TY - JOUR
T1 - An analysis of the gender and social determinants of health in urban poor areas of the most populated cities of Pakistan
AU - Ahmed, Khawaja Aftab
AU - Grundy, John
AU - Hashmat, Lubna
AU - Ahmed, Imran
AU - Farrukh, Saadia
AU - Bersonda, Dexter
AU - Shah, Muhammad Akram
AU - Yunus, Soofia
AU - Banskota, Hari Krishna
N1 - Funding Information:
This program of research was co funded through National Immunization Support Project (NISP)/Multi donor trust funds (MDTF), Gavi, the Vaccine Alliance and the EPI Program Pakistan.
Funding Information:
We hereby acknowledge the substantial efforts undertaken by the following Organisations in facilitating implementation of the urban health studies. These include the management and staff of the Federal and Provincial EPI Programs as well as the District Health Offices in the ten mega cities and for the technical advice provided by the staff of the World Health Organization and Civil Society Human and Institutional Development Program (CHIP). We would also extend our acknowledgements to UNICEF country office (Immunization team) and sub offices for their technical support, coordination and monitoring during implementation of this research, as well as to Regional and Headquarter technical staff especially Alyssa Sharkey, for their supervision and review of this paper. We also extend our thanks to Gavi- the vaccine Alliance for the commitments to improvements in vaccination services in Pakistan. Most of all, we would like to extend our appreciation to the many field researchers, health workers, managers and community members who participated in our field research.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Recent surveys, studies and reviews in urban areas of Pakistan have highlighted the impacts of social inequities on access of women and children to health services for women and children in Pakistan. Objectives: The Urban Slum Profiles and coverage surveys were conducted between 2017 and 2019. The objective of the profiles was to obtain an updated listing of slums and other underserved areas, and to better understand current vaccination and health service coverage in these areas. Utilising findings from these studies, this paper aims to better understand the gender and social determinants of health that are giving rise to health inequalities in the slums. Methods: The Urban Slum Profiles adopted a mixed methods approach combining both qualitative and quantitative methods. The study was comprised of two main survey approaches of Urban Slum Profiles and Immunisation Coverage Survey in 4431 urban poor areas of the 10 most highly populated cities of Pakistan. 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.
AB - Background: Recent surveys, studies and reviews in urban areas of Pakistan have highlighted the impacts of social inequities on access of women and children to health services for women and children in Pakistan. Objectives: The Urban Slum Profiles and coverage surveys were conducted between 2017 and 2019. The objective of the profiles was to obtain an updated listing of slums and other underserved areas, and to better understand current vaccination and health service coverage in these areas. Utilising findings from these studies, this paper aims to better understand the gender and social determinants of health that are giving rise to health inequalities in the slums. Methods: The Urban Slum Profiles adopted a mixed methods approach combining both qualitative and quantitative methods. The study was comprised of two main survey approaches of Urban Slum Profiles and Immunisation Coverage Survey in 4431 urban poor areas of the 10 most highly populated cities of Pakistan. 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.
KW - Gender
KW - Immunization
KW - Pakistan
KW - Primary health care
KW - Social determinants
KW - Vaccination
UR - http://www.scopus.com/inward/record.url?scp=85128251490&partnerID=8YFLogxK
U2 - 10.1186/s12939-022-01657-w
DO - 10.1186/s12939-022-01657-w
M3 - Article
C2 - 35436931
AN - SCOPUS:85128251490
SN - 1475-9276
VL - 21
JO - International Journal for Equity in Health
JF - International Journal for Equity in Health
IS - 1
M1 - 52
ER -