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

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

15. 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

16. 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

17. 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

25. 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

26. 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

27. 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

31. 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

32. 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.

33. 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

37. 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%.

38. 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

39. 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

40. 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

41. 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

42. 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

43. Thank You!