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Etawah City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

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NATIONAL URBAN HEALTH MISSION Program Implementation Plan

2013-14

Submitted by District Health Society, Etawah

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PREAMBLE

National Urban Health Mission aims to improve the health status of urban population

in general and the poor and other disadvantaged sections in particular, by facilitating equitable access to quality health care through a revamped primary public health

care system, targeted outreach services and involvement of the community and urban local bodies. Under the scheme, government proposes to set up one Urban

Primary Health Centre for every 50,000-60,000 population, an Auxiliary Nursing Midwives (ANM) for 10,000 populations and an Accredited Social Health Activist (ASHA) (community link worker) for 200 to 500 households in slum areas.

Etawah, with a population of 15.76 lakh (Census: 2011), having 3.66 lakh (Census:

2011), urban population out of that 92,711 (Source -SUDA) is the population residing in the slums. The sex ratio is quite low and it is around 870 per thousand is also a quite alarming. The AHS-2010-11 reports that institutional deliveries are around 52

% and city having the high IMR 55 (AHS 2011-12) with MMR 250 (AHS 2011-12) that is also area of concern. The unmet need for family planning at the district level is

44.1 % (AHS-10-11) and if we further see the data there are 20% unmet need in urban areas which comprise of 32.1 % for limiting and 12 % for spacing methods.

Looking the situation and available information from various surveys it reveals that Etawah is behind in so many indicators and planning of National Urban Health

Mission will complement for the betterment of urban people particularly to urban poor & slum dwellers.

The NUHM planning for this financial year based on the data, surveys and available information at city level and hoping that we will initiate the process very

systematically so that we can make the difference in improvement of quality life of urban people.

Dr. Udayveer Singh Shri P Guruprasad (IAS)

Chief Medical Officer District Magistrate, Etawah

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ACKNOWLEDGEMENT

The present work for the planning of National Urban Health Mission came with

maintaining hard work, dedication and perseverance. This work of planning would not have been completed without the help and support of a number of people.

We feel really overwhelmed in saying that this work would not have come up without

the valuable support and continuous encouragement of Shri P Guruprasad (IAS), District Magistrate, Etawah. His great confidence in team had inspired us into action.

My special regard goes to Dr. U.V. Singh, Chief Medical Officer, Etawah, a dynamic and enthusiastic personality. He has always been a source of great encouragement for us. The initiation and completion of this work would be substantiated only in his

sincere and able guidance, expertise and precious opinion, keen attention, constructive suggestions and constant help. His critical reading of all the parts of the

work has helped shape the NUHM planning in its present form.

I owe my sincere gratitude to Dr. M. R. Gautam (General Manager) & Dr. Usha Gangwar, (Deputy General Manager-NUHM) who have helped us immensely by

providing relevant information, expert suggestions. This planning work got accomplished with their valuable support and eagerness to help.

I express my gratefulness to Shri. Amit Kumar Ghosh, IAS, Mission Director, National Health Mission & Mr Shashank Vikram, IFS, Additional Mission Director, NUHM for extending support and building the thoughts in our mind.

I am privileged to have such good district level team specially Mr. Sandeep Dixit (DPM, NRHM), Mr. Anoop (DCPM), Mr. Hariom (DDAA), Mr. Sandeep (HMIS

Operator), Mr. Puneet & Mr. Ajeet Dubey who have supported, helped, put their great efforts into planning of NUHM at city level.

I am also pleased to appreciate the precious help and motivation which I got from my

respective departments DUDA, ICDS, Nagar Palika, Education department, CMS.

Last but not the least; I would like to thanks all those people who were involved in

the planning process directly or indirectly.

