An analysis of the Gender and Social Determinants of Health in Urban Poor Areas of the Most Populated Cities of Pakistan

Abstract

Background: Recent surveys, studies and reviews have highlighted the impacts of social inequities on access of women and children to health services for women and children in Pakistan. Utilising mixed methods for urban slum profiles, and facility and coverage surveys in 4431 urban poor areas of the top 10 highly populated cities of Pakistan, this paper describes and analyses the complex interactions between economic, social and gender determinants of health care access and considers health policy and program options for addressing them. Results: Findings are classified into six analytic categories of (1) access to health services, (2) female workforce participation, (3) gender friendly health services, (4) access to schools and literacy, (5) social connections, and (6) autonomy of decision making. Out of a national sample of 14,531 children in urban poor areas of 10 cities, the studies found that just over half of the children are fully immunised (54%) and 14% of children had received zero doses of vaccine. There are large shortages of health facilities and female health workforce in the slums, with significant gaps in the quality of health infrastructure, which all serve to limit both demand for, and supply of, health services for women and children. Results demonstrate low availability of schools, low levels of female literacy and autonomy over decision making, limited knowledge of the benefits of vaccination, and few social connections outside the home. All these factors interact and reinforce existing gender norms and low levels of health literacy and service access. Conclusion: The Urban Slum profiles and coverage studies provide an opportunity to introduce gender transformative strategies that include expansion of a female health workforce, development of costed urban health action plans, and an enabling policy environment to support community organisation and more equitable health service delivery access.

Universal health coverage in Pakistan: is the health system geared up to take on the challenge?

“…Pakistan's health system has imprinted structural and non-structural barriers, impeding and denying access to health services for the poor and marginalized groups, including women who continue to be disproportionately affected due to poor quality of care and lack of availability of basic essential commodities and services [6]. Country must develop a more gender and pro-equity focussed urban health strategy and costed action plans aligned with the national and provincial health plans, through the expansion of a female health workforce, in combination with institutional policies to support improved service availability [7]. There is a strong and wide consensus that Pakistan must pursue UHC attainment as the driving force for achieving the SDGs.…”

The Role and Impact of Female Health Workers on the Well-Being of Global South Communities: A Call for Gender-Transformative Action

“…CHW initiatives have taken a variety of regional-and country-specific forms. Some, such as the Brazilian Programa Saúde da Famiília [6,25,29], Ethiopia's health extension workers [16,30] and the Behvarzs of Iran [31], the BRAC's Shasthya Shebika Program of Bangladesh [16,19,32], the Lady Health Workers of Pakistan [33,34] and the Community Health Assistants of Liberia [20,22] have been part of broader social, political, and health sector changes, established in response to the public health challenge of high maternal, neonatal, and under-five mortality. The overwhelming care and social needs in southern African countries afflicted with HIV engendered home-based care and support that emerged organically through local community and non-governmental organizations.…”

“…Lady Health Workers have, likewise, successfully provided cognitivebehavioral interventions for postpartum depression. Approximately 60-70% of rural areas and urban slum populations are benefited by the programme [33,34].…”