Urban Health Updates
Switching Managua on! Connecting informal settlements to the formal city through household waste collection. Environment and Urbanization April 2013.
María José Zapata Campos and Patrik Zapata.
- Gothenburg Research Institute, University of Gothenburg, Göteborg, Sweden; e-mail: firstname.lastname@example.org
- School of Public Administration, University of Gothenburg, Göteborg, Sweden; e-mail: email@example.com
This paper explores the organizing of household solid waste management collection and disposal practices in informal settlements. It is based on a case study of an NGO project that supports Manos Unidas (Joined Hands), an informal waste picker cooperative in Managua, Nicaragua. Using horse carts, these waste pickers collect household solid waste from informal settlements where there was no previous regular, official waste collection.
Unlike many development projects, which try to control people’s agency, the support examined here focused on the residents of illegal neighbourhoods and the waste pickers, who themselves became city constructors and co-producers of basic services such as household waste collection rather than service recipients of aid programmes or municipal governments. By slightly changing the actions of the actors already involved in informal waste handling in the informal settlements, the project succeeded in transforming an agent of pollution into the solution to several interconnected problems, namely illegal dumping by the cart-men and residents, the cart-men’s low and irregular incomes and the lack of household waste collection services.
Health of the Urban Poor Program (HUP)
The Population Foundation of India (PFI) is assisting the central government and eight state governments in India, by leading a consortium of technical and implementation partners, in designing and implementing urban health programs, under the USAID-funded Health of the Urban Poor (HUP) program. The PFI-lead consortium works towards strengthening the planning and monitoring systems to deliver innovative models of healthcare, especially maternal, neonatal and child health services (including choices of family planning), while integrating the other determinants of health (nutrition, water, sanitation and hygiene), for the urban poor. These interventions are designed within a larger governance and convergence framework, in partnership with the available private and non-government sector, and supported by effective community engagement at the slum level.
The Health of Urban Poor (HUP) project strives to support, strengthen, and improve Government of India’s comprehensive package of maternal and child health services, and nutrition interventions, including promotion of water supply, sanitation and hygiene services in urban slums. HUP provides technical and capacity -building support to government of India, state governments, local self-governance institutions, line departments, and local civil society organizations to design and implement comprehensive health programs for urban poor in eight states.
The important relationship between landlords and tenants in improving sanitation – the case of Keko Machungwa, 2013.
Stella Stephen, et al.
In the informal settlements of Tanzania, particularly in Dar es Salaam, traditional pit latrines are commonly used for sanitation purposes. Many of these are poorly designed and constructed, and lack the necessary maintenance and formal arrangements for waste disposal. This is the case in Keko Machungwa, which is one of the informal settlements in Miburani ward, located in Temeke municipality. The settlement has a population of 15,644, distributed across 5,180 households. The relationship between landlords and tenants was highlighted by Keko Machungwa community members as a critical challenge in improving sanitation standards.
This is because they are responsible for the decision-making and investment around the choice and improvement of sanitation solutions, and most houses in Tanzanian informal settlements are owned by landlords. However, despite their responsibility in this area, most landlords do not pay much attention to the improvement and construction of good latrines within the houses they own. The Tanzania Urban Poor Federation (TUPF) and Centre for Community Initiatives) have been exploring ways of improving the relationship between landlords and tenants, with a view to improving sanitation in informal settlements.
Urban Inequalities: The Heart of the Post-2015 Development Agenda and the Future We Want for All, 2013.
Sheridan Bartlett, Diana Mitlin, David Satterthwaite
Urban inequalities are also masked by standards and definitions that fail to take account of urban realities. National poverty lines often disregard the higher cost of living in most cities and what it means to be tied to a cash economy. These inequalities really matter where every basic need has to be paid for or otherwise negotiated.
Applying global standards for the provision of sanitation and water can also be misleading in densely populated settlements, communicating a level of adequacy that is not warranted. Understanding the causes, nature and extent of urban inequalities is critical, not only because it calls attention to severe and increasing deprivation in many urban areas, but also because of the ramifications of these disparities for economic growth, for peace and security, for the health and well being of all citizens, rich and poor, urban and rural.
Reproductive Health Voucher Program and Facility Based Delivery in Informal Settlements in Nairobi: A Longitudinal Analysis. PLoS One, Nov 2013.
Djesika D. Amendah, et al.
