Urbanization is transforming India's demographic landscape, with projections indicating that by 2030, around 40% of the country's population will reside in urban areas. This rapid urban growth brings a corresponding increase in the demand for urban healthcare services. The complexities of urban healthcare are unique and multi-dimensional, influenced by environmental, structural, socioeconomic, and functional factors. Environmental challenges include air pollution, climate change, and diminishing green spaces. Structural issues encompass housing-related health risks and inadequate water and sanitation facilities. Socio-economic factors involve lifestyle issues, nutrition insecurity, and unhealthy diets. Functional problems relate to access to social safety services and primary healthcare. The urban poor, in particular, face significant health risks, akin to the rural population, a phenomenon known as the 'urban health disadvantage.'
Recognizing these challenges, the Indian government has implemented several measures to enhance urban healthcare delivery. The National Urban Health Mission (NUHM), launched in 2013, marked a significant step forward. In 2018, the Ayushman Bharat (AB) scheme was introduced to provide Comprehensive Primary Health Care (CPHC) services through Health & Wellness Centres (HWCs) and health insurance via the Pradhan Mantri Jan Arogya Yojana (PM-JAY) for secondary and tertiary care. Additionally, various initiatives have been undertaken to address health determinants, including piped water supply, affordable housing schemes, waste disposal, and transportation improvements. Despite these efforts, the rapid pace of urbanization has rendered these measures largely inadequate.
The 74th Constitutional Amendment aimed to devolve power and decentralize urban administration, empowering urban local bodies with greater authority and responsibility. However, this vision is yet to be fully realized.
In this context, formative research was conducted to address the growing importance of urban primary healthcare challenges in Mysuru city. This study is part of a larger implementation project aiming to strengthen and improve the existing primary healthcare system in Mysuru. A mixed-method study approach was employed, including a household survey, facility assessment, and qualitative situational assessment. This report focuses on the qualitative study, providing recommendations for enhancing CPHC in Mysuru based on the findings. The quantitative household survey and facility audit results will be presented in a separate report.
Mysuru city, with a population of 9.2 lakhs according to the 2011 census, is estimated to have reached around 11 lakhs in 2020. Approximately 18% of the city's population resides in slums and slum-like areas. Mysuru, a rich economic and cultural hub of Karnataka and South India, is also recognized as one of the cleanest cities in India. Five wards in Mysuru city were purposefully selected for the qualitative study based on socio-demographic and population characteristics. The study included 57 interviews, comprising 6 Key Informant Interviews (KIIs), 4 Public Engagement (PE) programs, 12 Focus Group Discussions (FGDs), 35 In-Depth Interviews (IDIs), along with field observations and notes covering about 211 participants. The participants included policymakers, program implementers, community members, private practitioners, and representatives from health and non-health-based institutions. Tailored interview guides were developed, pilot-tested, and refined before actual data collection. Thematic analysis was conducted by a team of qualitative researchers, ensuring thematic saturation and validation through triangulation of findings from different qualitative data groups. Research ethics were maintained throughout the study, especially during data collection.
The study identified barriers and facilitators to primary healthcare in Mysuru at various levels: community, facility, and health system. These insights enabled the formulation of key recommendations to improve and strengthen primary healthcare in the city. The findings underscore the need for a multi-faceted approach to address urban health challenges, incorporating environmental, structural, socio-economic, and functional dimensions. By addressing these factors, urban healthcare systems can be better equipped to meet the growing demands of urban populations and mitigate urban health disadvantages.
In conclusion, the formative research in Mysuru city provides a comprehensive understanding of the urban primary healthcare challenges and offers actionable recommendations for improvement. This study is a crucial step towards enhancing the quality and accessibility of healthcare services in urban India, ensuring a healthier future for its rapidly growing urban population.
