Making sense of Water Shortage and its impact on Healthcare

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There is a need for rethinking the way water crisis is analysed. A HE report.

Amudha, a household help in Chennai, doesn’t have the luxury of taking her child to an expensive private hospital in Chennai. “I had to take my child to a government hospital in Egmore, and the entire facility was stinking of urine. We cannot afford to go to a private hospital and shell out of thousands of rupees for the treatment of a child, so we have to tolerate clogged toilets and walking to the other end of the campus,” says the migrant labourer, who has to rely on the creaking public health sector of the sixth most populous city of the country.

Currently, even for government water tanker supply of 6000 litres, middle-class families have to shell out Rs 475, despite rains in the last two weeks. “The water crisis is still not over. We are quite careful about water consumption,” says Mithra M, a retired government official.

Making Life Worse

The price of a 12,000-liter water truck soared from 1,200 rupees ($17.50) in April to as high as 6,000 rupees since shortages began, The News Minute website reported. Neighbourhood clinics, often the first level of support for indigent patients, are the worst hit. “India has the filthiest, most polluted, inefficient, unhealthiest cities in the world. Look at the state of our cities. Fifteen of the most polluted cities in the world are in India. We breathe that air, drink that water, we live among mosquitoes, garbage. If you are rich then you can live in a fancy apartment, have bore-well and private security, and you can have some quality of life. However, what if we fall sick? What if you belong to the middle class or lower middle class? No one wants to talk about it. However, the water crisis affects profit margins of hospitals,” says a doctor, who runs a clinic in the medical tourism hub.

Around nine crore people live in the major cities of the country, which is several times the population of countries like New Zealand. Moreover, studies show than within five years, more people will be living in Indian cities than the United States of America. Point is what kind of quality of life will they have. Most of them would be in slums.

Source: LSE cities

Source: LSE cities

Most of the cities grow in an unplanned manner and come up by themselves without any infrastructure. People start living there and construct buildings and planners come later and put up infrastructure above or below them. Gurgaon, for instance, doesn’t have its sewage system. Every building has its septic tank and diesel tank.

Most of the people don’t even know who runs our cities. Sometimes it is as complicated as below. According to the official definition, any area already governed by an Urban Local Body (ULB) is considered urban. Besides, states can declare an area to be urban if they cross certain thresholds of population, population density, and economic activity. These thresholds are arbitrary and indicative and vary across states. Cities identified by the official definition are known as statutory towns and are governed by a ULB. By this definition, India is 26% urban.

Rural Local Bodies (RLBs) and ULBs were designed to cater to the varying governance needs of rural and urban areas. The 73rd and 74th Constitutional Amendment Acts specify different powers and functions for the two bodies. ULBs are mandated to provide water for residential, industrial, and commercial purposes, while RLBs are mandated to provide only safe drinking water. It means that industrial or business units in de facto urban areas may find it harder to access adequate water compared to those in regions governed by ULBs.Panchayats are not required to provide many of the other essential services expected of dense urban living, for example, sewerage lines, fire services, and building code regulations.

Delhi Political Representation

Source: LSE cities

Source: LSE cities

Is a flexible urban planning process the solution to this problem?

Unfortunately, urban planning in India is a top-down exercise. State governments, rather than local governments, have the final say in finalising plans. Take the example of the creation of master plans. It is a technical exercise undertaken by urban planning departments with no involvement of citizens or experts.

The planning process is further complicated by the presence of many authorities and poor coordination among them. Metropolitan regions have urban development authorities that have to make plans for those areas that are not within the planning jurisdiction of existing ULBs. Other planning authorities that may operate within cities or metropolitan regions include parastatals such as new town development authorities and individual planning authorities.

An urban settlement governed by a ULB rather than an RLB is likely to benefit from

Source: IDFC Reforming Urban India

Source: IDFC Reforming Urban India

For the time being, the majority of hospitals are happy that the situation has eased after a couple of rains. “We were always getting water from tankers only. I assume that the price must have gone up per tanker during the dry spell. We had a couple of good showers in and around Chennai in the past week and a half.  The situation is easing now,” says Dr Vijay Chockan at SRM Institute of Medical Sciences.

Relying on Technology is Not Enough

There are several technology-based solutions for the water crisis too. However, won’t it be exceedingly, complex to manage? There will be a place for technology in our urban infrastructure. However, more often, dumb cities perform better than smart cities. Technology usually ages pretty fast, and disruptions are usually frequent within a couple of months. Take the example of your mobile phone. Is the same rate of disorder acceptable for water or power services? City infrastructure is meant to last for centuries. Bridges are built to last at least 100 years and tunnels longer.

Further, in cities like Chennai, there are also inevitable moments like storm drops high levels of water as well as cuts the power supply for a smart stormwater management system.

Cities around the world are racing to declare themselves smart using sensors, data and cameras to make themselves safe and sustainable. Probably, one of the most notable projects is that of Toronto Sidewalk Labs, a sibling of Google, recently released a 1500 page master plan to remake neighbourhoods with things like snow- melting roads and an underground pneumatic tube network.

So, is technology the solution for the water crisis? Addressing urban challenges like water-shortage require stable long term financing, proper management and competent personnel.  However, what will be a durable and practical solution over the long term? What is the simplest adequate solution with minimum negative consequences? For many of our challenges, we don’t need shiny new technology, but rather the will, foresight and courage to use the best of the old ideas. “Successful urban planning projects blend disciplines, bringing  together experts in behavioral change alongside specialists in technology. Cities should work with citizens, universities and businesses to plan for the future,”says Dr Omana P, who runs Life Care Clinic in Kerala, which had to shell out money for buying water this summer.