Health of the Urban Poor in India: Concerns, Opportunities and … · 2006. 3. 2. · Karishma...
Transcript of Health of the Urban Poor in India: Concerns, Opportunities and … · 2006. 3. 2. · Karishma...
Health of the Urban Poor in India:Concerns, Opportunities and Way Forward
INTERNATIONAL CONFERENCEURBAN HEALTH INITIATIVES
February 9, 2006
Community Medicine Department, Government Medical College, Surat, Surat Municipal Corporation & Health & Family Welfare Department, Government of Gujarat, India.
Karishma Srivastav, Dr. Siddharth AgarwalUrban Health Resource Centre [formerly EHP India]
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Presentation Outline
• Urban Growth and Urban Poverty
• Health Concerns of the Urban Poor
• Challenges and Opportunities
• Suggestions
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Especially in Their Smaller and Medium Sized Cities
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
2-3-4-5 phenomenon of population growthUrban population - 285 million1
Urban poor estimated at 702 -903 million
Unabated Growth of the Urban Poor
1 2001 Census of India.2 1999-2000 NSSO (55th round) using 30 day recall of consumer expenditure. 3 Lawrence Haddad, Marie T. Ruel, and James L. Garrett, 1999. Are Urban Poverty And Under-nutrition Growing? Some Newly Assembled Evidence.
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Health Concerns ofUrban Poor
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
0
20
40
60
80
100
020406080
100120140160
Under 5 Mortality * Infant Mortality * Neonatal Mortality *
Poor Child Health and Survival
Health conditions of urban poor are similar to or worse than rural population and far worse than urban averages
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]
103.7
46.7
Rural Average
103.7
63.147
73.3
31.7
49.638.4
Urban Average Urban Poor
101.3
66
39.1
56.0
Nutritional Status
* Mortality per 1000 live births
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Poor Access to Health Services
0
10
20
30
40
50
60
70
80
Complete ANC (3ANC+IFA+TT)
Home deliveries
24.8
52.7
74.3
Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003
33.9
Rural Average
Urban Average
30.4
54.1
Urban Poor> 1million babies are born every year in slum homes
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Poor Access to Health Services
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]
0
10
20
30
40
50
60
70
36.6
60.5
Complete Immunization by age 12-23 months
Rural Average
Urban Average
42.9
Urban Poor
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Sub-optimal Health Behaviors
0
10
20
30
40
50
60
70
80
BreastfeedingInitiation within 1hr
Initiation of Complementary Feeds by 7mths
Rural Average
Urban Average
14.819.2
60.5
73
Urban Poor
17.9
56.5
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Poor Environmental Conditions
About two thirds urban poor households do not have access to piped water supply and toilet
facility
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
High Prevalence of HIV/AIDS in Urban Areas
51.34 Total
21.27 Urban
HIV estimates 2004(in lakhs)
30.07
Rural
http://www.nacoonline.org/facts_hivestimates.htm
Estimated Prevalence of HIV+ cases in urban areas is substantially higher as compared to rural areas
High risk categories include sex workers, migrant laborers, truck drivers
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Challenges and Opportunities
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Challenge 1
Urban poor searching for citizenship
Considered ‘Illegal’ and unwanted despite the vital contribution of this large informal work force
Few rights as urban citizens and consequently little power to influence their circumstances
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Challenge 2:Large proportion of slums are invisible
328 unlisted slums( population, , )5 10 397
452 listed slums( , , ) population 8 20 139
( )780 slums total
Findings (listed vs un-listed slums) from Agra (215 vs 178), Dehradun (78 vs 28), Bally (75 vs 45), Jamshedpur (438 vs 101)Besides unrlisted slum settlements, urban poor also include pavement dwellers, population residing
in construction sites, fringes of the city, floating population etc
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Challenge 3: Inadequate Urban Primary Health Infrastructure
There is one UFWC/HP for about 1.5 lakh urban population
Others1.0%
Chemists4.6%
Government doctors12.3%
Private doctors82.1%
Low utilization of public health services in urbanslums(Gujarat State-wide Multi-Indicator Cluster Surveys (MICSs), 1996)
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Challenge 4: Weak Demand Among Urban Poor
• Low awareness about services, behaviours and provisions
• Weak community organization and social cohesion
• Weak negotiation capacity
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Challenge 5: Greater focus on rural areas
79%
21%
ICDS coverage
ICDS not covered
Rural areas
16%
84%
ICDS coverage
ICDS not covered
Urban areas
ICDS Coverage Differentials
Source: Department of Women and Child Development, Ministry of Human Resource Development. Integrated Child Development Services (ICDS), New Delhi.2000.
