Urban Health: Slipping Through the Cracks

• What is the core message conveyed in your paper? 

Even though policy changes that have been advocated, formulated, and operationalised over the years for addressing urban health concerns in India including major government initiatives like the National Urban Health Mission, and the success of decentralisation via the 74^th Constitutional Amendment, the findings indicate that India currently lacks a coherent and cogent approach towards urban health. There is fragmentation both at the administrative and governance levels with diverse set of rules and policies across different urban entities in the country.

• What presents the biggest opportunity? 

To realistically address urban health, there is a need to work on two fronts simultaneously; 1) to bring all urban health facilities under one umbrella, whether in an existing ministry or creating a separate body for urban health. The administration can be unified and would be responsible for planning, research, coordination, and implementation. The finances can be from a diverse set of sources, but the planning for the finances for urban health needs to be done in an integrated manner.

In a parallel fashion, a multisectoral team can start an exercise of mapping the various sources of service provision and their finances, to assess the gaps therein and draw out a plan for human resources, infrastructure, and financing for urban health with roles and responsibilities of the major actors and players. To implement these effectively, a separate administrative body should be set up for urban health and a time-bound plan should be drawn out and implemented in a pre-planned manner.

2) There needs to be a policy initiative aimed at reducing the dependence of ULBs on the state and central governments for finances, as well as directives on how to utilise the funds. In addition to this, there is also an urgent need to increase overall public health spending in India.

Besides these, a robust health information system for urban areas that also provides the size of the target population in each category would be beneficial in the effective monitoring and evaluation of the National Urban Health Mission (NUHM).

• What is the biggest challenge? 

The horizontal and vertical fragmentation in urban health administration and governance is one of the biggest challenges in achieving equity in urban health outcomes. Several programs within and across ministries lack a coherent health coverage program covering basic health services, especially for informal sector workers.