutes poverty.

On the basis of the new definition of poverty, the rural poor were classified into“destitutes, manual scavengers and primitive tribal groups”. In the survey, urbanpoor were defined as those in vulnerable shelters, low-paid jobs and homesheaded by women or children. The survey was conducted alongside a caste censusto help identify those who were in need of state aid.

Census 2011 covered 35 States/Union Territories, 640 districts, 5,924 sub-districts,7,935 Towns and 6,40,867 Villages. In Census 2001, the corresponding figures were593 Districts, 5,463 sub-Districts, 5,161 Towns and 6,38,588 Villages. There is anincrease of 47 Districts, 461 Sub Districts, 2774 Towns (242 Statutory and 2532Census Towns) and 2279 Villages in Census 2011 as compared to Census 2001. On acomparison between the census of 2001 and 2011, it was found that -

♣ The growth rate of population for India in the last decade was 17.64%. Thegrowth rate of population in rural and urban areas was 12.18% and 31.80%respectively. Bihar (23.90%) exhibited the highest decadal growth rate in ruralpopulation.

♣ India’s population in 1901 was about 238.4 million, which has increased by morethan four times in 110 years to reach a population of 1,210 million in 2011.

Before the Census of 2011, the last poverty survey was conducted in 2002, but thisis the first time that details about caste and religion will be included. The last castecensus in India was in 1931.

There are various estimates on the exact number of poor in India. Officially, 37% ofIndia’s 1.21bn people live below the poverty line. But one estimate suggests thisfigure could be as high as 77%.

Under the new system, in rural areas, families owning fixed-line telephones,refrigerators and farmers who have a credit limit of 50,000 rupees ($1,112; £688)were not be counted among India’s poorest. Government staff or those earning10,000 rupees ($222; £137) a month were also be excluded. Home-owners with threeor more rooms were also not be classified as poor.

3. Schemes on Health and SanitationThere are various policies in India pertaining to Health and Sanitation. Some policiespertaining to Health are -

1) The National Health Policy - A National Health Policy was last formulated in 1983,and since then there have been marked changes in the determinant factors relatingto the health sector.

♣ A phased, time-bound programme for setting up a well dispersed network ofcomprehensive primary health care services, linked with extension and healtheducation, designed in the context of the ground reality that elementary healthproblems can be resolved by the people themselves;


♣ Intermediation through ‘Health volunteers’ having appropriate knowledge, simpleskills and requisite technologies;

♣ Establishment of a well-worked out referral system to ensure that patient load atthe higher levels of the hierarchy is not needlessly burdened by those who canbe treated at the decentralised level;

♣ An integrated net-work of evenly spread specialty and super specialty services;encouragement of such facilities through private investments for patients who canpay, so that the draw on the Government’s facilities is limited to those entitledto free use.

2) National Rural Health Mission

♣ The National Rural Health Mission (2005-12) seeks to provide effective health careto rural population throughout the country with special focus on 18 states, whichhave weak public health indicators and/or weak infrastructure.

♣ These 18 States are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, HimachalPradesh, Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya, MadhyaPradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and UttarPradesh.

♣ The Mission is an articulation of the commitment of the Government to rise publicspending on Health from 0.9% of GDP to 2-3% of GDP.

♣ It aims to undertake architectural correction of the health system to enable it toeffectively handle increased allocations as promised under the National CommonMinimum Programme and promote policies that strengthen public healthmanagement and service delivery in the country.

♣ It has as its key components provision of a female health activist in each village;a village health plan prepared through a local team headed by the Health &Sanitation Committee of the Panchayat; strengthening of the rural hospital foreffective curative care and made measurable and accountable to the communitythrough Indian Public Health Standards (IPHS); and integration of vertical Health& Family Welfare Programmes and Funds for optimal utilisation of funds andinfrastructure and strengthening delivery of primary healthcare.

Policies pertaining to Sanitation - The Millennium Development Goals (MDGs) enjoinupon the signatory nations to extend access to improved sanitation to at least halfthe urban population by 2015, and 100% access by 2025. This implies extendingcoverage to households without improved sanitation, and providing proper sanitationfacilities in public places to make cities open defecation free.

In 2001, about 285 million people, or 27.8% of India’s 1.02 billion population, livedin 5,161 cities. About 37% lived in 35 million-plus metros, the rest being equallydivided between 388 large towns (0.1 up to a million) and 4,738 small towns (less than0.1 million). Over the last five decades, annual rates of growth of urban populationranged between 2.7 to 3.8% - 2.7% being the growth rate during 1991-2001. Projectionsestimate that 331 million people would be living in Urban India by 2007, growing inthe Eleventh Plan period to 368 million by 2012 (Office of Registrar General andCensus Commissioner, Govt. of India, 2006).


3) National Urban Sanitation Policy

The specific goals are:

♣ Generating awareness about sanitation and its linkages with public andenvironmental health amongst communities and institutions;

♣ Promoting mechanisms to bring about and sustain behavioural changes aimed atadoption of healthy sanitation practices;

♣ All urban dwellers will have access to and use safe and hygienic sanitation facilitiesand arrangements so that no one defecates in the open. In order to achieve thisgoal, the following activities shall be undertaken:

— Promoting access to households with safe sanitation facilities (including properdisposal arrangements);

— Promoting community-planned and managed toilets wherever necessary, forgroups of households who have constraints of space, tenure or economicconstraints in gaining access to individual facilities;

— Adequate availability and 100% upkeep and management of Public Sanitationfacilities in all Urban Areas, to rid them of open defecation and environmentalhazards;

— Integrated City-Wide Sanitation Re-Orienting Institutions and MainstreamingSanitation;

— Mainstream thinking, planning and implementing measures related to sanitationin all sectors and departmental domains as a cross-cutting issue, especially inall urban management endeavours;

— Strengthening national, state, city and local institutions (public, private andcommunity) to accord priority to sanitation provision, including planning,implementation and O&M management;

— Extending access to proper sanitation facilities for poor communities andother unserved settlements.

Benchmarking Urban Health and Sanitation

After ratings for hospitals and Initial Public Offerings (IPO), in 2010, MoUD came upwith the proposal of grading cities on the basis of how well they handle their publichealth and sanitation.

It was proposed that the cities will be colour graded on the sustainable handling oftheir waste, and the comparable data on different cities is available on the publicdomain of MoUD on their website.8

Data from the cities were bench marked on their solid waste collection and disposal,storm-water management, prevalence of open defecation, among other things.

Those cities with a population of over one lakh, by the 2001 census, were be gradedalong the parameters of output, process and outcome — indicators laid out by theNational Urban Sanitation Policy of 2008.

8 Rank of Cities on Sanitation 2009-2010 – The table is available at http://urbanindia.nic.in/programme/uwss/rank_cities_0910.pdf


The grading shows a city in poor light, if it has a red grade of less than 33 marks,indicating a public health and sanitation “emergency”. As a city’s sanitationenvironment improves, its grading moves up to black, then blue and at the top ofthe ladder is green, indicating a healthy and green city.

A good grading is an endorsement that the city is doing well and its systems work,and it could also work as an indicator for investors evaluating locations to set upbusinesses.

The Ministry had appointed AC Nielsen Development and Research Services and theCentre for Environment Planning Technology (CEPT) to undertake the grading ofcities. In the grading process, samples would be taken from five public places andtested.

Expected to be a yearly exercise, an award is also to be given to the city that faresbest in this public health exercise. But data tell a powerful story and apart frombeing a competitive exercise, cities can also learn from the insights different citiesthrow up.

4. Priority Areas in Health and SanitationIndia is an under developed country and 50% of the population live in urban areas in anextremely below the poverty condition. As they are lured by massive industrialisation,economic and educational opportunities in cities like Chennai, Mumbai, Kolkata and Delhiare over crowded and the statistics says about one fifth live in slums Most of the healthproblems in India are generated from these slums only. Many are exposed to new typesof risks associated with industrial pollution, road accidents, air pollution, poisonings,threat to child adolescent health etc.

Central council of health was formed as per the constitution to check all health problemsin India. Health survey and Development Committee was the first committee to be formedin India which laid foundations for several activities in all five year plans to attend to allhealth problems attaching the millions in India.

