Status of health in urban settlements of Bengaluru

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A Collaborative effort from Makkala Jagriti, Mitr Sanketa, Sampark & Women’s Voice

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Training & data collection

• Data collector’s and FGD/IDI facilitators training :

Data collectors training held at Mitr Sanketa Office on 29/03/2024 , total 12 data collectors participated in the training

Second training on data collectors held on 2/05/2024 at MS office , total 12 data collectors participated.

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Focus group discussion : Total 5 FGD held , 23.05.2024 at Somasundar Pallya ,total 11 women participated in the FGD

2^nd FGD held on 23.05.2024 at Subhas Nagar, total 14 women involved , 3^rd FGD held on 25/05/2024 at Yarab Nagar , total 11 women joined,

1.06.2024 FGD held at Bhavani nagar, total 8 women and 03.06.2024 FGD held at Siddapura total 9 women participated in the FGD.

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Total 4 IDI held (Bandepallya, Somasundarpallya , Yarab Nagar and Subhas Nagar)

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Siddapura

Somasundarpallya

Yarab Nagar

Training at MS office

Key findings- Quantitative study

1. Socio-demographic Information: Overview of the population’s age, gender, education, and family size

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This survey covers about 1076 households from 12 different areas of Bangalore city. Over 4024 individuals responded to the survey.

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• 3% of the households have 1 member, 14% have 2 members, 23% have 3 members, 30% have 4 members, 19% have 5 members, 7% have 6 members, and 3% have over 7 members.
• 1% of households comprise single men / women living in a group. 23% of households speak Kannada, 52% speak Tamil, 14% speak Hindi / Urdu, 8% speak Telugu, and 1.3% speak Bangla. The remaining 1% speak Assamese, Bengali, Lambani, Marathi, and Oriya.
• Out of the 243 households that speak Kannada, about 86% of those households claim to be from Bangalore. The remaining 14% households have migrated from Mandya, Chitradurga, Gulbarga, Hassan, Mysore, Raichur, and Kanakapura.
• Out of the 812 households that don’t speak Kannada, about 73% of those households claim to be from Bangalore. The remaining households are from Tamil Nadu, West Bengal, Kolar, Andhra Pradesh, Uttar Pradesh, Madhya Pradesh, Odisha, and Kerala.

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Key findings- Quantitative study

• 70% of the families declared their monthly household income in the range of 7000/- to 24,000/-
• 8% of families declared their monthly household income in the range of 24,000 to 47,000 plus.

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• 93% of families in this income bracket worked in occupations including domestic work, construction, small business, garment manufacture work, and others. In most cases, multiple members of a single family earned incomes.
• 6% of households do not possess a mobile, 34% own 1 phone, 45% own 2 phones, 11% own 3 phones, and 2% own 4 phones.
• 38% of households owned a fridge, 31% owned a washing machine, 80% owned a mixer grinder, and 95% used cooking gas, 11% owned a bicycle, 47% owned a motorbike or scooter, and 86% owned a TV.
• 7.3% of households have been residing from 1-10 years, 16% from 11-20 years, 28% from 21-30 years, 24% from 31-40 years, 15% from 41-50 years, and 10% for over 50 years.

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Key findings- Quantitative study

• About 92% of households are resident in Bangalore all through the year. Of the remaining households, about 4% are resident in Bangalore between 10-11 months of the year. A very small percentage live less than 10 months in Bangalore.
• Almost 0% have declared that they go to other cities for work for some time during the year.
• About 46% or 500 out of 1076 households claim that they reside in their own house. Of the 488 households, 84% have pucca houses.
• About 53% or 574 households reside in rented or leased houses. Of the 574 households on rent or lease, 99 or 17% live in tin sheds
• None of the 1076 households lived in free housing provided by their employer.
• When it comes to drinking water, 85% of all households get their water from corporation taps or a borewell. 13% purchase water from a tanker or shop and 1% get RO water from an employer.
• 93% of households who claim to own their houses have private toilets. About 13% of all households use a shared toilet and less than 1% use open space.
• About 50% of the households dump their waste in a nearby garbage dump. The remaining households claim to segregate their waste.

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Key findings- Quantitative study

In terms of caste, 49% belong to Scheduled Caste, 6% belong to Scheduled Tribe, 16% belong to Other Backward Community, and 25% belong to General category.