Dr. R.K.Chaurasia

Addnl. CMO (RCH), Etawah

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ABBREBIATION

ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

AWC Aanganwari Center

AWW Aanganwari Worker

BSGY Bal Swasthya Guarantee Yojna

BSUP Basic services for urban poor

BSA Basic Shiksha Adhikari

CDPO Child Development Project Officer

DH District Hospital

DHS District Health Society

DUDA District Urban Development Authority

ICDS Integrated Child Development

Scheme

IDSMT Integrated Development of Small & Medium Towns

IDSP Integrated Diseases Surveillance Program

IHL Individual House level

IMR Infant Mortality Rate

KFA Key Focus Area

LHV Lady Health Visitor

LT Lab Technician

MAS Mahila Arogya Samiti

MMR Maternal Mortality Ratio

NHM National Health Mission

NPP Nagar Palika Parishad

NPSP National Polio Surveillance Program

NRHM National Rural Health Mission

NUHM National Urban Health Mission

OD Open Drainage

RSAP Remote Sensing Application Center

UA Urban Agglomeration

UCHC Urban Community Health Center

UFWC Urban Family Welfare Center

UHI Urban Health Initiative

UHP Urban Health Post

UPHC Urban Primary Health Center

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Etawah An Overview

The district of Etawah lies in the south-western portion of Uttar Pradesh 26° 47" north latitude and 72° 20" east longitude and forms a part of the Kanpur Division. In

shape it is a parallelogram with a length from north to south 70 Km. and East to west 66 Km. on one side and 24 Km. on the other side. It is bounded on the north by the districts of Farrukhabad and Mainpuri, while the small extent of western border

adjoins tahsil Bah of the Agra district. The eastern frontier marches with the district of Auraiya, and along the south lie Jalaun and the district of Gwalior, the division line

being, except for a short distance, the Chambal and Yamuna rivers. The total area

in 1999 is calculated to be 2434 Km.

Fig 1: Etawah Location Map

Etawah is well connected to the rest of country by rail and road transport. Several national highways pass through Etawah; NH-2 connects Etawah to Delhi & Lucknow, NH-91 connects Etawah to MP. Regular buses connect the city to destinations such

as Delhi, Agra, Jaipur, Gwalior, Bharatpur, Mathura, etc.

Etawah city experiences a tropical monsoon type climate. The summer temperature varies from 43 to 30 degrees Celsius and winter temperatures range between zero and 25 degrees Celsius.

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Etawah is famous for Saifai Mahotsav & Medical College RIMS & R placed in Saifai block. Saifai mahotsav is a commercial festival organized in Saifai block once in a

year in winter. Medical college RIMS & R also placed in Saifai block contribute all Emergency medical & health services catering all adjacent district Mainpuri,

Farrukhabad, Bhind (MP), Firozabad etc. Fig 2: Etawah City Map

Demographic & Social Profile

Total Population of city (in lakhs) 256838 Source: Census 2011

Slum Population (in lakhs) 49040 Source: SUDA

Slum Population as percentage of urban

population 25 %

Number of Notified Slums 83 Source: DUDA

Number of slums not notified 2 Source: Muncipulities

No. of Slum Households 15333

No. of slums covered under slum improvement programme (BSUP,

NA

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IDSMT,etc.)

Number of slums where households have

individual water connections* NA

Number of slums connected to sewerage network*

NA

Number of slums having a Primary

school

40 Source: BSA Deptt.

No. of slums having AWC 55 Source: ICDS Lucknow &

BSUP

No. of slums having primary health care facility

55

Demographic data for Etawah city from the 2001 Census has been analyzed to understand the demographic patterns. The total population of the city is 256724. The total sex ratio of the district is lower than the city sex ratio i.e. 870. The literacy rate

of Etawah 77.2 % was during 2001 census. The population of the city consists of Hindus, Muslims, Sikhs and Christians and it has been estimated that 15.1% of the

urban population is below the poverty line. Health System and Infrastructure

Health services are provided by the Public sector, including the Department of Medical, Health and Family Welfare, and by the Private sector (hospitals, nursing

homes, and clinics), Catering to a large urban slums & poor vulnerable population in the city. First Tier Facilities

Primary health care in the city is provided through 6 urban health posts located in various parts of the city (See Table 2). These primary health centres were created to

respond to both the growing slum population the peri-urban growth of the city. Table 2: Distribution of Health Facilities

Type of Facilities Number

Government Health Facilities

First Tier (Primary Health Care Facilities)

Urban Family Welfare Centre 0

Urban RCH Health Post 6

Urban RCH Nodal Unit 0

Ayurvedic Centers 2

Second Tier Facilities

District / Joint Hospital 1

District Women Hospital 1

Post Partum Centre/Child hospital 1

Specialty Hospital (Spinal; mental; eye)