The ministry of health and family welfare is handled by Secretary of the GoI. He isdirected by the cabinet minister of state or by his deputy. The ministry is concerned with

♣ maintenance of international health relations with other countries of the world andcoordination among them

♣ adoption of family welfare measures concerning population stabilisation and familyplanning.

The Directorate General of health services as the technical wing to the ministry of healthand family welfare and its activities cover the whole spectrum of medical care and publichealth apart from general administration. Other activities include establishment of drugstandards, prevention of food adulteration, control of drugs and poison, coordination withstate of health Authorities, implementation and monitoring of various health programmesand schemes etc.


At the state level we have the Directorate of Health Services to administer public health,medical services and medical education. Due to increasing responsibilities and abundanthealth problems some states have established more than one Directorate and separatedmedical care facilities and medical education from the public health. To boost the familywelfare activities some states have set up separate Directorate of family welfare or statefamily welfare Bureau.

At the District level we have the District health office that is in charge of all activitiesconcerning medical, public health and family welfare and district health administration.To lay more importance to family welfare programmes, a separate family welfare officerhas been appointed.

In urban areas we have local self governing bodies having three tier administrations.

♣ Medical officer in charge

♣ Zonal officer in charge

♣ The chief executive in charge

a) Child/ Adolescent Health and Welfare

Urban malaria, tuberculosis and pneumonia, leprosy, meningitis, preventable infectionsin children such as measles, whooping cough and polio, diarrhoea diseases and intestinalworm infections are some of the most common health problems apart from highermorbidity and mortality due to accidents.

Among the major public health programmes, the Maternal and Child Health Servicesconstitute an integral part of the family welfare programmes and occupy an importantplace in the socio economic development planning. It also plays a crucial role inhuman resource development and in improving the quality of life of the people. TheGovernment has sponsored immunisation schemes for infants and children againstnutritional anaemia among mothers and children and prophylaxis against blindnessdue to vitamin ‘A’ deficiency are also in operation. Programme for oral rehydrationtherapy is another important child survival scheme. Diarrhoea disease is a majorhealth problem in India especially among children below five years of age.

To liberate the children from common communicable diseases, the expanded programmeof Immunisation (EPI) was started by the Governments of India in 1978. The objectivesof the programme are to reduce morbidity and mortality due to diphtheria, pertussisand tetanus, poliomyelitis, tuberculosis and typhoid fever by making vaccinationservices available to all eligible children and pregnant women.

Universal Immunisation Programme (UIP) is an important step towards achieving thegoal of Health for All by the Year 2000. The programme was dedicated to the memoryof the former Prime Minister, Mrs. Indira Gandhi. Under the UIP, it was proposed tocover all eligible infants and pregnant mothers by the end of 1990. A “TechnologyMission on Immunisation” has been launched covering all aspects commencing fromresearch and development to actual delivery of services to the affected population.

Urban Malaria Scheme was initiated in November 1971. The main objective of thescheme is to control malaria transmission by eliminating aquatic stages of vector


mosquitoes by weekly application of larvicides in breeding sources. The scheme hasat present been sanctioned for 133 towns distributed over 17 states and two UnionTerritories.

Overcrowding, poor housing, choked drains, high density of insects and rodents, lackof garbage disposal facilities, poor personal hygiene and hygienic conditions are hallmarks of urban slums in India. Unplanned and rapid urbanisation put a strain on thealready dwindling civic amenities. Under such conditions gastroenteritis and otherinfectious diseases are rampant. Children affected by serious diarrhoea diseases arelikely to spend 20 per cent of their first two years of life suffering from seriousdiarrhoea with a median number of 4.9 episodes per child per year. Studies fromurban slums of Ludhiana show that children under two years of age had 3.8 episodesof diarrhoea per year.

b) Maternal Health

Maternal health is a rather wide term. Often, the term is confused with only theperiod of time, when the women gives birth to the child. However maternal healthcare is a concept that encompasses family planning, preconception, prenatal,and postnatal care.

In the Indian scenario, all the above mentioned phases are not very well defined. Thisstems from the lack of education and awareness among women. Crisis also varies withlocation like urban or rural, with income of the family and even with castes likescheduled tribes.

Family planning in India has been a matter of debate since time immemorial, consideringthe exploding number of people. Government has come up with various nationwideprogrammes to curtail the increasing number. Despite having one of the oldest familyplanning programmes in the world, India has a fertility rate of 2.9 and a crude birthrate of 23/1,000 persons. Thus statistically, the number of births per female is arather high number. Such high rates of birth and fertility indicates that on an averagewoman give birth to at least two children during their reproductive age. While thatmay sound perfectly normal, however in the rural scenario women may give birth toas many as ten children irrespective of the fact whether they can sustain them or not.

Thus often they do not get enough time to recover from childbirth. Factors likehaemorrhage (both ante and post partum), toxaemia (Hypertension during pregnancy),anaemia, obstructed labour, puerperal sepsis (infections after delivery) and unsafeabortion cause a high maternal mortality rate.

Maternal death is defined as death of women while pregnant or within 42 days oftermination of pregnancy from any cause related to or aggravated by pregnancy orits management. The maternal mortality ratio is maternal death per 100,000 livebirths in one year. WHO estimates show that out of the 529,000 maternal deathsglobally each year, 136,000(25.7%) are contributed by India. This is the highest burdenfor any single country.

In urban areas, services offered for maternal health care sees patterns of inequality.Urban marginalisation takes place in which only the poor are excluded. Private healthcare services are beyond the budget of marginalised women. While the marginalised


may go for birth and check-ups in government run hospitals; however they nevermeasure the survival rate of these women. The Indian government stated that maternalhealth in the country had considerably improved because 10 million women had givenbirth in healthy facilities in 2009 and in 2010. Under its flagship National Rural HealthMission and Janani Suraksha Yojana (JSY), or Safe Motherhood Scheme, the Indiangovernment uses cash incentives to encourage women to give birth in health facilities.The government does not, however, measure the numbers of women who survive thedelivery and the post delivery period. Any data or record is yet to be maintained tomeasure a much more accurate rate of success.

As a natural process, females do gain considerable amount of weight during pregnancyand this carries on even after child birth. But many of them ignore this change andremain unaware of the complications which arise due to them. The condition howeverbecomes, so worse that women become obese which leads to hormonal imbalancesand increasing hypertension. Further, many now face the crisis of not been able toconceive on time after marriage. Many of such women lie in the above 30 age group,who have devoted much of their time in career building.

Our society is caught in the crossroads; emerging from the traditional methods ofchild birth, government schemes and women’s rights. Caught in this confusion, manyfamilies know what is the right thing to do, but they are blinded by lack of awarenessand lack of information.

c) Water Supply

Water supply and sanitation in India continue to be inadequate, despite long-standingefforts by the various levels of government and communities at improving coverage.The level of investment in water and sanitation, albeit low by international standards,has increased during the 2000. Access has also increased significantly. For example,in 1980 rural sanitation coverage was estimated at 1% and reached 21% in 2008. Also,the share of Indians with access to improved sources of water has increased significantlyfrom 72% in 1990 to 88% in 2008. At the same time, local government institutions incharge of operating and maintaining the infrastructure are seen as weak and lack thefinancial resources to carry out their functions. In addition, no major city is knownto have a continuous water supply and an estimated 72% of Indians still lack accessto improved sanitation facilities.

A number of innovative approaches to improve water supply and sanitation have beentested in India, in particular in the early 2000. These include demand-driven approachesin rural water supply since 1999, community led total sanitation, a public-privatepartnerships to improve the continuity of urban water supply (as experimented andimplemented in Karnataka), and the use of micro-credit to women in order to improveaccess to water.

Water supply and sanitation is a State responsibility under the Indian Constitution.States may give the responsibility to the Panchayati Raj Institutions (PRI) in ruralareas or municipalities in urban areas, called Urban Local Bodies (ULB). At present,states generally plan, design and execute water supply schemes (and often operatethem) through their State Departments (of Public Health Engineering or RuralDevelopment Engineering) or State Water Boards.


