Enhancing Public Health Services in Urban Local Bodies

When you wake up to cleaner streets, drink water without second thought, or see municipal workers fogging neighborhoods during dengue season, you’re witnessing Urban Local Bodies (ULBs) at work. These city-level governments form the backbone of public health in urban settings, quietly shouldering responsibilities that directly determine whether cities become thriving hubs or breeding grounds for disease. With urban populations projected to reach 600 million by 2030, the stakes have never been higher.

Why public health sits at the heart of urban local governance 🔗

The 74th Constitutional Amendment Act of 1992 gave ULBs constitutional recognition and handed them 18 functions under the Twelfth Schedule. Public health and sanitation sit among the most critical of these obligatory functions, covering street cleaning, garbage management, drainage, sewage, and disease prevention. It’s not an exaggeration to say that the quality of public health in any city is a direct reflection of how well its ULB functions.

Historically, Indian policy has under-invested in the public health potential of ULBs. Recognising this gap, the Fifteenth Finance Commission broke from convention and recommended a large specific-purpose health grant for local governments for 2021-26, aimed at plugging critical gaps at the primary health care level. This shift acknowledges a truth long ignored: the tier of government closest to people is best placed to manage their daily health needs.

Sanitation and solid waste management: the first line of defence 🔗

Sanitation is perhaps the most visible-and most politically charged-public health function. Collection, transportation, processing, and disposal of solid waste, along with maintaining sewerage systems, form the bedrock of urban hygiene. When these services fail, everything else collapses with them.

The solid waste management framework 🔗

India generates enormous quantities of waste, with per capita waste generation in Indian cities ranging from 200 to 600 grams per day, translating to about 62 million tonnes annually. Alarmingly, only about 75-80% is collected, and a mere 22-28% of what’s collected is actually processed. The rest ends up in landfills, where it quietly poisons soil and groundwater.

The Solid Waste Management Rules, 2016 brought much-needed structure to this chaos. They mandated source segregation into wet, dry, and domestic hazardous waste streams, and extended their scope beyond municipal areas to urban agglomerations, census towns, industrial townships, and even religious pilgrimage sites. More recently, the Ministry of Environment, Forest and Climate Change has notified the Solid Waste Management Rules, 2026, which came into force on April 1, 2026, integrating principles of Circular Economy and Extended Producer Responsibility. The new rules empower ULBs to levy environmental compensation based on the ‘Polluter Pays’ principle.

Why segregation matters for health 🔗

Unsegregated waste isn’t just an aesthetic nuisance. It creates perfect breeding conditions for rodents, flies, and mosquitoes-vectors that carry leptospirosis, cholera, dengue, and malaria. When wet waste mixes with plastics and hazardous items, the mixture leaches toxins and generates methane, polluting air and water. ULBs that enforce source segregation through bye-laws, user fees, and penalties for littering are essentially running a silent disease-prevention programme.

Controlling contagious and vector-borne diseases 🔗

Urban density is both a strength and a vulnerability. People living in close quarters can access shared services efficiently, but they also transmit infections faster. ULBs play a frontline role in surveillance, prevention, and rapid response.

The mosquito-borne disease challenge 🔗

Dengue, malaria, chikungunya, and filariasis remain persistent urban threats. Unplanned urbanization, restricted water supply leading to domestic storage, and accumulation of non-degradable containers have dramatically increased mosquito breeding potential. The Urban Malaria Scheme, launched in 1971, currently protects nearly 142.9 million people across 131 towns in 19 states and Union Territories, and the scheme explicitly emphasizes implementation of urban bye-laws to prevent mosquito breeding in domestic and peri-domestic areas.

City-level work looks remarkably hands-on. Pune Municipal Corporation’s Vector Borne Disease Control department conducts weekly larvicide programs, fogging around dengue-positive cases, door-to-door blood smear collection, and removal of water hyacinth from rivers. Similarly, Surat Municipal Corporation’s Vector Borne Diseases Control Department combines active surveillance, community health education, and space spraying within a 200-meter radius of suspected dengue cases. These aren’t glamorous activities, but they save lives.

COVID-19 and the expanded role 🔗

The pandemic forced ULBs to step far beyond traditional duties. During COVID-19, urban local bodies served as frontline coordinators, managing quarantine facilities, tracking contacts, and distributing essential supplies. Mumbai’s MCGM became a case study in data-driven outbreak response. The pandemic exposed both the indispensability and the fragility of ULB health systems-a lesson that shaped the Finance Commission’s subsequent allocations.

Food safety and preventing adulteration 🔗

Food safety is where public health meets consumer protection. The Food Safety and Standards Act, 2006 replaced the older Prevention of Food Adulteration Act, 1954, consolidating multiple laws under a single umbrella. While FSSAI sets science-based national standards, enforcement happens at the ground level.

