1
HEALTH SERVICES DELIVERY
1.5
PROGRAMME FOR VULNERABLE POPULATIONS
1.5.6
Improving the health of peoples in urban slums (as of March 2008)
A
Focal Point
B
Implementing Agencies
C
Target Areas & Beneficiaries
Estate & Urban Health unit, Ministry of Healthcare &
Nutrition
Ministry of Healthcare & Nutrition, Ministry of Local
Government and Provincial councils, PDHS, RDHS,
Municipal MOH and the staff,
MOH of the particular urban council areas.
All the people living in the Municipality areas and the Urban
council areas.
Project Summary:
The health problems of urban people are mainly related to their life style such as food habits,
sanitation, etc and resource constrains. However, not much data is available. High risk groups
specially the poor, living within the urban that need special care. As such we have to identify the major
health problems, issues and presently available services and develop a policy and strategies to provide
better health security to the urban population specially to those under privileged urban slum people.
This project includes.
 Situation analysis and the health problems of those who live in the urban areas.
 Development of a policy and strategies for the Urban Health.
 Identifying Major areas and issues and factors influencing the health and health hazards in
urban areas.
 Identifying mechanisms to implement remedial activities.
1. Justification:
The proportion of the population living in the large towns, grown from 5% to 50% over the past 2
centuries. It is estimated that 50% of the city population lives in low-income settlements, therefore, the
approximate population living in low-income settlement in Colombo is 321,000 or 77,612 families.
33% of those families have difficult access to drinking water, and only 33% of families have their own
toilets. Only 12% have regular sources of employment, and 34% depend on self-employment
activities.
Urbanism potentate many changes in human health and wellbeing due to exposure to hazardous
physical environment and risk taking behaviour due to stress and strains, resource constrains and lack
of community support. Urban dwellers have better access to quality curative care services than in any
rural setting.
People’s health status is influenced not only by access to health services and quality of care, it is even
more a reflection of their access to resources such as sufficient and nutritionally balanced safe food,
safe water, clean air, protective habitat, community supports. The hazards to which they are exposed in
society in general such as environmental pollution with refuse, petroleum products and stagnating
water, loud sounds. In their occupations, their own life skills and risk behaviour such as drug
addictions, smoking, trauma, obeycity and health seeking behaviour etc...
Poverty in any society is a social as well as an economic phenomenon concentrated in
“underprivileged groups”, who have higher health needs than the general population and are usually
suffer impediments to access quality health care services.
Therefore, it is important to address the needs of the urban slum poor as one of the key planning issues
in formulating a master plan for health sector in Sri Lanka. Remedial activities for health benefits
include improving housing and providing safe water, sanitation and waste removal.
2. Important Assumptions/Risks/Conditions:
Health status of a population is dependant on the living condition, water supply, sanitation, access to
other basic resources and community support.
We have to have a multi-sectoral approach in health prevention and promotion strategies and it should
be through appropriate technology in delivering the services. Most of the activities we have to work
with Municipal council or urban councils. Also we have to use the existing systems and mechanism to
implement the programmes. Also political factors are important.
3. Project Objective:
Objective
Indicators
To develop strategies to

Strategic frame
provide better PHC services
work available
to the urban population with

% Utilisation of PHC
special reference to street
services
children, migrant workers,

Selected health
slum dwellers and home less indictor segregated for urban
people.
areas
Means of Verification
Records and retunes
Periodic surveys
4. Project Output/Product:
Outputs
strategic framework developed for
urban population based on
identified service needs
Indicators


Records

Periodic survey

Periodic survey

Changes in public policies
in favour of urban health.

Periodic survey
 No of programme /
activities with high
community participation

Periodic survey
Strategic frame work available
Enhanced service accessibility at all  % of population
level.
utilising basic public health
services
A proper refuse disposal
system  Amount of solid waste
established for safe physical
disposed currently and in the
environment.
past
Target group becomes accessible to
basic needs such as food, water, and
shelter.
Enhanced community participation
in making decisions affecting their
lives, health and wellbeing.
Means of Verification
5. Related Projects:
Project No.
Project Title
National programmes on environmental pollution, occupational health,
communicable/ non communicable disease control programme, mental health
programmes and other community health related projects.
6. Relevant Agencies to be Coordinated:
Municipality and Urban councils and water supply and drainage board, Non-governmental agencies.
Ministry of Social services, Ministry of Urban Development and planning, Ministry of Housing and
Ministry of education, Local media, police and Local top political leaders.
7. Monitoring & Evaluation:
1. Who? Provincial, Central and local government health authorities.
2. When? Periodical monitoring and Evaluation of the programme
8. Activities:
Activities
Expected Results
Process Indicators
1
Conduct a situation analysis to Needs identified
find out the current status and GIS
mapping of composition (by age,
gender, education) of urban slum
areas and also find out nutritional
status and educational standards
Develop TOR
Recruit a consult team
Compilation of baseline
data
2
Develop a policy for urban health Policy document for
services
urban health
developed
Develop the TOR
Identify the policy
development team
3
Develop strategies to provide the
services.
Develop the TOR
Identify the strategy
development group
4
Conduct
health
promotional Increased service
activities on sexual health accessibility for
(substance
abuse,
weaning sexual health
practices etc.).
Identify training needs
Design the training
programme
Develop Trg. materials
5
Carryout a programme for life Developed life skills
skill development of street for street children
children
Identify training needs
Design the training
programme
Develop materials
6
Establish proper refuse disposal Refuse disposal
system
for
safe
physical system established
environment.
Develop a TOR
Hire a consultant group
Design the system
7
Health promotional activities on
Identify training needs
Strategic framework
developed
Reduced Vector
prevention
diseases
of
vector
borne Borne disease
prevalence/incidence
Design the training
programme
Develop materials
8
Develop advocacy programme to
Developed advocacy
facilitate basic needs of the urban programmes
slums
Identify training needs
Design the training
programme
Develop training
materials
9
Develop a mechanism to enhance Community participation
community
participation
in maximized
making decisions affecting their
lives, health and well-being
Develop a TOR
Deploy
a
consultant
group
Design the system
10
Assessment of factor affecting
Survey report on community Identify training needs
community participation of people participation
Design the training
living in the urban slums
programme
Develop training
materials
11
Train
project
enhancing
participation
mangers
on Developed
skills
on Identify training needs
community community participation
Design the training
programme
Develop training
materials