Mapping of "urban health facilities" in "Maharashtra" by Anandi Dantas

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Presented in Seminar on Spatial Dimensions on Health Care-Use of GIS in Health Studies by Anandi Dantas, Organised by Centre for Enquiry into Health and Allied Themes (CEHAT) and Department of …

Presented in Seminar on Spatial Dimensions on Health Care-Use of GIS in Health Studies by Anandi Dantas, Organised by Centre for Enquiry into Health and Allied Themes (CEHAT) and Department of Geography, University of Mumbai on 24th Sep 2010

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  • 1. Mapping of urban health facilities in Maharashtra Anandi Dantas
  • 2. Rationale  Very few studies have graphically mapped the temporal and spatial growth of health delivery systems in the urban areas in relation to population growth. We would like to see if growth in health facilities have been adequate and kept pace with the growth in the population from 1991 to 2001 in selected cities  There is a dearth of studies that have examined over the years, the growth and the distribution pattern of health facilities at the intra city level and the possible processes at work, especially for cities at the second tier level
  • 3. Objectives of the Study  To examine the growth of health facilities with the growth of population in the four cities of Aurangabad, Nashik, Solapur and Nagpur from 1991 to 2009/10  To examine the growth and the distribution pattern of health facilities at the intra city level- looking at areas of concentration and areas with few facilities
  • 4. Top 10 cities of Maharashtra by population Source: Census of India 2001: series 28, Maharashtra: 17 Rank City Name Population 2001 (Municipal Corporation) 1 Mumbai 11,914,398 2 Pune 2,540,069 3 Nagpur 2,051,320 4 Thane 1,261,517 5 Kalyan-Dombivli 1,193,266 6 Nashik 1,076,967 7 PimpriChinchwad 1,006,417 8 Solapur 873,037 9 Aurangabad 872,667 10 Navi Mumbai 703,947
  • 5. Population growth rate of the four cities of Maharashtra: 1991-2001 Aurangabad 52.34% Nashik 63.98% Solapur 44.40% Nagpur 26.30%
  • 6. The Study Area Source: Maps of India (www.mapsofindia.com/maps/maharashtra)
  • 7. Data and Methodology  Census 1991 and 2001 for city population details  Public and registered private health facilities lists from municipal corporations, EW map, EW area description  Google map and hospital yellow pages to locate health facilities in respective EW for the respective city
  • 8. Limitations & Problems  Unavailability of census city ward map  Registered private facility data with municipal corporations used, actual number of health facilities may be more  Data collections in Aurangabad and Nashik took a longer time (6-8 months)  Nashik municipal data not updated, NMC research unfriendly  Data used of private health facilities show date of registration, which may be different from date of establishment
  • 9. Limitations & Problems  Data recording in municipal corporations not uniform across the state  Growth of population and growth of health facilities may not be directly comparable but gives us an indicator of growth  The paper examines the availability of health facilities, not the ‘access’, affordability or quality
  • 10. Aurangabad-Facility:Population Ratios Health Centres 1991 1994* 2001 2009* Total Population 1: 81896 1: 57327 1: 43666 1: 41586 0 - 6 age 1: 16032 1:11222 1: 6782 1: 6459 Public Hospitals Total Population 1: 191091 1: 191091 1:218328 1:109164 Females 1: 89300 1: 89300 1:103504 1: 51752 0 - 6 age 1 :37407 1: 37407 1: 33910 1: 16955 Private Hospitals (registration date) Total Population NA 1: 5850 1: 4746 1: 2426 Females NA 1: 2734 1 :2250 1: 1150 0 - 6 age NA 1: 1145 1: 737 1: 377 Total Population NA NA NA 1:460 Beds Total NA NA NA 1:196 Public Hospitals NA NA NA 1:724 1:268 Private Hospitals NA NA NA NA-not avail
  • 11. Key Findings for Aurangabad  Aurangabad shows that it had a growth rate of 186 per cent (from 7 HC in 1991 to 20 HC in 2001). PH had a growth rate of 33 per cent (from 3 PH in 1991 to 4 PH in 2001)  Registered private hospitals had a growth rate of almost 88 per cent (98 private hospitals in 1994 to 184 private hospitals in 2001). So the growth rates of HC and registered private hospitals have exceeded the population growth rate, while the growth rate of PH lags behind
  • 12. Observations for Aurangabad  Clustering of public and private health facilities near the city centre the last twenty years. Less geographical access to both public and private health facilities for the population of the peripheral areas of the city  90% of the registered private hospitals in Aurangabad have PNDT/USG facilities
  • 13. Nashik-Facility: Population ratios For bed ratio 1239 pvt hospitals used Urban Health Posts 1991 1996* 2001 2009** Total Population 1: 59720 1: 59720 1: 82864 1: 59846 0 - 6 age 1: 9973 1: 9973 1: 11378 1: 8218 Public Hospitals Total Population 1: 93846 1: 50533 1: 76945 1: 67327 Females 1: 44215 1: 23808 1: 35821 1: 31344 0 - 6 age 1: 15671 1: 8438 1: 10566 1: 9245 Private Hospitals (registration date) Total Population NA 1: 5214 1: 5855 1: 1458 Females NA 1: 2456 1: 2726 1: 679 0 - 6 age NA 1: 871 1: 804 1: 200 Beds*** Total NA NA NA 1: 133 Public Hospitals NA NA NA 1: 676 Private Hospitals NA NA NA 1: 166
