New health hope for India's urban poor

By Health Team on Wed, 12 February 2014

Written by Susann Roth, Senior Social Development Specialist

The continued urban boom across Asia and the Pacific offers a host of exciting new opportunities for the region but it also presents huge challenges― not least in the critical field of health.

Nowhere is this truer than in India. Today, more than 30% of the Indian population lives in cities and that share is increasing every day.  However, for many residents living conditions are bleak. About 20% of Indians in urban centers live in slums, with the number swelling to more than 50% in some mega-cities. This leaves them seriously exposed to many dangers, including poor health.

Health statistics tell a grim story. The latest national family health survey for 2005-2006 shows that the under-five mortality rate was 73 for every 1,000 live births amongst the urban poor, compared to an average of 48 for all city dwellers. In addition, the data shows that one in every 10 children born in the slums did not live to see their fifth birthday, while just 40% of all slum children received all the recommended vaccinations. The data for stunted, underweight and malnourished children in slum areas is also alarming.

Many of these low health outcomes are linked to contaminated drinking water, poor sanitation, and a lack of access to basic health care. There are also growing threats from non-communicable diseases caused by risk behaviors like smoking, drinking, and high intake of saturated fats. Injuries from accidents and gender-based violence are also higher in urban than rural settings.

The public sector has largely failed to provide the comprehensive access to primary health care needed to reverse the problems in urban areas. By contrast, many rural dwellers are better off thanks to the government’s National Rural Health Mission, launched in 2005.

While urban areas have a greater number of doctors per head than rural areas (80 % of all India’s doctors serve urban areas) they are often more inaccessible to the urban poor because of high costs. Many health care providers in urban poor areas also operate without proper training and the quality of care is low with many patients forced to rely on secondary or tertiary public and private hospitals, where waiting times are long and out-of-pocket expenses are unpredictable.

To improve health outcomes amongst the urban poor, India’s National Urban Health Mission was launched in 2013.  It aims to revamp the public health system by delivering equitable access to quality health care for all. The tools for achieving this ambitious goal include spatial mapping of slums, along with health facilities, so that city agencies can identify and reach out to all urban poor. It also aims to partner with private providers and nongovernment organizations, to fill health ‘gaps’ and to improve access to, and quality of, health services through regular outreach activities.

Other targets include more community mobilization, provision of clear points of entry into the public health system, a defined referral system, provision of equitable access to national vertical health programs like communicable diseases and vaccinations, and evidence-based planning with disaggregated data collection.

This critical mission will run over 5 years with individual state governments given the flexibility to carry out activities, based on their own specific needs. This is a key feature. It also provides a great opportunity to further empower urban governance and local bodies. Of course the ultimate acid test is results, and the program’s concrete, on-the-ground measures offer real hope for improved health outcomes amongst India’s urban poor.