Effect of Urbanization on Health

Urban Health in Uttar Pradesh: Challenges and Opportunities Presented in Workshop on Maternal, Neonatal and Child Health Scenario in the Slums of Meerut, Uttar Pradesh: Implications for Programme and Policy 14th April’09, New Delhi April 09, By Dr. Gajraj Prasad Add. Director, MCH Directorate of Family Welfare Government of Uttar Pradesh Outline Growing Urbanization and Urban Poverty in Uttar Pradesh Health related Problems among Urban Poor Barriers limiting access to MCH care Upcoming opportunities i Utt U i t iti in Uttar Pradesh Growing urbanization and urban  poverty in Uttar Pradesh

Growing Urban Poverty in Uttar Pradesh Growing Urban Poverty in Uttar Pradesh • Uttar Pradesh, the most populous state of India, is also urbanizing rapidly. • Urban population of Uttar Pradesh will increase from 4. 1 b l f d h ll f crore1 in 2008 to 6. 7 crore in 20262. • An estimated 1. 17 crore comprising 30. 6 percent of the state’s urban population is poor3. • Uttar Pradesh houses the largest number of urban poor in a single state4. • Public Health efforts in UP need to take care of an estimated: • 340,0005 annual pregnancies among urban poor • 3. lakh6 annual births among urban poor • 11. 7 lakh7 children under-5 among urban poor 1-Projections for 2008 by Technical Group on Population Projections 2-Census, 2001 population, Projections, 2001-26 3 Poverty 3-Poverty Estimates 2004-2005 and 1999-2000 2004 2005 1999 2000 4-Report on State of Urban Health in Uttar Pradesh, UHRC: 2006 5- Based on NFHS-3 reanalysis by wealth quintiles; UHRC 2008 6-Based on CBR 28. 2 for urban poor population in UP and 1. 17 crore urban poor population 7 – Based on NFHS-3 reanalysis by wealth quintiles; UHRC 2008

L l f U b i ti A Di t i t i Utt P d h Level of Urbanization Across Districts in Uttar Pradesh 6 largest Cities in Uttar Pradesh Health related problems among  urban poor Health Related Problems among Urban Poor Urban poor suffer much poorer health status and access to healthcare. Lower access to i i i L institutional d li i l deliveries Lower coverage of immunization Higher infant mortality g y Higher prevalence of child undernutrition Higher prevalence of infectious diseases on account of poor living environment Lower access to housing, safe water supply & sanitation

Barriers limiting access of urban  poor to health care Barriers Limiting Access of Urban Poor to Barriers Limiting Access of Urban Poor to  Health Care Illegal status of Urban Poor Large proportion of urban poor live in unlisted slums g p p p Constant threat of eviction This compromises their access to basic services (water,  sanitation) and to entitlements e. g JSY  it ti )  d t   titl t Multi? dimensional vulnerability y Irregular employment, struggle for livelihood Denial of entry / access in healthcare institutions Sub? ptimal primary health care services Uneven distribution of urban primary healthcare centres Vacant Staff positions and low motivation of workers Timings inconvenient to urban poor Weak referral linkages and emphasis on curative care than  preventive ti Lack of convergence and programme experience g p g p Weak coordination among stakeholders Weak urban health capacity of functionaries Few examples of planned and well? managed urban health programmes to guide and inform ongoing and new  programmes High cost of private healthcare for the poor

Weak community demand for health care Poor literacy and lack of awareness about services, schemes  and entitlements Poor knowledge about health and hygiene behaviours Poor status of women leading to neglect of women s health  Poor status of women leading to neglect of women’s health  and lack of family support to mother / caregiver Wide prevalence of culturally influences practices that may be  harmful to health h f l t  h lth 12 Upcoming opportunities in Uttar  Pradesh Upcoming Opportunities in UP Government initiatives under RCH?

II: Spatial Mapping of all Health Facilities and slums of 14 cities  initiated Review of UH Services in 14 high focus cities Baseline study for identification of health indicators in slums of 14  cities Uttar Pradesh UH Policy being evolved by State Government y g y Initiation of Public Private Partnership as a Pilot in large cities of  State City Specific Urban Health Planning has been initiated Cit  S ifi  U b  H lth Pl i  h  b  i iti t d Growing interest among international agencies in urban  health in UP 16