Introduction – In Kenya, the maternal mortality rate had ranged from 328 to 501 deaths per 100,000 live births over the last three decades. To reduce these rates, the government launched in 2006 a means-tested reproductive health output-based approach (OBA) voucher program that covers costs of antenatal care, a facility-based delivery (FBD) and a postnatal visit in prequalified healthcare facilities. This paper investigated whether women who bought the voucher for their index child and had a FBD were more likely to deliver a subsequent child in a facility compared to those who did not buy vouchers.
Methods and Findings – We used population-based cohort data from two Nairobi slums where the voucher program was piloted. We selected mothers of at least two children born between 2006 and 2012 and divided the mothers into two groups: Index-OBA mothers bought the voucher for the index child (N=352), and non-OBA mothers did not buy the voucher during the study period (N=514). The most complete model indicated that the adjusted odds-ratio of FBD of subsequent child when the index child was born in a facility was 3.89 (p<0.05) and 4.73 (p<0.01) in Group 2.
Discussion and Conclusion – The study indicated that the voucher program improved poor women access to FBD. Furthermore, the FBD of an index child appeared to have a persistent effect, as a subsequent child of the same mother was more likely to be born in a facility as well. While women who purchased the voucher have higher odds of delivering their subsequent child in a facility, those odds were smaller than those of the women who did not buy the voucher. However, women who did not buy the voucher were less likely to deliver in a good healthcare facility, negating their possible benefit of facility-based deliveries. Pathways to improve access to FBD to all near poor women are needed.
Promoting health and advancing development through improved housing in low-income settings. J Urban Health. 2013 Oct;90(5):810-31.
Haines A, Bruce N, Cairncross S, Davies M, Greenland K, Hiscox A, Lindsay S, Lindsay T, Satterthwaite D, Wilkinson P. Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK,
There is major untapped potential to improve health in low-income communities through improved housing design, fittings, materials and construction. Adverse effects on health from inadequate housing can occur through a range of mechanisms, both direct and indirect, including as a result of extreme weather, household air pollution, injuries or burns, the ingress of disease vectors and lack of clean water and sanitation.
Collaborative action between public health professionals and those involved in developing formal and informal housing could advance both health and development by addressing risk factors for a range of adverse health outcomes. Potential trade-offs between design features which may reduce the risk of some adverse outcomes whilst increasing the risk of others must be explicitly considered.
Policy Paper: Sustainable Service Delivery in an Increasingly Urbanized World, 2013. USAID.
This Policy seeks to move away from a development approach oriented around an artificial urban-rural dichotomy. Instead,the Agency believes that development efforts must span a continuum from rural to urban to form an interdependent system. It is the vision of this Policy to support service delivery that attains large-scale benefit to urban residents in a sustainable manner over the long term. This Policy therefore encourages Missions to support programs that will improve governance, encourage accountability, and bolster capacity to manage urban service delivery systems.
The Health of Women and Girls in Urban Areas with a Focus on Kenya and South Africa: A Review, 2013.
Kate Hawkins, Hayley MacGregor and Rose Oronje. Institute of Development Studies.
With respect to the kinds of ‘evidence’ prevalent in the literature, the review revealed a bias towards quantitative biomedical research evidence with a narrow disease focus, which has dominated debates on urban health in developing countries, at the expense of qualitative as well as gender-focused analyses reflecting a broader range of the interconnecting health concerns of women and girls. The knowledge that appears to have dominated debates on urban health in developing countries is largely quantitative, whereas qualitative evidence, including experiential knowledge of poor and marginalised groups that live in informal settlements, has been less prominent.
The bias in the existing body of knowledge on urban health in developing countries has thus to a large extent silenced the voices of the inhabitants of these areas in key decision-making processes. Indeed, it has been argued that relativist scientific knowledge and lay knowledge, although often marginalised in the health sector, are critical in decision-making as they capture contextual issues, which are critical for policy action (Theobald and Nhlema-Simwaka 2008). It has also meant that some important determinants of health have received less attention. Much of the existing evidence does not
provide much insight on how gender inequalities interact with the health disadvantage of living in poor urban settings. Critics have argued that urban health studies often ignore the political and systemic nature of social stratification, instead studying the health impact of decontextualised and isolated characteristics of population groups.
