Health emergencies: Research points to practical financial solutions for India’s urban poor

May 22, 2013 · 0 comments

Health emergencies: Research points to practical financial solutions for India’s urban poor | Source: May 9, 2013, RAHIL RANGWALA |

How do Indian families living in urban poverty approach health care? To answer this question and better understand how to structure a customized emergency health loan product for India’s urban poor, the foundation recently commissioned a study of families in five Mumbai slums. 

The research, conducted between December 20, 2012 and February 8, 2013, surveyed members of 545 low-income households located close to hospitals.

The families surveyed all had monthly incomes ranging between INR 7,500 to 20,000 (US $139 to $370.) When the results were collated, we learned that:

  • 82 households had a major health issue in the last two years. Reported ailments included cardiac issues, broken bones, accidents, malaria, dengue fever and others.
  • The average cost to treat heart-related illnesses, which topped the list of major illnesses, was INR 82,000 (US $1,515.)
  • Around 50 percent of participating households had taken out loans at interest rates of over 60 percent per annum to meet their health financing needs.
  • Local private clinics (usually unlicensed medical practitioners) were typically the first point of contact for respondents seeking care. As such, these clinics play an important role in influencing behavior for both minor and major ailments.
  • Respondents were skeptical or wary of private hospitals, because they worried about either being overcharged or being treated poorly.
  • Participants had a positive perception of government-run hospitals, where they felt they would be well treated at an affordable cost.
  • Participants responded positively to the concept of an emergency health loan at an interest rate of roughly 20 percent per annum.
  • Private hospitals offer differential pricing based on ability to pay.

[click to continue…]

Bookmark and Share

UNICEF – Cholera Toolkit 2013

May 17, 2013 · 0 comments

To tackle the alarming resurgence of cholera, UNICEF has launched a new comprehensive Cholera Toolkit on 15 May 2013.

The toolkit launch [...] will be the culmination of a thorough review of existing guidance and global consultation with UNICEF at all levels and from all divisions in Africa, along with main partners in the fight against cholera, such as the World Health Organization as the lead agency.

There are 3-5 million cholera cases each year, killing 100,000 to 120,000 people, half of whom are children under 5 years old. Only 5-10% of cases are reported. In Western and Central Africa, there were more than 80,000 cases of cholera in 2012 resulting in nearly 1,500 deaths.

The Toolkit provides the health and WASH sectors an integrated approach to cholera prevention, preparedness and response. In addition it includes specific content linked to education, nutrition, communication for development (C4D), child protection and other relevant sectors.

UNICEF Cholera Kit, p. 41 UNICEF Cholera Kit, p. 41

“What the toolkit does is harvest the best and most up-to-date knowledge in the field and brings it together in one location,” said UNICEF Chief of Water, Sanitation and Hygiene Sanjay Wijesekera. “It looks at the evidence. It looks at practices that have produced results.”

Download the Toolkit at: www.unicef.org/cholera

Related websites:

Source: UNICEF, 15 May 2013

India – For better health

May 16, 2013 · 0 comments

India – For better health | Source: Deccan Herald, May 11, 2013 |

The Union cabinet’s approval for the launch of a national urban health mission (NUHM) is welcome for its aim of providing basic health services to the poor and disadvantaged sections in cities and towns.

The Rs 22,500 crore programme plans to cover 7.75 crore people living in 779 urban clusters and is mainly targeted at the poor people living in slums. The national rural health mission (NRHM) was launched in 2005 and it has taken about eight years to design a similar programme for city-dwellers.

Both missions will be part of the bigger national health mission. The launch of a populist programme intended to benefit large numbers of people months before elections may have a political angle. But that should not detract from the value of the programme if it is implemented efficiently.

Provision of public health facilities to the poor and needy is the responsibility of the state. All the health indicators in the country are much below par. The poor cannot afford even meagre expenses on health and so the government has to provide the infrastructure and personnel to them.

The scheme at present intends to provide one health centre for 10,000 people and nursing midwives and health activists for specified numbers of people and households. Seventy-five per cent of the funding will be met by the Centre in most states. As different from the NRHM, the programme seeks to involve non-government bodies also in the NURM as these are active in many urban areas. A decentralised system of implementation involving state, district and ward level bodies is envisaged so that the programme can reach the lowest levels.

The aims, design and methods of the programme may be good but its success will depend on how well it is administered. The NRHM has suffered in many places from corrupt practices like leakage and misutilisation of funds and failure to create necessary health infrastructure and to reach out to the needy people. The lessons should guide the implementation of the NURM.

