Urban health: Slipping through the cracks

A large volume of evidence sharply highlights the rural-urban divide in health outcomes in India, along with the differences in availability, accessibility, and affordability of health care services between rural and urban areas. This paper attempts to address the challenges of urban health in India. It reviews current definitions of ‘urban,’ administrative and governance challenges, major government initiatives, and the success of decentralisation—an important factor for improving urban indicators—via the 74th Constitutional Amendment.

The paper finds that India is far from reaching the goal of effective self-governance of local bodies in urban areas, and one casualty of this gap has been the lack of a coherent and cogent approach towards urban health. Urban health outcomes remain adverse, especially for the urban poor, and service provision remains woefully inadequate for all, with a disproportionate burden on the less privileged. The lack of equitable and available primary care services, coupled with overburdened secondary and tertiary care services with inadequate availability of human resources and infrastructure, has led to high out-of-pocket expenditures for many households without financial protection. Sensibly addressing urban health requires an urgent overhaul of institutional, administrative, and governance structures that often work in parallel without converging. Such reform would have a far-reaching impact on not only the health sector but on sectors such as education, labour, water, and sanitation as well.

The paper can be accessed here.

This article is authored by Indrani Gupta & Alok Kumar Singh, CSEP.