Urban Health in Developing Countries: Progress and Prospects

THIS EDITED VOLUME looks at trends in urban health development policy since the late 1980s and outlines the activities of multilateral and bilateral organizations and NGOs in this area. Chapter one summarizes recent policy developments in health and in urban development. That far more collaboration is needed between these two sectors if health interventions are to be successful is a central theme of the book. Subsequent chapters look in more detail at the various strands of urban health policy. Chapter two focuses on mobilizing communities to participate in primary health care and family planning delivery. Ideas for building communities’ capacity to forge and maintain linkages between their members, health care providers and agencies involved in service delivery are discussed. Chapter three looks at features and determinants of urban health status, and makes a series of policy recommendations for the design and implementation of future urban health programmes. The organization and management of urban health services is the subject of chapter four. Four factors currently of importance to health services management and planning are: government decentralization policies; debates about health service tiers; the relationship between government and private sector providers; and the need to improve general management capacity in the health sector. Chapter five looks at the issue of urban health research. It is argued that since processes of urbanization impact in complex ways on health, priority setting tools must be used to determine “which health problems are of concern to society, have significant public health impact and are amenable to intervention” (page 79). In this way research agendas will reflect what needs to be researched rather than simply what researchers feel they are able to research. Chapter six turns to the costing and financing of urban health and environmental services, and refers to current debates about the appropriate public/private mix of finance and provision of health services, about health insurance and donor assistance to the health sector. The chapter explains clearly and succinctly what is a rather complex aspect of current health policy. A framework for “analyzing recurrent and capital expenditure in a city on health care, water and sanitation services and municipal environmental provision” (page 82) is outlined. It is argued that the lack of information on health sector financing, particularly on how expenditure patterns relate to health status, or how expenditure is targeted at the poor, is a serious constraint to appropriate health services management and planning.

Chapters seven to eleven look at the role of multilateral and bilateral agencies, including the World Health Organization, the World Bank, UNICEF, USAID, and GTZ, in the urban health development arena. Chapter twelve switches to the role of international NGOs in urban health, and includes case study material on the activities of Save the Children Fund UK and Save the Children USA. Three themes are developed: the establishment of participatory urban primary health care; assessing whether approaches used in rural areas are equally appropriate in the urban context; and developing strategies for scaling up NGO activities in urban areas. Chapter thirteen looks at the work of a Christian missionary group, Servants, in health care delivery in Manila, and discusses the way in which it evolved from being a provider of health care in slum areas to a facilitator of community mobilization for health.