Highly centralised decision-making and approvals at the state level, which are characteristicof the Indian civil service, affect the management of water supply and sanitation services.For example, according to the World Bank in the state of Punjab the process of approvingdesigns is centralised with even minor technical approvals reaching the office of chiefengineers. A majority of decisions are made in a very centralised manner at the headquarters.In 1993 the Indian constitution and relevant state legislations were amended in order todecentralise certain responsibilities, including water supply and sanitation, to municipalities.Since the assignment of responsibilities to municipalities is a state responsibility, differentstates have followed different approaches. According to a Planning Commission report of2003 there is a trend to decentralise capital investment to engineering departments at thedistrict level and operation and maintenance to district and gram panchayat levels.

Policy and regulation - The responsibility for water supply and sanitation at the centraland state level is shared by various Ministries. At the central level, The Ministry of RuralDevelopment is responsible for rural water supply through its Department of DrinkingWater Supply (DDWS) and the Ministry of Housing and Urban Poverty Alleviation is responsiblefor urban water supply. However, except for the National Capital Territory of Delhi andother Union Territories, the central Ministries only have an advisory capacity and a verylimited role in funding. Sector policy thus is a prerogative of state governments.

Service provision in Urban areas - Institutional arrangements for water supply and sanitationin Indian cities vary greatly. Typically, a state-level agency is in charge of planning andinvestment, while the local government ULBs is in charge of operation and maintenance.Some of the largest cities have created municipal water and sanitation utilities that arelegally and financially separated from the local government. However, these utilitiesremain weak in terms of financial capacity. In spite of decentralisation, ULBs remaindependent on capital subsidies from state governments. Tariffs are also set by stategovernments, which often even subsidise operating costs. Furthermore, when no separateutility exists there is no separation of accounts for different activities within a municipality.Some states and cities have non-typical institutional arrangements. For example, in Rajasthanthe sector is more centralised and the state government is also in charge of operation andmaintenance, while in Mumbai the sector is more decentralised and local government isalso in charge of planning and investment.

Private sector participation - The private sector plays a limited, albeit recently increasingrole in operating and maintaining urban water systems on behalf of ULBs. For example,the Jamshedpur Utilities & Services Company (Jusco), a subsidiary of Tata Steel, has alease contract for Jamshedpur (Jharkhand), a management contract in Haldia(West Bengal),another contract in Mysore (Karnataka) and since 2007 a contract for the reduction of non-revenue water in parts of Bhopal (MP). French water company Veolia won a managementcontract in three cities in Karnataka in 2005. In 2002 a consortium including Thames Waterwon a pilot contract covering 40,000 households to reduce non-revenue water in parts ofBangalore, funded by the Japan Bank for International Cooperation. The contract wasscaled up in 2004. The Cypriot company Hydro-Comp, together with two Indian companies,won a 10-year concession contract for the city of Latur (Maharashtra) in 2007 and anoperator-consultant contract in Madurai (Tamil Nadu). Furthermore, the private Indianinfrastructure development company SPML is engaged in Build-Operate-Transfer (BOT)projects, such as a bulk water supply project for Bhiwandi (Maharashtra).


Some Best Practices

1) Achieving continuous water supply with the help of a private operator inKarnataka

In the cities of Hubli, Belgaum and Gulbarga in the state of Karnataka, theprivate operator Veolia increased water supply from once every 2–15 days for 1–2 hours, to 24 hours per day for 180,000 people (12% of the population of the 3cities) within 2 years (2006–2008). This was achieved by carefully selecting andring-fencing demonstration zones (one in each city), renovating the distributionnetwork, installing meters, introducing a well-functioning commercial system,and effective grass-roots social intermediation by an NGO, all without increasingthe amount of bulk water supplied. The project, known by its acronym as KUWASIP(Karnataka Urban Water Sector Improvement Project), was supported by aUS$39.5 million loan from the World Bank. It constitutes a milestone for India,where no large city so far has achieved continuous water supply. The project isexpected to be scaled-up to cover the entire area of the three cities.

2) Micro-credit for water connections in Tamil Nadu

In Tiruchirapalli in Tamil Nadu, the NGO Gramalaya, established in 1987, andwomen self-help groups promote access to water supply and sanitation by thepoor through micro-credit. Among the benefits are that women can spend moretime with their children, earn additional income, and sell surplus water toneighbours. This money contributes to her repayment of the Water Credit loan.The initiative is supported by the US-based non-profit Water Partners International.

3) The Jamshedpur Utilities and Services Company

The Jamshedpur Utilities and Services Company (JUSCO) provides water andsanitation services in Jamshedpur, a major industrial center in East India that ishome to Tata Steel. Until 2004 a division of Tata Steel provided water to thecity’s residents. However, service quality was poor with intermittent supply, highwater losses and no metering. To improve this situation and to establish goodpractices that could be replicated in other Indian cities, JUSCO was set up as awholly owned subsidiary of Tata Steel in 2004.

Efficiency and service quality improved substantially over the following years.The level on non-revenue water decreased from an estimated 36% in 2005 to 10%in 2009; one quarter of residents received continuous water supply (although theaverage supply remained at only 7 hours per day) in 2009; the share of meteredconnections increased from 2% in 2007 to 26% in 2009; the number of customersincreased; and the company recovered its operating costs plus a portion ofcapital costs. Identifying and legalising illegal connections was an importantelement in the reduction of non-revenue water. The utility prides itself today ofthe good drinking water quality provided and encourages its customers to drinkfrom the tap. The utility also operates a wastewater treatment plant that meetsdischarge standards. The private utility pays salaries that are higher than civilservice salaries and conducts extensive training programmes for its staff. It hasalso installed a modern system to track and resolve customer complaints.Furthermore, it conducts independent annual customer satisfaction surveys.JUSCO’s vision is to be the preferred provider of water supply and other urbanservices throughout India. Together with Ranhill Malaysia it won a 25-yearconcession contract for providing the water supply in Haldia City, West Bengal.


d) Solid Waste Management

Drainage system is poor in Chennai, Kolkata and Mumbai which cause high incidenceof infections disease and epidemics. High densities of dwellings and lack of internalroads cause poor accessibility for emergency and life saving services. New squattersettlements come up on the periphery often on inhabitable lands because of their lowvalues and cause environmental hazards.

Municipal Solid Waste - Garbage is generally referred to “Waste” and is also termedas rubbish, trash, junk, unwanted or undesired material. As per the Municipal SolidWaste (Management & Handling) Rule, 2000 garbage is define as Municipal Solid Wastewhich includes commercial and residential wastes generated in a municipal or notifiedareas in either solid or semi-solid form excluding industrial hazardous wastes butincluding treated bio-medical wastes. Municipal solid waste consists of householdwaste, construction and demolition debris, sanitation residue and waste from streets.This garbage is generated mainly from residential and commercial complexes. MainSources of Municipal Waste –

♣ House hold waste

♣ Commercials

♣ Street sweeping

♣ Hotels and restaurants

♣ Clinics and dispensaries

♣ Construction and demolition

♣ Horticulture

♣ Sludge

In India the biodegradable portion dominates the bulk of Municipal Solid Waste.Generally the biodegradable portion is mainly due to food and yard waste. With risingurbanisation and change in lifestyle and food habits, the amount of municipal solidwaste has been increasing rapidly and its composition changing. There are differentcategories of waste generated, each take their own time to degenerate.

The term municipal solid waste refers to solid waste from houses, streets and publicplaces, shops, offices and hospitals. Management of these types of waste is mostoften the responsibility of Municipal or other Governmental authorities. Except in themetropolitan cities, SWM is the responsibility of a health officer who is assisted bythe engineering department in the transportation work. The activity is mostly labourintensive, and 2-3 workers are provided per 1000 residents served. The municipalagencies spend 5-25% of their budget on SWM. A typical waste management systemin a low- or middle-income country like India includes the following elements:

♣ Waste generation and storage

♣ Segregation, reuse and recycling at the household level

♣ Primary waste collection and transport to a transfer station or community bin

♣ Street sweeping and cleansing of public places


♣ Management of the transfer station or community bin

♣ Secondary collection and transport to the waste disposal site

♣ Waste disposal in landfills

But in most of the Indian cities open dumping is the Common Practices which isadversely affecting on environment and Public health. An open dumping is defined asa land disposal site at which solid wastes are disposed of in a manner that does notprotect the environment, are susceptible to open burning, and are exposed to theelements, vectors and scavengers. Open dumping can include solid waste disposalfacilities or practices that pose a reasonable probability of adverse effects on healthor the environment.

