Urban Health Scenario in...

Urban Health Scenario in Maharashtra

JOINT ANNUAL STATE CONFERENCE OF IAPSM & IPHA – MAHARASHTRA CHAPTER

DMIMS, University, Sawanghi, WardhaDecember 29,2006

Anuj K Srivastava, Siddharth Agarwal, Karishma SrivastavaUrban Health Resource Centre, New Delhi

• Urban Growth and Poverty in Maharashtra

• Health Scenario among Urban Poor

• Challenges in addressing Unmet Health Needs of Urban Poor in Maharashtra

• Basket of Opportunities

Outline of the Presentation

Urban Growth and Poverty in Maharashtra

Urbanization in Maharashtra at a glance…

• State with the highest urban population of 41 million in 2001 and currently about 48 million

• Second most urbanized state in India with 42.4 per cent urban population

• Rapid growth of urban population at 31.4 per cent 1991-2001

• Nearly one-fifth viz., 7 out of the 35 million plus cities in Maharashtra

• 80 percent of urban population resides in 40 Class I cities* of Maharashtra. The remaining 20 percent resides in 338 towns / cities

* Cities with population of 1 lakh and above

Total Urban Population: 41 million (42% of Total Population)Maharashtra: Urbanization

Mumbai

Urban Poverty in Maharashtra• Maharashtra has 10.6 million urban poor

population (27% of urban population), largest among all states and equal to 1 per cent of India’s total population

• Growth of Urban Poverty: Percentage of urban poor to total poor in Maharashtra has almost doubled (from 24% to 45% between 1977 and 2000)

[Ref: State Planning Division, Planning Commission; Maharashtra State Development Report, Chapter 13; 2005]

Urban Health Scenario in Urban Maharashtra

Neonatal and Infant Mortality

Maharashtra

24.634.7

46.3

64.573.8

43.9

01020304050607080

Neonatal mortality Infant mortality

Urban Poor Urban Average Rural Average

[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP (now UHRC) : 2003

Mumbai: NFHS 2, 1998-99

Mumbai

18.4

28.1

8.2

16.315.3

24.5

05

1015202530

Neonatal mortality Infant mortality

Slum Non-slum Mumbai

Health conditions of urban poor are similar to rural population and far worse than urban averages

[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP (now UHRC) : 2003]

Mumbai: NFHS 2 (1998-99)

Poor Child Health among Urban Poor in Maharashtra

40.935.9

46.3

0

10

20

30

40

50


Maharashtra

Weight for age <-2 SD

42.9

24

38

0

10

20

30

40

50

Slum Non-Slum Mumbai

Mumbai

Weight for age <-2 SD

Under-nutrition among children <3

Poor Access to Health Services

73.9 67 6783.43 84.7 83.4

66.4 72.8

34.8

020

4060

80100

Received IFA for 3+months

Received atleast 2 TT Institutional Delivery

Perce

ntage


96.8

89.8

83.5

96.792.7 91.9

96.8

90.6

85.8

7580

8590

95100

Received IFA for 3+months

Received atleast 2 TT Institutional Delivery

Perce

ntage


Maharashtra Mumbai

Antenatal Care and Delivery



Poor Access to Health Services

80.9

89.4

82.6

767880828486889092


42.9

80.473.4

0

20

40

60

80

100


Maharashtra Mumbai

Complete Immunization by 12 months of age

Childhood Immunization



Poor Access to Water and Sanitation

Urban Maharashtra Mumbai



18.8

45.2

71.6

8.522.3

85.1

0

20

40

60

80

100

Households w ith pipedw ater suply at home

Households w ith no toiletfacility


58.9

4.4

93.5

0.2

74.7

2.50

20

40

60

80

100

Households w ith pipedw ater suply at home

Households w ith no toiletfacility

Slum Non Slum Mumbai

Challenges in Addressing Health Needs of Urban Poor

in Maharashtra

Challenge 1:Urban Poor Suffering Social Exclusion

Perceived to be ‘Illegal’ and unwanted despite the vital contribution of this large informal work force

Few rights as urban citizens, suffer social exclusion and consequently have little power to influence their circumstances

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 (84 vs 77). Besides unlisted slum settlements, urban poor also include pavement dwellers, population residing in construction sites, fringes of the city, floating population etcAccording to NSSO 52nd Round (2003) 6,472 (63.5%) slums are un-notified in Maharashtra

Challenge 3: Inadequate Urban Primary Health Services

There is one UFWC/HP for about 1.35 lakh urban population1

Quality of services sub-optimal and not encouraging

1 Based on urban population of 41million (2001 Census) and 303 Govt. urban primary health facilities* in Maharashtra

* Source: IIPS (2005) National Report on Evaluation of Functioning of Urban Health Posts/UFWCs in India.Sponsored by MOHFW,GOI,New Delhi.

Private doctors48.3%

Government hospitals

17.2%

Private Clinics34.5%

Low utilization of public health services for fever and cough in urban slums; private sector predominantly accessed(National Family Health Survey, Maharashtra – 1998-99)

Rural Areas*

65%

35%

ICDS Coverage

ICDS Not Covered

According to recommendation on ICDS by the National Advisory Council (2004) at least 42,677 more AWCs will be required in urban Maharashtra to universalize ICDS

Urban Areas

23%

77%

ICDS Coverage

ICDS Not Covered

*Includes Rural and Tribal Projects

Lesser ICDS Coverage in Urban Areas

Source: Status Report of ICDS on 14.10.2005.Department of Women and Child Development, Ministry of Human Resource Development.

Population: 55,732,513 (Cenus 2001) Population: 41,019,734 (Cenus 2001)

• Low access to facility based Maternity services and newborn health services for the poor

• Weak referral linkages from community as well as from Primary facilities

• Lack of community health insurance mechanisms for the poor

• High usage of Public facilities by middle and higher income segments

Challenge 4: Weak Referral Mechanisms

Challenge 5: Low Awareness of, Weak Demand for MNH care

Low awareness about Health services

Limited trust in public sector Health services owing to low quality.

Weak negotiation capacity ( to demand for services)

Weak community organization and social cohesion

Challenge 6: Weak Family Support for Home Care of Infants

Pressing need to resume wage earning

Lack of family support to Mother/care giver

Sub-optimal household behaviours

81 % urban poor households do not have access to piped water supply and more than half (55%) do not have a toilet facility

Challenge 7:Constant Struggle with Environmental Conditions

Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]

Opportunities RCH II has dedicated focus on urban health In Maharashtra, under RCH II Urban Helath

programs are being taken up in 22 corporations and 18 councils

Additional support for RCH services to all other councils with >10,000 population

Expansion of ICDS is moving rapidly in urban areas also

State Nutrition Mission also lends additional focus and programs

Large presence of capable NGOs

PPP is an important strategy for meeting the critical public health challenge of quickly expanding services in urban areas.

Utilizing existing private infrastructure rather than building new infrastructure saves time and costs

Empanelment of private doctors can increase access to services

Private and Govt Medical Colleges can adopt slum clusters and demonstrate innovative Urban Health models including referral

Most vulnerable slums can be covered through Public – Private – People - Partnerships e.g. Pune, Nagpur, Mumbai

Private NGOs can help improve community demand and hence increase utilization of existing services

Public – Private – People - Partnership

Let us all partner to provide improved health care to the urban underserved

for a healthier tomorrow

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