Primary Healthcare in Urban Slums

This paper addresses the underdevelopment of the urban health policy in Maharashtra, the state which has the highest number of slum dwellers in the country. Yet primary healthcare for urban slums remains in a state of neglect. Maharashtra faces the challenge of providing primary healthcare services to a slum population of more than 40 million [Census of India 2001]. The issue of primary healthcare for slums requires the immediate attention of policymakers given the rapidly growing urban population. The paper describes the health status of slum dwellers in Maharashtra and discusses the constraints in the existing urban health delivery system. It examines the quality of primary services provided by the health posts in urban areas, outlines key areas for policy advocacy and recommends specific steps to improve primary healthcare services. The paper also highlights the differences within the urban sector, for example between recognised and unrecognised slums; and corporation and council towns, etc. Health posts and post-partum centres in urban areas have by and large become hospital-based programmes which do not cater effectively to slum populations.

The present scenario depicts a depressing picture where the poorest and most vulnerable groups residing in urban slums are outside the ambit of any public health coverage. The health status in urban slums is presented in three sections – women’s health, child health and emerging issues like HIV/AIDS and TB. The low health status of women can be seen from indicators such as antenatal care coverage, prevalence of anemia, prevalence of reproductive tract infections and violence against women. An assessment study on maternal and child health in urban Maharashtra (excluding Greater Mumbai) presents findings on slums, council towns and municipal corporations [Godbole and Talwalkar 2000]. The data for the urban study conducted by Godbole and Talwalkar comes from 8,575 women, who had delivered within 12 months or less of the survey. Table 1 provides antenatal care coverage by slums and non-slums, by type of municipal council and overall for urban and rural areas. The difference between slums and non-slums is quite high, especially for three or more ante-natal check-ups – 55 per cent for slum women compared with 74 per cent for non-slum women.