The following is a report I had written for my Primary Health Care course after a field visit to Rehri Goth and the Urban Health Program (UHP) that has been set up there by AKU. I will first provide you with some background before talking about the UHP.



With the advent of industrialization and with the global population rising at an unexpected rate, the world has witnessed a rapid urban growth from rural areas. Cities across the globe are rapidly increasing in size and in numbers due to increased opportunities and incentives for its people. However, despite of its obvious benefits, urbanization has been accompanied by negative and devastating consequences, especially for the poor in the developing world. In the developing world, economic growth and development in urban areas are severely inadequate to meet the needs of the growing population. This has resulted in environmental degradation and poverty at an unprecedented rate. Due to poverty and lack of available land, individuals and their families are forced to settle in slums or ‘squatter settlements.’

A squatter settlement is a residential area in an urban locality inhabited by the very poor who have no access to land which they can claim as their own. With the population of Karachi (an urban hub) continuously on the rise, so are the numbers of squatter settlements in this city. One such example is Rehri Goth (remember I talked about this village in one of my earlier blogs), located in the outskirts of Karachi, Pakistan. Rehri Goth is a 400 year old village at the coastal margins of the Arabian Sea with a population of 40,000. As with any other squatter settlement, Rehri Goth has her own share of health and developmental problems. For example, living conditions are extremely crowded and there exists unsafe housing infrastructure. Income generated from the fishing industry is not enough to meet the needs of the people. As a result, poverty is getting worse and worse. To further complicate the matter, literacy levels are very low with only 10% men and 4% women having attended formal schooling. A system for proper waste disposal does not exist within the community and neither is there a functioning sewage system. Additionally, as clean water supply is severely limited, diarrhea and other water-borne illnesses are of major concern. This is further aggravated by limited health education and unhygienic living conditions, leading to severe health complications such as acute respiratory infections and skin infections. Malnutrition is also a major concern within the community, resulting in anemia and poor growth and development. Therefore, crude birth rates, maternal mortality and infant mortality are on the rise and need serious attention.

In order to address the health and developmental needs of squatter settlements, such as Rehri Goth, a Primary Health Care model is needed. Primary health care is a people-centered approach aimed at providing universal coverage for essential health care services based on the principles of equity, accessibility, and affordability. This can only be accomplished through the participation of various stakeholders, especially communities. Other key elements of achieving this goal, as outlined by WHO, includes the reduction of social and economic disparities, organizing health services as per the needs and expectations of the community, and integration of health into all government sectors through public policies and reforms.