Areas such as Chembur, Bhandup, Goregaon, Jogeshwari, Dahisar and parts of Ghatkopar have very poor accessibility to health services, a one-of-a-kind study measuring accessibility to health care in metropolitan Mumbai by l ‘Indian Institute of Technology-Bombay (IIT-B) revealed. The study also found that Chembur, parts of Malad and Malwani need to improve the public transport system as a priority in order to improve accessibility to health services for its residents.
The article “Approaching Public Transport Accessibility to Understanding Equity in Public Health Services: A Case Study from Greater Mumbai” was published on June 25 in the peer-reviewed Journal of Transport Geography. The study was conducted by Gajanand Sharma, doctoral student in the department of civil engineering, and Gopal Patil, professor in the same department at IIT-B.
Unequal access to public health facilities affects the entire urban population and can have an impact on the vulnerable population who mainly depend on these services. In this study, researchers measured the accessibility of health services by public transport. They used the travel time and number of transit stops (including transit connectivity) for Greater Mumbai.
They also identified socially vulnerable neighborhoods (administrative units) using a social vulnerability index (SVI), developed on the basis of 16 indicators using the Principal Component Analysis calculation tool.
“Accessibility means the ease with which one can access services such as hospitals, shopping malls and schools / colleges. In transport, we quantify this ease of access to services mainly by considering travel time. For example, suppose that from zone A it takes 20 minutes to reach a hospital by public transport, while it takes 30 minutes from zone B, assuming the same level of public transport infrastructure, we can say that the accessibility for hospitals in zone A is better than that in B. In our definitions, we also take into account the number of bus stops to measure accessibility. A higher number of bus stops increases accessibility, ”Patil said.
In this study, researchers measured accessibility to health facilities for a population of 12.4 million people in Greater Mumbai, which includes 577 traffic analysis zones.
Four different types of public health services – hospitals, maternities, dispensaries and health posts – were considered.
For hospitals, eight of the 24 departments in Mumbai – R-North (Dahisar), P-North (Malad), P-South (Goregaon and parts of Jogeshwari), S (Bhandup), N (Ghatkopar), M-East (Govandi) and M-West (Cembur) – fell into the critical category.
This meant that these areas had poor accessibility to health services and high social vulnerability.
The city is doing better in terms of access to maternity care units – only the R-North, M-East and S districts fall into the critical category. Regarding access to municipal dispensaries, R-Nord, P-Nord, P-Sud and M-Est were critical. For access to health posts, the R-Nord, P-Nord and M-Est services fare the worst.
“Suppose there are 10 hospitals in an urban area. But from different areas it can have different accessibility values to reach these hospitals; therefore, we have developed an accessibility measure for an area, say a neighborhood. From now on, this accessibility measure is estimated for all districts of the city (districts A, B, C, D, etc.). Next, we present the spatial distribution of these estimated accessibility measures over the study area, and then we find which areas have better accessibility and which have poor accessibility, ”Patil explained.
Almost 35% of the city’s population resides in services where accessibility to hospital services is low and social vulnerability is high, according to the study.
Social vulnerability refers to the socio-economic factors that affect the resilience of communities to disease. The study also found that the eastern part of Mumbai lacked reasonable access to health services. In addition, people living in slums had more limited access to public health facilities; the average accessibility value for all public health services is lower for those living in slums than for those living in non-slum areas.
Shankar Das, dean of the School of Health Systems Studies, Tata Institute of Social Sciences, who was not part of the study, said: “We know that poverty and poor health are inextricably linked. ; therefore, it requires a multidimensional investigation of vulnerabilities such as poor housing quality, overcrowding, undernutrition, poor education, unemployment / underemployment, economic conditions, etc. to recommend a holistic and equitable distribution of health care in these disadvantaged communities.
The IIT-B study makes suggestions to improve the accessibility of health care for each service.
Areas requiring urgent improvement in terms of health and public transport infrastructure are Dahisar, Malad, Chembur, Trombay, Ghatkopar and Govandi.
“These services could be adopted as high priority services for public health infrastructure development and service delivery so that the supply of health care providers can keep pace with the demand for services. A number of strategies could be adopted using telehealth to provide universal health services as well as regular mobile health clinics in underserved communities, ”Das said.
Dr Abhijit More, public health activist of Jan Swasthya Abhiyan, who was not part of the study, said: “There is an urgent need to improve the quality and quality of treatment available in primary health facilities and secondary. Facilities should be close to people’s homes, especially in a high density city like Mumbai. “