Context: The report on ‘Health Care Equity in Urban India’ exploring health vulnerabilities and inequalities in cities in India was recently released.
About the report

• The report is released recently by Azim Premji University in collaboration with 17 regional NGOs across India.
• It notes that a third of India’s people now live in urban areas, with this segment seeing rapid growth from about 18% (1960) to 28.53% (2001) to 34% (in 2019).
• The study draws insights from data collected through detailed interactions with civil society organizations in major cities and towns.
• This also included an analysis of the National Family and Health Surveys (NHFS), the Census of India, and inputs from State-level health officials on the provision of health care.
• It also looks at the availability, accessibility, and cost of healthcare facilities, and possibilities in future-proofing services in the next decade.

Key highlights of the report

• Urban poverty on rise: Close to 30% of people living in urban areas are poor.
• Declining life expectancy: Life expectancy among the poorest is lower by 9.1 years and 6.2 years among men and women, respectively, compared to the richest in urban areas.
• Chaotic health governance: The report, besides finding disproportionate disease burden on the poor, also pointed to a chaotic urban health governance.
• Multiplicity and non-coordination: The multiplicity of healthcare providers both within and outside the government without coordination challenges to urban health governance.
• Lack of political attention: Urban healthcare has received relatively less research and policy attention.

Major recommendations
The report calls for

• Strengthening community participation and governance
• Building a comprehensive and dynamic database on the health and nutrition status, including co-morbidities of the diverse, vulnerable populations
• Strengthening healthcare provisioning through the National Urban Health Mission, especially for primary healthcare services
• Putting in place policy measures to reduce the financial burden of the poor
• A better mechanism for coordinated public healthcare services and better governed private healthcare institutions

Road Ahead

• As urbanization is happening rapidly, the number of the urban poor is only expected to increase. A well-functioning, better coordinated, and governed health care system is crucial at this point.
• The pandemic has brought to attention the need for a robust and resourced healthcare system. Addressing this will benefit the most vulnerable and offer critical services to city dwellers across income groups.