**1.1 Lessons from Chennai on mitigating some of the negative impact on health outcomes**<sup>**15**</sup>

The CMC’s Health Department seeks to mitigate this uneven allocation of resources by focusing their services especially on the most vulnerable. This is stated on their website: ‘The main aim of the Public Health Department in the Chennai Corporation... is to reduce health inequalities throughout the city of Chennai targeting resources, programs, and attending to high need neighborhoods in the city.’<sup>16</sup> The Health Department manages the Urban Primary Health Centres (UPHCs), and uses them systematically to provide active medical outreach to vulnerable populations with a view to (a) helping the individual, (b) dealing with cases of communicable disease before they cause an outbreak, and (c) improving their disease surveillance data so that they can analyze disease patterns and tailor their services accordingly.

They send teams to slums to provide general medical care and to conduct routine “fever screenings” for vector-borne diseases, typhoid, etc., and seasonal diseases such as conjunctivitis. The frequency of these health camps depends on needs. For example, during the monsoons they hold two camps daily until the “fever” cases decline, and in healthier seasons they hold two camps a month. This supplements the health care they provide to slum residents who visit the UPHCs directly. UPHCs are typically located close to slums.

The two branches of the CMC’s Health Department (medical and public health) work in tandem for these camps. Sanitary Inspectors (from public health) arrange the camps’ location. Along with Basic Health Workers (from public health) and Female Health Visitors (from medical services), the Sanitary Inspectors conduct health education on communicable disease prevention, mosquito breeding, personal/domestic hygiene, and environmental sanitation.

The public heath staff conduct vector control in the slums. They also test the water quality and general environmental sanitation conditions, and inform the Water and Sewerage Board (MetroWater) and the Engineering Department respectively of shortfalls. They would be far better placed to protect population health if they had more authority to require other departments to improve environmental sanitation in slums and more broadly across the city.

Similar active screening and treatment is conducted in the Homeless Shelters. The CMC’s Public Health Department is the nodal agency for the shelters, and the Zonal Health Officers are responsible for ensuring that the shelters in their area are well run.<sup>17</sup> Active outreach is also conducted for maternal and child health (MCH) services including contraception, antenatal care, delivery, postnatal care, and immunization. The Family Welfare staff under the Zonal Medical Officer have a program to visit slums every month on fixed dates, so that women know when to expect them for services. They enumerate marriages, pregnancies, births, deaths, who is eligible for family planning, and new people who have moved to the slum. In their home visits for MCH care, they look for cases of fever, vector-borne and diarrheal diseases, and any re-emergence of diseases like polio. These cases are followed up by the medical staff, and referred to the public health staff for tracing contacts and preventive measures.

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