After months of unending rain, before the seasons change to cool winters, there is often a season of rampant vector borne diseases. While malaria was common, some of these diseases such as Dengue and Japanese Encephalitis Virus (JEV) are new entries to the geographies of smaller cities. Monsoon has led to severe disease outbreaks in several Indian states, with Kerala and Bihar among the worst hit. Assam is facing a dual-layered challenge of flooding and a rise in JEV cases.

Spreading beyond major centres, these diseases have hit smaller cities and towns hard. 90% of the dengue cases in Patna have been reported in the months of July and August, coinciding with the monsoons. Beyond Bihar’s capital, dengue has also affected smaller cities like Motihari, and Hasanpur. Meanwhile, Chabua, Chapar, and Golakganj in Assam have witnessed a surge in JEV cases. Amid heavy torrential rains, Ernakulam is being continually described as the ‘dengue capital’ of Kerala, with around 1250 cases in August 2024!

While we easily found recent news headlines that majorly discussed cities like Delhi and Mumbai, we wondered: what about smaller cityscapes? How are they dealing with outbreaks of these mosquito-borne diseases (MBD)? And why were they spreading so much?

To find answers for these questions, we dived deeper into this pressing issue through qualitative research, supplemented by research articles and several news reports. We also did an exploratory survey through informal networks that yielded 23 responses, along with 3 key informant interviews. While this cannot be considered representative, it provided some initial insights that can point to areas of further investigation. The responses offered preliminary indications of participant perspectives and experiences. The survey responses were analysed using a thematic approach and the themes provide contextual information that complements our broader qualitative analysis.

Our research pointed us towards how in the recent times, climate change has begun to play a major role in the surge of these diseases. Changes in rainfall patterns and the overall increase in average minimum temperature have substantially increased the risk of vector-borne diseases. In 2023, the surge of dengue in Patna sustained till mid-October due to erratic rainfall, along with a delayed arrival of winter that led to continued usage of air coolers. This created severe pressure over the city’s Municipal Corporation, as now vector monitoring and control has become a requirement throughout the year.

Meanwhile, parts of Chabua in Assam’s Dibrugarh district had been submerged for over a week due to heavy monsoon rains this year in August. In our conversations with a Medical Intern from Assam Medical College (AMC) Dibrugarh, we found out that Chabua has been badly hit by rising cases of JEV, aligning with this trend of stagnant rainwater increasing the risk of vector-borne diseases.

In Kerala’s Kalamassery, while some health officials connected public waste dumping with the rise in dengue, the municipality’s former health standing committee chairperson also mentioned inadequacies in the fumigation process by the authorities themselves. Since last year, municipalities around Ernakulam district have been trying to emphasise the need for multi-level preventive actions. While municipal bodies need to have a more robust system of sanitation and vector control, such initiatives have to be supported by inter-departmental coordination and public awareness created by community mobilisation.

There is a meagre 2.69% of the total government budget being spent through local bodies, with much of the attention diverted to larger municipal corporations. While institutional information on health spending of smaller cities is limited, even larger cities such as Bengaluru and Mumbai spend only 3-4% of their overall budget on public health. With the rising burden of diseases beyond metropolitan cities, “preventive health action remains largely absent in smaller towns and rural bodies.” Multiple reports as well as our exploratory survey suggest that people prefer private healthcare given the inferior quality of healthcare in public health care centres.

While a requirement for a resilient health system is being extensively talked about by policymakers and public health professionals, what is the present scenario in India’s small cities? How are the smaller cities and their local bodies fighting dengue along with other monsoon challenges? And can improving citizen awareness along with supporting community-led efforts help balance out India’s healthcare systems’ burden?

If you are also being plagued by such questions about your hometown, then check out our report: “Monsoon Mayhem: Why are smaller cities falling ill?”