In terms of religion, 77% are Hindu, 14% are Muslim, 8% are Christian, and 0.5% belong to other religions

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Percentage of Households vs. Caste Types

Key findings- Quantitative study

Socio-demographic Information: Overview of the population’s age, gender, education, and family size:

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• Children below the age of 14 made up 20% of the individuals in the survey.
•  Almost 90% of the households claim to have lived in Bangalore for over 10 years and work in the city all through the year.
• Close to 70% of the families reported a monthly household income of 7000/- to 24,000/-
• Age group : 21% of all individuals were children between ages of 0-14 years. 48 % of all households have children. 45% of households with children had 1 child, 42% had 2 children, and 13% had 3+ children.
• The top 3 male dominated occupations were mechanic, construction work, and security.
• The top 3 female dominated occupations were domestic worker, cleaning / housekeeping, and street vendor.

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Key findings- Quantitative study

1. Socio-demographic Information: Overview of the population’s age, gender, education, and family size:

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• 61% of all individuals are in the 15-45 age group
• 17% of all individuals are in the 46-60+ years age group. 55% of individuals in this age group are either illiterate or know one language they can read or write
• Amongst the surveyed households, 7% are children up to 6 years of age and 14% are in the 7-14 years age.

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Percentage of Individuals vs. Age Range

Key findings- Quantitative study

Socio-demographic Information: Overview of the population’s age, gender, education, and family size:

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• Education-wise, 73% of individuals have studied up to high school or intermediate/ diploma. Of these individuals, 47% are women. 67% of these women are in the age group of 15-45 years and about 7% are over 45 years old.
• 6% of individuals have a graduate/ professional degree. 46% of these individuals are men and 92% of these men are in the age group of 15-45 years. 96% of the women with a graduate / professional degree were in the age group of 15 – 45 years.

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Key findings- Quantitative study

Occupation & Health: Insights into employment types and how different occupations affect health conditions

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• About 37% of the individuals are not in remunerative work (no occupation mentioned). Typically, children or old persons no longer in work comprise this group. 51% of all individuals not in remunerative work are female. Of the females not in remunerative work, 35% are in the age group 15-45, 6% are in the age group 46-60, and 8% are in the age group 60+.
• Out of 4024 individuals, 63% mentioned an occupation. Of the 37% who did not mention an occupation, 64% were either too old or young. 8% of all individuals claimed that they were unemployed,
• In terms of working conditions of working individuals, 57% of those individuals work for 8-10 hours per day, 27% work 1-7 hours per day, and 16% work over 10 hours per day. 66% of individuals have a weekly off, 56% of individuals get a break in their working day and 13% of individuals work in shifts.

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Key findings- Quantitative study

• Health issues & occupation-
• Excluding children (below the age of 15), 62% of all women have listed an occupation and 77% of all men have listed an occupation.
• 45% of individuals engaged in domestic work, 39% in construction, and 37% in other occupations suffer from either BP, tiredness, or diabetes. 75% of individuals in cleaning / housekeeping and 40% of individuals working in a garment factory suffer from either back pain, diabetes, or BP.

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Key findings- Quantitative study

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• Less than 5% of individuals working in all occupations declared that they suffer from alcohol, heart, or lung problems.
• 38% of women engaged in remunerative work had no ailments and 31% spoke of suffering from either BP, diabetes, tiredness, back / knee pain, or body ache problems.
• 50% of men engaged in remunerative work had no ailments and 27% spoke of suffering from BP, tiredness, diabetes, or back / knee pain problems.

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Top 3 occupations for Female and Male Workers

Key findings- Quantitative study

Public Health Facilities: Level of awareness and usage of available public health services.

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• 373 or 34% of households were found to be aware of both their nearby PHC & Namma Clinics
• 171 or 16% of households were found to be aware of their nearby PHC but not aware of their nearby Namma Clinics
• Only 39% of those households with awareness of their nearby PHC or Namma Clinic had visited these facilities. Of those households who had visited a PHC or Namma Clinic, 90% received medicines, 8% went for tests/ x-ray & 2% visited and got referred to another public health facility.

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Key findings- Quantitative study

Public Health Facilities: Level of awareness and usage of available public health services.

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• Households that were aware of their nearby PHCs/ Namma Clinics yet not visited these facilities cited the following reasons for not visiting these facilities-

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Key findings- Quantitative study

Public Health Facilities: Level of awareness and usage of available public health services.