♣ The health risks associated with illegal dumping are significant. Areas used foropen dumping may be easily accessible to people, especially children, who arevulnerable to the physical (protruding nails or sharp edges) and chemical (harmfulfluids or dust) hazards posed by wastes.

♣ Rodents, insects and other vermin attracted to open dump sites may also posehealth risks. Dump sites with scrap tires provide an ideal breeding ground formosquitoes, which can multiply 100 times faster than normal in the warm stagnantwater standing in scrap tire causing several illnesses.

♣ Poisoning and chemical burns resulting from contact with small amounts ofhazardous, chemical waste mixed with general waste during collection andtransportation.

♣ Burns and other injuries can occur resulting from occupational accidents andmethane gas exposure at waste disposal sites.

♣ Environment pollution and Air pollution is caused by such dumping. Dust generatedfrom on-site vehicle movements, and placement of waste and materials. Waterpollution is another big challenge. Runoff from open dump sites containing chemicalsmay contaminate wells and surface water used as sources of drinking water opendumping can also impact proper drainage of runoff, making areas more susceptibleto flooding when wastes block ravines, creeks, culverts and drainage basins andalso contamination of groundwater resources and surface water from leachateemissions.

♣ Permanent or temporary loss of productive land and soil contamination.

Legal Framework for Municipal Solid Waste in India - Municipal Solid Waste(Management and Handling ) Rule was notified by the Ministry of Environment andForest, Govt. of India.9 The objective of these Rules was to make every municipalauthority responsible for the implementation of the various provisions of the Ruleswithin its territorial area and also to develop an effective infrastructure for collection,storage, segregation, transportation, processing and disposal of Municipal Solid Wastes.The Civic bodies have the responsibility to enforce these rules.

9 vide No.S.O.908 (B) dated the 25th September 2000.


The major functions of civic body include

♣ Prohibiting littering of street.

♣ Organising house to house waste collection.

♣ Conducting awareness programmes to disseminate information to public.

♣ Providing adequate community storage facilities.

♣ Use of colour code bins and promotion of waste segregation.

♣ Transport of wastes in covered vehicles.

♣ Processing of wastes by adopting an appropriate combination of composting,anaerobic digestion, Pellatisation etc.

♣ Upgradation of the existing dump sites and Disposal of inert wastes in sanitarylandfills.

As per the Rules, the citizens are responsible for

♣ Segregation of wastes at source.

♣ Avoid littering of streets.

♣ Delivery of wastes in accordance with the delivery system notified by the respectiveCivic body.

e) Health Care Delivery

In India, more than nine million people live in slums of which 12,50,000 are inBombay, 11,00,000 in Calcutta, 9,00,000 in Madras and 7,00,000 are in Delhi. It is nowonder that slum dwellers should be the victims of air-borne and water-borne infections,and should suffer from nutritional deficiencies as also from undiagnosed mental illness.The disorganisations in various aspects of life breed apathy and psychology of defeatwhich is manifested in fatalism, crime or lack of enthusiasm about preventive aspectsof health, although offered free of charge.

There is constant deprivation, particularly of children among urban poor. Deterioratedhouses crowded together, open sewer, uncollected garbage, poor sanitation, flies,starling water and poor lighting are common. People face threat of eviction if theyare squatting on someone else’s land. Joblessness and alcoholism make men angry orhopelessly drunk and lead to abandoned wives and children. Women must go to workto survive without a male breadwinner or to help him make both ends meet. For someof them, domestic service and prostitution are virtually the only options. Olderchildren, some no more than 10 year old, take care of their younger siblings whilethe adults are away.

Consequently, children remain undernourished and underweight with their growthstunted from insufficient food. Diarrhoea, gastro–enteritis and respiratory ailmentsare common illnesses to which many succumb during their first year of life.

Urban areas continued to develop being the seats of power, money and intellect. Theyalso became the first places to experiment with ideas. As a result, various agenciesof health representing municipal, provincial and national levels developedsimultaneously with voluntary, private and philanthropic institutions. However, curative


aspect got precedence over preventive and promotional aspects. Health care systemcontinues to veer around doctors, drugs and patients. Piped water supply and modernsanitation also developed but in selected urban localities. However, the water supplyis almost always intermittent, and in most of the cities / towns drainage often getsclogged for one reason or another.

It is not uncommon to see medical colleges and hospitals belonging to various medicalsystems such as modern, ayurveda and homeopathy in one Indian city. India providesan excellent example of medical pluralism. People follow home remedies, spiritualremedies and treatment from various medical systems simultaneously or one afteranother. Metropolitan urban areas provide medical facilities which are available indeveloping countries such as cardiac surgery, treatment of all kinds of cancers, or inbrief, for the diseases which are associated with affluence. The major diseases identifiedin South–East Asia Region under WHO are malaria, filarial and other mosquito–bornediseases, diarrhoea diseases, leprosy, tuberculosis, sexually transmitted diseases,poliomyelitis and other children diseases, tetanus, nasopharyngeal and cervical cancers,visual impairment and blindness, etc.

The organised sectors in urban areas such as employees of government and publicundertakings bargain for medical benefits like Employees State Insurance Scheme andGovernment Health Schemes. In same cases, medical expenses are reimbursable iftreated at recognised hospitals. At the same time, there is a lot of overlap and eventhe private medical practitioners seem to thrive well simultaneously. However, theunorganised sector such as domestic workers, self-employed, porters, cart-pullers,load-carriers and urban poor mostly living in slums do not get these benefits. Theyare also deprived of piped water and modern sanitation, or in any case, the facilitiesare woefully inadequate.

Urban poor whose hallmark in expenditure is cheapness get adulterated food anddrugs. On an average, milk, milk-products, edible oils, wheat flour, spices and eventea leaves are adulterated to the tune of 50 per cent.

Mental health has yet to receive due attention in India. While westernised urban eliterequire the services of psychiatrists in increasing number, for others family continuesto provide psychic treatment. If crime rate, suicide, divorce, riots and indiscipline areconsidered as parameters of mental health, urban area need urgent attention.

It is often said that a large proportion of population suffers from protein caloriemalnutrition. However, the range of nutrition in which people can function efficientlywithout getting nutritional deficiencies is wide and what are commonly given asrecommended quantities for intake of nutrients are much higher than what are required.

Urban poor are unfortunately use bottle feeding and baby feeds under the influenceof commercial advertising on radio, television and through other popular media likefilms.

The revolution in drugs coincided with freedom from colonial rule. The drug industryhas developed out of proportion in comparison with basic amenities like potable waterand sanitation.


Pharmaceutical industry measures developed out of proportion of country in terms ofintakes of per capita consumption of drugs. In India, drugs are only consumed among20 per cent urban people. The per capita consumption is perhaps the lowest in theworld. However, this code does not represent the correct picture in view of the factthat about 75 per cent population in rural areas and urban poor has yet to have accessto drugs. Major share of these drugs are taken away by vitamins tonics and antibiotics.It is estimated that out of the total production 25 per cent was taken away byvitamins and tonics, and 20 per cent by antibiotics.

Primary health care is available to the whole population, with at least the following:

♣ Safe water in the home or within 15 minutes walking distance, and adequatesanitary facilities, in the home or immediate vicinity;

♣ Immunisation against diphtheria, tetanus, whooping cough, measles, poliomyelitis,and tuberculosis;

♣ Local health care, including availability of at least 20 essential drugs, within anhour’s walk or travel; and

♣ Trained personnel for attending pregnancy and child-birth, and caring for childrenup to at least one year of age.

National Filarial Control programme was taken up in urban areas from 1955 in orderto contain the diseases. Anti-larval and antiparasitic measures are being taken in 199towns distributed in 13 states and four Union Territories.

Tuberculosis is a major public health problem in the country. The National TuberculosisProgramme was launched in 1962. A total of about 46,000 beds are functioning in thecountry for treatment of seriously sick and emergent TB patients.

Leprosy control programme has been in operation since 1955 but it was only after1980 that it received a high priority and it was redesigned as National LeprosyEradication Programme (NLEP) in 1983 with the goal of arresting the disease in allknown leprosy patients by the year 2000.