Cost of behavior change communication channels of Manoshi -a maternal, neonatal and child health (MNCH) program in urban slums of Dhaka, Bangladesh. Cost Eff Resour Alloc. 2013 Nov 14;11(1):28.
Sarker BK, et al
BACKGROUND: The cost of behavior change communication (BCC) interventions has not been rigorously studied in Bangladesh. This study was conducted to assess the implementation costs of a BCC intervention in a maternal, neonatal and child health program (Manoshi) run by BRAC, which has been operating in the urban slums of Dhaka since 2007. The study estimates the costs of BCC tools per exposure among the different types of BCC channels: face-to-face, group counseling, and mass media.
METHODS: The study was conducted from November 2010 to April 2011 in the Dhaka urban slum area. A micro-costing approach was applied using primary and secondary data sources to estimate the cost of BCC tools. Primary data were collected through interviews with service-providers and managers from the Manoshi program, observations of group counseling, and mass media events.
RESULTS: Per exposure, the cost of face-to-face counseling was found to be 3.08 BDT during pregnancy detection, 3.11 BDT during pregnancy confirmation, 12.42 BDT during antenatal care, 18.96 BDT during delivery care and 22.65 BDT during post-natal care. The cost per exposure of group counseling was 22.71 BDT (95 % CI 21.30-24.87) for Expected Date of Delivery (EDD) meetings, 14.25 BDT (95% CI 12.37-16.12) for Women Support Group meetings, 17.83 BDT (95% CI 14.90-20.77) for MNCH committee meetings and 6.62 BDT (95% CI 5.99-7.26) for spouse forum meetings. We found the cost per exposure for mass media interventions was 9.54 BDT (95% CI 7.30-12.53) for folk songs, 26.39 BDT (95% CI 23.26-32.56) for street dramas, 0.39 BDT for TV-broadcasting and 7.87 BDT for billboards. Considering all components reaching the target audience under each broader type of channel, the total cost per exposure was found to be 60.22 BDT (0.82 USD) for face-to-face counseling, 61.40 BDT (0.82 USD) for group counseling and 44.19 BDT (0.61 USD) for mass media.
CONCLUSIONS: The total cost for group counseling was the highest per exposure, followed by face-to-face counseling and mass media. The cost per exposure varied substantially across BCC channels due to differences in cost drivers such as personnel, materials and refreshments. The cost per exposure can be valuable for planning and resource allocation related to the implementation of BCC interventions in low resource settings.
Pathways of Economic Inequalities in Maternal and Child Health in Urban India: A Decomposition Analysis. PLoS One, March 2013.
Srinivas Goli , Riddhi Doshi, Arokiasamy Perianayagam
Background/Objective: Children and women comprise vulnerable populations in terms of health and are gravely affectedby the impact of economic inequalities through multi-dimensional channels. Urban areas are believed to have better socioeconomic and maternal and child health indicators than rural areas. This perception leads to the implementation of health policies ignorant of intra-urban health inequalities. Therefore, the objective of this study is to explain the pathways of economic inequalities in maternal and child health indicators among the urban population of India.
Methods: Using data from the third wave of the National Family Health Survey (NFHS, 2005–06), this study calculated relative contribution of socioeconomic factors to inequalities in key maternal and child health indicators such as antenatal check-ups (ANCs), institutional deliveries, proportion of children with complete immunization, proportion of underweight children, and Infant Mortality Rate (IMR). Along with regular CI estimates, this study applied widely used regression-based Inequality Decomposition model proposed by Wagstaff and colleagues.
Results: The CI estimates show considerable economic inequalities in women with less than 3 ANCs (CI =20.3501),institutional delivery (CI =20.3214), children without fully immunization (CI =20.18340), underweight children (CI=20.19420), and infant deaths (CI =20.15596). Results of the decomposition model reveal that illiteracy among women and her partner, poor economic status, and mass media exposure are the critical factors contributing to economic inequalities in maternal and child health indicators. The residuals in all the decomposition models are very less; this implies that the above mentioned factors explained maximum inequalities in maternal and child health of urban population in India.
Conclusion: Findings suggest that illiteracy among women and her partner, poor economic status, and mass media exposure are the critical pathways through which economic factors operate on inequalities in maternal and child health outcomes in urban India.
Health Inequalities among Urban Children in India: A Comparative Assessment of Emprowered Action Group (EAG) and South Indian States. Journal of Biosocial Science, March 2013.