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• Jan Aushadhi Kendra-awareness & utilisation- 311 or 29% of all households were aware of the Jan Aushadhi Kendras. Of which, only 188 households or 60% had visited the nearby Jan Aushadhi Kendra.
• 70% households said they get their medicines from a Medical shop near the clinic 16%, 11%, and 2% of households said they bring medicines from the doctor whom they visited, a PHC / Namma clinic, and Jan Aushadhi Kendra respectively.
• 43% households declared that they first go to a medical store and ask for advice when there is an illness at home, 25% consult a doctor at a private clinic, 23% take medicine available at home, 7% consult a PHC / Namma clinic, and 2% consult a traditional practitioner.

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Key findings- Quantitative study

Public Health Facilities: Level of awareness and usage of available public health services.

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• Out of the 33% who knew who their ASHA worker is, 65% had availed of ASHA services.
• 71% of those services pertained to Antenatal services or immunization services.
• Only 29% said they had availed of testing services or sought information from ASHA worker for a specific health issue.

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Key findings- Quantitative study

1. Public Health Facilities: Level of awareness and usage of available public health services.

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Percentage of Households Enrolled in Health Schemes

Key findings- Quantitative study

The top 3 schemes in terms of the numbers of households receiving benefits were Gruhajyothi, Anna Bhagya, and Gruhalakshmi schemes.

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Percentage of Households availing Top 4 Schemes

Key findings- Quantitative study

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The table below indicates the % of households receiving each of the entitlements listed

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Key findings- Quantitative study

Health Entitlements: Awareness and access to government health schemes and benefits.

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• 90% of households had a local Aadhar card, 8% had an Aadhar card from other parts of India and less than 1% did not possess an Aadhar card.
• Among eligible (household with a child aged 0-3, breastfeeding or pregnant mother) households or 199 households, 36% or 72 households received supplementary nutrition from Anganwadi
• Among eligible (a household with a pregnant or breastfeeding mother) household or 226 households, 17%, 19%, and 20% had received benefits from Thayi Bhagya scheme, Matru Vandana scheme & Madilu kit respectively. 57% of eligible households had received at least one of these three scheme benefits.
• 78% of households possessed a BPL card (either locally, from another district in Karnataka or from other states). 18% of households did not possess a BPL card.
• 16% of households possessed a Labour card.
• When it came to a ration card from here or from their hometown, 77% had BPL ration card, 3% had APL ration card, 20% did not possess ration cards at all.

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Key findings- Quantitative study

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Out-of-pocket Expenses: Data on personal spending for healthcare and its financial impact on households.

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• 31% of all households said they had avoided visiting a doctor in the preceding 6 months period due to financial reasons. 7% did not wish to answer this question.
• A government health facility was preferred by 26% (287 households), 20% (214 households), and 19% (207 households) for recurring health issues such as frequent cold / cough / fever, frequent gastric problems, and hypertension respectively. 73% (783 households), 48% (516 households), and 42% (458 households) preferred consulting with private practitioners for frequent cold / cough / fever, frequent gastric problems, and hypertension respectively.
• For recurring issues such as frequent cold / cough / fever and gastric problems, 44% of all households preferred home remedies or self-medication and less than 1% preferred AYUSH practitioners.
• Faith healers are preferred by 2-4% of households for recurring health issues such as frequent cold / cough / fever and gastric problems.

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Key findings- Quantitative study

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Out-of-pocket Expenses: Data on personal spending for healthcare and its financial impact on households.

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• 19%, 14%, and 13% of households visited a government facility for frequent cough / cold / fever, frequent gastric issues, and BP respectively.
• 23%, 15%, and 13% of households visited a private facility for frequent cough / cold / fever, frequent gastric issues, and BP respectively.
• For recurring health issues, on a month-on-month basis, 36% of households spend up to 1000 INR and 55% of households spend between 1000 to 5000 INR.
• 1032 or 95% of all households reported an average of 20% of monthly income for health expenses. 33 or 3% of all households reported over 100% of monthly income for health expenses.

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Key findings- Quantitative study

Out-of-pocket Expenses: Data on personal spending for healthcare and its financial impact on households.

