Student Dissertation

Agency : Health Services; Urban Slum; Urban Health; NU Healthcare Needs; Health care Facilities; Slum Dwellers

Objective : To study the key healthcare needs, pattern of utilization of health services, barriers to access health services among dwellers of Krishna Nagar, an identified slum in the urban Shimla, Himachal Pradesh and to document the status of implementation of National Urban Health Mission in the city with special focus on the poor and vulnerable population.

Methodology : A closed ended questionnaire was used to collect information on the healthcare needs, utilization of health services, barriers to access health services from 70 households comprising of 304 individuals of both sexes and all ages selected randomly from the identified urban slum area in the heart of the city of Shimla. Krishnanagar slum was identified as the study area because of the largest inhabitant slum population out of the identified High Focus Areas in Shimla. Access to basic determinants of good health such as housing, water, and sanitation was also elicited. Besides, health needs based on self-reported disease conditions were compiled. Interviews were held with state health department officials, urban local body officials, medical officers and other health staff using interview guides to document the extent of services available and status of implementation of NUHM in Shimla.

Findings : Majority of respondents were living in poor housing and insanitary conditions. Besides the burden of communicable diseases (especially in children), incidence of non-communicable diseases was found to be as high as 42 percent in the survey population. Private medical practitioners were more accessible than government facilities. More than 60 percent sought treatment from private medical facilities for their own ailments as well as for sickness in children. The main barriers to health care identified were time constraints, long waiting time, affordability and attitude of health workers. Despite of close proximity to government health facilities a clear predilection towards private health providers was noticed because of the above-mentioned barriers. However, the Government facilities serve as the main providers for maternal care and child care services. The implementation of NUHM is in its preliminary stages in Shimla and the objective of NUHM to provide primary healthcare services through an array of U-PHC’s with special focus on poor and vulnerable populations needs immediate attention and emphasis. The underprivileged in Shimla continue to have poor access to basic determinants of health as well as to curative services from government sources during illness. The efforts in the planning and implementation of National Urban Health Mission have still to see the wide light of the day.

Setting and Design: A cross-sectional household survey in an identified urban slum in Shimla and interviews with state health department officials and Urban Local Body (Municipal Corporation, Shimla) officials.


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