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Tete-a-tete with Mr. Dhiraj Kumar Nath, Staff Consultant, Urban Health, ADB

What is the present scenario of health service delivery in the urban sector?
In 1974 the urban population was 8.8% and now according to the Population and Health Census the urban population stands at 30% and by 2050 it will be 50%. The total population growth rate is 1.38% but the urban population growth rate is more than 5%. Therefore with such rapid urbanization on process there is very little going on for the development of infrastructure for the urban sector. In 1989 Asian Development Bank initiated the urban primary health care project with collaboration between government and non government organizations. Now it is in its third phase.  Most of the work is being done by the non government organizations with very little intervention by the government.

What are the gaps and challenges in the service delivery?
Urban health care sector has a big gap in service delivery in maternal and child health, post natal care and ante natal care. Still now 72% deliveries are home deliveries and of which only 4-5% are by skilled birth attendant. This arises many complications including RTI and STIs. The social workers and the service delivery workers are not properly trained. The common people are now generally conscious but there is lacking in institutional support. In future urban health care will be a severe burden if the challenges in the urban health sector are not addressed now.

What should be done to address these challenges?
The Ministry of Health and the Ministry of Local Government and Rural Development and Cooperatives should work together for the capacity building of the health workers and the social workers.  These ministries should have a committee which addresses the welfare of the NGO workers as motivation for the workers are largely needed for better service delivery. The government should enhance the capacity building approaches for the health assistants, family welfare assistants and family welfare volunteer. The local government, directorate General of Health and the City Corporations should also be strengthened.

What more can you suggest?
Proper MIS reporting should be done. BCC campaigns on issues like hand washing and child health, breast feeding. Baby nursing has to be strengthened as an intervention from the Ministry of Health and Family Welfare.

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