Improving Urban Healthcare System in

the City of Ahmedabad, India:A GIS Approach

Amit Patelapatelh@gmu.edu

An action research project by:

Center for Management of Health Services

Indian Institute of Management, Ahmedabad

(Funded by UNFPA)

June 17, 2009

Brownbag Seminar

Center for Global Development

Indian Scenario: Year 2004Urban

Population

30%

Rural

Population

70%

Urbanization Trends in India: an Overview

Population 2 %

Urban India 3 %

Mega cities 4 %

Slums 5 %

2-3- 4-5 Syndrome

Global Scenario: Year 2008

Urban

Population

50%

Rural

Population

50%

•Lack of public health infrastructure

•Poor living conditions

•Malnutrition

•Prevalence of HIV/AIDS

•Infectious Diseases

Indian Scenario (Last decade)

•Urban health management very critical

Health Infrastructure in India

Sub Centers – 142000

PHCs - 23000

CHCs - 3200

DHs - 550

Teaching Institutions

Health Infrastructure in Villages

Health Infrastructure in Cities

Prim

ary

Secon

dary

120,000 Population

30,000 Population

5000 Population

Urban Health System?

Only After 9th FYP (1997-2002)

1 per 100,000 Population

ONE per district

Terti

ary

Context: City of Ahmedabad

• Sixth Largest City in India

• Historic City founded in 1411 AD

•‘Manchester of East’

• Center of Freedom Movement

Ahmedabad: A Quick Profile

General Information

AMC Population 35,15,361

AMC Area (Sq Km) 190.84

Population Density 18,420

Literacy 83.16

Male Literacy 89.26

Female Literacy 76.36

Total Dwelling Units 7,00,000

Slums (Including Chawls)

Number of Slums 1000

Dwelling Units in Slums 2,00,000

Population in Slums 8,00,000

Number of Chawls 1500

Dwelling Units in Chawls 1,50,000

Population in Chawls 7,00,000

Pop. in Slums & Chawls 15,00,000

Slum Population: 43 %

Ahmedabad : Slum Locations

General Information

AMC Population 35,15,361

AMC Area (Sq Km) 190.84

Population Density 18,420

Literacy 83.16

Male Literacy 89.26

Female Literacy 76.36

Total Dwelling Units 7,00,000

Slums (Including Chawls)

