Health and immunisation services for the urban poor in selected countries of Asia

Abstract

Background: Asia is a region that is rapidly urbanising. While overall urban health is above rural health standards, there are also pockets of deep health and social disadvantage within urban slum and peri-urban areas that represent increased public health risk. With a focus on vaccine preventable disease and immunisation coverage, this commentary describes and analyses strengths and weaknesses of existing urban health and immunisation strategy, with a view to recommending strategic directions for improving access to immunisation and related maternal and child health services in urban areas across the region. The themes discussed in this commentary are based on the findings of country case studies published by the United Nations Childrens Fund (UNICEF) on the topic of immunisation and related health services for the urban poor in Cambodia, Indonesia, Mongolia, Myanmar, the Philippines, and Vietnam.

Main body: Although overall urban coverage is higher than rural coverage in selected countries of Asia, there are also wide disparities in coverage between socio economic groups within urban areas. Consistent with these coverage gaps, there is emerging evidence of outbreaks of vaccine preventable diseases in urban areas. In response to this elevated public health risk, there have been some promising innovations in operational strategy in urban settings, although most of these initiatives are project related and externally funded. Critical issues for attention for urban health services access include reaching consensus on accountability for management and resourcing of the strategy, and inclusion of an urban poor approach within the planning and budgeting procedures of Ministries of Health and local governments. Advancement of local partnership and community engagement strategies to inform operational approaches for socially marginalised populations are also urgently required. Such developments will be reliant on development of municipal models of primary health care that have clear delegations of authority, adequate resources and institutional capabilities to implement.

Conclusions: The development of urban health systems and immunisation strategy is required regionally and nationally, to respond to rapid demographic change, social transition, and increased epidemiological risk.

Keywords: Community engagement; Disease control; Governance; Health equity; Urban health; Urban immunisation.

Fig. 1

Numbers and percent living in urban areas and slums 2014. Data sourced from [42]

Fig. 2

Building the enabling environment for improving urban health systems