Healthcare choices in Mumbai slums: A cross-sectional study

Abstract

Informal urban settlements, known as slums, are the home for a large proportion of the world population. Healthcare in these environments is extremely complex, driven by poverty, environmental challenges, and poor access to formal health infrastructures. This study investigated healthcare challenges faced and choices made by slum dwellers in Mumbai, India. Structured interviews with 549 slum dwellers from 13 slum areas in Mumbai, India, were conducted in order to obtain a population profile of health-related socio-economic and lifestyle factors, disease history and healthcare access. Statistical tools such as multinomial logistic regression were used to examine the association between such factors and health choices. Private providers (or a mixture of public and private) were seen to be preferred by the study population for most health conditions (62% - 90% health consultations), apart from pregnancy (43% health consultations). Community-based services were also preferred to more remote options. Stark differences in healthcare access were observed between well-known conditions, such as minor injuries, pulmonary conditions, and pregnancy and emerging challenges, such as hypertension and diabetes. A number of socio-economic and lifestyle factors were found to be associated with health-related decisions, including choice of provider and expenditure. Better planning and coordination of health services, across public and private providers, is required to address mortality and morbidity in slum communities in India. This study provides insights into the complex landscape of diseases and health providers that slum dwellers navigate when accessing healthcare. Findings suggest that integrated services and public-private partnerships could help address demand for affordable community-based care and progress towards the target of universal health coverage.

A contextual exploration of healthcare service use in urban slums in Nigeria

“…On the other hand, if people held health beliefs about specific symptoms associated with common communicable diseases, whether medically accurate or not, they may perhaps initially try to address these informally. Although the results align with previous findings [56] on slum residents using a combination of private and public health facilities for most of their health conditions, it has implications for referral systems between informal and formal providers in the slum sites. In the informal sector, PMVs are often the first point of community contact, including in our study sites where a higher proportion of visits to pharmacies/PMVs was for new conditions than existing conditions [33].…”

“…For maternal and perinatal conditions, slum residents have higher odds of using formal healthcare facilities for maternal and perinatal conditions than other medical conditions. Perhaps, this is because formal healthcare services are often regulated institutions with skilled healthcare providers for maternal and child health, or it may be due to the longer-term investments made by governments on maternal and child health programs [19,56,58,59]. These include free services, community awareness/mobilization and health promotion campaigns directed at maternal child health issues in the country.…”

Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh: A descriptive cross-sectional study in two urban settings

“…[25] Naydenova (2018) reported similar findings in their study of slums in Mumbai, noting an overall preference for private sector care, and an association between socioeconomic status and choice of healthcare provider. [23] Sex differences in chronic healthcare seeking were also apparent, with women across slums relying on private clinics to a greater degree than men compared to drug shops or public facilities. These findings may be related to the attributes slum dwellers value in making healthcare provider choices for chronic illness care.…”

“…[17,18] While comparatively limited data exists on slums [19][20][21][22] they point to alarming levels of tobacco use among men, overweight and raised total cholesterol in women, as well as rates of diabetes well above the national average. [17,19,21] Given the health risks and challenges that slum-living presents, we need to better understand the full range of chronic health problems that slum dwellers face, the healthcare choices they make [22][23][24][25] and the economic burden this represents. However, evidence suggests that illness experiences may vary substantially between and within slums due to differences in socio and physical environment, geography, income poverty as well as neighborhood and habitat type [7,21,26,27].…”

“…[10] Less is known about variations in healthcare seeking for chronic conditions in slum settings, and what evidence exists focuses more on averages than the complexities that determine healthseeking. [22][23][24] Given Bangladesh's fragmented and pluralistic healthcare system, and the dominant presence of the informal private sector in and around slum settlements [28], heterogeneity in disease burden, health seeking behavior and health expenditures are likely. In this study we document this complexity in two slum settings in Bangladesh.…”