P. Arokiasamy, K. Jain, S. Goli, J Pradhan
As India rapidly urbanizes, within urban areas socioeconomic disparities are rising and health inequality among urban children is an emerging challenge. This paper assesses the relative contribution of socioeconomic factors to child health inequalities between the less developed Empowered Action Group (EAG) states and more developed South Indian states in urban India using data from the 2005–06 National Family Health Survey. Focusing on urban health from varying regional and developmental contexts, socioeconomic inequalities in child health are examined first using Concentration Indices (CIs) and then the contributions of socioeconomic factors to the CIs of health variables are derived.
The results reveal, in order of importance, pronounced contributions of household economic status, parent’s illiteracy and caste to urban child health inequalities in the South Indian states. In contrast, parent’s illiteracy, poor economic status, being Muslim and child birth order 3 or more are major contributors to health inequalities among urban children in the EAG states. The results suggest the need to adopt different health policy interventions in accordance with the pattern of varying contributions of socioeconomic factors to child health inequalities between the more developed South Indian states and less developed EAG states.
Living and health conditions of selected cities in India: Setting priorities for the National Urban Health Mission. Cities 28 (2011) 461–469.
Srinivas Goli, P. Arokiasamy, Aparajita Chattopadhayay
The concept of ‘‘healthy city’’ promotes the physical, mental, social, and environmental well-being of people who live and work in urban areas. Fostering sustainably healthy cities is the prime objective of the National Urban Health Mission (NUHM) in India. However, attaining this goal requires establishing priorities, key concerns, strategies and guidelines for action.
This paper aims to assist policymakers by providing critical insights into the health and living conditions in selected major cities in India, with special emphasis on slums. This paper presents evidence that many of India’s major cities face significant deficits in the provision of basic amenities, including shelter, safe drinking water, improved sanitation and electricity.
Demographic and health conditions in these cities lag far behind the goals set forth in national policies almost a decade ago. Despite the apparent proximity of city dwellers to urban health facilities, less than one third of the urbanites in India utilize government health facilities.
ICUH 2014 – Manchester, England, March 4-7, 2014
Registration and abstract submission are now open for the 11th International Conference on Urban Health. The conference will take place in Manchester, United Kingdom, from March 4-7, 2014. Please go to www.icuh2014.com for more information.
The over-arching theme for ICUH2014 is “Crossing Boundaries – Partnerships for Global Urban Health“.
Confirmed speakers include:
- Professor Sir Michael Marmot (Director, UCL Institute of Health Equity, Marmot Institute)
- Professor Ilona Kickbusch (Director of the Global Health Programme, Geneva)
- Professor David Vlahov (Dean, School of Nursing, University of California, San Francisco)
- Trevor Hancock (Co-founder, Healthy Cities and Communities)
- Alex Ross (Director of the World Health Organisation, Kobe Centre)
- Claudia Stein (Director of the Division of Information, Evidence, Research and Innovation at the World Health Organisation Europe Centre)
KIT – E-learning: Urban Health in Low- and Middle Income Countries, April-June 2014.
At the end of this course, participants will be able to:
1. Describe demographic trends and prospects worldwide with respect to urbanisation and interpret the health situation of ‘average’ urban populations in developing countries in the light of existing inequalities.
2. Identify and appraise the important factors implicated in health and inequalities in a (poor) urban environment using a framework of social determinants of health.
3. Ascertain the role of (local) health systems in relation to service provision, health practices and in addressing inequalities in determinants, health status, access, financial contributions and/or consequences of ill-health.
4. Critically evaluate the principles of governance, accountability, participation and voice in relation to marginalised communities in urban environments.
5. Advocate with stakeholders for collaborative intersectoral action to promote urban health.
6. Review good practices and critically appraise interventions and own experiences in the context of urban health and formulate program and policy recommendations.
Factors affecting immunization coverage in urban slums of Odisha, India: implications on urban health policy. Healthcare in Low-Resource Settings, Oct 2013.
Santosh K., et al.
Infectious diseases are major causes of morbidity and mortality among children. One of the most cost-effective interventions for improved child survival is immunization, which has significant urban-rural divides. Slum dwellers constitute about one-third of Indian population, and most children still remain incompletely immunized. The main purpose of this study was to understand the factors behind partial or non-immunization of children aged 12-23 months in slum areas of Cuttack district, India. Session-based audit and a population-based survey were conducted in the urban slums of Cuttack city, April-June 2012. Total 79 children were assessed and their mothers were interviewed about the nature and quality of immunization services provided.