Kala-azar which was almost on the verge of eradication, reappeared in Bihar in 1970sand in West Bengal during 1977. Later it spread to more states. The Kala–azar unitof National Malaria Eradication Programme (NMEP) is monitoring the Kala-azar situationalong with the incidence of Japanese Encephalitis in the country.

National AIDS Control Programme has emerged as a devastating fatal disease. Up toApril 1989, as many as 2,55,589 risk persons were screened. Of these, 941 have beenHIV positive. Amongst these, as many as 29 are the full blown cases of AIDS whichinclude 11 foreigners. The Government of India constituted a task force in the year1985 under Indian Council of Medical Research and established two surveillance centers,viz., National Institute of Virology, Pune and Christian Medical College, Vellore toscreen high risk people for AIDS. An AIDS cell has been established in the DirectorateGeneral of Health Service to coordinate all activities pertaining to AIDS control. Atpresent, 40 surveillance centers and four referral centers are available in the country.


Apart from the above national health programmes, there are programmes like, NationalProgramme for Control of Blindness, National Mental Health Programme, Sexually–Transmitted Diseases Programmes and National Goiter Control Programme.

Failure of Urban Health Care System - Health Care System in India in the last 45years has focused on increasing coverage in the rural areas. There has been little orno development of organised health care services for the vast urban areas. The 3,600odd cities and towns of India with some 40 million people living in slums have todepend largely on private practitioners (mostly quacks) for their health care needs.Out of the 3,000 plus urban local bodies in India only about 100 have been somesemblance to a health care service while the rest have only a sanitary inspector oreven a lower functionary to look after the health care system.

From the foregoing discussion it would be obvious the prevalence of malnutrition inurban areas particularly in the urban slums would he quite high.

In a 30,000 urban population of Ludhiana, mostly from the slums, it was found overall prevalence of malnutrition, in children under five years to be 67 per cent formales and 69 per cent for females. Further, the analysis of 280 deaths in childrenaged 1-5 years mostly from urban slums showed that malnutrition was an associatedcause in two-third of the deaths.

Although urbanisation is one of the indicators of development, very fast growth ofurbanisation in developing countries has created problems of proliferation of slums. Slumshave become the unavoidable and evil symbols of industrial and urban growth. The rateof urban growth cannot match housing, educational and health service facilities includingdrinking water and sanitation.

5. Role of Education and Health ServicesThe analysis shows that wealthiest 20% of the population received about 25% of the actualgovernment health spending while the poorest 20% received only 15%. The poverty ofhealth is exacerbated not only by wealth but also by other socio-economic measures, suchas sex, race, ethnic group, language, educational level, occupation and residence. Lackof access to formal land market forcing poor people to inhabit unhealthy environmentwhich creates serious implications on their health and they have to spent higher percentageof their income on health care. Physical inability, social discrimination by education,caste, sex and economic stratification increases the gap between demand and inadequatesupply of services. Besides the physical and social factors, lack of access to money poorare unable to use health services and have less access to the facilities in the public orprivate sector. They hardly seek heath care when they are ill. The poor have to dependon loans and sale of assets to pay for hospitalisation. Cost is a greater barrier than thePhysical access to health providers. There is no provision in the government programmefor the unorganised sector to get access to medical benefits while the organised sectoremployees have provisions for medical benefits.

As in the case of health services, there are evidence of discrimination between the richand the poor/disadvantaged children in their access to quality education. The accessproblem is further compounded along the gender, caste and physical and mental disabilitylines. There is a big difference between the proportion of children accessing education in


million plus cities compared to smaller cities. The two critical problems pointing out bythe author in this field are access and the quality of education. Quality defines in termsof poor teaching standard and facilities, teacher absenteeism, insensitive curriculum andcontent, poor motivation of teachers. This is compounded with lack of physical access andinfrastructure.

The analysis also shows that smaller million-plus cities have more schools per capitapopulation when compared to four mega polis. Contrary to health services, educationinfrastructure is poorer in cities with larger population and there is a huge gap in achievinguniversal access to education in all cities, impacting the disadvantaged children the mostand million plus cities, which are hub of economic activities, need to improve access ofgirl children to education. The proportion of children from marginalised communities inmega cities is very low compared to smaller towns.

The chapter draws the following inferences and way forward:

♣ Health access is poorer in cities from central and northern regions of the country,indicating poor health infrastructure, services and quality of providers.

♣ Health need for women (especially among SCs/STs and other marginalised groups) andadolescents are not prioritised, and services to these groups are almost non-existent.Delhi needs to improve on access of its services to women.

♣ Larger a city is, the better is health environment and the lesser prone is it tocommunicable diseases likes pneumonia and diarrhoea. Similarly, cities from southernstates of India have healthier population, while the least healthy are from cities incentral India.

♣ Health access is poorer in cities from central and northern regions of the country,indicating poor health infrastructure, systems and quality of providers.

♣ Health need for women (especially among SCs/STs and other marginalised groups) andadolescents are not prioritised, and services to these groups are almost non-existent.Delhi needs to improve on access of its services to women.

♣ Costs of health services (direct cost, indirect cost and opportunity cost) continue asthe single largest barrier to access for urban poor. The urban poor are out of coverageof any social security net.

♣ Education infrastructure is poorer in cities with larger population base and higherurbanisation, thus increasing the possibility of marginalising children of urban poorfrom education.

♣ There is still a huge gap in achieving universal access to education in all cities,impacting the disadvantaged children the most.

♣ Million plus cities, which are hub of economic activities, need to improve access ofgirl children to education.

♣ A holistic and integrated approach in response to the specific needs of each area needto be adopted along with adequate resource back-up.


♣ Urban health should be taken up in mission mode, much on lines of the NRHM, tofacilitate programmatic focus, resource commitment and accountability for effectivelyaddressing the health needs of the urban population.

♣ The states should incorporate initiatives for urban health needs in their ProgrammeImplementation Plan.

♣ Systematic strengthening of the health department of the Municipal Corporation/Municipality.

♣ Increasing role of the corporate, private sectors and NGOs for health services to thepoor.

♣ Development of a social security system that is pro-poor and is inclusive of groups likemigrant population, socially marginalised groups and also adolescents.

♣ Effective monitoring and surveillance system for improving the student-to-classroomand student-to-teacher ratio in the cities.

♣ Vigorous community mobilisation campaigns need to be initiated in urban slums urgingthe poor households to send their children to schools.

♣ Innovative approaches to increase school enrollment at primary level and retentionrate in schools, particularly for girls.

♣ Convergence of health and education with other basic services for achieving synergy.

6. References and Recommended ReadingsAgarwal, S and K Sangar (2005), “Need for dedicated focus on urban health within national

rural health mission”, Indian Journal of Public Health Vol 49, No 3, pages 141–151.

Agarwal, S, S Kaushik and A Srivasatava (2006), State of Urban Health in Uttar Pradesh,Ministry of Health and Family Welfare, Government of India and Urban Health ResourceCentre, Delhi, 79 pages.

Agarwal, S, A Srivastava, B Choudhary and S Kaushik (2007), State of Urban Health inDelhi, Ministry of Health and Family Welfare, Government of India and Urban HealthResource Centre, Delhi.

Bhan, Gautam (2009), “This is no longer the city I once knew; evictions, the urban poorand the right to the city in Millennial Delhi”, Environment and Urbanization Vol 21,No 1, April, pages 127–142.

Bapat, M (2009), Poverty Lines and Lives of the Poor; Underestimation of Urban Poverty,The Case of India, Poverty Reduction in Urban Areas Series, Working Paper 20, IIED,London, 53 pages.

Government of India (2001), “Poverty estimates for 1999–2000”, Planning Commission,New Delhi, accessible at http://www.planningcommission.gov.in/hindi/reports/articles/ncsxna/index.php?repts=ar_pvrty.htm.


Government of India (2002), National Sample Survey 58th Round (2002), Ministry of Statisticsand Programme Implementation, New Delhi.

Government of India (2009), “Report of the expert group to review the methodology forestimation of poverty”, Planning Commission, New Delhi, 32 pages.

Government of National Capital Territory of Delhi (2006), Economic Survey of Delhi 2005–2006, Planning Department, New Delhi.

Gupta, K, F Arnold and H Lhungdim (2009), Health and Living Conditions in Eight IndianCities; National Family Health Survey (NFHS-3), India, 2005–2006, International Institutefor Population Sciences, Calverton, Maryland, 113 pages.