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• Out of the households that participated in the study,
• In 42% households, one of the household members had to get hospitalised in the last 1 year
• Less than 1% of households had utilised a health facility in their home town for hospitalisation
• Across all health issues that had necessitated hospital stay in the last 1 year, the average number of days of hospital stay was 10 with maximum number of days being 121 & the most common value being 3 days. (121 days for deaddiction, 15- 20 days for heart related and stroke, women health & 90 days for skin disease)
• 23%, 18%, 8%, 8%, and 4% of households reported getting hospitalization for frequent gastric trouble, other issues, heart problems, accident injuries and diabetes respectively. The most frequent other issues included stroke, weakness, and BP.
• Across all health issues that had necessitated hospital stay in the last 1 year, 42% or 465 households reported an average hospitalisation expenditure was 78,900/- with maximum expenditure of over 15,000/- being for accident injuries. treatments. 15% of all households spent between 10,000 & 50,000 INR on hospitalization costs.

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Key findings- Quantitative study

Out-of-pocket Expenses: Data on personal spending for healthcare and its financial impact on households.

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Sources of funding:

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Key findings- Quantitative study

Out-of-pocket Expenses: Data on personal spending for healthcare and its financial impact on households.

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Source of borrowing :

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Key findings- Quantitative study

Out-of-pocket Expenses: Data on personal spending for healthcare and its financial impact on households.

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Key findings- Qualitative study

• Key takeaways from FGDs and in-depth interviews (in bullet points)

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1. Awareness of Healthcare Facilities:

Most participants were unaware of Namma clinics and Jan Aushadi Kendras. They primarily relied on local medical clinics and private hospitals for treatment due to accessibility and perceived quality of care.

PHCs were generally not used due to their distance and the poor quality of services provided.

2 .Common Health Problems:

Health issues commonly mentioned included heart problems, diabetes, blood pressure, thyroid issues, respiratory problems, and nerve-related conditions.

Participants often resorted to self-medication initially and visited nearby clinics for common ailments like fever, gastric issues, and skin allergies.

3.Hospitalization Expenses:

1.Hospitalization and treatment expenses were a significant financial burden, with costs ranging from Rs 1 lakh to Rs 6 lakhs. These expenses were typically met through borrowing from private moneylenders, SHGs, and microfinance institutions.

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Key findings- Qualitative study

Key takeaways from FGDs and in-depth interviews (in bullet points)

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4. Use of Government vs. Private Hospitals:

While the majority preferred private hospitals for their efficiency and better care, a few participants, particularly from Muslim families, expressed satisfaction with government hospitals, having used them for generations.

5.Experiences with Healthcare Services:

There were mixed experiences regarding the effectiveness of treatments received at PHCs and government hospitals. Some participants felt that medications from PHCs did not suit them, while others had positive experiences with certain government facilities.

6. Access to Benefits:

Experiences with accessing benefits from Anganwadis and Asha workers varied significantly. Some participants reported receiving all necessary support, while others faced neglect and had to fend for themselves.

This summary highlights the significant challenges faced by women from low-income groups in accessing healthcare and managing health outcomes. It also underscores the need for improved awareness and accessibility of government healthcare schemes and facilities.

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Key findings- Qualitative study

a. Key takeaways from IDI

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Prevalence of Abuse: All interviewees reported experiencing physical and verbal abuse by their husbands, and in three cases, also by in-laws.

Nutritional Deficiencies: During pregnancy, the women often lacked proper nutrition and food, impacting both their health and that of their children.

Economic Challenges and Loan Burden: The women frequently incurred unexpected health expenditures, leading to significant loan burdens, with most of their earnings going toward loan and interest repayments.

Educational Aspirations for Children: Despite their circumstances, all the women showed a strong desire to provide good education for their children, often making personal sacrifices to achieve this goal.

Personal Health Issues: The women reported various personal health issues, including heart problems, stress-related conditions, and consequences of physical abuse.

Many of them had ongoing health problems requiring regular medical attention and medication, further straining their financial resources.

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Key findings- Qualitative study

Key takeaways from IDI

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Employment and Financial Management:

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The women were engaged in various forms of employment, including domestic work and small business ventures, often working multiple jobs to manage their financial needs and healthcare costs.

They demonstrated significant stress management skills, juggling work, family responsibilities, and health challenges.

Community and Family Support:

Emotional and some financial support from family members, particularly mothers, played a vital role in helping these women cope with their situations.

Community support varied, with some receiving assistance from employers or local organizations, while others had minimal external support.

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Analysis & Interpretation

Key insights drawn from both quantitative and qualitative findings

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This survey covers about 1076 households from 12 different areas of Bangalore city. Over 4024 individuals responded to the survey. Children below the age of 14 made up 20% of the individuals in the survey.

