.

The Pune Centre was established in 1995. The Centre was set up to develop low cost audio-visual and training materials for the NGO & Government sectors; and for addressing urban health issues in slums. The Pune Centre also has a research and documentation unit.

Slums in Pune City
Pune City has experienced a steady growth of population and reached 2.5 million in 2001 (Census of Maharashtra, 2001). There has been a concurrent increase in slum settlements. In 2001 there were 503 slums pockets in Pune City, 40 percent of the total population of Pune City was living in slums, 340 were declared or recognised slums and 132 were undeclared or unrecognised slums (PMC, 2000).

IHMP's entry in Pune
In 1996 - 97, the Institute of Health Management Pachod (IHMP) conducted a study in 16 slums (8 authorised or recognised and 8 unauthorised or unrecognised) of Pune City, using both quantitative and qualitative research methods. The IHMP studied community perceptions about availability and utilization of RCH services, health providers, and the unmet needs of women and children. The study indicates that unlike rural areas, the health infrastructure in Pune slums is weak and non-existent in certain slums. The utilization and coverage of RCH services are lower as compared to rural Maharashtra. There is greater dependence on institutional services and on private sector resulting in a very large expenditure for even the poorest families living in urban slums (IHMP, 1997). The study also brought out clear differences with respect to provision and utilization of maternal and child health care services between recognised and non-recognised slums in Pune City.

The Needs Assessment study on delivery of health care services in slums of Pune city, conducted by the IHMP, Pune came out with following important conclusions.
Urban primary health services have been neglected at both policy and
programmatic levels.
There is a need for paradigm shift to the Community Needs Assessment
(CNA) approach (formerly known as Target Free Approach)
The existing urban primary health delivery system is hospital based.
Lack of front-line worker is a major deficiency in health care delivery system.
Since there is no separate IEC infrastructure in the urban sector, demand creation and health promotion services are minimal.

Realizing all the above aspects related to the delivery of health care services in the slums of Pune, it was decided to undertake a Community - Based Urban Slum Reproductive and Child Health Project in 28 slums of Mundhwa - Ghorpadi areas of Pune city for 5 years. The main reason for selecting these slums was non existence of any Health Post in the area. Besides, as the area is near the IHMP office it becomes easier for operations.

Socio-demographic characteristics of the project area
After it was decided to undertake a Community Based Urban Slum Reproductive and Child Health Project in 27 slums of Mundhwa-Ghorpadi areas of Pune city for the period of 5 years, it was felt necessary to have a thorough knowledge about the community regarding the numbers, age- sex composition of the people; characteristics such as literacy and educational attainment, religious composition, languages spoken, housing conditions, household possessions, birth rate, death rate and infant mortality etc. Hence it was decided to conduct a population and household census in the slums of Mundhwa-Ghorpadi areas of Pune city. The population and household census was conducted during February to April 1998.

In all 33,350 persons were enumerated, 22,559 in recognised slums, 5006 in unrecognised slums and 5785 in non-slum areas. Over all sex-ratio of the total slum population which is 891 females per 1000 males, indicates numerical excess of males in the community. The sex ratio of 840 females per 1000 males is observed in unrecognised slums is still more adverse to the females. The sex ratio of 945 females per 1000 males observed in non-slum areas is less unfavourable to females.

The slums experience a heavy influx of migrants, majority of them in the prime working age groups. Median age of slum and non-slum population is 24 and 28 years respectively. This indicates that non-slum population is showing the signs of aging. An attempt was made to study the marital status distribution of female population by 5 year age groups from age 10 onwards. The proportion of married women in the age groups 10-14 and 15-19 is greater in unrecognised slums (1.6 percent in age group 10-14 and 38 percent in age group 15-19), as against 0.5 percent in age group 10-14 and 29 percent in age group 15-19 in recognised slum. These findings show that in unrecognised slums a higher proportion of the girls are married below age 19. In non-slum areas only 13 percent of the girls age 15-19 are married. The literacy rates among males of age 7 years and above in recognised, unrecognised and non-slum areas are 82, 78 and 93 percent respectively. The same for females are 62, 56 and 79 percent. Thus in all areas of study the females literacy rates are lower than male literacy rates. Ninety percent of boys and 89 percent of girls in the age group 6-14 in recognised slums are attending school. However 87 percent of boys and 79 percent of girls in the age group 6-14 are attending school in unrecognised slums. In non-slum areas 95 percent of boys and girls are attending school.

Only 3 percent of the boys age 6-14 in slum areas are working. Most of them work as unskilled workers. The labour force participation rate among males and females was 52 and 16 percent in slum areas. Most of the (around 40 percent) workers are working as unskilled workers followed by those working in petty businesses and those working as skilled workers.

A large majority of women (73 percent of all women in age group 15-64) are not working. Among those who are working majority are engaged in petty businesses and unskilled jobs.

Fifteen per 1000 persons in total slum areas are found to suffer from some disability. The male disability rate of 17 per 1000 males is higher than female disability rate of 13 per 1000 females.

The analysis of factors related to the environment of the slums such as, source of lighting, drinking water, drinking water in summer, fuel for cooking, sanitation facility, type of house and crowding (number of persons per room) indicates that in general the situation in unrecognised slums is worse than that in the recognised slum and non-slum areas enjoy a cleaner environment. The same is the finding regarding possession of various household goods.

Although average age at marriage for girls marrieds during 1996-1998 is 19 years, a little more than one-third of the girls in all slum areas were married off before attaining legal minimum age at marriage i.e. 18 years. The mean age at marriage for non-slum girls was 20 years.

The Crude Birth Rate in slums during 1996-1998, is found to be 24.6 births per 1000 population and in non-slum areas it is only 17 per 1000 population. The peak fertility was observed at the age 20-24 and declines substantially at age 25-29. The Crude Death Rate during 1996-1998, was 5.5 per 1000 population for all slums and 7.2 per 1000 population for non slum areas. The Infant Mortality Rate for all slum areas was 25 per 1000 live births.

Contact Person:
Dr. Nandita Kapadia-Kundu, Additional Director

Address:
Institute of Health Management Pachod, Pune Centre,
Sr. No. 32/2/2, Sonai Park, Kharadi Rd.,
Chandan Nagar,
Pune - 411014
Maharashtra, India
Telephone: +91-20-64100790, 25120833
Email: ihmp@vsnl.com

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