A study into the health of Phnom Penh's residents has found that "non-slum poor"

have the city's worst health indicators.

The survey of women from 2,200 households, which was conducted by the Ministry of

Health and the World Health Organization, found that those who live in slum-like

conditions - but not in slum areas - suffer from the worst health services.

"A large, and growing, proportion of the urban poor is inadequately served by

the existing health system," said David Wilkinson, technical advisor to the

municipality's project on urban health.

The study was presented to Medicam, an umbrella group of health NGOs, at a seminar

on July 19. The data were collected between January and March 2001 and were based

on the format of the countrywide Demographic Health Survey (DHS) conducted in 2000.

The earlier DHS study determined that urban residents were largely better off than

those in rural areas. The new report looked more closely at disparities in urban

areas by examining health indicators for different classes of Phnom Penh residents.

The Phnom Penh Intra-Urban Health Survey 2001 (UHS) categorized city residents into

three tiers: 'slum poor' (SP), 'non-slum poor' (NSP) and 'non-slum non-poor' (NSNP).

The poorest showed similar low health indicators to rural households.

The 'non-slum poor' category contained households scattered around the city, including

squatters, rooftop dwellers and those camping on the sides of the streets. That group

was shown by a range of indicators to be worse off than those in established slum

areas.

It noted that all of the NSNP had access to sanitation and most enjoy safe drinking

water. For the slum poor the figures were 90 percent and 43 percent; only half of

the non-slum poor have toilet facilities and just one-third can get safe drinking

water.

The study provides a timely warning as more people head to the capital and join the

NSP ranks every year. Official statistics show the city's population is just below

one million, but is growing by 5 percent a year. At that rate, the report stated,

the city's population would double by 2015 and triple by 2023.

The recent relocation of many slum poor following fires in squatter areas has added

to the non-slum poor population. Many residents have been forced to leave relocation

sites to eke out a living closer to work and trade opportunities.

"Because their previous support mechanisms have been destroyed, people will

now fall into the category of non-slum poor, with the attendant problems of low health,

housing and environmental indicators," said Wilkinson.

The report noted that "the problem of the marginalized urban poor of Phnom Penh

will not disappear with relocation". It argues instead for sound investment

in the provision of low cost, quality health services for the urban poor.

It also showed that while the disconnected and itinerant non-slum poor were worst

off, the city's slum dwellers also have poor health.

"The slum poor population also show poor health indicators, particularly with

teenage pregnancies, abortion, prevalence of illness and injury, female education

levels and low contraceptive use," the report says.

Fifty-seven percent of the slum poor lack access to safe drinking water and around

one-third of babies were delivered outside a health facility. However the second

figure compares favorably with the NSP, for whom 70 percent of deliveries are outside

a health center. NSNP residents registered just 10 percent.

The report put the relatively better health and environment experienced by slum dwellers

down to "the benefits of living in a slum community with more social cohesion

to organize facilities and generally receiving more support from development projects".

The scattered community of rooftop dwellers, people who live on the streets, and

others who make up the non-slum poor category are more likely to go unnoticed by

the authorities and NGOs providing support services. Not only are the NSP most likely

to become sick or injured, but they also find it most difficult to pay for health

care when they need it.

Almost 30 percent of the NSP cannot afford health care out of their own income or

savings, compared to 17 percent of slum dwellers and 4 percent of the capital's NSNP.

That leads many into debt to cover what amounts to an average $25 spent on each episode

of illness or injury.

Wilkinson said that although the Ministry of Health was giving greater attention

to the needs of the urban poor in its new strategic plan, "there is still a

need for more donor support for this component".

The survey also found that the poorer a woman is, the more children she is likely

to have. It noted that women in Phnom Penh have fewer than the average 4.2 children

born to their rural counterparts.

"A woman living in non-slum non-poor areas will give birth to an average of

two children during her lifetime, compared to three children for SP and 3.5 children

for NSP women," the report stated.