  • 14. Key Findings for Nashik  Nashik city population grew by 63.98% between 1991-2001 The growth rate of health facilities from 1991 to 2001:  UHP grew by 18 per cent, while the population grew by 63.98 per cent (from 11 in 1991 to 13 in 2001)  Public hospitals (NMC, state and central government) grew by 100 per cent (from 7 in 1991 to 14 in 2001)  Registered private facilities grew by 46%(1996-2001) and over 300% 2001 to 2010
  • 15. Observations for Nashik  Clustering of private facilities near the city centre. This trend is noted from 1991 to 2009. The 2 areas incorporated later into the city, viz Satpur and Nashik Road are under served. These are the 2 outlying areas of the city  The UHP locations that are in the same precinct as the NMC hospitals seem to be redundant and needs to be addressed by the NMC
  • 16. Solapur- Facility: Population ratios UHP 1991 2001 2010* Total Population 1: 46478 1: 67114 1: 45920 0 – 6 age 1: 7669 1: 9187 1: 6286 Public Hospitals Total population 1: 50351 1: 72707 1: 72707 Females 1: 24475 1: 35645 1: 35645 0 – 6 age 1: 8308 1: 9952 1: 9952 Registered Private Hospitals Total population 1: 8277 1: 6017 1: 2958 Females 1: 4023 1: 2950 1: 1450 0-6 age 1: 1366 1: 824 1: 405 Beds Total NA NA 1: 159 Public hospital NA NA 1: 687 Private hospital NA NA 1: 206
  • 17. Key Findings Solapur  0% growth rate of UHP & PH between 1991-2001 (ratios worse as population grew by more than 44%)  Private hospitals grew by 98% same period  Private hospitals grew by 103% 2001- 2010
  • 18. Observations for Solapur  Spatial and temporal analysis of the expansion of public/private health facilities show a tendency to cluster near the city centre. There is very little lateral expansion in the peripheral wards of the city. Growth has taken place close to Bijapur and Pune highways. The only concentration is near the city centre in the Railway Lines area.  There is no heavy concentration of hospitals as found in Aurangabad and Nashik cities. Out of 98 electoral wards, 37 wards do not have any private hospitals.
  • 19. Nagpur- Facility: Population ratios UHP 1991 2001 2010* Total Population 1: 147705 1: 186551 1: 97717 0-6 age 1: 21907 1: 22712 1: 11897 Public & Registered Private hospitals Total Population 1: 12404 1: 5169 1: 3157 Females 1: 5937 1: 2499 1: 1527 0-6 age 1: 1840 1: 629 1: 384 Public hospitals Total Population 1: 203094 1: 228007 1: 228007 Females 1: 97220 1: 110256 1: 110256 0-6 age 1: 30122 1: 27759 1: 27759 Registered private hospitals Total Population 1: 13209 1: 5289 1: 3201 Females 1: 6323 1: 2557 1: 1548 0-6 age 1: 1959 1: 644 1: 390 Beds (total) Total NA NA 1: 206 Public hospitals NA NA 1: 734 Private hospitals NA NA 1: 286
  • 20. Key Findings for Nagpur  The growth rate for public health facilities, ie that of UHPs from 1991 to 2001 was 0% (11 UHPs in 1991 and 2001), though the population grew by 26.30% in this period  The number of public hospitals grew from 8 to 9 during this period (an increase of 12.5%)  Registered private hospitals were 123 by 1991, grew to 388 by 2001 and to 641 in 2010.  The growth rate between 1991 and 2001 was 215% and from 2001 to 2010 was 65%.
  • 21. Observations for Nagpur city  Clustering of public facilities near city centre  Heavy concentration of private hospitals in the upmarket areas in the western part of the city  Over 30% EW with no registered health facility
  • 22. Factors affecting health facility locations  UHP locations are influenced by the location of slums and Mun. Corp. land/building availability  Private hospitals mainly influenced by the economic criterion of market needs (especially in Aurangabad, Nagpur)  Land availability influenced private hospital locations and the proximity of market, bus hubs in Nashik  Solapur locations influenced by transport hubs-bus and train. There is no major concentration in Solapur  Road network, especially highways have also primarily dictated private facility locations in EW along the highways, exemplified by Aurangabad (serves a larger hinterland of class III,IV & V towns) and Nashik
  • 23. Factors affecting health facility locations  What’s interesting is the cities that have new or growing industries show a greater growth in health facilities both temporally and spatially. These are Nashik and Aurangabad. These cities also have the highest population growth between 1991-2001 in Maharashtra  Both Solapur and Nagpur are stagnating economically. This is shown in declining population growth, Nagpur’s growth being less than the country’s and state’s urban population growth. Solapur is now being termed as ‘pension city’ and there seems to be a lack of political will power to attract growth in the city
  • 24. Conclusion and Policy Issues  The need for an urban norm for location of public health facilities, especially that of HC  Importance of a norm for location of private hospitals in an urban area  Availability of services have been analyzed. There is a need for the government to tie in with private hospitals so that the population can afford to ‘access’ these hospitals
  • 25. Conclusion and Policy Issues  There is a need to define city census ward areas by area names and/or by maps so that the census wards can be located within the city. This would be a useful exercise so that the census data can be used for research/planning purposes. This will facilitate the use of intra-city detailed census ward data
  • 26. Thank You!