Coverage
Coverage
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Higher urban allocation for bigger citiesWhile medium-small cities have significant urban population
Percentage Distribution of urban population by size of Towns/UA (Census of India, 2001)
156
179
2131
01020304050
10 millionand above
5 millionto 10
million
1 millionto 5
million
500,000to 1
million
100,000to
499,999
Below100,000
Today’s 35 million plus urban agglomerations (37% total urban population) will double by 2026 *
Municipal Capacity weak in medium-small cities
Preparedness needed to meet the challenge of rapidly growing medium sized cities
*Dyson et al, 2004. Twenty First Century India. Population, Economy, Human Development and the Environment
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Diminishing MCH service delivery capacity of most Municipal Bodies
Weak health program management experience
Inadequate infrastructure (Health Dept+ Municipal): One Urban Primary Health Centre for about 1.5 lakh urban population,
often with 3-4 ANMs
Weak political consciousness about significance of urban health1083 UFWCs (1950) and 871 Health Posts (under Urban Revamping Sceme1983); many run from hospitals, not proximal to slums
IPP VIII (1993 to 2003) covered 7 million slum population (8% of India’s urban poor) in 4 mega cities and 94 smaller towns in 4 states
Challenge # 6
Municipal Health Infrastructure/Services Inadequate
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Most Vulnerable
Moderately Vulnerable
Less Vulnerable
Challenge 7:
All slums are not equal…
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
…Hence the Need to Prioritize Most Vulnerable
32.3 23.6
61.7 48.839
27.6 21.749.8 45.3
42.8
11.4 19.630.8 33.8
46.5
0102030405060
Water Supply Use of SpacingMethods
InstitutionalDeliveries
CompleteImmunization
Underwieght <--2SD
Most Vulnerable Moderately Vulnerable Less Vulnerable
Reference: EHP, 2004:Indore Slum Maternal and Child Health Survey
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Opportunities in Urban Areas
Growing recognition of the problem and burgeoning interestamong Government agencies, corporate sector, donors and NGOs
Resources and Potential Partners available for collaboration
NRHM has projected a separate financial outlay for Urban Health
74th Constitutional Amendment, a mandate-backed opportunity for Municipal Bodies
Urban Poor clusters geographically approachable
Easier to reach with communication activities
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
How can we work towards improved health of urban poor populations?
Suggestions
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Suggestion 1:
Strengthen Supply/Services
Identify and map all urban poor (e.g. Map of Agra)
Strengthen Urban Health services including outreach activities with focus on vulnerable urban settlements
Promote Public Private Partnership for expanding and improving health service delivery
Develop inter-sectoral mechanism at different levels
Motivational training to health providers (ANMs, Supervisors, MOs)
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Strengthen Municipal Health Program Capacity[Specially in medium-small cities]
Negotiate with Central and State Governments for complete implementation of 74th amendment
Facilitate linkage of ULBs with professional technical agencies
Leverage existing municipal buildings used for health services e.g. rent out portions to private doctors/enterprise
Initiate multi-stakeholder coordination at Ward level to improve reach and quality of health services
§ Train elected representatives and officials on 74th amendment, Govt. policies, programs including exposure visits/cross learning
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Increase awareness about optimal behaviors, services and provisions
Enhance capacity of slum communities to negotiate, improve behavior by strengthening CBOs (youth clubs, Mohalla Samitis, SHGs)
Identify and train Community Health Volunteers in slums to strengthen community-provider linkages through NGOs
Ensure that demand is met with increased availability
Suggestion 2:
Strengthen Demand and Community Behaviour
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Suggestion 3: Public Private Partnership
Private sector caters to most of the health needs even among the poor
• PPP can be an important strategy for meeting the critical public health challenge of quickly expanding services in urban areas.
• Utilizing existing private infrastructure (where available) rather than building new infrastructure saves time and costs eg. in Guwahati
• PPP can help in improving quality and broadening range of services
• Most vulnerable slums can be covered through Public Private Partnerships eg. Bangalore
• Private NGOs can help improve community demand and hence increase utilization of existing services
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
• Supplement Health Investments and services needed to address urban health challenge
• Sharing of expertise pertaining to demand generation, marketing and management
• Advocacy for enhanced attention to health of urban poor population
& . Potential Role of Corporate Non Govt Sector
Baroda Citizens Council Health Services Delivery in Slums
Federation of Gujarat Industries MS University of VadodaraVadodara Municipal Corporation
Corporate Partnership for Urban Health in Baroda since 1966
Example of Corporate supported Urban Health Efforts
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Suggestion 4: Better Policies and Policy Implementation
Increased attention and resources to the urban poor
Improve policies to make them more urban poor friendly, practical and measurable
Ensure energetic policy implementation by training of officers and increased information to urban poor
Real progress on inter-sectoral approaches is vital
Identify and address policy constraints to PPP
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Recall the face of the poorest and the weakest manwhom you may have seen and ask yourself,
if the step you contemplate is going to be of any use to him.Will he gain anything by it?
Will it restore him to a control over his own life and destiny?
In other words, will it lead to Swaraj for the hungry and spiritually starving
millions?-- Gandhi ji, 1947
Srivastav K and Agarwal S (2006). Health of the Urban Poor in India : Concerns Opportunities and the Way Forward. Presentation made at the International Conference on Urban Health Initiatives, Surat, February 9-11, 2006.
Let us build bridges of enablementfor a healthier tomorrow