The article has been authored by Mohan HL- CEO, Karnataka Health Promotion Trust.

The pace of urbanisation in India has increased drastically in the past two decades, and the world’s fifth-largest economy is projected by the United Nations to have 675 million of its people, about 43%, living in cities by 2035, up from 35% in 2021. Although urbanisation is often considered synonymous with development, it does not equate to better standards of living or the availability of health care services for all. A city may seem to offer endless options for health care, from the corner clinic to towering corporate hospitals, but many of these options are out of reach, physically and financially, for the urban poor and vulnerable. Where government health facilities exist, they are often constrained by human resource and infrastructure limitations.

The 15th Finance Commission report highlights how the Covid-19 pandemic stretched government health facilities in India, particularly in urban areas. It recommends paying attention to fragmented urban health systems, shifting the management of primary health facilities to local governments, and addressing social and gender norms while making provisions for equitable health care.

As urban landscapes change with a growing population, the traditional notion of the slum as an expansive area of kaccha dwellings is changing as well. Large-scale migration is resulting in the vertical growth of temporary shelters and slum-like structures within and in the periphery of the city. These structures are not notified under the Census or by the local administration, and its residents are vulnerable to illness due to congestion, poor sanitation and hygiene facilities, and the nature of their occupations. Socio-economic barriers, the lack of knowledge about available services and mobility challenges often lead to a delay in access to care. Health indicators for the urban poor are sometimes no better than those of rural populations. Data from the National Family Health Survey indicates that only 58% of children in urban areas have been fully immunised. Women also have limited access to health care, with less than 20% undergoing critical health examinations.

Addressing the needs of these groups through the provision of accessible infrastructure and quality services is key to improving urban health overall. In the wake of the pandemic, the Government of India launched the Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) in 2021 with the goal of establishing Health and Wellness Centres (HWCs) for every 15,000-20,000 people. This scenario runs the risk of HWCs being established through political considerations or using existing government buildings, without considering the concentration of vulnerable people, and potentially bypassing them entirely. A scientific approach is a must to determine where the centres need to be located to achieve the National Urban Health Mission’s (NUHM) vision of equitable, affordable and quality health care for all.

The NHM in Karnataka is aiming to fast-track the establishment of new HWCs (called Namma Clinics) and polyclinics that provide specialist health services, enabling a robust public health system in urban areas. With the support of the Mysuru City Corporation, Karnataka Health Promotion Trusts (KHPT) — a not-for-profit entity that spearheads focused initiatives to improve the health and wellbeing of communities in India — developed and tested a mapping exercise to identify locations to establish HWCs and existing Urban Primary Health Centres (UPHCs) to be designated as polyclinics to maximise the number of vulnerable people reached and minimise the distance they would have to travel to access health services.

Firstly, KHPT listed notified slum populations from government sources, and interviewed service providers and key informants from the community to record the populations of non-notified slums and slum-like structures, as well as their distance to existing UPHCs. This data was used to identify locations where sanctioned HWCs could be positioned, with the potential to serve a large proportion of vulnerable communities. Secondly, to select UPHCs to function as polyclinics, KHPT assessed the readiness of the existing facility based on their infrastructure, including equipment to run routine tests and laboratory facilities and distance from areas with concentration of vulnerable communities

This scientific approach to mapping enabled the identification of strategic locations and facilities in the city. This mapping exercise has the potential to be adapted in metro cities and small towns across the country, in alignment with 15th Finance Commission recommendations and the principles of the Ayushman Bharat scheme. As urban settings expand and evolve, the approaches to making available accessible, affordable and quality health care must be able to keep up just as rapidly, looking at not only what services are provided, but who needs and can benefit from them most.

The article has been authored by Mohan HL- CEO, Karnataka Health Promotion Trust.