At this grassroots level, municipal corporations, municipalities, and panchayats serve as the frontline for day-to-day enforcement, handling awareness generation, licensing, and working directly with food businesses. Food Safety Officers working under state Commissioners inspect premises, collect samples, and initiate action against adulteration. Penalties under the FSSA are stiff-manufacturing or selling substandard food attracts fines up to ₹5 lakh, and unsafe food can lead to imprisonment.

In practice, ULBs manage the licensing of street vendors, eateries, and slaughterhouses, while coordinating with state food safety departments on sampling drives. During festivals, when sweet shops and milk vendors see a spike in business, ULB health departments often ramp up inspections to prevent adulteration scandals that have historically plagued cities like Delhi, Mumbai, and Kolkata.

Other public health functions ULBs handle 🔗

Beyond the big-ticket items, ULBs handle a range of less-discussed but equally important responsibilities that shape everyday urban health.

Primary healthcare and immunization 🔗

ULBs run primary healthcare centres, municipal hospitals, and dispensaries, particularly in urban slums where access to private care is limited. They implement immunization drives such as pulse polio, measles-rubella campaigns, and routine childhood vaccinations. Larger municipal corporations like Brihanmumbai Municipal Corporation and the Municipal Corporation of Delhi operate substantial hospital networks that form the safety net for the urban poor.

Cremation grounds and burial sites 🔗

Managing cremation grounds, burial sites, and electric crematoria is a public health function often overlooked until a crisis hits. Improper management leads to groundwater contamination, air pollution, and, during epidemics like COVID-19, dangerous backlogs. ULBs are responsible for maintaining dignity and safety at these sites.

Regulation of offensive trades 🔗

Activities like tanneries, slaughterhouses, and certain small manufacturing units generate waste that directly affects community health. ULBs issue trade licenses, enforce zoning, and monitor compliance with pollution and hygiene norms.

Environmental pollution control 🔗

Air and water quality are deeply intertwined with public health outcomes. ULBs regulate construction dust, manage urban green cover, enforce plastic bans, and coordinate with State Pollution Control Boards. Progressive local bodies have introduced rainwater harvesting mandates and waste-to-energy plants that reduce environmental burden while generating revenue.

The integration challenge 🔗

Effective public health can’t happen in silos. A ULB’s health department needs to work seamlessly with its engineering wing (for drainage and water), revenue department (for trade licenses), and town planning (for land use). Simultaneously, it must coordinate with state health departments, parastatal agencies, and central programmes like the National Health Mission.

This is easier said than done. Larger urban centres are characterized by overlapping jurisdictions of different tiers of government and semi-autonomous parastatal bodies, which adversely impact service quality and blur accountability pathways. A dengue outbreak, for instance, requires the health department to handle surveillance, the sanitation wing to clear breeding sites, the engineering department to fix drainage, and state-level labs to confirm diagnoses. When coordination breaks down, epidemics spread.

Challenges that stand in the way 🔗

Despite their central role, ULBs face structural challenges that limit their effectiveness. Financial constraints top the list-most municipalities depend heavily on state and central grants, with own-source revenue often insufficient to fund preventive public health work. Capacity gaps in trained health professionals, sanitary inspectors, and entomologists are widespread. Political interference can redirect resources toward visible infrastructure rather than less glamorous public health activities. And data systems remain fragmented, making outbreak response slower than it should be.

The Fifteenth Finance Commission’s health grants were designed to address some of these gaps, but data from the first three years shows inconsistencies in allocation, release, and actual spending, which may affect the realization of stated objectives. Money alone doesn’t fix a governance problem.

The way forward: partnerships and decentralization 🔗

Strengthening ULB public health services requires more than just bigger budgets. It calls for genuine devolution of power, better human resource capacity, and strong partnerships with state and central governments. Cities that have invested in ward-level health committees, integrated disease surveillance, and citizen participation consistently outperform those that haven’t.

Technology is also transforming the landscape. Real-time waste tracking, mobile food testing labs (FSSAI’s Food Safety on Wheels deploys over 300 such units nationally), geospatial mapping of breeding sites, and citizen complaint apps are making ULB health services more responsive. Schemes like Swachh Bharat Mission, AMRUT, and Smart Cities Mission have injected both funds and accountability, though implementation quality varies widely across states.

What do you think? Should public health functions in cities be fully handed over to ULBs with robust funding and autonomy, or does the complexity of urban health demand continued joint control with state and central agencies? And which single public health function-sanitation, disease control, food safety, or primary healthcare-do you believe deserves the most urgent attention in your own city?

References

1. https://journalism.university/human-development-and-communication/urban-governance-types-functions-ulbs-india/
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC12679917/
3. https://www.pib.gov.in/newsite/printrelease.aspx?relid=138591
4. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2219676&reg=3&lang=1
5. https://nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=529&lid=3822
6. https://www.pmc.gov.in/en/vector-borne-disease-control-0
7. https://csr.education/csr-process/key-functions-local-bodies-india/
8. https://foodsafety.institute/food-laws-standards/implementation-food-safety-acts-india/
9. https://www.sciencedirect.com/science/article/pii/S2949856225000753