Urban Health Challenges in India By- Charles Minz Moderator- Dr. Subodh Gupta.

Urban Health Challenges in India

By- Charles Minz

Moderator- Dr. Subodh Gupta

Framework

• History Urban Health India

• Why does Urban health Matter?

• Current Scenario

• Urbanization- The Changing Trends and Patterns

• Impact of rapid Urbanization

• Key Challenges to the Health System

• What can be done?

• Initiatives for better Health and Living for the Urban Poor

• Conclusion

History of Urban Health in India- Mohenjo Daro 6000 BC

India – Delhi 2015

Why does Urban Health Matter?

• Rapid migration from rural areas as well as natural population growth are putting

further pressure on limited resources in cities, especially in low-income countries.

• Scarcity of resources results in cities being unable to provide the services needed

by those who come to live there.

• Poorly planned or unplanned urbanization patterns which have negative

consequences for the health and safety of people.

Current Scenario

• Globally, more people live in urban areas than in rural areas, with 54 per cent of

the world’s population residing in urban areas in 2014.

• In Asia, despite its lower level of urbanization, is home to 53 per cent of the

world’s urban population, followed by Europe (14 per cent) and Latin America

and the Caribbean (13 per cent).

• In India the urban population is 37.7 million in the year of 2011 i.e. the 31.16

percent of the total population.

• 2-3-4-5 phenomenon of population growth.

• India's urban population will grow to 590 million, accounting for nearly 40

percent of the total population by 2030.

*(as per census 2011)

Definition

• Urban Unit (or Town):

• All places with a municipality, corporation, cantonment board or notified town

area committee (known as Statutory Town)

• All other places which satisfied the following criteria (known as Census Town):

A minimum population of 5,000.

At least 75 per cent of the male main workers engaged in non-agricultural

pursuits.

A density of population of at least 400 per sq. km.

• Slum-

“A slum is a compact settlement of at least 20 households with a collection of poorly built tenements, mostly of temporary nature, crowded together usually with inadequate sanitary and drinking water facilities in unhygienic conditions” *

*(Dr. Pronab Sen Committee Report on Slum Statistics/Census)

Urbanization –The changing Trends and Patterns

2001 2011 Difference

India 102.9 121.0 18.1

Rural 74.3 83.3 9.0

Urban 28.6 37.7 9.1

(Population in crores)

Migration Cob web

Migration

Overcrowding

Stretching of Overburdened

system

Injuries

StressLifestyle Modification

Non Communicable

Diseases

Communicable Disease

Unhygienic Conditions

Slums Illiteracy

Unemployment

Poverty

CrimesMental Illness

Maternal Health Indicators by place of residence

Complete ANC Check Institutional Deliveries0

10

20

30

40

50

60

70

80

90

10.2

28.923.7

67.4

11

44

29.5

78.5

Rural Average Urban Average Urban Poor Urban Non Poor

Axis Title

Perc

enta

ge

Child Survival Indicators of Urban Poor in India

Neonatal Mortality Infant Mortality Under 5 Mortality Children Completely Immunized

42.5

62.1

81.9

38.65

28.7

41.7

51.957.6

34.9

54.6

72.7

39.9

25.5

35.541.8

65.4

Overall Rural Overall Urban Urban Poor Urban Non Poor

Environmental Conditions, Infectious Diseases and access to Health Care in Urban Poor

Piped Water Supply Sanitory Latrines

11.8

26

50.7

83.2

18.5

47.2

62.2

95.9

Chart Title

Overall Rural Overall Urban Urban Poor Urban Non Poor

Impact of Urbanization

• Horizontal growth of Cities

• Speed of growth can outpaced infrastructure requirements.

• Triple Threat

A) Infectious Diseases

B) Non Communicable Diseases

C) Accidents ,Injuries, road accidents ,Violence and crime.