However the strategies will have to be different for rural and urban areas. In the NURM there is a proposal to reimburse private practitioners for their services at government rates. The accent should be on providing necessary infrastructure and services by the government. It will also have to be supported by schemes for sanitation, clean drinking water and other basic conditions for good health.

India – Cabinet approves launch of National Urban Health Mission

May 16, 2013 · 0 comments

Cabinet approves launch of National Urban Health Mission | Source: Big News Network, May 1, 2013 |

The Union Cabinet on Wednesday approved the launch of National Urban Health Mission (NUHM) to reduce rates of infant mortality, maternal mortality and for universal access to reproductive health care.

The scheme, which will focus on the primary health care needs of the urban poor, will be implemented in 779 cities and in towns that have a population of over 50,000. It will cover about 7.75 crore people.

The estimated cost of NUHM for a five year period is Rs.22,507 crore, with the Central Government’s share of Rs.16,955 crore.

The Centre-State funding pattern of the scheme will be seventy five is to twenty five.

However for North Eastern states and other special category states like Jammu and Kashmir, Himachal Pradesh and Uttarakhand, the funding pattern between Centre and State governments will be ninety is to ten.

Recognizing the seriousness of the problem, urban health will be taken up as a thrust area for the Eleventh Five Year Plan.

The NUHM will be launched with focus on slums and other urban poor. At the state level, besides the state health mission and state health society and directorate, there would be a state urban health programme committee.

At the district level, similarly there would be a district urban health committee and at the city level, a health and sanitation planning committee.

At the ward slum level, there will be a slum cluster health and water and sanitation committee.

For promoting public health and cleanliness in urban slums, the Eleventh Five Year Plan will also encompass experiences of civil society organizations (CSO) working in urban slum clusters.

It will seek to build a bridge of NGO-GO partnership and develop community level monitoring of resources and their rightful use.

Economic Inequalities in Maternal and Child Health in Urban India

April 30, 2013 · 0 comments

Goli S, Doshi R, Perianayagam A (2013) Pathways of Economic Inequalities in Maternal and Child Health in Urban India: A Decomposition Analysis. PLoS ONE 8(3): e58573. doi:10.1371/journal.pone.0058573.

Background/Objective – Children and women comprise vulnerable populations in terms of health and are gravely affected by the impact of economic inequalities through multi-dimensional channels. Urban areas are believed to have better socioeconomic and maternal and child health indicators than rural areas. This perception leads to the implementation of health policies ignorant of intra-urban health inequalities. Therefore, the objective of this study is to explain the pathways of economic inequalities in maternal and child health indicators among the urban population of India.

Methods – Using data from the third wave of the National Family Health Survey (NFHS, 2005–06), this study calculated relative contribution of socioeconomic factors to inequalities in key maternal and child health indicators such as antenatal check-ups (ANCs), institutional deliveries, proportion of children with complete immunization, proportion of underweight children, and Infant Mortality Rate (IMR). Along with regular CI estimates, this study applied widely used regression-based Inequality Decomposition model proposed by Wagstaff and colleagues.

Results – The CI estimates show considerable economic inequalities in women with less than 3 ANCs (CI = −0.3501), institutional delivery (CI = −0.3214), children without fully immunization (CI = −0.18340), underweight children (CI = −0.19420), and infant deaths (CI = −0.15596). Results of the decomposition model reveal that illiteracy among women and her partner, poor economic status, and mass media exposure are the critical factors contributing to economic inequalities in maternal and child health indicators. The residuals in all the decomposition models are very less; this implies that the above mentioned factors explained maximum inequalities in maternal and child health of urban population in India.

Conclusion – Findings suggest that illiteracy among women and her partner, poor economic status, and mass media exposure are the critical pathways through which economic factors operate on inequalities in maternal and child health outcomes in urban India.

Solid waste management in African cities: Sorting the facts from the fads in Accra, Ghana

April 30, 2013 · 0 comments

Solid waste management in African cities: Sorting the facts from the fads in Accra, Ghana. Habitat International, Volume 39, July 2013, Pages 96–104.

Martin Oteng-Ababio, et al.

Municipal solid waste management continues to be an environmental health burden in many African cities. Overwhelmed with the magnitude of the problem, city authorities tend to seek out ‘environmentally friendly’ but costly “win–win” technologies via public-private partnerships with firms often from the North, yet these technologies may be inappropriate for the local conditions. While the authorities’ intentions may be laudable, the approach may be born out from an empirical vacuum. Using case studies from Accra, we illustrate how investments in new solid waste management technologies may well be ill-fated if the requisite waste stream composition data does not exist to justify such investments.