UNIT 9URBAN POVERTY MANAGEMENT

Contents Page No.

1. Introduction 39

2. Policies, Scheme and Programmes 40

3. Urban versus Rural Poverty 45

4. Income Growth, Distribution or Decentralisation 45

5. Conclusion 46


1. IntroductionAs elsewhere in the world, the increasing concentration of population in slums in urbanareas in India is seen as an indication of increasing urban poverty. According to a UnitedNations study in 1995, by the year 2015, ten of the world’s fifteen largest cities will bein Asia (excluding Japan); three of these will be in India. The structural reforms institutedin the country since 1991 have expected to link India with the global economy, increasethe inflow of foreign capital, facilitate indigenous investment and boost the pace ofurbanisation. Close to a half of the world’s population that lives in poverty can be foundin South Asia.

Recent data on the level and trend of poverty in India show that although there has beena decline in rural poverty at the national level, the urban poverty level has increased. In1999-2000, about one-quarter of the population in rural areas (27 per cent) and urbanareas (24 per cent) were living below the poverty line. According to the PlanningCommission’s estimates for 2004-05, 26 per cent of the population in urban areas fellbelow the poverty line (Planning Commission, 2007). It has also been observed thatpoverty in urban areas is qualitatively very different from rural poverty and that it ismultidimensional.

Urban poverty presents some issues that are distinct from those addressed in the typicalanalysis of poverty, such as commoditisation, environmental hazard and social fragmentation(Baker and Schuler, 2004; Moser, Gatehouse and Garcia, 1996). According to the Governmentof India, the definition of poverty is linked to the expenditure required by an averagehousehold to meet a specified minimum nutrition in terms of calories and urban povertyin particular is denoted by an intake of 2100 calories per capita per day.

Poverty is the worst side effect of pollution. But poverty in itself creates environmentalproblems. At the same time that policies need to be adopted to reduce poverty, care mustbe taken to stop environmental degradation and achieve sustainable development. Measuresof net domestic product do not capture the loss of depletion of natural environmentalresources such as nation’s stock of water, soil, air, non-renewable resources and wildlands. With a given economic structure and policy environment, rapid growth is betterthan slow growth in eradicating poverty. But the economic structure and the policy forenvironment do not remain constant. Even with respectable rate of growth, the total


number in poverty can increase. And it has done in so in many structure and the absenceof appropriate policies by government. Growth does not help poor unless it recesses thepoor, nor does government help unless the poor are the beneficiaries of public policies.1

2. Policies, Scheme and ProgrammesEradication of poverty has continued to be the target of most of the policies framed inIndia. However, a large part of this discussion involves the rural poor and often it ismisunderstood that urban poverty is not as prevalent as its rural counterpart. Removal ofpoverty became a distinct objective since the Fifth Five Year Plan (1974-79) in India.However, no distinction was made between urban and rural poverty. It was only in theSeventh Plan (1985-90) onwards that issues related to urban poverty were discussed. It laydown that poverty could be reduced only by generating employment, skill formation andimprovement of the slum dwellers.

The interest in addressing urban poverty peaked when the Planning Commission allocateda separate section to urban poverty in the Ninth Five Year Plan (1997-2002), putting anunprecedented focus on urban development and urban poverty alleviation. Structuraladjustment programmes were introduced in the country post independence taking the loanfrom the IMF and the World Bank. There were two parts to this adjustment plan.

The first consisted of short-term stabilisation policies- and the second part consisted oflong term economic reforms, which included streamlining the public sector and privatisationof social programmes, etc. However, all of the above measures have been harsh policiesand the impact has been the worst on the vulnerable sections of society such as the urbanpoor.

The reform policies have brought about changes in the domestic economy, ownershipstructures, the industrial development scene, financial and capital markets, employmentpatterns, wage structures, inflation, prices, consumption patterns and migration trends.These have then resulted in affecting urbanisation as a whole, which is evident from theliving conditions of a majority of the people in the cities.

Some Policies - Policy makers need to understand the phenomenon of urbanisation inrelation to economic growth and migration to address issues arising out of the growth incities. Urban population and economic output tend to grow together. There is a provenrelationship between urban growth and planned industrialisation. There is also a relationshipbetween urban growth and the economic output of India’s states. India currently hasmainly rural population, but its population in urban areas is growing faster than in ruralareas. It is predicted that nearly 50% of India’s population will be urban by the year 2030.

In India, urban poverty is defined in terms of minimum calorie intake, at 2100 calories percapita per day. This is a convenient measure for identifying urban poor for the purposeof implementing Urban Poverty Alleviation Initiatives (UPAIs). The Planning Commission’srevised methodology of 1997 results in an average poverty line for India of Rs. 353 percapita per month for 1996-97. This equals approximately Rs. 21,180 per household perannum. On this basis, Planning Commission data indicates that the urban poor wereestimated to be 7.5 crores, comprising 38% of the total urban population in 1988. Thisnumber rose to 7.63 crores in 1993-94, i.e. 32% of the total urban population.

1 Williamson, Inequality, poverty and History, p-97.

Urban Poverty Management 41

The number of Government sponsored Urban Poverty Alleviation Initiatives (UPAIs) beingintroduced year after year has increased, indicating that urban poverty has seen a gradualrise in importance for the policy-maker. The Center’s UPAIs can be categorised into threewaves: Housing, Welfare and Credit & Employment.

Housing was the first wave; it started in the 1950s and still continues to be a priority.Welfare programmes constitute the second wave that started with the Urban CommunityDevelopment Programme in 1958 and grew in the 1960s and 1970s. Credit and Employmentprogrammes started in 1977 with the extension of the Differential Rate of Interest schemeto the urban poor and became increasingly popular in the 1990s. An important feature ofthese waves is their simultaneous existence. The first wave did not stop before the secondbegan, and all 3 waves continue today. Starting with the 20-Point Programme in 1986, newschemes became holistic and often contained components from all three waves.

The interest in addressing urban poverty peaked when the Planning Commission allocateda separate section to urban poverty in the 9th Five-Year Plan (1997-2002), puttingunprecedented focus on urban development and urban poverty alleviation. Urban povertywas until then considered an extension of rural poverty or part of general urban developmentissues. In fact Central government UPAIs first addressed urban poverty as a result ofunchecked rural poverty.

Experts emphasize the importance of pursuing an “empowerment” approach vs. a “delivery”approach that treats beneficiaries as mere recipients and not as subjects of change. Theimplementation methodology of a programme can mitigate more than just economicpoverty, by involving the community in a genuine manner and addressing the issue of lowself-esteem. As programmes are implemented and beneficiaries gain, the poor begin tointegrate with mainstream economic activity. They gain acceptance as legitimate citizensand do not remain “objects of charity”. Successful efforts to raise the self-esteem ofpeople can allow them to arrange for their own daily requirements like water, sanitationfacilities, housing, job or food. Only very recently have Indian UPAIs begun to addressempowerment. Usually empowerment is limited to programmes for groups of women andNeighbourhood Development Committees in some schemes. Most UPAIs continue to focuson providing visible primary goods, healthcare and education. They fail to addresssociological, anthropological and political perspectives of poverty. Additionally, empowermentis not part of the success criteria set for evaluating the few programmes that do havesome design focus on the issue.

Most UPAIs do not pay adequate attention to the complexity of urban market transactionsin these societies. An example of this problem is the relocation of slum dwellers away fromthe economic centers that provide them income and access to informal markets. Thiscompensates for the formal markets from which they are excluded. UPAIs are identicalacross the country, showing that the urban condition is understood to be the sameeverywhere. Since there are many differences in climatic conditions, culture, resources,goods and services, prices and nature of transactions, it is futile to have uniform programmesimplemented throughout the country.

Programmes and Schemes

The Department of Urban Employment & Poverty Alleviation is monitoring the implementationof four significant urban poverty alleviation programmes.


— The Nehru Rozgar Yojana

— The Urban Basic Services for the Poor

— The Environmental Improvement of Urban Slums

— Prime Minister’s Integrated Urban Poverty Eradication Programme.

♣ Nehru Rozgar Yojana

In response to the challenge posed by urban poverty, the Nehru Rozgar Yojana waslaunched by the Ministry in October, 1989. It was recast in March, 1990 and accordinglythe guidelines were suitably revised. The entire expenditure on the Yojana is to beshared on a 60:40 basis between the Central Government and the State Governments.

