Surat today is a model for how cities can stay one step ahead of disease.

How Surat used the 1994 plague as a catalyst for improving local administration is a well-known story in India. Two government officials, S.R. Rao and S. Jagadeesan, who served as Surat's municipal commissioners in quick succession in the mid- and late-1990s, overhauled trash collection and street cleaning, enforced hygiene standards in food establishments and upgraded slums with paved streets and toilets. These and other changes turned Surat from a filthy, flood-prone, disease-ridden city to one of the cleanest in the country today. Despite rapid population growth, cases of mosquito-borne parasitic diseases such as filariasis and malaria are steadily declining.

Unlike many Indian cities, where municipal corporations or local bodies hardly play a role in health care, the Surat Municipal Corporation maintains a fairly extensive network of 41 urban health centers, two major public hospitals, and a number of maternity homes. The Corporation also runs mobile medical clinics, and established a medical college and a teaching hospital in 2000. Surat also has more than 500 private hospitals and more than 1,300 private dispensaries where people can buy medicines.

While Surat’s successes are notable, its challenges are also mounting. By one measure, Surat is the world’s fourth-fastest growing city. A rapid influx of migrants seeking work in the signature industries here—textiles and diamond polishing—is putting new strains on the health system. About 40 percent of the city’s residents live in slums. While some diseases have declined, they can easily come raging back if health authorities let down their guard.

Dr. Arpita Patel, medical officer of Athwa (Panas) Urban Health Centre, says Surat is well positioned for the challenge. “We do active and passive surveillance,” Patel says. “We not only have the door-to-door teams, we also offer instant diagnosis for those who walk into this place. Teams of health workers fan out to slums and construction sites. There is a lot of word-of-mouth publicity along with posters and banners.”

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Dr. Vikas Desai is old enough to remember when Surat was a small fraction of its current size and has lived through most of its modern-day health crises.

“I grew up in a Surat which had open drains,” she recalls. “In the late ‘50s, Surat got underground drainage. A small unit for filariasis control was set up within the municipal corporation. In 1985, Surat was hit by one of the worst bouts of malaria. The disease persisted in the late eighties and early nineties. Then came the plague in 1994. I was then with the public health department of the local medical college. Each night, I used to get phone calls from panic-stricken residents of the walled city. Doctors started leaving.”

Now, Desai is the Technical Director of the Urban Health and Climate Resilience Center. The center was launched in March 2013 as the latest health-related climate change project by ACCCRN—and the first of its kind in Asia. The center conducts research on how climate change is impacting health and patterns of disease—for example, dengue fever used to be a seasonal phenomenon in Surat and many other tropical cities but now is becoming less predictable. The center also plays an advocacy role with policy makers and does training and capacity-building work locally. The Center is an initiative of the Surat Climate Change Trust, an organization that brings together business leaders, policymakers and scientists, with the Surat Municipal Corporation as the main stakeholder.