growing reproductive and child health needs of the urban poor · contribution of the urban poor to...
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Growing Reproductive and Child Health Needs of the Urban Poor
Workshop forSouth Asian Journalists on Reproductive and
Child Health: Issues and ChallengesAugust 23-24-, 2007
Siddharth Agarwal [email protected] Health Resource Centre, India
India is Urbanizing
Population Growth Trends in India
2 – 3 – 4 - 5All India Urban areas Large cities Slums
Urban population-328 million [Projections for 2007 by Technical Group on Population Projections]India is expected to be approximately 40% (550 million) urban by 2026 [Census, 2001 population, Projections, 2001-26]Urban poor population expected to increase from 100 million to 202 million by 2020 [National Population Policy, 2000; State of World’s Cities, 2006/07]More than 2 million births annually among the urban poor [Based on CBR 19.1 for urban population and 100 million urban poor population]
Contribution of the Urban Poor to National Economy
Almost 90% of urban poor are involved in urban informal sector.1
Urban sector contributes 60% of Gross Domestic Product (GDP).2
Informal sector’s contribution to non agricultural GDP is 45%.3
1. USAID (2002). Making cities work, India Urban Profile. 2 Chaudhary O. New vistas in financing for development of real state. National Real Estate Summit. FICCI-3rd September 2004
3 International Labour Office.2002.Women and Men in Informal Economy.
Health conditions of urban poor are similar to or worse than rural population and far worse than urban averages
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]
Urban Average
Urban Poor
103.7
63.1
* Mortality per 1000 live births
Poor Child Health and SurvivalD
eath
s Pe
r 100
0 Li
ve B
irths
0
20
40
60
80
100
120
140
160
Under 5 Mortality *
101.3
Rural Average
0
20
40
60
80
100
Childhood under-nutrition among urban poor is worse than rural population and far worse than urban averages
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]
Rural Average
49.638.4
Urban Average Urban Poor
Nutritional Status
Childhood Under-nutrition
Per
cent
age
of u
nder
3 y
ears
unde
rwei
ght f
or a
ge (<
–2
SD
)
56.0101.3
0
10
20
30
40
50
60
70
80
BreastfeedingInitiation within 1hr
Initiation of Complementary Feeds by 7mths
Rural Average
Urban Average
14.819.2
60.5
73
Urban Poor
17.9
56.5
Sub-optimal Child Nutrition behaviors
Poor Coverage of Slum Children against Vaccine Preventable Diseases
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]
0
10
20
30
40
50
60
70
36.6
60.5
Complete Immunization by age 12-23 months
Rural Average
Urban Average
42.9
Urban Poor
Poor Access to Maternal Health ServicesPoor Access to Maternal Health Services
0
10
20
30
40
50
60
70
80
Complete ANC (3ANC+IFA+TT)
Home deliveries
24.8
52.7
74.3
Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003
33.9
Rural Average
Urban Average
30.4
54.1
Urban Poor> 1million babies are born every year in slum homes
Poor Access to Services in the Shadow of big Hospitals
Large family size in Urban Slums
2.27
3.28
2.85
0
0.5
1
1.5
2
2.5
3
3.5
Urban Average Urban poor Rural Average
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]
51.2
39.9 42.3
0
10
20
30
40
50
60
Urban average Rural average Urban poor
Modern contraceptive prevalence rate
Total fertility rate
Health Conditions far Worse in Less Developed States
47.7
68.6
49.2 50.732
55
31.8 38.1
91.4 91.4
69
90.6
0102030405060708090
100
Womenreceiving 3 ormore ANC
Womenreceiving 2 or
more TT
Womenreceiving IFAtablets for 3
months
Deliveriesattended by any
healthprofessional
All India Madhya Pradesh Tamil Nadu
[Re-analysis of NFHS 2 (1998-99) by Standard of Living Index, EHP: 2003]
1. Urban Poor constitute one-fourth of India’s poor
2. Urban Poor contribute substantially to India’s economic growth story
3. Growth rate of Urban slum population is almost double that of urban population in India
4. Over 2 million births take place among urban poor
5. Average health data mask the inequities: Reproductive & Child Health and Nutrition situation of urban poor are similar to or worse than rural population
6. Health conditions of urban poor in less developed States far worse than what is indicated by national average data
Key messages
What are the Challenges?“Growing Reproductive and Child Health Needs of the
Urban Poor”
Insufficient and Less effective RCH services
Lack of policy focus on urban health; greater focus on rural health (since had remained primarily rural for many decades)High imbalanced investment on curative services in urban areas: neglect of primary health services1 Urban Health Centre for about 2,00,000 population against norm of 1 UHC for every 50,000 personsWeak coordination among different agencies Poor capacity and role of Urban Local Bodies in health service delivery
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328 unlisted slums (population 510,397)
452 listed slums (population 820,139)
780 slums (Total)
According to NSSO 58th Round (2002) 49.4% slums are non-notified in India
City Slums on official List Unlisted Slums
Agra 215 178
Dehradun 78 28
Bally 75 45
Jamshedpur 84 77
452 328
Invisible and Uncounted slums
Urban poor face social exclusion, illegality, many overlooked by official enumeration systems
Weak demand among urban poor communities
Low awareness about services, behaviors and provisions Weak capacity to negotiate for MCH services
Gender inequity
Low awareness and compromised confidence among women to assert for and obtain needed health care Insufficient family support to womenMany women face family violence; widespread alcoholismPressing need of mother to resume wage earning
Very few examples of coordinated, planned slum health programs in most States
Weak capacity among government and NGO managers on urban health
19
Lack of program examples, capacity
Poor Housing and Environment
Poor Sanitation and Water Supply
Inadequate public Urban Primary Health Infrastructure makes urban poor more dependent on ill-equipped informal sector or expensive private sector.
