A Proposal to Improve the Health Care Systems for the Urban Poor in the Squatter Settlements of the Developing Countries
> download pdf of paper

by Prof. Richard Larson and Nebibe Varol

July 2003

Introduction
The world population is rapidly becoming urban. The major concern with the rapid urbanization of the world population is the fact that over the next 30 years virtually all population growth will take place in urban areas of the developing countries. For most of the developing countries, which have unstable economies and inadequate infrastructure, a rapid urbanization process is overwhelming because it refers to much more than simple population growth. The most challenging features of rapid urban growth are the economic, environmental and social changes it introduces in the urban environment and urban life.

The rapid and unplanned growth of cities strains the capacities of service providers. Governments are not able to meet the soaring demand for energy, education, health care, transportation, sanitation and physical security. Inadequate provision of services and the inability to maintain the basic upkeep of cities due to insufficient revenues and limited budgets result in “urban sprawl”, serious environmental problems, and widespread poverty. In many cities in the developing world, urban sprawl exists in the form of city dwellers living in the urban periphery in poverty and environmental degradation with lack of urban services, including running water, trash pickup, electricity or paved roads. These living conditions tremendously increase the burden of health for the urban poor.

Rapid urbanization and large scale population movements from rural to urban areas have resulted in unprecedented health crises in the developing countries. In addition to communicable diseases, respiratory infections and malnutrition, psycho-social stresses due to marginalization and exclusion from social activities and employment prospects are also prevalent. Considering the rate of urban growth rate and the rapid increase in the percentage of the poor living in urban areas, the debilitating effects of health crises and urban poverty are going to exacerbate if no precautions are taken. In this respect, it is a critical point in time to come up with effective health care strategies for the urban poor. This document provides an insight into the reasons behind the current health problems of the urban poor and the determinants of health in developing countries, and proposes use of operations research to come up with handling strategies for the major subdivisions of the health problem in the developing world.