India is witnessing rapid urbanization. An estimated 30 per cent of the country’s population or about 300 million people are living in towns and cities. Unprepared for such rapid growth, the cities lack infrastructure and basic services. Nearly one-third of urban inhabitants (100 million) are living in slums or slum-like conditions characterized by overcrowding, poor hygiene and sanitation and absent civic services. The health of the urban poor is as bad as, if not worse than, that of the rural population.
NFHS-3 (2005-06) figures highlighted that nearly 100,000 babies in Indian slums die every year before their fifth birthday. Poor access to healthcare, poor nutrition and health-seeking behaviour, poor environmental conditions and resultant high prevalence of infectious diseases contribute to the high maternal and child morbidity and mortality among the urban poor. Compounding this, is the rapidly growing slum population, with Total Fertility Rate (TFR) of 2.8, above the national average of 2.7, and the growing in-migration to towns and cities. Moreover, slums are mainly illegally inhabited areas, vulnerable to eviction and rapid migration.
Affordable quality health care
Although we have been supporting action research projects on maternal and child health (MCH) in urban areas in partnership with NGOs, these initiatives have been limited in scope and geographic reach. With the declining status of urban health and the emerging need to increase efforts to strengthen primary health initiatives in urban areas, PFI entered into a partnership with USAID India in October 2009 to start a comprehensive Health of the Urban Poor (HUP) Project.
The project envisages the development of a responsive, functional and sustainable urban health system that provides need-based, affordable and accessible quality healthcare and improved sanitation and hygiene for the urban poor in eight states and three cities. The project builds on past and current investments of USAID India, like Expanded Urban Health Programme (EUHP) and Financial Institutions Reform and Expansion – Debt (FIRE-D) project and draws technical strength from three ongoing USAID-funded flagship health sector programmes – the Vistaar Project, the Maternal and Child Health Sustainable Technical Assistance and Research (MCH-STAR) and the Maternal and Child Health Integrated Programme (MCHIP).
Principles of convergence
The project adopts the principle of convergence of various development programmes to-
The HUP project aims at improving the governance skills of local self-governance institutions, line departments and local civil society organizations. By providing technical assistance and capacity-building inputs, the project is in the process of developing three city demonstration and learning models for replication, introducing management support methods to ensure effective and efficient management and delivery of health systems.
Given the evidence that the quality of the lives of the urban poor cannot be improved unless the conditions of health determinants (like water, sanitation, nutrition, hygiene) are improved, the project lays emphasis on institutional convergence of the various programmes, implemented by various departments like Urban Development, Health and Family Welfare, Women and Child Development, and Water and Sanitation. The HUP project is an example of collaboration and partnerships between organizations with varied competencies and strengths.