While far from perfect, this system of handling complaints is a serious one. It contrasts sharply with the situation in Delhi, where citizens’ complaints and almost daily newspaper reports detailing poor health and sanitary conditions are not acted upon. The Delhi High Court sometimes intervenes and orders the MCD to act, but even this may be ignored.<sup>49</sup> Other standard management procedures in the CMC include recruiting staff only to fill posts that have been sanctioned and included in the budget. Recruitment is through the Employment Exchange, from whose lists the Commissioner sends a list of potential candidates for approval to the Appointments Committee (of elected representatives). By contrast, in Delhi, staff recruitment especially at lower levels is treated largely as an instrument of political patronage. The ranks of field staff such as sweepers are bloated as a result, exacerbating the MCD’s financial crisis.<sup>50</sup> The CMC Health staff are also helped by having their authority limited in other ways, reducing the potential lucrativeness of their functions. Drugs are procured externally by the Tamil Nadu Medical Services Corporation, which also instructs them on what insecticides to procure and from whom. Trade licensing is handled by the CMC’s Revenue Department, with a “No Objection Certificate” required from the Public Health Department only for larger enterprises. CMC health staff report that in meetings chaired by elected representatives, the discussion is largely on departments such as Engineering, for which large contracts need to be approved.

Public health services in the CMC are also helped by being underpinned not only by the Municipal Act, but also by Tamil Nadu’s Public Health Act. The latter offers a much more comprehensive legal basis for public health action than India’s Municipal Acts. Unfortunately, most states lack a Public Health Act.

The CMC Health Department’s clear understanding of public health is reflected in the mission statement on its website.<sup>51</sup> This contrasts sharply with the largely ad hoc list of services that are listed on the health department websites of most Indian municipalities, including Delhi.<sup>52</sup>

# **_(b) Tight organization of public health services_**<sup>**_53_**</sup>

The CMC’s public health services are tightly organized on the ground. Chennai is divided into three regions, each with an Additional City Health Officer and a Sanitary Officer. The main operational units are the 15 zones headed by Zonal Health Officers. These are staffed with (a) entomologists who conduct daily vector surveillance, (b) Sanitary Officers and Sanitary Inspectors whose tasks include conducting inspections, testing water quality, supervising the work of field staff, and collating vital registration and disease surveillance data. Each zone has 3-4 units, each supervised by a Sanitary Officer, and each unit has 5 divisions.

The division is a major operational unit for public health services. These are headed by a Sanitary Inspector, and staffed with a Basic Health Worker and Sector Workers allocated to sectors of about 500-800 households each. The Sector Workers are responsible for visiting each household once a week to check for vector breeding in and around homes, and take anti-larval measures. However, their staff size needs to be increased in response to rapid urban population growth. If these workers come across cases of fever, they report these to the Sanitary Inspector.

Sanitary Inspectors inform the Solid Waste or the Engineering Department if they see insanitary conditions such as overflowing sewers, water accumulation, or garbage accumulation, and if no 11