We also highlight the importance of recognizing the innovations of “informal” waste pickers and legitimizing them with the formal system. Until the evidence – along with appropriate institutional and financial instruments – show favorable conditions for investing in advanced waste management technologies, authorities in African cities would do well to consider integrating proven innovations taking place in their own “backyard.”

Toxocariasis in Waste Pickers: A Case Control Seroprevalence Study

April 30, 2013 · 0 comments

Alvarado-Esquivel C (2013) Toxocariasis in Waste Pickers: A Case Control Seroprevalence Study. PLoS ONE 8(1): e54897. doi:10.1371/journal.pone.0054897.

Background – The epidemiology of Toxocara infection in humans in Mexico has been poorly explored. There is a lack of information about Toxocara infection in waste pickers.

Aims – Determine the seroepidemiology of Toxocara infection in waste pickers.

Methods – Through a case control study design, the presence of anti-Toxocara IgG antibodies was determined in 90 waste pickers and 90 age- and gender-matched controls using an enzyme-linked immunoassay. Associations of Toxocara exposure with socio-demographic, work, clinical, and behavioral data of the waste pickers were also evaluated.

Results – The seroprevalence of anti-Toxocara IgG antibodies was significantly higher in waste pickers (12/90: 13%) than in control subjects (1/90: 1%) (OR = 14; 95% CI: 2–288). The seroprevalence was not influenced by socio-demographic or work characteristics. In contrast, increased seroprevalence was found in waste pickers suffering from gastritis, and reflex and visual impairments. Multivariate analysis showed that Toxocara exposure was associated with a low frequency of eating out of home (OR = 26; 95% CI: 2–363) and negatively associated with consumption of chicken meat (OR = 0.03; 95% CI: 0.003–0.59). Other behavioral characteristics such as animal contacts or exposure to soil were not associated with Toxocara seropositivity.

Conclusions – 1) Waste pickers are a risk group for Toxocara infection. 2) Toxocara is impacting the health of waste pickers. This is the first report of Toxocara exposure in waste pickers and of associations of gastritis and reflex impairment with Toxocara seropositivity. Results warrant for further research.

India – The high cost of diarrhoeal illness for urban slum households-a cost-recovery approach

April 8, 2013 · 0 comments

BMJ Open. 2013 Apr 3;3(4). pii: e002251. doi: 10.1136/bmjopen-2012-002251.

The high cost of diarrhoeal illness for urban slum households-a cost-recovery approach: a cohort study.

Patel RB, Stoklosa H, Shitole S, Shitole T, Sawant K, Nanarkar M, Subbaraman R, Ridpath A, Patil-Deshmuk A.
Departments of Emergency Medicine, Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract

OBJECTIVES: Rapid urbanisation has often meant that public infrastructure has not kept pace with growth leading to urban slums with poor access to water and sanitation and high rates of diarrhoea with greater household costs due to illness. This study sought to determine the monetary cost of diarrhoea to urban slum households in Kaula Bandar slum in Mumbai, India. The study also tested the hypotheses that the cost of water and sanitation infrastructure may be surpassed by the cumulative costs of diarrhoea for households in an urban slum community.

DESIGN: A cohort study using a baseline survey of a random sample followed by a systematic longitudinal household survey. The baseline survey was administered to a random sample of households. The systematic longitudinal survey was administered to every available household in the community with a case of diarrhoea for a period of 5 weeks.

PARTICIPANTS: Every household in Kaula Bandar was approached for the longitudinal survey and all available and consenting adults were included.

RESULTS: The direct cost of medical care for having at least one person in the household with diarrhoea was 205 rupees. Other direct costs brought total expenses to 291 rupees. Adding an average loss of 55 rupees per household from lost wages and monetising lost productivity from homemakers gave a total loss of 409 rupees per household. During the 5-week study period, this community lost an estimated 163 600 rupees or 3635 US dollars due to diarrhoeal illness.

CONCLUSIONS: The lack of basic water and sanitation infrastructure is expensive for urban slum households in this community. Financing approaches that transfer that cost to infrastructure development to prevent illness may be feasible. These findings along with the myriad of unmeasured benefits of preventing diarrhoeal illness add to pressing arguments for investment in basic water and sanitation infrastructure.

