Urban health systems in India were never a policy and programme priority. However in an increasingly urban India, there has been a sense of urgency for some time now. The Eleventh Five-Year Plan proposed to introduce the National Urban Health Mission (NUHM) as a “thrust area”, which in conjunction with the National Rural Health Mission (NRHM) would form the Sarva Swasthya Abhiyan. The Healthy Cities and Municipalities Movement approach of the WHO called for putting health high on the political and social agenda, underpinned by the principles of the Health for All strategy emphasising equity, participatory governance and inter-sectoral collaboration to address the social determinants of health.
Urban health systems are highly complex entities involving “sub-actions” across many institutions with numerous goals. NUHM however envisages organisation of service delivery is a more simplistic manner as a matter of distribution of services across different facilities and human resources, choices of technology and programme design and financing. The Mission focuses on the primary level in particular. This presentation shall explore in greater detail the complexities of the urban systems such as basic patterns of urban healthcare delivery systems; their strengths and limitations; utilisation experiences of existing institutions; potentially optimal solutions for ‘mix-and-match’ of needs, services and facilities; and optimal package of services at various levels of healthcare delivery. Some of the more challenging domains include communitisation options, ‘legacy management’, financing and governance.
Dr. Rajib Dasgupta graduated in medicine from the University of Calcutta in 1989 and obtained his Masters and PhD in Community Health from Jawaharlal Nehru University, New Delhi. He served a decade with the Epidemiology Division of the Municipal Corporation of Delhi and dealt with Plague, Dengue and SARS epidemics – problems that were challenging both technically as well as politically. He joined the Centre of Social Medicine & Community Health, Jawaharlal Nehru University in 2003 where he is currently Professor and Chairperson. He was Fulbright Senior Research Fellow and Visiting Associate Professor at the Johns Hopkins Bloomberg School of Public Health during 2010-11. His book, Urbanising Cholera: The Social Determinants of its Re-emergence has recently been published by Orient Blackswan. He is closely engaged with key national programs and policies including as Member, Expert Group, National Committee for Certification of Polio Eradication and Convener, WG2, Technical Resource Group, National Urban Health Mission.