Children fully immunized were 64.6%. Antigen-wise immunization coverage was highest for Bacillus Calmette-Guérin (BCG) (96.2%) and lowest for Measles (65.8%), which indicates high instances of late drop-out. Frequent illnesses of the child, lack of information about the scheduled date of immunization, frequent displacement of the family and lack of knowledge regarding the benefits of immunization were cited as the main factors behind coverage of immunization services.
The study showed that there is an urgent need to revise the immunization strategy, especially for urban slums. District and sub-district officials should reduce instances of early and late dropouts and, in turn, improve complete immunization coverage. Community participation, intersectoral co-ordination and local decision making along with supportive supervision could be critical in addressing issues of drop-outs, supply logistics and community mobilization.
Quantification of microbial risks to human health caused by waterborne viruses and bacteria in an urban slum. Journal of Applied Microbiology, October 2013.
A.Y. Katukiza, et al.
Aims – To determine the magnitude of microbial risks from waterborne viruses and bacteria in Bwaise III in Kampala (Uganda), a typical slum in Sub-Saharan Africa.
Methods and results – A quantitative microbial risk assessment (QMRA) was carried out to determine the magnitude of microbial risks from waterborne pathogens through various exposure pathways in Bwaise III in Kampala (Uganda). This was based on the concentration of E. coli O157:H7, Salmonella spp., rotavirus (RV) and human adenoviruses F and G (HAdv) in spring water, tap water, surface water, grey water and contaminated soil samples. The total disease burden was 680 disability-adjusted life years (DALYs) per 1000 persons per year. The highest disease burden contribution was caused by exposure to surface water open drainage channels (39%) followed by exposure to grey water in tertiary drains (24%), storage containers (22%), unprotected springs (8%), contaminated soil (7%) and tap water (0.02%). The highest percentage of the mean estimated infections was caused by E. coli O157:H7 (41%) followed by HAdv (32%), RV (20%), and Salmonella spp. (7%). In addition, the highest infection risk was 1 caused by HAdv in surface water at the slum outlet, while the lowest infection risk was 2.71×10-6 caused by E. coli O157:H7 in tap water.
Conclusions – The results show that the slum environment is polluted and the disease burden from each of the exposure routes in Bwaise III slum, with the exception of tap water, was much higher than the WHO reference level of tolerable risk of 1×10-6 DALYs per person per year
Significance and impact of the study – The findings this study provide guidance to governments, local authorities and non-government organisations in making decisions on measures to reduce infection risk and the disease burden by 102 to 105 depending on the source of exposure to achieve the desired health impacts. The infection risk may be reduced by sustainable management of human excreta and grey water, coupled with risk communication during hygiene awareness campaigns at household and community level. The data also provide a basis to make strategic investments to improve sanitary conditions in urban slums.
Oct 2, 2013 – Building Livable Cities and Healthy Communities Policy and Planning Approaches for Resilience and Sustainability
Please join the Comparative Urban Studies Project of the Woodrow Wilson International Center for Scholars for a seminar on:
Building Livable Cities and Healthy Communities: Policy and Planning Approaches for Resilience and Sustainability - (pdf version for printing)
- Wednesday, October 2, 2013
- 3:00 – 5:00 pm
- 5th Floor Conference Room
- Woodrow Wilson International Center for Scholars
Please RSVP to firstname.lastname@example.org; acceptances only
Featuring presentations by:
- Robert Ogilvie, Vice President for Strategic Engagement, ChangeLab Solutions
- Jon L. Gant, Director of Office for Healthy Homes and Lead Hazard Control, US Department of Housing and Urban Development (HUD)
- Robin Schepper, Senior Advisor, Nutrition and Physical Activity Initiative, Bipartisan Policy Center
- Victor Barbiero, Adjunct Professor, Department of Global Health, George Washington University
Chronic diseases have surpassed communicable diseases as leading causes of death worldwide. Enviromental and policy conditions that enable unhealthy diets, physical inactivity and high rates of tobacco underly increasing chronic disease rates. This makes good health in many communities with developing economies, difficult – if not impossible – to achieve.
