Findings

INDEX  : 

Common Health Problem

  • Fever – malaria, dengue, typhoid, upper respiratory tract infections
  • Undernourishment amongst kisoris and young women/ mothers Pockets within slums with more vulnerable groups especially single income families with insecure income- maybe also related to substance abuse and dietary choices
  • Teen pregnancies
  • Multiple pregnancies with problems (some areas worse -Ashapura)
  • Vaccination coverage very poor in some areas
  • Headache (proxy for stress and tension)
  • Abdominal pain – Reproductive health problems
  • Safed pani ( sexually transmitted diseases)
  • Substance abuse amongst adults and adolescent youth in most areas
  • Anemia (may be related to substance abuse)
  • Men's health issues

Health knowledge /awareness

  • Huge knowledge gaps about disease prevention including vaccinations- measles immunisation rates extremely low (cultural barriers, fear) so herd immunity absent
  • Health related behaviours- connection between hygiene and health- boiling drinking water, poor personal hygiene, disposal of body waste materials -cultural and educational
  • Antenatal check-ups infrequent or absent amongst some groups, gaps in post natal care and care of the newborn, iron/ calcium supplements
  • Family planning issues centred around religious/ cultural barriers
  • Cultural barriers especially with sexually transmitted diseases can mean inadequate treatment / health communication in culturally sensitive manner/ men's health issues

Coverage of Child Health Services in Urban Slums of 6 Municipal Corporations and Rural Areas of Gujarat

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Entitlements

  • Land tenure absent- All except GIDC are unlisted slums so civic services missing especially waste disposal, drainage
  • BPL cards confusion – some not aware whether they are still registered
  • Some clearly eligible but without BPL cards
  • Knowledge of entitlements due under BPL cards
  • Promised payments that never arrive or incomplete payments
  • Accountability issues within public health care delivery (cause of death/ disability)
  • Bureaucratic system makes it difficult to obtain BPL cards
  • Issues with supplies at anganwadis/ physical location
  • No primary health centre within close proximity so most use private facilities and spend Rs 5000 to 20,000 annually depending on complexity of illness

Physical environment

  • No waste disposal services so pile up of hazardous waste as a public health issue
  • No gutters or overflowing gutters in some slum areas
  • Unstable and often unsafe water supply (Shivam Ram)
  • Sanitation issues with some households lacking adequate facilities
  • Overcrowded living arrangements
  • Poor public lighting

Education

  • Cultural barriers especially with young girls- approximately 90% in the FGDs did not go to school past 7th grade perpetuating cycle with marriages arranged at young age (15-20 years) to similarly lower educated boys.
  • Financial barriers - most secondary schooling is in Bhuj centre and slum areas are further out so transport costs prohibitive
  • Undernourishment / anemia may be responsible for lack of attention or apathy amongst young girls.

Community cohesiveness

  • Most slum areas comprised of mixed communities divided along socioeconomic lines, caste, religion and ethnicity
  • Some areas had inherent problems of illegal liquor brewing, gambling including women which fractures communities and the neighbourhood showed obvious signs of neglect – Valmiki Nagar
  • Lack of land tenure gives little incentive to improve physical environments of unlisted slums- households, green spaces, responsible waste disposal

System level issues

  • Focus still on rural health while urban migration has put pressure on urban services which cannot cope
  • Large under-served slum areas (8 sub centres planned in the Urban Health Plan) UH plan needs to take into account unlisted slums and situate sub centres / anganwadis accordingly
  • Little political will
  • Inadequate human and financial resources (2 nurses each servicing 23 anganwadis (8 positions) limiting reach. CBV 10 in all with target of 23 – 1 per 2000 slum population
  • Inefficiencies in operating
  • Private facilities especially charitable trusts fill health services gap as they often prove cheaper than government facilities
  • System level issues -contd
  • Anganwadi hours not convenient for women who work or perceived as “not for us”
  • Lack of inter-sectoral collaboration or influence with non health sectors that impact on health (housing, education, water, sanitation, urban planning, services such as outdoor mosquito sprays)
  • Urban Health focusses on family planning and vaccination numbers without the supportive structure to address cultural barriers and behaviour change
  • Little faith in the public system- difficult to navigate, time consuming, transport costs - low demand and usage of services (“You only get a bed there”) except by the very poor

Existing services - Mamta Day Datarniya Vas

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