As per the Census 2001, 22.2 percent of the total population of Jharkhand state is living in towns and cities. Half of the urban population in Jharkhand concentrated in four cities Jamshedpur (particularly in Adityapur, Jugsalai and Mango suburbs), Dhanbad, Bokaro Steel City and Ranchi. With the rapid urbanization in Jharkhand, State Government has initiated many steps to improve the health conditions of the people residing in the urban area of Jharkhand. Although in recent time due to deteriorating health status of the urban poor has drawn attention of the policy makers and Government has launched various programmes for improving the living condition of the urban poor. In this connection an analysis is being done to understand the condition of the urban poor in Jharkhand. One of the major problems in analyzing the condition of the urban poor is the dearth of data as very limited data is available in this arena. In this analysis data from Census-2001, NFHS- III, reports from Health department has been drawn. These data indicates the status of the urban poor in urban area which will help us to devise our strategy and meet the goals of the programme. This analysis will pave the way for our future strategy and will fix the thrust area for the programme. Further, data pertaining to vital rates and demographic measures, such as sex ratio and mean age of marriage, through valuable light on gender dimension. While IMR has decreased from 33% in 2005 to 31% in 2007, birth rate and death rate has increased correspondingly in the same way. Thus one of our major strategies would be decrease IMR in urban area. One of the major causes of increase in IMR in urban area is absence or poor status of health facilities. Census shows negative decadal growth in urban population. Urbanization has picked up after the formation of new state due to migration and development activities. Poor livelihood opportunities and increasing naxal activities in the rural areas accelerated the migration of rural population to urban areas. The decadal growth of urban population is 28.36% in comparison to the rural population of 27.97%. Poverty estimates are 20.1 percent for urban Jharkhand which is higher than the urban poverty levels (23.6 per cent) in the country. In absolute terms, the State houses 23.9 lakh urban poor. However, these estimates do not reflect the true magnitude of urban poverty because of “un-accounted” for, unrecognized squatter settlements and other populations residing on pavements, construction sites, fringes etc. Health indicators suggest that 85.5% of the deliveries in Urban Poor are at conducted at home and only 14.4% deliveries are conducted at health centers. This also implies that only 14.4% deliveries are attended by a health professional at home or at health center. 2001 Census depicts that the infant mortality rate is 57.4 % as against the child mortality rate of 89.4%. Urban Health Status of Jharkhand is also alarming as NFHS-II & III describes that Infant Mortality Rate is around 50/1000 and under age 5yrs mortality is even higher which is 58/1000. Only 17.5% of urban women received complete ANC and an institutional delivery among urban poor is 26.9%. Total unmet need for urban poor is 22%. Unplanned rapid urbanization has given rise to problems such as over crowdedness, contaminated water, poor sanitation, smoke-polluted indoor air/air pollution, and exposure to mosquitoes which are favourable to spread serious diseases. Groundwater potential is getting reduced due to urbanization and thus the water quality is deteriorating in state of Jharkhand. Open defecation defiles ecology, pollutes water resources and causes infections in surrounding areas. Existing systems and available resources are often inadequate to deal with the associated social and behavioural factors, thus contributing towards ecological problems and various health implications like Malaria, Typhoid, and Diarrhea, intestinal worms and other water or vector borne diseases. Women and adolescent girls living in informal settlements (slums) are particularly affected by lack of adequate access to sanitation facilities for toilets. Women have different physical needs from men, (for example, related to menstruation) but they also have greater need of privacy when using toilets. Inadequate toilets creates feeling of insecurity and unsafe among women. Only 7% of urban poor have access to piped water which is considered as safe source and less than one third of the urban poor have access to toilet facilities.
Strategies for Urban health:
- Continue with the baseline study and GIS Mapping of Urban Area in 7 identified cities which is in process.
- Strengthening all the 50 existing UHCs.
- Formation of Mahila Arogya Samittee (MAS) and urban social Health activist (USHA) in the remaining 6 districts and 10 days residential training in two alternate quarters for USHA and 4 days non residential training for MAS in two alternate quarters.
- PPP with local bodies/Non government institutions/hospitals to ensure health services for the urban poor population.
- Formation of a state and district level task force
- Convergence with ICDS, water and Sanitation, education, JNNURM and all Municipal Corpora ration.
- IEC /BCC Activities for Urban healthUrban Community based monitoring through MAS and USHA (Shahari Jan Sam wad)