Understanding the nature and scale of urban risk in low- and middle-income countries

April 1, 2013 · 0 comments

Understanding the nature and scale of urban risk in low- and middle-income countries and its implications for humanitarian preparedness, planning and response, 2013.

David Dodman, et al. International Institute for Environment and Development.

More than half of the world’s population now lives in urban centres. Most of the world’s urban population and its largest cities lie outside the most prosperous nations and almost all future growth in the world’s urban population is projected to be in low- and middle-income countries. Within these urban centres it is common for up to 50 per cent of the population to live in informal settlements. These are often located on land that is exposed to hazards, with poor-quality provision for water, sanitation, drainage, infrastructure, healthcare and emergency services. The residents of these low-income and informal settlements are therefore highly vulnerable to a range of risks, many of which are specific to urban settings.

Yet despite this, many humanitarian agencies have little experience of working in urban areas, or of negotiating the complex political economies that exist in towns and cities. This working paper has two main purposes: (1) to review the quality of the evidence base
and to outline knowledge gaps about the nature and scale of urban risk in low- and middleincome countries; and (2) to assess the policy implications for humanitarian preparedness, planning and response. It does so by analysing a wide range of academic and policy
literature and drawing on a number of interviews with key informants in the field. It particularly focuses on evidence from Africa and Asia, but also draws on case studies from Latin America, because many examples of good practice come from this region. The paper
aims to help ensure that humanitarian and development actors are able to promote urban resilience and disaster risk reduction and to respond effectively to the humanitarian emergencies that are likely to occur in cities.

Nairobi – Bad Air, Ill Health: Air Pollution in Urban Slums

March 25, 2013 · 0 comments

Bad Air, Ill Health: Air Pollution in Urban Slums | Source: By Thaddaeus Egondi and Diana Warira, African Population & Health Research Center, March 1, 2013 |

Although there is a wealth of information on the health consequences of air pollution, little information exists on the level of air pollution in LMICs (Lower-middle-income countries), in general, and in urban areas, in particular. In Nairobi, Kenya’s capital city, for example, the few studies that have assessed air pollution levels have been conducted along roads and provide a limited picture of exposure levels in residential areas.

Yet we know that air pollution – obviously present in poor urban areas– has been linked to respiratory infections, heart problems, lung cancer and undesirable pregnancy outcomes, such as low birth weight and still births. The World Health Organization (WHO) estimates that air pollution leads to 3.1 million premature deaths worldwide every year. More than half of the global burden of disease stemming from air pollution occurs in LMICs.

Research indicates that young children, expectant mothers, old people, and those with chronic health problems, such as asthma, heart and lung disease, suffer more when exposed to air pollution. The extent to which an individual is harmed by air pollution usually depends on thetotal exposure to pollutants, a measure of the duration of exposure and the concentration of the pollutants.

Slums are a pervasive feature of many cities in LMICs. The level of air pollutants in slum settlements is likely to be higher than in non-slum settings due to close proximity to industries, dust from unpaved roads, poor waste disposal, burning of trash and heavy use of solids fuels such as charcoal and wood. Nairobi as one of the rapidly growing cities is not exceptional from these environmental concerns. Research we have done at the African Population and Health Research Center (APHRC) on the main fuel type for household energy needs in two slums (Korogocho and Viwandani) indicates that 84% of households use kerosene/paraffin, 14% charcoal and 2% use other fuels such as firewood, animal waste and gas. Outdoor air pollution in slum setting contributes to the level of indoor air pollution because of infiltration of air pollutants into poorly ventilated structures.

It’s Time to Monitor Air Quality

Establishing air pollution levels and associated health impacts is critical for programmatic and policy action to reduce air pollution levels. Quantifying the health impact of air pollution is a challenge faced by LMICs due to the lack of health outcome registries and air monitoring data.

In response to this gap, APHRC has recently initiated a study on air pollution in two urban slums in Nairobi (Korogocho and Viwandani). This study, which is nested in the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), aims to understand community perceptions on air pollution, and assess the level of air pollution and related health effects. In addressing these objectives, the Center will start monitoring indoor and outdoor air pollution levels in the two slums.

The study provides an important first step in providing community-level air pollution information to policy makers. In addition, it is envisaged that sharing the findings from the study with community residents will create awareness on exposure risk and encourage urban slum residents to take measures to reduce pollution levels in their community.  In the long run, this vital information about urban environments may not only decrease the health burden associated with pollution, but also serve to decrease emissions and mitigate the effects of global warming.

← Previous Entries

Next Entries →