Key Challenges to Urban Health

Social Determinants Operational

Administrative Burden of Disease

Key Challenges to Urban Health

Social Determinants

• Housing, Land Tenure and security

• Water

• Sanitation

• Food

• Urban Transport

• Noise Exposure

• Outdoor and Indoor Pollution

• Climate change

• Illiteracy

Operational Challenges

• Inequitable distribution of health facilities

• To connect every household to health facilities is a big challenge

• Poor Referral

• Lack of standards for• Provision of safe water and sanitation facilities • Housing and waste disposal systems

• No public health bill for setting up and regulating these standards

• Lack of understanding of recent demands of urban health care delivery and poor planning/implementation

Administrative Challenges

• A more complex planning system due to lack of involvement of local urban bodies

• Lack of coordination between State Government, local bodies, autonomous bodies and Central Government

• Lack of grass root level structures like Panchayati Raj Institutions

• Need for clarity of responsibilities among various administrative bodies

• Lack of clear and well defined norms for delivery of primary care

• Health service guarantee and concurrent audit at the levels of funds release and utilization

• Need for stronger laws for illegal and unauthorized settlements

Currently in Maharashtra -Brihan Mumbai Municipal Corporation (BMC)

• With a population of 1.19 crore and a slum population of about 60 lakh, is the largest Municipal Corporation in India, and a major provider of public health-care services at Mumbai.

• It has got a network of 3 Teaching Hospitals, 14 Municipal General Hospitals, 26 Maternity Homes across Mumbai .

• Apart from this there are 185 Municipal Dispensaries and 176 Health Posts to provide outpatient care services and promote public health activities in the city.

• The state government in addition has one medical college hospital and 3 general hospitals and 2 health units have a bed capacity of 2871 beds

What can be done ?

Promote urban planning for healthy behaviors and safety

Improve urban living conditions

Ensure participatory urban governance

Build inclusive cities that are accessible and age friendly

Make urban areas realized to emergencies and disaster

NGOs working towards Better Urban Health

• Urban Health Resource Centre

• Urban Health Initiative - FHI 360

Urban Health Resource Centre (UHRC)-Urban Health Programme (UHP).

Objectives

To increase coverage of services and adoption of key health behaviors in

neonatal survival, diarrhoea control and other child health priorities.

To improve the capacities of local stakeholders and slum-based groups in

health behavior promotion.

To develop replicable models of urban maternal and child health (MCH)

programmes.

Programme planning

Urban health situation analysis of the city Slum identification, and plotting Vulnerability assessment

List of

438 slums

FGD

Classifying

Vulnerable and

Non-vulnerable

Slum Review and Validation

Triangulation and Mapping

Source:Municipal ListMayors OfficeDistrict Collectors Office

Participants:Public Sector StaffNGO & CBO

Objectives:To observe andunderstand thereality of criteriaas lived by slumdwellers

Purpose:Developmentof detailedvulnerabilitycriteria

35 primary andsecondarystakeholdersinvolved in scoringand identification ofmissed slums

How did they achieve it?

• Demand supply linkage approach

• Ward co-ordination approach.

Demand supply linkage approach

Outcomes

Ward co-ordination approach.

Outcomes

FHI 360-Urban Health Initiative

• Innovation

• Capacity Building

• Empowerment

Initiatives for better Health and Living for the Urban Poor

• National Urban Health Mission

• National Urban Sanitation Policy

• Jawaharlal Nehru National Urban Renewal Mission

• Rajiv Awas Yojna

National Urban Health Mission

• Goal-

The National Urban Health Mission would aim to improve the health status of the

urban population in general, but particularly of the poor and other disadvantaged

sections, by facilitating equitable access to quality health care through a revamped

public health system, partnerships, community based mechanism with the active

involvement of the urban local bodies.

Major Focus Areas

• Urban Poor Population living in listed and unlisted slums

• Targeting vulnerable population.

• Public health thrust on sanitation, clean drinking water, vector control, etc.