The Yojana consists of three schemes:

— Scheme of Urban Micro Enterprises (SUME)

— Scheme of Urban Wage Employment (SUWE)

— Scheme of Housing & Shelter Up-gradation (SHASU).

♣ The Scheme of Urban Micro Enterprises (SUME)

The Scheme of Urban Micro Enterprises (SUME) assists the urban poor in upgradingtheir skills and setting-up self employment ventures. At present, the criterion ofurban poverty is an annual household income less than Rs. 11,850/-. Subsidy isprovided towards setting up the micro enterprises up to 25% of the project cost witha ceiling of Rs. 5,000/- for SC/ST/Women beneficiaries and Rs. 4,000/- for generalbeneficiaries. The remaining amount of the project cost is available from banks as aloan up-to a maximum of Rs. 15,000/- for SC/ST and Women beneficiaries andRs. 12,000/- for general category beneficiaries. This Scheme is applicable to all urbansettlements. A large number of States have set up State Urban Development Agencies/District Urban Development Agencies for streamlining the administrative mechanismfor implementing the Nehru Rozgar Yojana.

♣ The Scheme of Urban Wage Employment (SUWE)

The Scheme of Urban Wage Employment (SUWE) provides wage opportunities to theurban poor by utilising their labour for construction of socially and economicallyuseful public assets in the jurisdiction of Urban Local Bodies. A material-labour ratioof 60:40 is to be maintained under the Scheme for various public works aggregatingat the district level. The minimum wages prevalent in each urban ‘area are to be paidto the unskilled labour’. This scheme is applicable to all urban areas with a populationbelow one lakh.

♣ The Scheme of Housing and Shelter Upgradation (SHASU)

The Scheme of Housing and Shelter Upgradation (SHASU) seeks to provide assistancefor Housing and Shelter up gradation to economically weaker sections of the urbanpopulation as well as to provide opportunities for wage employment and up-gradationof construction skills. A loan up-to a ceiling of Rs. 9,950/- and a subsidy up-to aceiling of Rs. 1, 000/- is provided under this scheme to entitled beneficiaries forhousing/shelter up-gradation. In case of enhanced financial requirement beyond Rs.10,950/-. An additional loan up-to Rs. 19,500/- can be taken from HUDCO under its


scheme for EWS Housing. This scheme is applicable to urban settlements having apopulation up-to twenty lakhs. Requirements for institutional finance for the schemeare met by the Housing and Urban Development Corporation (HUDCO). The targetsin this scheme could not be achieved as the States are not coming forward withschemes to HUDCO due to post-sanction formalities like furnishing of State Guaranteeetc. Urban Local Bodies are playing a significant role in the implementation of theNehru Rozgar Yojana. They are involved in providing work places and selling-outletsto the beneficiaries, maintaining liaison with banks and ensuring provision of backwardand forward linkages so that the micro enterprises set up under the Scheme recordstable growth. Non-Governmental Organisations (NGOs) are also expected to play asignificant role in the implementation of the Nehru Rozgar Yojana especially in relationto training and strengthening backward-forward linkages under SUME, setting upMunicipal Service Centers and craftsmen’s guilds under SUWE and Housing Corporation/Associations under SHASU. Thus, the Nehru Rozgar Yojana through activities aimed atskill up-gradation, assistance for setting up microenterprises, wage opportunity throughconstruction of public assets and assistance for shelter up-gradation seeks to usher ina brighter future for the urban poor in India.

♣ Urban Basic Services for the Poor (UBSP)

The Urban Basic Service (UBS) Programme in India was initiated during the VII FiveYear Plan period for urban poverty alleviation. Based on the experience of implementingthe UBS Programme and there commendations of the National Commission onUrbanisation, the Government revised it as Urban Basic Services for the Poor (UBSP)(1991) and integrated it with other urban poverty alleviation programme, namely,Environmental Improvement of Urban Slums (EIUS), Nehru Rozgar Yojana (NRY) andLow Cost Sanitation (LCS).

The objective of UBSP is to create participatory community based structures throughwhich community participate in identifying normative/ felt needs, prioritise them andplay a major role in planning, implementing, maintaining services and monitoringprogress.

One of the important features is to provide social services and physical amenitiesthrough convergence of various ongoing schemes of Ministry of Urban Affairs andEmployment and various specialist departments like Health, Family Welfare, Womenand Child Development, Education, Welfare Labour, Small Scale Industry, Non-conventional Energy Resources and Science and Technology. The urban poor residingin low income neighbourhood are the target groups for provision of social servicesunder the Scheme and physical amenities to be provided under the EnvironmentalImprovement of Urban Slums (EIUS) Scheme.

Within the UBSP programme, NGOs are involved as Field Training Institute for citylevel training. At city level, NGOs conduct collaborative activities including communitymobilisation, basic education, women’s income generating and thrift societies andcommunity nutrition etc.

♣ Environmental Improvement of Urban Slums

The scheme of Environmental Improvement of Urban Slums (EIUS) was formulated asa response to the growing problem of slums during the Fifth Five Year Plan. The


scheme was made an internal part of the Minimum Needs Programme (MNP) in 1974and was transferred to the State Sector. The scheme aims at ameliorating the livingconditions of urban slums dwellers and envisages provision of drinking water, drainage,community baths, community latrines, widening and paving of existing lanes, streetlighting and other community facilities. The improvements are meant to be carriedout in notified slums which are not likely to be cleared within the next 10-15 years.

The total outlay on this scheme during the Seventh Plan was Rs. 269.55 crores basedon a per capita expenditure of Rs. 300 per slum dweller. The target for coverageduring the Seventh Five Year Plan period was 9 million slum dwellers against which9.98 million slum dwellers i.e. more than the target had been covered. Moreover, thescheme is now to be implemented in convergence with the programme of Urban Basicfor the Poor.

♣ Prime Minister’s Integrated Urban Eradication Programme (PMI UDEP)

Recognising the seriousness and complexity of urban poverty problems, especially inthe small towns where the situation is more grave due to lack of resources forplanning their environment and development, the Prime Minister had announced on15th August, 1994 an integrated scheme for eradication of poverty known as PrimeMinister’s Integrated Urban Poverty Eradication Programme (PMI UPEP), which seeksto address the problems of urban poverty with a multi-pronged and on term strategy.The new strategy is to put the community structures in the center with directparticipation and control by the very groups who are envisaged to benefit from thisprogramme. The programme launched in November 1995 is applicable to all Class IIUrban Agglomerations (345 Nos.) with a population ranging between 50,000 and onelakh as per 1991 Census, subject to the condition that election to urban local bodieshave been held there. However, in order to ensure that the urban poor could availof the benefits under this new Programme irrespective of the fact that elections tourban local bodies have not been held for one or the other reason, it was decidedwith the approval of the Prime Minister to allow implementation of the Programmein such towns as well, as a onetime exception (1995-1996). Also keeping in view thepeculiar problem of backward and hilly States, it has been decided to extend the PMIUPEP to the district towns in North Eastern States, Sikkim, J & K, Himachal Pradeshand Garhwal and Kumaon Regions of Uttar Pradesh subject to the condition that (i)the district town has urban population not exceeding one lakh and (ii) neither thedistrict town nor any other Class II town under it is already covered being a Class IIUrban Agglomerations.

The foremost objective of the new programme is to attack several root causes ofurban poverty simultaneously in an integrated manner with an appropriate and suitableplan strategy for covering the inputs available in other sectoral programmes of CentralGovernments, Ministries/Departments as well as Non-Governmental Organisations byenvisaging participatory implementation of the programme with the aim to eradicateurban poverty from the targeted areas by the turn of the century. The specificobjectives under the new programme are (i) effective achievement of social sectorgoals, (ii) community empowerment, (iii) convergence through sustainable supportsystem, (iv) improvement of hygiene and sanitation, (v) employment generation andshelter up-gradation and (vi) environmental improvement. The programme will beimplemented on whole town/project basis extending the coverage to all the targeted


groups for having visible impact and facilitating overall development of the towns tobe covered. While the target group of the programme is urban poor, especially womenbeneficiaries and beneficiaries belonging to Scheduled Castes and Scheduled Tribeswill constitute special target groups among the urban poor.

