BENGALURU: Despite a 10-fold difference in cost between public and private health facilities, the urban poor are increasingly opting for non-government care, revealed a report released by Azim Premji University titled 'Health Care Equity in Urban India'.
"Availability of urban public health services via urban Primary Health Centres falls far short of the government’s own norms by about 40% across the country. In addition, the available facilities are poorly distributed, and often located far away from slums and other areas that house the most vulnerable," the study stated.
For example, 30 percent of even the poorest quintile in India seek delivery care from private sources, resulting in high out-of-pocket expenditure. Such inequities in access to and cost of services result in the poor delaying or entirely forgoing health services, particularly those with chronic conditions requiring long-term care.
The study also pointed to a disproportionate disease burden on the poor, where the life expectancy among the poorest is lower by 9.1 years and 6.3 years among men and women, respectively, compared to the richest in urban areas.
"For some health conditions, the disease burden is higher among the urban poor even when compared to the rural poor, such as underweight, obesity and tuberculosis among children. The exposure to risk factors such as alcohol, khaini and smoking are much higher among the urban poor as compared to the urban rich and the rural poor. Mental ill-health is also more prevalent in urban areas, especially in lower socio-economic groups and women," the report found.
The study examined health systems in Bengaluru, Raipur, Thiruvananthapuram and Davanagere where a major governance challenge is overlapping jurisdictions of state health services and urban local bodies causing chaos.
"Lack of sufficient health personnel in government facilities, including doctors, nurses, and other paramedics, as well as poor infrastructure and lack of essentials such as drugs and consumables are a direct result of abysmally low budget allocations to urban health," the study said, adding that funding for urban primary health needs to be three-fold.
1) In KG Halli slum of Bengaluru, Primary Health Centres do not always have access to medicine and laboratory services. Also, public care centres do not stock all types of medicines to manage non-communicable diseases.
2) A dysfunctional referral mechanism overloads tertiary care centres. In Davanagere and KG Halli slum in Bengaluru, even normal deliveries get referred to tertiary level hospitals.
3) In Bengaluru, 16% of slum households spent over 10% of household income on out-patient care. Spending for care of chronic diseases worsened poverty, with some households borrowing money or selling assets.