Urban Health Care Delivery Model

U-CHCInpatient facility, 30 -50 bedded

(100 bedded in metros)*Only for cities with a population of above 5 lakhs

U-PHCMO I/C – 1 2nd MO (part time) – 1,Nurse - 3,LHV – 1,Pharmacist – 1,ANMs - 3-

5,Public Health Manager/ Mobilization Officer – 1,Support Staff - 3,M & E Unit - 1

1 ANMOutreach sessions in area ofevery ANM on weekly basis

Community HealthVolunteer (ASHA/LW)

Mahila Arogya Samiti

For every2.5 lakh population (5 lakh for metros)

For every 50,000population

For every 10,000population

200- 500 HHs(1000-2500 population)

50-100 HHs(250-500 population)

Community Level

Primary Level

Referral Level

National Urban Sanitation Policy (NUSP)

• Goals

-The overall goal of this policy is to transform Urban India into community-driven, totally sanitized, healthy and liveable cities and towns.

Components of NUSP

• Awareness Generation

• Institutional Roles

• Reaching The Un-Served And Poor Households

• Capacity Building

• Financing

• City Reward Scheme

Jawaharlal Nehru National Urban Renewal Mission (2005-2012)

Mission Statement:

• The aim is to encourage reforms and fast track planned development of identified cities. Focus is to be on efficiency in urban infrastructure and service delivery mechanisms, community participation, and accountability of ULBs/ Parastatal agencies towards citizens.

Objectives of the Mission

(a) Focused attention to integrated development of infrastructure

services in cities covered under the Mission.

(b) Ensuring adequate funds to meet the deficiencies in urban

infrastructural services.

(c) Planned development of identified cities including peri-urban areas,

outgrowths and urban corridors leading to dispersed urbanization .

(d) Scale-up delivery of civic amenities and provision of utilities with

emphasis on universal access to the urban poor.

(e ) Special focus on urban renewal programme for the old city areas to

reduce congestion.

(f) Provision of basic services to the urban poor including security of

tenure at affordable prices, improved housing, water supply and

sanitation, and ensuring delivery of other existing universal services of

the government for education, health and social security.

Rajiv Awas Yojna (2013-2022)

Mission

• Encourage States/Union Territories (UTs) to tackle slums in a definitive manner, by focusing on:

Bringing all existing slums, notified or non-notified within the formal system and enabling them to avail the basic amenities that is available for the rest of the city.

Redressing the failures of the formal system that lie behind the creation of slums by planning for affordable housing stock for the urban poor.

Objectives:• Improving and provisioning of housing, basic civic infrastructure and social

amenities in intervened slums.

• Enabling reforms to address some of the causes leading to creation of slums.

• Facilitating a supportive environment for expanding institutional credit linkages for the urban poor.

• Institutionalizing mechanisms for prevention of slums including creation of affordable housing stock.

• Strengthening institutional and human resource capacities at the Municipal, City and State levels through comprehensive capacity building and strengthening of resource networks.

• Empowering community by ensuring their participation at every stage of decision making through strengthening and nurturing Slum Dwellers’ Association/Federations.

The possible solutions can be

• Political Will and Commitment

• Ensuring adequate and reliable health related data

• Inter-sectoral co-ordination

• Sharing of successful experiences and best practice models

• Reducing the financial burden of health care through improved

financing techniques

• Strengthening public private partnerships

• Strengthening public health care facilities

References• Agarwal S, Satyavada A, Kaushik S, Kumar R. Urbanization, urban poverty and

health of the urban poor: status, challenges and the way forward. Demography India 2007; 36(1): 121.

• Dilip T.R., Duggal R. Unmet need for public health-care services in Mumbai, India. Asia-Pacific Population Journal. 2004;19 (2):27–40

• International Institute for Population Sciences and Macro International. National Family Health Survey (NFHS-3), 2005–2006, India, Maharashtra. Mumbai: IIPS; 2008

•  Butsch, C., Sakdapolrak, P. & V.S. Saravanan (2012). Urban Health in India, Internationales Asienforum, Vol. 43, No. 1–2, pp. 13–32.

• Yadav K, Nikhil S, Pandav CS. Urbanization and health challenges: need to fast track launch of the national urban health mission. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine 2011;36(1): 3-7.

•  http://www.urbanindia.nic.in/DMU/JNNURM/DMU-JNNURM.pdf .

•   National Urban Health Mission,Fraework for Implementation. New Delhi: Government of India, Welfare MoHF; 2013.

Thank You