ChangeLab Solutions is pioneering a new approach to public health advocacy by building collaboration between public health officials and other local government agencies. Often called health in all policies or shared governance, this collaborative governance model is garnering attention at the World Health Organization and other nongovernmental organizations dedicated to addressing the social determinants of health and fostering healthy, resilient and sustainable environments in which the healthy choice is the easy choice.
By creating good laws and policies that link housing, education, jobs, and the built environment to healthy outcomes – and by working with communities to implement them – ChangeLab Solutions is helping to create places where people have easy access to affordable and healthy food, safe and easily accessible places to live and play, plenty of opportunities to bike, walk, or take transit, fresh water, and clean air indoors and out. ChangeLab Solutions works with neighborhoods, cities, and states to transform communities with laws and policies that create lasting change. Its unique approach, backed by decades of solid research and proven results, helps the public and private sectors make communities more livable, especially for those who are at highest risk because they have the fewest resources.
A panel of experts will discuss innovative law and policy solutions for creating healthier neighborhoods, cities. Speakers will identify environmental change solutions for diseases like diabetes, obesity, asthma, and lung cancer. This seminar will showcase the latest in research and practice on how best to incorporate legal and policy tools into public health strategies.
Contracting urban primary healthcare services in Bangladesh – effect on use, efficiency, equity and quality of care. Tropical Medicine & International Health, Volume 18, Issue 7, pages 861–870, July 2013.
A Heard, et al.
Objective – To evaluate a large, ongoing effort to improve urban primary health care (PHC) in Bangladesh through expansion of publicly funded urban health facilities and contracting with partner non-governmental organisations (NGOs).
Methods – A part of Chittagong was assigned to a contracted NGO while the other parts of the city were contracted to the local government. Performance was assessed by baseline and follow-on household surveys, an endline health facility survey and routinely collected data.
Results – The results of a health facility survey indicated that overall quality of care was better in the NGO area, and routinely collected data showed that the NGO provided many more services per capita. Based on household survey data, the NGO area of Chittagong was poorer and had lower coverage at baseline. There were significant improvements in both government and NGO-run areas. However, larger improvements were observed on some coverage indicators in the NGO area compared to the government area. Improvements in coverage among the poorest 50% of the population were greater in the NGO-run area. The cost per service delivered was 47% lower in the NGO area.
Conclusions – Investments in urban PHC led to an improvement in the coverage of basic services. Contracting with an NGO had an additional effect in terms of improving coverage, equity, quality of care and efficiency. Increased investments in PHC facilities and contracting with NGOs may be effective in improving urban health services.
Open innovation as a new paradigm for global collaborations in health. Globalization and Health 2013, 9:41.
Open innovation, which refers to combining internal and external ideas and internal and external paths to market in order to achieve advances in processes or technologies, is an attractive paradigm for structuring collaborations between developed and developing country entities and people. Such open innovation collaborations can be designed to foster true cocreation among partners in rich and poor settings, thereby breaking down hierarchies and creating greater impact and value for each partner.
Using an example from Concern Worldwide’s Innovations for Maternal, Newborn & Child Health initiative, this commentary describes an early-stage pilot project built around open innovation in a low resource setting, which puts communities at the center of a process involving a wide range of partners and expertise, and considers how it could be adapted and make more impactful and sustainable by extending the collaboration to include developed country partners.
Mobile health clinics: Meeting health needs of the urban underserved. Indian J Community Med cited 2013 Sep 5];38:132-4.
Limalemla Jamir, et al.
In general, the services delivered by the mobile health team are immunization, promotion of community health, including diarrhea management, antenatal care, child nutrition, family planning services, information education and communication services (disease awareness, sexually-transmitted diseases), referral and basic laboratory tests, primary medical care, mental health, and addiction counseling.
Studies have reported on the benefits of mobile health clinics. Immunization coverage increased to 80% in Gwalior, Madhya Pradesh, infant mortality declined, and the marriage age rose from 15.9 to 16.5 years.  In Bhopal, family planning increased by 14%, use of oral contraceptive pills increased by 63%, and condom use increased by 20%. 
Patro et al., studied client satisfaction with mobile health clinics in an urban resettlement colony of the National Capital Territory of Delhi.  Curative services were provided 5 days a week wherein treatment of minor ailments was provided, and specialized clinics provided antenatal and immunization services twice a week. They reported that two-thirds to three-fourths of the clients were satisfied with the mobile health care services.