Bihar is the third largest state in terms of total population size, occupies the 11th position, its share in national urban population being 3.04 percent. 2001 census shows that Bihar has an urban population of 8.67 millions comprising 10.47 percent of the state. There has been a decline in urbanisation of Bihar during 1990s. In 1991, undivided Bihar had 13.1percent urban population, which came down to 10.47 percent in 2001. Partly it is attributed to going of big urban centres like Dhanbad, Jamshedpur and Ranchi to Jharkhand after the division of state. However, it is also attributed to the process of liberalization. The migration to urban centres in developed states has been more due to higher flow of financial, industrial and infrastructural investments. However, the backward states have not attracted private capital due to lack of infrastructure. Even the government has not been able to achieve much in terms of industrialization of backward states.
Patna, the capital of Bihar with 41.80 percent urban population is the most urbanised district and has almost one fourth(22.69 percent) of total urban population of the state Patna district with a percentage decadal growth of 43.02 during 1991-2001 has an urban population of 1.96 millions (census 2001)
There are 19 cities in Bihar (having population of 100,000 and above). Of this patna falls into sub-class M5 (population between 1,000,000-1,999,999), Gaya Bhagalpur and Muzaffarpur in sub-class M3(300,000500,000),Darbhanga, Biharsharif and Arrah in sub-class M3(200,000-299,999) and rest 12 cities in sub-class M1(100.000-199,999).
It is observed that the highest incidence of urban poverty is mostly in small cities. NSS survey shows that with the increase in size of town the incidence of poverty declined steadily. The head count ratio of the urban poor in M1 towns in 1987-88 was 47.4 percent and M5 towns were 26.73 percent. Bihar with only one M5 city is dotted heavily with small cities and towns and thus has a large burden of urban poor population. As per the estimates given by the planning commission for 1993-94, thirty-five percent of the urban population in Bihar was below the poverty line. As per TCPO, estimates Bihar had a slum population of about 3.5 millions in 2001. The census of India puts slum population to be little over 0.5 millions only.
Health Issues of Urban Poor
The state urban health infrastructure is in extremely bad shape. Bihar has 6 medical college hospitals, 23 district hospitals out of 38 districts and only 23 sub-divisional hospitals out of 101 subdivisions (RCH II). Bihar does not have a single urban PHC or health post. Only Patna andBhaghalpur have 2 municipal dispensaries in each district according to an estimate. There are less than one dozen family welfare centres in the state. 19 cities of Bihar have 33 urban dispensaries.
More than one-fifth of the females in urban Bihar still have to marry before 19 years of age. Only 23 percent of married women in urban Bihar make decision for obtaining health care of her. The median age at first cohabitation is 16.4 for women living in households with a low standard of living. It reflects that the women are the disadvantaged[1] lot even in urban households as regards to making decision in terms of either seeking health care for herself or having teenage pregnancy.
Water sources and sanitary facilities have an important influence on the health of household members, especially children. Only 35 percent of the urban population has access to piped drinking water. One third of the urban population has no sanitary facility of latrines/toilets. Crowded conditions also affect health as well as the quality of life. 37 % of the urban households live in houses with three or more persons per room. One-forth households in urban Bihar have low standard of living index (SLI), defined in terms of ownership of household goods like durable goods and type of kitchenware used.
In reference with the scenario of health status in Bihar, briefly described above, a survey was undertaken in various cities of Bihar. Major conclusions are given here –
Preference for facilities for seeking Health Services
- Urban poor do not have confidence in Govt. hospitals when it comes to curative services.
Only 1/10th of respondents visited the OPD( outpatient departments) for treatment of children in case of diarrhoea and of women in case of RTIs - (Reproductive Tract Infections).
- Neighbourhood chemist shops are major provider of curative services to urban poor ( 28% in case of Diarrhoea an 29% in case of RTI ). Every 3 out of 10 urban poor are opting a chemist shop for seeking treatment.
- Urban Poor’s confidence in promotional health services offered by Government health services providers in marginally more as compared to their faith in curative services provided by them.
- Routine Immunization of children for the urban poor is the most preferred service of Government Health delivery setting.
- Almost 4/5th of children (79%) were immunized at a Government health centre.
- In between the Government hospital and Angan Wari Centres (AWC), the hospitals, which are, preferred most by the respondents. Only 9 % of children were immunized at AWC.
For the other promotional health services the urban poor mostly go to private heath providers - Less than 1/3rd pregnant women go to Govt. Health providers for T.T.(Tetanus Toxoid) injections and Ante Natal checkups (ANC). Private health providers did 71% of TT administration and 68 % of ANC of pregnant women.
- 1/5th of pregnant women received T.T. shots at small chemist shops. The quality of cold chain maintenance at small chemist shops in a matter of concern.
- Amongst the pregnant women, only 2 % went to AWC for T.T. administration and meagre 1% for ANC.
- Less than 1/5th of pregnant women went to Govt. hospital for a delivery of a child.Child Care Indicators
- Only 23% children between 12-23 months were fully immunized.
- Tow-third children age 12-23 months did not have the immunisation card.
- 39% was the drop out for RI (Routine Immunization) among children.
- 13% of children did not complete the RI due to post injection side effects.
- 12% of respondents did not take their children for RI in absence of facility of RI in their vicinity.
Maternal Care Indicators
Place of delivery and assistance during delivery
- More than half of the pregnant women did not seek ANC during last pregnancy. Only 46% of pregnant women went for ANC during the last pregnancy and most of them had only gone once for ANC
- More than 1/5th of the pregnant women didn’t receive any TT shots.
- 61% of deliveries were conducted at home and rest 39% were institutionalized deliveries at either Govt. hospital or private hospital.
- Traditional Birth Attendants (TBAs) are conducting 86% of the deliveries in case of domiciliary delivery.
Safe Delivery Practices
- All the 5 cleans ( i.e. hands with soap before conducting delivery, use f new blade for cutting the umbilical cord, use of sterilised cord for tying umbilical cord, not applying any thing on the stumps after cutting the cord) for safe delivery was not observed in any household in case of home deliveries.
- Using new blade for cutting the umbilical cord was universally (99%).
Washing hands before conducting delivery by TBAs was mostly practiced (91%)
In less than half of the deliveries, sterilized cord was being used for tying the stumps (38%). - In almost all cases medicine/oil/ash/ was applied on the stump of the umbilical cord. In only 4% cases, nothing was applied on the stumps after cutting it.
The Disease Burden
- 28% of children t 5 years had at least one episode of diarrhoea during last six months.
- 38% of children under the same category had cough and 27% had Acute Respiratory Infection (ARI) during the last six months.
- 13% of children have suffered from Measles during the last one year.
- 36% of mothers had suffered from RTI (Reproductive Tract Infection).
- Majority of the women suffering from RTI did not seek any treatment.
Infant and Child Mortality
- There was death of a child less than 5 years in every 10th house of the urban poor during last one year.
- 139 children under 5 years under 5 years has died during last 1 year of which more than two-third children died before celebrating their 1st birthday.
- Among the children dying before their first birthday, 59% were neonates.
- 1/4th children died of diarrhoea which was leading cause of death.
- ARI (Acute Respiratory Infection) was the next most frequent reason for death of children under 5 years. 16% children died of ARI.
- Diarrhoea and ARI along with Tetanus (12%) was responsible for death of more than half of children under 5 years.
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