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Health, Environmental and Social Conditions for the Urban Poor in the Largest Cities of Pakistan –Policy and Planning Implications for Urban Poor Health Strategy

Author(s): Khawaja Aftab Ahmed , John Grundy, Lubna Hashmat, Imran Ahmed, Saadia Farrukh, Dexter Bersonda, Muhammad Akram Shah, Soofia Yunus, Hari Krishna Banskota

Uncertainty regarding numbers and locations of slums resulted in the conducting of urban slum profiles in the ten most populated cities of Pakistan between 2017 and 2019. The aim of this paper is to provide a national overview of health and social conditions in these urban areas and consider the policy and planning implications for improvements in health and social services. The Urban Slum Profiles included physical verification of slums, and assessments of health and social services and an immunisation coverage survey. The profiles found that 48% of the total urban population of the ten cities is living in slums or areas classified as being underserved by essential health services. Lower health service coverage is associated with poor housing and environmental conditions, under-employment, low-income status, inadequate availability of health services, and low health literacy coupled with profound gender and education disparities. Of the 14,531 children surveyed, 53% are fully immunised (n=5774), with rates of zero dose vaccination greater than 15% (n=1985) in six of the ten cities. Facility surveys (n=422 facilities) demonstrate insufficient availability of vaccination, social welfare, and nutrition services. Just 66% (n=9659) of mothers stated that vaccination protects from disease. Low participation in health by community-based organisations reinforces social marginalisation and lack of access to information on health care. Policy and planning implications from these findings rationalise the need for pro equity health services planning in urban poor areas, integration of services, and development of governance and social accountability mechanisms for health and immunization services management and delivery. The development of an integrated urban health strategy with a costed action plan will not only benefit the health of the urban poor, but will also serve to accelerate the overall economic, health and social development of Pakistan.

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