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Hardly Smart About Urban Health Care

Hardly Smart About Urban Health Care


  • To date, the COVID-19 pandemic crisis has largely affected only urban centers.
  • Megacities like Delhi, Mumbai, Bengaluru, and Chennai have accounted for most of the COVID-19 positive cases.
  • India's urban center is not only facing a public health crisis due to the COVID-19 epidemic but also associated with this health emergency is a larger crisis of economic issues and livelihoods.
  • The majority of the urban population has lost employment due to the nationwide lockdown and even their future lies in uncertainty.
  • This editorial discusses the crisis in the urban centers in India and analyses whether they are well equipped to deal with the pandemic and its aftereffects.


2.1 Urban centers as the new focus of policymakers

  • Over the last 15 years, cities have been the primary focus of policymakers and governments as is evident from the dedicated national-level programs on urban development.
  • The present regime's flagship program ‘Smart Cities Mission’ completed its 5 years in June 2020.
  • Buzzwords like “smart cities” and “bullet trains” were widely used during the initial years of the present regime, but in the last few years, they hardly find any mention by the top political leadership.

2.2 Smart Cities Mission

  • The ‘Smart Cities Mission’ aimed at making a hundred selected cities 'SMART' primarily through an “Area-Based Development” model under which a small portion of the city would be upgraded by retrofitting or redevelopment.
  • However, the enthusiasm regarding Smart Cities seems to have faded after five years since its inception.

2.3 Performance of Projects under ‘Smart Cities Mission’

  • Several projects under the ‘Smart Cities Mission’ are behind schedule as revealed by the Ministry of Housing and Urban Affairs.
  • According to the Ministry:
    • There were a total number of 5,151 smart city projects across the 100 cities to be launched.
    • Out of these around 4,700 projects have been tendered and only 1,638 projects have been completed.
    • In terms of expenditure, out of a total investment of ?2,05,018 crore, projects worth ?26,700 crores only has been completed.
  • Given the dismal performance of the projects under ‘Smart Cities Mission’, the idea of completely transforming India’s derelict cities into “smart cities” within five years now seems a pipe dream.


3.1 A formidable challenge

  • Presently most of the urban centers of India are reeling under the devastation caused by COVID-19.
  • The Integrated Command and Control Centres developed as “war rooms” under the ‘Smart Cities Mission ‘are being used for monitoring real-time data regarding the spread of the virus.
  • Generally speaking, handling the public health emergency and its associated economic fallout remains a formidable challenge.

3.2 A Blind Spot

  • As a matter of fact, the ‘Smart Cities Mission’ had hardly propelled the basic services such as public health.
  • A detailed analysis of projects under ‘Smart Cities Mission’ shows that only 69 of over 5,000 projects undertaken under the Mission were for health infrastructure.
  • Moreover, the total estimated cost of all the 69 projects is around ?2,112 crore which is a mere 1% of the total cost of the mission.
  • Therefore, public health seems to be a major blind spot in India’s smart city dreams.

3.3 Health infrastructure as a part of ‘Smart City’

  • Some critics argue that health infrastructure is not a core element of 'Smart City'.
  • However, the stated objective of the ‘Smart Cities Mission’ was improving the quality of life of urban residents.
  • The mission never focused merely on technology.
  • Public health is an essential function of the local government in India’s constitutional scheme.
  • The Seventy-Fourth Constitutional Amendment to the Indian constitution introduced the 12th Schedule according to which, “public health” is one of the 18 functions to be devolved to the municipalities.
  • Despite the constitutional scheme, the public health infrastructure of the urban centers of India has suffered negligence over the years and new initiatives as the ‘Smart CitiesMission’ have further driven local governments away from their core responsibilities.


  • The COVID-19 pandemic has exposed the institutional and human capacity of Indian urban centers to handle a public health emergency.
  • Despite the cities being at the center of renewed policy focus, Indian Urban Local Bodies suffer from a number of problems most notably of which are:
    • They continue to be financially and administratively weak
    • They are heavily understaffed.
    • There is also a huge number of vacancies of Accredited Social Health Activist (ASHA) workers.
  • Presently ASHA workers are acting as frontline public health workers carrying out contact tracing, in urban areas, especially in COVID-19 hotspot cities such as Mumbai.


5.1 Relative success of Kerala

  • The relative success of Kerala in containing the pandemic has shown how a decentralized political and administrative system with strong local governments and high investment in local public health care can be effective.

5.2 Downside of participation of resident welfare associations

  • Given the absence of participative local government institutions, the authorities in some big cities have roped in resident welfare associations to monitor COVID-19 cases.
  • However, the downside of the movie is that resident welfare associations have become emboldened in the process and are often imposing draconian rules in a fashion as private authoritarianism in their neighborhoods.

5.3 Lessons for the economic sector

  • Apart from the health sector implications, the COVID-19 experience also shows that the economic conditions of the vulnerable section in the urban cities are also very fragile.
  • There are a large number of job cuts and pay cuts depending on the vulnerability of their jobs in the wake of nationwide lockdown and experts are even suggesting a ‘direct’ urban employment guarantee program for urban centers on similar lines as an NREGA (National Rural Employment Guarantee Act).
  • From the present experience of COVID-19 shows that in order to efficiently and effectively tackle a similar epidemic like situation following needs to be done:
    • strengthening local government capacities is an important step
    • urban public health systems are in dire need of heavy investment
    • promote programs that improve the livelihoods of urban vulnerable communities


Special programs like the ‘Smart Cities Mission’ have unbalanced and skewed priorities.

Due to their parallel governance structures of Special Purpose Vehicles, they offer little hope in strengthening the local institutions in dealing with formidable challenges of a COVID-19 like an emergency.

Instead of such 'special' programs, already existing programs as the National Urban Livelihoods Mission and National Urban Health Mission, which are underutilized and have not been able to deliver desired results due to limited focus and resources, need to be strengthened.


Smart Cities Mission

  • There is no universally accepted definition of a smart city and would have a different connotation to different people.
  • The objective of the Indian Government under the Smart Cities Mission is to promote cities that:
    • provide core infrastructure to the citizens
    • give a decent quality of life to its residents
    • has a clean and sustainable environment and application of ‘Smart’ Solutions

The focus under the Smart Cities Mission is on sustainable and inclusive development and the idea is to look at compact areas, create a replicable model, which will act as a lighthouse to other aspiring cities.

The core infrastructure elements in a smart city would include:

  1. adequate water supply,
  2. assured electricity supply,
  3. sanitation, including solid waste management,
  4. efficient urban mobility and public transport,
  5. affordable housing, especially for the poor,
  6. robust IT connectivity and digitalization,
  7. good governance, especially e-Governance and citizen participation,
  8. sustainable environment,
  9. safety and security of citizens, particularly women, children and the elderly,
  10. health and education

Source: The Hindu