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• Almost 90% of the households claim to have lived in Bangalore for over 10 years and work in the city all through the year.

Close to 70% of the families reported a monthly household income of 7000/- to 24,000/-

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• 95% of all households possessed at least one phone and also used cooking gas.

• 65% of all individuals have studied up to high school or possess a diploma.

• 63% of all individuals mentioned an occupation with 23% being too old or young and 8% were unemployed.

• The top 3 male dominated occupations were mechanic, construction work, and security. The top 3 female dominated occupations were domestic worker, cleaning / housekeeping, and street vendor.
•  One third of all households were aware of both their PHC and Namma clinics.
•  The primary reason that households (29%) aware of these PHC and Namma clinics did not visit such clinics was the distance from their homes to the clinics.

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Analysis & Interpretation

Key insights drawn from both quantitative and qualitative findings

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• 40% of households who were aware of either their PHC or Namma clinics had visited these clinics.

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• The primary reason that households (29%) aware of these PHC and Namma clinics did not visit such clinics was the distance from their homes to the clinics.

• The top 3 schemes in terms of the numbers of households receiving benefits were Gruhajyothi, Anna Bhagya, and Gruhalakshmi schemes.

• The average out of pocket expense for a hospitalization was about 20% of the monthly household income.

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• Less than 5% used the Ayushman Bharat Scheme, ESI, or private insurance to pay for hospitalization expenses.

• The most common sources for borrowing to pay for hospitalization expenses were money lenders, self-help groups, family, and friends.

• The average annual interest rates for such loans exceeded 25%.

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Key findings- Qualitative study

Highlight key themes that emerged (e.g., challenges in access to healthcare and generic medicines, other barriers faced, etc.)

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• The Study covered more domestic workers, homemakers, and women involved in informal labour such as street vending, construction work, and housekeeping. Most of them were not aware about the Namma clinic and PHC. Many were not aware of the timings of the Namma Clinic. Hence they could not access the Namma clinic, as they found it shut when they went for treatment.

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• Those who had information ,actually did not use the facilities. They were surprised that the Jan Aushadi Kendra's were set up to provide for the poor inexpensive medicines.

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• The economic hardship, health challenges, and the resilience of these women in striving for better health and education for their families despite significant barriers.

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Conclusion, Key recommendations & Next steps

Highlight the most critical outcomes of the study

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Some of the highlights of the survey include

1. The medical costs of over 20% of monthly income is a large fraction of monthly expenditure per household.
2. The interest rates at which households borrow to cover hospitalization expenses is high and can leave households in a debt cycle.
3. There may be a limited awareness of the Ayushman Bharat scheme or it is not being utilized by households that could clearly benefit from the scheme.
4. In comparison, there is a general awareness and usage of state sponsored schemes like Gruhajyothi and Anna Bhagya.
5. The most popular first response to a medical requirement in a household is the pharmacist at the local medical shop, who may not be the best source for medical treatment.

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Conclusion, Key recommendations & Next steps

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Provide practical community focused recommendations

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* Subhash Nagar women particularly asked for a government hospital close by .They had to go to private clinics otherwise for immediate treatment .

* Information and awareness o the medical facilities near to them. Many were unaware of Namma Clinics and PHC facilities.

• Public interactions by the staff of clinics and hospitals, should be friendly and respectful.
• There should be more information on schemes or financial help ,to help patients and their families. A recommendation is to enlist social workers/ counsellors as the first response for patients who come in distress from far and near.

* There should be a monitoring of the role and service of Asha workers, as well as the Anganwadis so that accountability factors in! And if this is a partnership with the community organizations and the health department ,this will go a long way .(Vigilant health committees inclusive of the community and officials)

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Conclusion, Key recommendations & Next steps

How we plan to continue the work or implement changes

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• Collective action by the organisation to disseminate the findings especially related to health seeking behaviour.
• Engage the community to organise awareness camps to seek more information about medical facilities and services of the government in the field of health .

* Facilitate the health schemes available of the Central and State governments…(Ayushmann Bharat Health card ,ESI facilities ,Labour Card ,etc )

* Connect to best practices of private hospitals ,so that in emergency the public can use these services.

* Preliminary discussions already on ,especially for domestic workers ,about relevant OPD and IPD insurance schemes.

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��Status of health in urban settlements of Bengaluru��

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Thank you

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Presentation By : Geeta Menon

Chief Functionary

Mitr Sanketa

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