3. Urban versus Rural PovertySince independence, Indian policy-makers focused on rural development in response toGandhi’s call that “India lives in its villages”. This focus was also justified by the fact thatagriculture is subject to high risks from dependence on nature. As a result, urban povertywas sidelined because the urban poor were seen as people who had greater access toopportunities in dynamic urban systems and were therefore exposed to less seriousuncertainties. The choice made was to address the graver ill first.

According to the National Commission on Urbanisation, the share of municipal expenditureof the overall government expenditure (sum of center, state and local) was only 8% in1960-61 and fell to 4.5% in 1980-81. Over the same period, the urban population rose from16% to almost 24%. As urban poverty grows, policymakers must understand that its causeis not simply unchecked rural poverty, but other causes as well.

As the population in urban areas rowsed faster than its infrastructure facilities, attemptswere made to stall the migrant population in rural areas through the launch of many ruralpoverty alleviation programmes. Another approach to curb rural-urban migration was tocreate suitable conditions for the migrant population to settle in small and medium townsby developing infrastructure amenities in these areas. The main approach was to createemployment opportunities for the educated unemployed in towns with less than 5 lakhpopulation, that have the potential of being regional growth centers, through programmeslike the Integrated Development of Small and Medium Towns (IDSMT).

4. Income Growth, Distribution or DecentralisationPublic policy instruments can be divided into two parts: (i) indirect instruments, i.e.,those which use resources to accelerate growth and thereby impact on the incomes of thepoor i.e., the trickle down or Kuznet’s theorem); and (ii) direct instruments, i.e., thoserely on public provision of shelter, services and subsidies and other form of transfers. Theprimary distinction between the two is that the former is keyed to enhancing income andhence consumption, while the latter aims to provide direction consumption involvingredistribution between different groups. The paper points out that the initial decades ofdevelopment planning in India focused on “income growth” as a policy to reducing poverty,but on the ground that this policy was not making the desired impact, direct provisioningof services came into being as a policy instrument from the Seventh Five Year Plan, withprogrammes such as the EIUS. The scope of poverty-related programmes continued toexpand to include employment, basic services etc. The Constitution (seventy-fourth)Amendment, 1992 followed by the Jawaharlal Nehru National Urban Renewal Mission — thetwo landmark Central government initiatives — looks at and conceptualises policies forurban poverty in a different light altogether. These two initiative rest on the postulatethat decentralisation and governance are central to urban poverty reduction, a postulatethat signals perhaps the most extraordinary shift that has occurred in India in designingpolicies for poverty reduction. The JNNURM started in the year 2005, and it is too earlyto evaluate it for its impact on poverty. However, the experience of implementing the


JNNURM shows that decentralisation as envisaged has not reached out to the ULBs; urbanpoverty alleviation activities continue to be in the domain of the higher tiers of government.The SFCs too have not used the leverage of its mandate to incentivise a defacto transferof urban poverty functions to the ULBs. Nor is the intergovernmental fiscal system designedto factor in the extent and depth of urban poverty. Most ULBs function without anyautonomy in terms of designing urban poverty alleviation programmes and activities or interm of determining their tax policies.

5. ConclusionMany of the good things that happened in India, have happened in cities. Many social andmedieval issues have been effectively broken in the cities. Cities provide an opportunityto remodel India based on good principles. Cities are central to inclusive growth of aneconomy. They improve the economic condition by unleashing the investments and offeringmany opportunities to its citizens. Though urbanisation is associated significantly witheconomic growth, it has also been linked with larger numbers of urban poor and urbanpoverty in less developed countries like India. However, economic growth is quite impressivein some cases, it has not created adequate civic amenities and employment opportunitiesfor the poor migrants in urban areas or cities.

The increasing pressure on the agricultural land and slow social and economic developmentis forcing rural poor and the unskilled to urban areas in search of employment or livelihood.The United Nation’s ‘World Urbanisation Prospects Report-1996’ estimated that 30 per centof the world’s poor people lived in urban areas in 1996, and this was projected to reach40 per cent by the year 2020, and 50 per cent by 2035 (half of the world’s population).McKinsey Global Institute reported that around 340 million people already lived in urbanIndia in 2008, representing nearly 30 per cent of the total population. It also stated thatnearly 590 million people will live in cities by 2030.

Many factors including the city planning, irregularities in land markets, issues ofimplementation, regulatory and institutional, all have aggravated the urban poverty.According to Asian Development Bank 2008, 16 major Asian economies including India arebelow the Asian poverty line standard.

There is a need to recognise the severity of the problem and focus attention on reducingurban poverty. With the growing urban population, the cost of not paying attention tourban poverty will be enormous. The urban poverty in the coming years would depend onhow successfully poverty reduction policies are implemented. The aim should be to integratethe urban poor into the city urban development process by giving them access toemployment, developing their productive assets and providing them basic services andinfrastructure thereby improving their quality of life.

Some suggestions were made to the committee constituted by the Planning Commissionto review the existing methodology for official poverty estimation in India. In brief, thesuggestion was to accept the official All-India urban poverty estimate of 25.7% for 2004-05, derive the All-India urban poverty line that corresponds to this using the multiple(MRP) rather than uniform (URP) reference period distribution, and to recalculate fromthis modified poverty line new state-wise urban and rural poverty lines that reflect actualspatial variations in cost of living during 2004-05. This suggestion is based on sixconsiderations:


1) First, that in light of unnecessary past controversies on the matter, it is essential toclarify that poverty in India is measured purely on the consumption dimension andthat all other dimensions, including calorie norms on which present poverty lines wereoriginally constructed, are incidental and only of historical significance.

2) Second, that once it is agreed that what is being measured is consumption poverty,a basic requirement for valid spatial or inter-temporal comparison of this is thatpoverty lines used across space and time should represent equivalent purchasingpower (PPP) at whatever reference consumption level is taken to be the cut-off forbasic minimum needs. In particular, once this reference cut-off is chosen, this shouldapply equally and without discrimination to all locations, rural and urban, with theonly location specific adjustment being for differences in cost of living.

3) Third, in order to maintain continuity of presently accepted notions of the minimumstandard of living required to avoid absolute poverty, it is desirable that the referencecut-off be anchored to some aspect of present practice. There are two possiblereferences, the present All-India urban and rural poverty lines, of which only one canbe chosen since the other must be determined by actual cost of living differences.

4) Fourth, official rural poverty estimates are widely perceived to be too low and nolonger conforming to acceptable basic needs. Since official urban poverty estimatesare less controversial, our choice of reference consumption cut-off is the MRP equivalentof the present official All-India urban poverty line, which leaves measured All-Indiaurban poverty incidence unchanged from its current official estimate.

5) Fifth, the relatively minor matter of choosing the MRP cut-off that gives the sameurban poverty rate as official, rather than taking the present official urban povertyline directly, is because NSSO now uses the MRP rather than URP in most of itssurveys. It is necessary to have poverty lines that correspond to MRP distributions.

6) Sixth, although the new poverty lines are not based on any particular norm of basicneeds, and are outcome of a purely technical exercise to calculate cost of livingindices relevant around the present All-India urban poverty line, this choice can bedefended normatively. In particular, albeit modest norms of nutrition and of paid-outeducation and health costs are adequately met at the All-India level and in most,although not all, States.

6. References and Recommended ReadingsEngendering Health and Human Rights - The IFHHRO Conference 2005: A Brief Report.

Anagol Malati and Sundaram S.K.G., Problems of Financing Informal Sector Enterprises,Himalaya Publisihing House, Mumbai. (1995).

Radhakrishna and Ray Shovan, Poverty in India : Dimensions and Character, India DevelopmentReport, Edited by Kirit Prakash and Radhakrishna, Indira Gandhi Institute of DevelopmentResearch, Oxford University Press, (2004-05).

Vyas V. S. and Bhargava Pradeep, Public Intervention for Poverty Alleviation in India :Poverty Reduction in Developing Countries, Edited by Vyas and Bhargava, Institute ofDevelopment Studies, Rawat Publications, Jaipur. (1999).

COURSE 3: LAW AND POLICIES PERTAINING TO …2. History of Urbanisation in India When India gained independence the country’s population was a mere 350 million. Since 1947, the population

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