urban health scenario in...
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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
Urban Poor Urban Average Rural Average
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
Urban Poor Urban Average Rural Average
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
Slum Non-Slum Mumbai
Maharashtra Mumbai
Antenatal Care and Delivery
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP (now UHRC) : 2003]
Mumbai: NFHS 2 (1998-99)
Poor Access to Health Services
80.9
89.4
82.6
767880828486889092
Slum Non-Slum Mumbai
42.9
80.473.4
0
20
40
60
80
100
Urban Poor Urban Average Rural Average
Maharashtra Mumbai
Complete Immunization by 12 months of age
Childhood Immunization
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP (now UHRC) : 2003]
Mumbai: NFHS 2 (1998-99)
Poor Access to Water and Sanitation
Urban Maharashtra Mumbai
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP (now UHRC) : 2003]
Mumbai: NFHS 2 (1998-99)
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
Urban Poor Urban Average Rural Average
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