Asian Urban Information Center of Kobe

Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls

Section One - The New Urban Challenge for Primary and Reproductive Health Care

Executive Summary

Asian urbanization has been one of the most massive population movements in human population history. In a mere century, a quarter of a million urbanites in a few scattered cities have become more than 3 billion urbanites living in scores of megacities and thousands of other cities and towns. This situation presents a new set of challenges for governments seeking to provide services to improve reproductive health. The historical contrast is striking. When modern population planning began half a century ago, most of Asia was rural and the problem was reaching the millions who lived in scattered and often remote villages. Asian countries made impressive progress in overcoming this physical distance and bringing effective services, information and supplies to the rural populations. Today’s new urban condition provides some advantages but also new challenges. Urbanization means people are closer together and physically closer to service centers. But many new urbanites are uprooted, “floating” populations with few networks that link them effectively to those service centers. Many are often made vulnerable by poverty and the new crush of urbanization. The challenge today is to find ways to serve these densely settled, often socially isolated and transient populations. 

AUICK’s Associate City Workshop program was developed to help find ways to meet the new urban challenges. It has been the product of a specific UNFPA-Kobe agreement in 2004 to develop Workshops to promote the advancement of the Millennium Development Goals (MDGs). It brings together urban administrators from nine cities to Workshops twice a year. In each Workshop one of the MDG issues is addressed. Kobe provides presentations on their programs to address that issue and Workshop participants discuss their cities and related problems. Then the administrators each develop an Action Plan to address some aspect of that problem in their own cities. The great majority of these Action Plans has been implemented in the Associate Cities and the plans have demonstrably improved the quality of life of the citizens. 

This Research Project focuses on reproductive health services in the nine Associate Cities. It seeks to learn how urban administrators view the city’s RH conditions and what they have done to improve RH services and conditions. Individual city reports were prepared by AUICK associates, shown in Section Two, and the overall report was edited by the AUICK Secretariat. 

A regional analysis shows first the expected: cities in wealthier countries have higher levels of RH services and conditions than cities in poorer countries. But the “deviant cases” are more interesting. Faisalabad is the most troubled city. Poorer Danang and Chittagong do better in RH. Moreover, Weihai does slightly better than Khon Kaen, though China is less wealthy than Thailand. As cities, however, Weihai is considerably wealthier than Khon Kaen. From this we derive the following lesson. 

It seems clear that single, homogeneous strategies are not appropriate for RH international assistance. The most effective assistance will be tailored to the specific condition of a city or country. In addition, the successful innovations in RH services throughout the nine cities suggest that they can learn a great deal from one another. The “best practice” reports in the AUICK Workshops were the primary mechanism for this learning. It is likely that they can learn more from one another than from “experts” located far away from the field of action. This leads as well to the suggestion to increase the regional programs by which countries learn from one another, which we return to later. 

Individual City Analyses provide another set of lessons. 

1. Use Local Administrators. Strategies that focus on local administrators and lead them to address their problems can make major headway in improving the quality of life in cities, and especially in improving RH services. 

2. Data systems. It would be especially useful for international assistance agencies to help cities develop good data systems so they can more effectively identify and address their own problems. This suggests a general strategy, not the specific steps needed in each case. It suggests bringing together organizations (universities and city governments) that have special capacities and having them develop an information system appropriate to their local conditions. AUICK experience, noted later, in leading cities to develop Management Information Systems, or City University Partnerships, suggests an effective way to assist in the development of effective data systems. 

3. Regional Programs can help countries learn from one another and improve greatly the quality of services they provide to their people. They can also be highly cost effective.




Section One

The New Urban Challenge for Primary and Reproductive Health Care

Executive Summary

1. Background: Urban Growth and Urban Primary / Reproductive Health (RH) Services

2. An AUICK Research Project Report

3. Regional Findings

4. Individual City Findings

5. Summary and Implications

Section Two

Providing Primary / Reproductive Health Services in Asian Urban Areas with Attention to Vulnerable Populations, Especially Women and Girls:

Nine AUICK Associate City (AAC) Reports

6. Kuantan, Malaysia

7. Khon Kaen, Thailand

8. Weihai, China

9. Surabaya, Indonesia

10. Olongapo, Philippines

11. Chennai, India

12. Faisalabad, Pakistan

13. Danang, Vietnam

14. Chittagong, Bangladesh

Annex I.
Research Instrument: AUICK Research Project Outline

Annex II.
AUICK Research Project Participants

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