NEW DELHI: The 285 million urban people in India account for 28 per cent of the country's total population, a number that is estimated to double by 2025. Approximately one-fourth of urban India, comprising over 70 million people, lives in slums or illegal settlements without basic infrastructure and public services.

Lack of clarity

Though it appears that health facilities are concentrated in urban areas, these are often not accessible or affordable to most urban poor. The Integrated Child Development Schemes (ICDS), an important health and nutrition initiative of the Government, covers only one-sixth of the urban population compared to 80 per cent coverage in rural areas.

Under the Government's ambitious flagship National Rural Health Mission (NRHM), the focus on rural areas has pushed urban health into the background. As a result, there is lack of clarity regarding accountability and resource allocation for the urban health.

Logistics problem

"While on the one hand, there is lack of targeted health programmes for the urban poor, the sheer logistics of health delivery in urban areas are also a challenge. Health services usually do not reach hidden and missing pockets of urban poor that in many instances are not part of official slum lists,'' according to Siddharth Agarwal, Executive Director of Urban Health Resource Centre (UHRC), a non-profit organisation that addresses the health concerns of the poor living in urban settlement colonies. "These un-notified slums and their inhabitants with no regular incomes, social exclusion, insecurity relating to land tenancy, lack of basic amenities are the most vulnerable when it comes to health," he adds.

Broaden scope

The UHRC believes that the scope and focus of the NRHM should be broadened to include urban poor and the private sector given a role in the implementation of the health programmes besides developing innovative urban health programmes for cities. However, successful implementation of these programmes in urban areas would largely depend on efficient municipal governance, it points out.

The strain on the urban health infrastructure is reflected in the health or its inhabitants, particularly the poor. More than half of the urban poor children suffer from malnutrition and even more are not completely vaccinated against preventable diseases.

According to the Re-analysis report of the National Family Health Survey-2, less than one-third of the urban poor have access to sanitation, three-fourths do not have piped drinking water supply.

Of the two million births each year among the urban poor, more than 50 per cent deliveries occur at home. For the two million births, 1.1 million mothers would not have received adequate ante-natal care. Close to a million children have low birth weights and breastfeeding is likely to be delayed.

On an average there is only one urban primary health facility for the 2.38 lakh urban population often with only 2-4 health workers, as against the specified one centre for every 50,000 population.

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