The mushrooming challenge of urban
poverty and deprivation

THE
GROWTH
OF THE
URBAN POOR

2%

Overall Population Growth

3%

Urban Population Growth

4%

Mega-City Population Growth

5%

Slum Population Growth

STORY BEHIND THE NUMBERS

While the well to do have access to a diversity of healthcare facilities, the urban poor find even basic medical access beyond their means. In fact, the gap between services accessible by the urban population and its poorest sections is evident from studies that have found that urban poor remain under-served by the health system. Their health status is worse than that of the rural poor.

This website offers a peek into the role USAID has played to focus attention on the health of the urban poor and development of the National Urban Health Mission to improve healthcare for them.

The Need for an Urban Health Programme

According to the World Health Organization (WHO), urbanization is one of the leading global trends of this century. Increasing urbanization directly affects the quality of health available to the most vulnerable of its residents. Experts say that by 2050, over 68 per-cent of the world's population will live in cities.

While cities may offer the promise of prosperity, they also face significant health challenges. The urban poor face the risk of epidemics of HIV/AIDS, TB, pneumonia, diarrhea and malaria given the density of slums. Additionally, there has been rapid growth in non-communicable diseases like asthma, heart disease, cancer and diabetes.

THE ORIGINS OF THE PROGRAMME

The Urban Health Timeline

The National Urban Health Mission (NUHM) programme has expanded across India, providing free health care to about 200 million people. Until the year 2000 there were only sporadic campaigns with no programmatic approach for health. This changed, but slowly, and over 15 years. The timeline chronologically maps the journey of the Urban Health legacy in India.

2000

USAID MISSION
TO INDIA

Identified urban health as an important focus area

Set up the Environment Health Office to orient government policy and create evidence and models

"USAID provided a systematic approach to urban health programme"

Mr. A R Nanda

Former Health Secretary

2002

ENVIRONMENT HEALTH
PROJECT STARTS

The Environment Health Project, modeling urban health care

  • The Environment Health Project, modeling urban health care
  • USAID launched this project in Indore followed by Agra
  • he objectives were to demonstrate a model that would provide health services to the last mile and effectively create a demand for health services among the urban poor

The Results

  • Developed a method to identify the most vulnerable in a city
  • Piloted a model to deliver services to them
  • Created community structures that created demand and facilitated service delivery
"Being an ASHA has given me recognition in my community. Since 2003, I have worked as an ASHA. I take people to hospitals or anganwadis if they have health issues. People look up to me to resolve disputes and other issues as well."

Usha Kushwaha

ASHA

2005

URBAN HEALTH RESOURCE
CENTRE SET UP

Urban Health Resource Centre, building up local resources

UHRC built on EHPs' success with demonstration projects in Delhi and Meerut. It generated, compiled and disseminated information on urban health to address knowledge gaps and draw attention to the poor state of the health of the urban poor.

2009

HEALTH OF THE
URBAN POOR STARTS

Health of the Urban Poor, scaling up the model

Following the success of EHP, and keen to try it out at larger scale, USAID initiated the Health of the Urban Poor project. It expanded to half a million people in eight states and five cities. HUP's team drew on EHP and its own lessons while drafting the framework and guidelines for the National Urban Health Mission. Many aspects of the two projects found space in NUHM.

Over the next few years, HUP's team:

  • Drew up urban health plans in Odisha and Chhattisgarh
  • Reorganized state health societies in Uttarakhand
  • Brought in health determinant-based approaches in Rajasthan's state program
  • Included WASH activities in urban health in Uttarakhand, Chhattisgarh and Rajasthan
  • Generated evidence and focused on health determinants in all states
2014

NATIONAL URBAN
HEALTH MISSION LAUNCHED

National Urban Health Mission, the national program

NUHM was launched in January 2014. It incorporated most elements from the USAID-supported EHP and HUP projects. As a major milestone of USAID's support to improving urban health in India, NUHM covers 200 million urban poor people across all states. The major threads it has picked up from EHP and HUP are

  • Vulnerability mapping through NGOs and CBOs
  • Expanding access to health care through ASHAs, primary care centres and health camps
  • A policy and program framework with guidelines for state

Download the Report

This detailed report on the Urban Health programme in India highlights the various facets of the programme – from project to programme, from first steps to challenges including methodologies, evidences and impact.

DOWNLOAD
Disclaimer: This website is made possible by the support of the American People through the United States Agency for International Development (USAID). The Learning4impact partnership is supported by USAID/India Health Office, under Cooperative Agreement # 72038618CA00001 with Swasti. The information provided on this website is not official U.S. Government information and does not necessarily represent the views or positions of USAID, the United States Government, or Swasti.
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