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Nepal wealthier urban populations. As this report illustrates, the urban poor and other hard-to-reach communities often lack access to basic quality health services. • National human resource plans should include provisions to strengthen the health care delivery system in urban areas and include an assessment of health workforce capacity among slum dwellers and informal settlements that are often neglected by urban health professionals. National plans should include deploying, training and retaining frontline health workers in urban poor settings. These plans must also include ways to address urban health inequalities. • Every child must be in reach of a properly trained, supported and equipped health workers. The human resource plans should include a plan for training new frontline health care workers and other health professionals to deliver health services in urban areas as well as rural areas, particularly among slum dwellers and informal settlements. For example, Ethiopia is training over 4,000 health extension workers in urban areas. • Donors should provide technical and financial assistance to countries to support health systems strengthening and human resources plans and work with countries to ensure that these plans includes a focus on poor urban areas. • Remove financial barriers and ensure quality health care services. Often a barrier to accessing health care services among the urban poor is not due to a lack of health systems but because of poor quality and high cost. For the poorest populations, out-of-pocket expenditures, including user fees, often represent a critical barrier to timely and appropriate care-seeking or cause financial hardship. Mechanisms such as fair and large-scale pooling arrangements should be put in place to allow for cross-subsidization between the rich and healthy and the poor and sick. Direct payments should be eliminated, at a minimum for essential reproductive, maternal, newborn and child health services, or, where this is not yet agreed or seen as practical by decision-makers, sharply reduced to minimize barriers to access and use of these services. • Health systems strengthening plans must ensure good quality health care services. All health facilities should have water, sanitation, electricity and equipment. A zero discrimination policy must be enforced – quality of health services should not vary on the basis of identity, ethnicity, gender, or other factors. • Develop innovative models to address the specific challenges of the urban poor. Reaching the urban poor presents a unique set of challenges – and opportunities. Urban public sector health systems are often weak and under-funded, and strategies that work in rural settings may not be successful in urban settings. Socio-cultural factors require different approaches to community engagement, but greater access to technology, especially media and communications, offers new opportunities for reaching and engaging communities. Private providers are more plentiful, but those offering quality care are typically not 50 Take Action Now for the Urban Poor
Different Patterns of Inequality Require Different Responses Patterns of inequality in child death rates 100 UNDER-5 MORTALITY RATE (DEATHS PER 1,000 LIVE BIRTHS) 90 80 70 60 50 40 30 20 Marginal exclusion Mass deprivation Stepwise Relative equity ● Kenya (2008) ● India (2005) ● Jordan (2009) ● Cambodia (2010) 10 0 Bottom 20% Second 20% Middle 20% Fourth 20% Top 20% Urban poorest Urban richest Patterns of inequality in skilled care at birth 100 Complete coverage 90 BIRTHS ATTENDED BY SKILLED HEALTH PERSONNEL (%) 80 70 60 50 40 30 20 10 Stepwise Mass deprivation Marginal exclusion ● Jordan (2007) ● Egypt (2008) ● Nepal (2011) ● Bangladesh (2007) 0 Bottom 20% Second 20% Middle 20% Fourth 20% Top 20% Urban poorest Urban richest Strategies to address mass deprivation, where all but the richest are doing poorly (shown by the red lines for urban Kenya and Bangladesh) must take a “whole population” approach, where resources are invested in all (or most) subgroups. To address situations of marginal exclusion (as seen in urban Cambodia and Egypt, in blue), health interventions should prioritize the most disadvantaged subgroup(s) of the population. A stepwise or queuing pattern that shows consistently better outcomes and/or coverage across the socioeconomic spectrum (shown in purple for urban India and Nepal) requires an approach that combines populationwide and targeted interventions. Where complete coverage has been achieved and there is relative equity in outcomes (shown in green for urban Jordan), further interventions may not be required to address inequalities, but ongoing monitoring and actions may be warranted to ensure that the situation improves and/or remains favorable for all. Data source: WHO. Available at who.int/gho/data under “Urban health.” Data are from years shown in parentheses. Figure modeled after WHO. Handbook on Health Inequality Monitoring. (Geneva: 2013) p.68 STATE OF THE WORLD’S MOTHERS 2015 51
Page 1 and 2: The Urban Disadvantage STATE OF THE
Page 3 and 4: The Urban Disadvantage Save the Chi
Page 5 and 6: Introduction Save the Children work
Page 7 and 8: Executive Summary: Key Findings and
Page 9 and 10: Urban and Unequal In cities around
Page 11 and 12: increases more quickly in urban tha
Page 13 and 14: Global Trends in Child Survival and
Page 15 and 16: 1 in 3 City Residents in Developing
Page 17 and 18: High Risk of Death for the Poorest
Page 19 and 20: Unequal Life Chances for the Urban
Page 21 and 22: Manila, Philippines treatment and d
Page 23 and 24: A nurse in the capital of the Democ
Page 25 and 26: Urban Health Fairness Assessment Sa
Page 27 and 28: City Health Care Equity Ranking RAN
Page 29 and 30: Blantyre, Malawi Progress, But Not
Page 31 and 32: Saving Lives in Slums What is worki
Page 33 and 34: Cairo, Egypt The facts: Cairo has a
Page 35 and 36: Manila, Philippines The facts: Metr
Page 37 and 38: irth attendants are more affordable
Page 39 and 40: Guatemala City, Guatemala women of
Page 41 and 42: In Cambodia overall, there is a ver
Page 43 and 44: Urban Inequity in Wealthy Countries
Page 45 and 46: How Stockholm Battled Inequity and
Page 47 and 48: Infant Death Rates in 25 High-Incom
Page 49 and 50: Take Action Now for the Urban Poor
Page 51: Northern Nigeria d. The final post
Page 55 and 56: addressing sufficient living space,
Page 57 and 58: Appendix: The 2015 Mothers’ Index
Page 59 and 60: What the Numbers Don’t Tell You T
Page 61 and 62: Frequently Asked Questions about th
Page 63 and 64: The Complete Mothers' Index 2015 MA
Page 65 and 66: The Complete Mothers' Index 2015 (C
Page 67 and 68: Methodology and Research Notes The
Page 69 and 70: Intra-urban mortality data by wealt
Page 71 and 72: New Zealand; KIDS COUNT (USA). Nati
Page 73 and 74: tive of these regions as a whole. F
Page 75 and 76: and ICF International. Egypt Demogr
Page 77 and 78: 145 Burström, Bo, Lisa Oberg and L
Page 79 and 80: Page 29 - Caroline Trutmann Ethiopi

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