India is witnessing rapid (often unplanned) urbanisation. A third of India’s people are now living in urban areas! According to the Census of India (2011), India’s urban population has seen a rapid growth from about 18% (1960) to 34% in 2019. Yet provisions of services including health care are not commensurate with this growth.

Urban India now comprising close to 30% of all the poor, calls for a compelling policy response and the need to attend to urban health care issues on a priority basis. Who are the urban poor? What explains their health vulnerabilities? Who is responsible and accountable to provide health care in urban areas – State Health Department, Urban local bodies, industrial hospitals, central government schemes, private hospitals? How is National Urban Health Mission (rolled out in 2013) is being implemented to streamline health care provision specifically for the range of poor and vulnerable groups? What actions are needed and by whom to address health inequity in urban areas? The Report ​‘Health care equity in urban India’ addresses these questions head on.

The report is based on the data drawn from detailed interactions with civil society organisations working on urban health in different cities and town across geographies including Mumbai, Bengaluru, Surat, Lucknow, Guwahati, Ranchi, Delhi etc., inputs from health officials in select cities, analysis of select databases including NFHS, Census of India, government websites and secondary literature on urban health. It also outlines the detailed provision and governance of health care in four different cities and towns including Bengaluru (Tier I), Thiruvanthapuram (Tier II), Raipur (Tier II) and Davanagere (Tier III). 

The report outlines how urban poor is not a homogenous category and their vulnerabilities are complex deriving from poor work and living conditions, inadequate access to safe drinking water, sanitation, poverty, and social exclusion. Data clearly show how the poor and vulnerable groups in urban areas bear a disproportionate burden of diseases and poor health outcomes. 

Urban health governance is chaotic with a range of providers without any coordination resulting in overlapping jurisdictions and fragmented accountability to the communities they serve. Availability of urban public health services — via urban Primary Health Centres (UPHCs) — falls far short of the government’s own norms by about 40% across the country (Source: Rural Health Statistics 2019 – 20, Ministry of Health and Family Welfare, Govt. of India).

“Urban primary healthcare infrastructure in India needs an architectural correction. The Government must establish at least one Health and Wellness Centre for 5 – 1 thousand urban population,” states Samir Garg, Director, State Health Resource Centre, Chhattisgarh.

The report calls for specific actions at community, health systems and policy levels to address growing health inequalities in urban areas. 

As the process of urbanisation is happening at a rapid pace, the number of urban poor is expected only to increase. A well-functioning, better coordinated and governed health care system is the need of the hour for catering health needs not only of the vulnerable populations, but also of all. COVID19 pandemic has reminded us all, that the time to act is NOW!