Number of Slums 1000

Dwelling Units in Slums 2,00,000

Population in Slums 8,00,000

Number of Chawls 1500

Dwelling Units in Chawls 1,50,000

Population in Chawls 7,00,000

Pop. in Slums & Chawls 15,00,000

AMC Health Facilities

Dispensaries 23

Hospitals 3

Maternity Homes 8

Family Welfare Centers 37

Eye hospital 1

Infectious disease hospital 1

Mapping Govt. Health Facilities

Vatva

Vasna

Isanpur

Danilimda

Navrangpura

Bag-e-firdos

Odhav

Nikol Road

Thakkarbapa nagar

Bapunagar

Rajpur

Old Wadaj

Gandhigram

Naranpura

New Wadaj

Saijpur Bogha

Kubernagar

Sardarnagar

Naroda MuthiaSabarmati

Madhupura

Kalupur

Raikhad Khadia

Baherampura

Maninagar

Bhaipura

Hatkeshwar

Khokhara

Mahemdabad

Gomtipur

Rakhial

DariyapurSaraspur

Jamalpur

Paldi

SP StadiumGirdharnagar

Potaliya

NarodaRoad

Dudheshwar

Wards without any

Govt. Health Facility

State Govt. Health Facilities

Civil Hospital 1

Cancer Hospital 1

Kidney Hospital 1

Heart Hospital 1

Central Govt. Health Facilities

ESI General Hospital 1

ESI Chest Hospital 1

ESI Dispensaries 42

Socio Economic

Cultural Profile

Public Health Facilities

Community Health

Needs Assessment

(Sample of 250 Slum HH +

100 Others)

Current Practices of

meeting health needs

Urban Health Center

Community Needs Assessment

Level of Awareness

Local Professional

Service Providers

Local Political Leaders

•Integrated Services

Consultation

Investigation

Medication

•Easy Access

•Availability – 24 hours

•Affordable Charges

•Referral Services

•Prevention / Health Awareness

•Data recording – IT / computer

Academia

Seeking Professional help

for In-Patient healthcare

Public

32%

Private

68%

Public Health Infrastructure

0

20

40

60

80

100

1 2 3 4 5

Perc

en

tag

e

Elc

etir

city

91%

Wate

r S

upply

64%

Wate

r+D

rain

age 5

0%

wate

r+D

rain

age+T

oile

t 44%

AllF

our

Facilitie

s 4

2%

Seeking Professional help

for Out-Patient healthcare

Public

3%

Private

97%

Improving Urban Healthcare: a GIS Approach

Step 1: Community Health Needs

Assessment

Community Health Surveys

Local Consultations

Step 2: Create GIS Maps

Digitize Town Planning Map

Locate Slums & Health Centers

Step 3: GIS Analysis

Estimate Service Levels

for Existing, Alternate Locations

Step 4: Framework for PPP

Survey Health Facilities

Legal Issues & MOU

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

Juhapura

Slums

Vasna Ward: Slums

Akhand

Jyot

Step 1: Community Health Needs

Assessment

Community Health Surveys

Local Consultations

Step 2: Create GIS Maps

Digitize Town Planning Map

Locate Slums & Health Centers

Step 3: GIS Analysis

Estimate Service Levels

for Existing, Alternate Locations

Step 4: Framework for PPP

Survey Health Facilities

Legal Issues & MOU

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

Juhapura

Slums

UHC location at Akhand Jyot

Slum Distance

Mangal Talav(25%) 1.3 km

Pravin Nagar(50%) 3.2 km

Rajiv Nagar (25%) 3.4 km

Service Level: Existing UHC

Akhand

Jyot

Akhand

Jyot

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

Juhapura

Slums

Mun. School

Op.1: UHC location at Mun. School

0 – 0.5 km 3 %

UHC location at Akhand Jyot

Slum Distance

Mangal Talav(25%) 1.3 km

Pravin Nagar(50%) 3.2 km

Rajiv Nagar (25%) 3.4 km

Service Level: UHC at Mun. School

Akhand

Jyot

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

Juhapura

Slums

Mun. School

Op.1: UHC location at Mun. School

0 – 0.5 km 3 %

0 – 1.0 km 36 %

Service Level: UHC at Mun. School

UHC location at Akhand Jyot

Slum Distance

Mangal Talav(25%) 1.3 km

Pravin Nagar(50%) 3.2 km

Rajiv Nagar (25%) 3.4 km

Akhand

Jyot

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

Juhapura

Slums

Mun. School

Op.1: UHC location at Mun. School

0 – 0.5 km 3 %

0 – 1.0 km 36 %

0 – 2.0 km 98 %

Service Level: UHC at Mun. School

UHC location at Akhand Jyot

Slum Distance

Mangal Talav(25%) 1.3 km

Pravin Nagar(50%) 3.2 km

Rajiv Nagar (25%) 3.4 km

Akhand

Jyot

Vasna Ward: Slums + Clinics + Hospitals

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

Juhapura

Slums

Step 1: Community Health Needs

Assessment

Community Health Surveys

Local Consultations

Step 2: Create GIS Maps

Digitize Town Planning Map

Locate Slums & Health Centers

Step 3: GIS Analysis

Estimate Service Levels

for Existing, Alternate Locations

Step 4: Framework for PPP

Survey Health Facilities

Legal Issues & MOU

Akhand

Jyot

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

Juhapura

Slums

COC Vasna

Mun. School

Op.1: UHC location at Mun. School

0 – 0.5 km 3 %

0 – 1.0 km 36 %

0 – 2.0 km 98 %

Op. 2: UHC location at COC Vasna

0 – 0.5 km 36 %

Service Level: UHC at Community Oncology Center, GCS

UHC location at Akhand Jyot

Slum Distance

Mangal Talav(25%) 1.3 km

Pravin Nagar(50%) 3.2 km

Rajiv Nagar (25%) 3.4 km

Akhand

Jyot

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

COC Vasna

Mun. School

Op.1: UHC location at Mun. School

0 – 0.5 km 3 %

0 – 1.0 km 36 %

0 – 2.0 km 98 %

Op. 2: UHC location at COC Vasna

0 – 0.5 km 36 %

0 – 1.0 km 67 %

Service Level: UHC at Community Oncology Center, GCS

UHC location at Akhand Jyot

Slum Distance

Mangal Talav(25%) 1.3 km

Pravin Nagar(50%) 3.2 km

Rajiv Nagar (25%) 3.4 km

Akhand

Jyot

Rajiv

Nagar

Mangal

Talav

Om

Nagar

Gupta

Nagar Pravin

Nagar Yogeshwar

Nagar Shiv Shankar

Nagar

Juhapura

Slums

COC Vasna

Mun. School

Op.1: UHC location at Mun. School

0 – 0.5 km 3 %

0 – 1.0 km 36 %

0 – 2.0 km 98 %

Op. 2: UHC location at COC Vasna

0 – 0.5 km 36 %

0 – 1.0 km 67 %

0 – 2.0 km 88 %

+ Juhapura

Service Level: UHC at Community Oncology Center, GCS

UHC location at Akhand Jyot

Slum Distance

Mangal Talav(25%) 1.3 km

Pravin Nagar(50%) 3.2 km

Rajiv Nagar (25%) 3.4 km

Public & Private Partners for Vasna UHC

GCS AJF(Mother NGO)

SAATH(Field NGO)

AMCResource Allocation

Performance Monitoring

Construct UHC & Handover to AMC

GCRIInvestigation Facilities

Healthcare Services

Community Services

Thank You!