Urban poverty has been neglected while most attention has been on rural areas
Illegality, social exclusion, threat of eviction result in a sense of resignation among slum dwellers about their surroundings and wellbeing.
There is a need to prioritize the most vulnerable urban poor within cities
Lack of family support to the mother in an urban poor household
Poor environment, housing, sanitation, water services
Key messages
Growing recognition of the issue and increasing interest among Government, donors and civil society in India.
MOHFW, GoI set up National Urban Health Task Force (2006) and based on recommendations has announced decision to soon launch the National Urban Health Mission
JNNURM presents opportunities for health infrastructure and basic services to the poor
Greater presence of experienced NGOs, academia in urban areas
Growing body of urban poor specific research & data.
Geographical accessibility in urban areas is an advantage.
More options for communication activities
May be more early adopters among urban poor
Opportunities in urban areas
“Growing Reproductive and Child Health Needs of the Urban Poor”
How have these challenges been addressed in the Indore Urban Health
Program
Listed SlumsUn-listed Slums
INDORE INDORE
9 CLUSTER COORDINATION TEAMS cover 1.5 lac urban poor population
(also called Lead CBOs; 7-9 slums per cluster)
Trained, encouraged and supported by programSeven now registered as voluntary organizations.Plan and negotiate regular health services
Linkages with Public and Private service providers (Maternal & Child Health, Water & Sanitation) Monitor and support Basti CBOs in health
activities as necessary
NGOs with support from UHRC undertake periodic program review and implement appropriate improvement measures as identified during review
Building Sustainable Institutions in Slum Communities
BASTI (Slum) LEVEL CBOs(90 community groups of 7-12 members, including dais across 79 slums or bastis)
Community based monitoring of MCH careCounsel slum families on healthy behavioursIdentify un-reached families and ensure access for themSupport regular MCH days in slums
Building Sustainable Institutions in Underserved UrbanCommunities
Building Sustainable Institutions in Underserved UrbanCommunities
Community Activities for Improving RCH Services and Behaviors
Trained Slum Volunteers encourage women for ANC checkups during outreach camps
Information and community motivation –CBO members singing health songs
Immunization tracking – identifying left-outs and drop-outs through slum mapping
Dissemination of health messages – CBO members counseling pregnant women during
outreach session
Community Health Funds: a Risk Pooling Measure
Health funds are used to address obstetric emergencies, neonatal, infant and childhood illnesses and also serve as an empowerment mechanism
Community Groups Negotiate for Improved Water Supply and Toilet Facility
Regular Outreach Health Services by Government and Private Providers
Ward levelCore Group
Ward levelCore Group
Total Coverage: 70, 000 slum population in 2 wards in Indore, being replicated in 5 additional wards of Indore
Community Groups by Coordinating with Health Services and Related Agencies at Ward Level Help Making MCH Services Accountable
NGOs & CBOs
Charitable organizations
Elected Representatives
Municipal Corporation(Zonal office)
DUDALocal Resources
(Local Clubs, Schools)
Health dept
ICDS
Improved Health Indicators in Indore Slums
55
38
59
23
46
32
69
52
85
43
29
72
0
25
50
75
100
% mothersreceived 3 ANC
% mothersdelivered in
health facilities
% infantsbreast fed
within one dayof birth
Children 0-3months who
are exclusivelybreastfed
% children<2yrs
underweight forage ( <–2 SD)
% children (12-23 mths)completely
immunized by1 yr of age
Baseline (October 2003)
Midline (After Intervention- March 2006)
“Growing Reproductive and Child Health Needs of the Urban Poor”
Let us work together to translate words into real
health improvements among urban poor
Media can create constructive social uproar to influence politicians, other Govt.
departments, corporate sector and highlight plight of mothers and children
among urban poor [malnutrition, un-safe deliveries, lack of immunization]
Can document and disseminate best practices from working models to encourage
and inspire others e.g. Streehitkarini, SNEHA (all Maharashtra), Arpana (Delhi),
Sumangli Sevashram (Bangalore), UHRC (Indore)
Can promote health behaviors e.g immunization, breast feeding. Examples of
effective partnering with media include Pulse Polio Campaign, HIV/AIDS
Awareness, Anti-Smoking Campaigns
Regional language media (including TV and radio channels) can reach and appeal
among the masses
Crucial Role of Media
Let us Translate Policy Beginnings into Action
National Urban Health Mission to be launched shortly by Govt of IndiaAlong with JNNURM and universalization of ICDS, stage seems to be set for greater focus on improving Reproductive & Child Health and nutrition status of the urban poorEffective implementation of these programmes to bring about real changes in the lives of the urban poor will be key.
37
Accountable,Effective
Urban Health System Long Lever of :
a) Commitment , Motivationb) Knowledge, Experiencec) Proximity to problemsd) Accountability, responsibility
Socially Committed, passionate Media partnering with, Civil Society, Govt., slum communities
With Hope and Confidence
““A small body of determined spirits fired by an A small body of determined spirits fired by an unquenchable faith in their mission, can alter the unquenchable faith in their mission, can alter the course of historycourse of history”” -- Mohandas Karamchand Gandhi Mohandas Karamchand Gandhi
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