Medical College 1

ESI 1

Railway 0

Defense 0

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Private Health Facilities

Private for Profit Health Post/Clinics

Maternity /Nursing Homes 16

Abortion Providers 6

DMPA providers 0 NGO/Not for profit/Charitable

Clinics 1

Source: Office of Chief Medical Officer, 2012 Second Tier Facilities

In Etawah there are 3 Government-run secondary/tertiary level hospitals. These 3

hospitals cater to the secondary care needs of the entire district. Private (for profit) Health Facilities

A large number of slum residents seek medical care from the private sector, which includes a huge network of for profit institutions. As per the list provided by the Chief

Medical Officer, Etawah has a total of 16 private Maternity nursing homes/clinics. Health Indicators

As per the recent District Level Household and Facility Survey (DLHS-3) 2007-2008, only 25.4% of currently married women are using a modern method of contraception.

The DLHS-3 estimates the unmet Family Planning need in Etawah is at 44.1%; it comprised 12.0% unmet need for spacing methods and 32.1% unmet need for

limiting methods. The Ministry of Health and Family Welfare, Family Planning Division has recognized Etawah as a high priority district for family planning programs in Uttar Pradesh.

According to family planning statistics shared by the Chief Medical Officer, the

uptake of family planning methods is very low in Etawah as compared to other districts in Uttar Pradesh.

Table 1: District level indicators, Etawah

Population* – District 15,79,160 persons Urban population*- District 3,66299 persons Slum population*** District 92,711 persons

Source: * Census of India, 2011

** District Level Household Survey-3, 2007-08 *** State Urban Development Authority, 2003-04

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Indicators based on DLHS-2 and DLHS-31

DLHS** (2007-08) figures for DLHS-2 Total

DLHS-3 Total

Women married <18 years 32.3 25.6

Women 20-24 with 2+ Births - 65.8

Institutional Births 15.2 26.5

Family planning use

Any method 50.4 31.2

Any modern method 28.5 25.4

Female sterilization 13.7 15.5

Male sterilization 0.2 0.1

IUD 1.2 1.4

Pill 2.6 1.9

Condom 10.4 6.4

Family Planning unmet need

Spacing 7.7 12.0

Limiting 18.3 32.1

Total 26.0 44.1

Slums in Etawah: -

Etawah district is having a total number of 83 listed slums as per DUDA list and unregistered 2 slums including Etawah, Jaswantnagar & Bharthna Municipalities as well as Lakhana, Bakewar & Ekdil Nagar Panchayat. The total population of slums, as per government records is 74623 (Source-DUDA) & 92711 (Source -SUDA).

Population of slums is a matter of debate as different agencies are claiming different

population. Total number of 55 slums will be covered under NUHM in Etawah city.

S. No. Name of Slums Population

1 Lalpura Balmiki Basti 60

2 Sati mohalla 359

3 kali kabre 162

4 Gadipura Nale ke Kinare 791

5 Katra Fateh Mahmood kha 1512

6 Purbia Tola Nale ke kinare 1115

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S. No. Name of Slums Population

7 Shanti colony (Bheem nagar) 420

8 Annand Nagar Balmiki Basti 255

9 Chipeti Emli Tola 68

10 Sundarpur 176

11 Sultanpur Kala 260

12 Choki Samseri 410

13 Kokpura 780

14 Madiya Shiv Narayan(Rabibag) 3031

15 Karool 416

16 Gatiya Ajmat Ali 478

17 Rahatpura 294

18 Ashok Nagar Poorvi 348

19 Chipeti (mali tola) 387

20 Usra Adda 971

21 Mewati Tola 1287

22 Barahi Tola 171

23 Ajeet nagar 297

24 Shagran 179

25 Barahipur 814

26 Naurangabad Balmiki Basti 157

27 Peepal ka Adda 351

28 Nkhasa 447

29 Madiya Kyali Ram 344

30 Tulsi ka Adda 847

31 Dhokran tola 733

32 Ludhpura 2179

33 Ahieri tola south 1474

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S. No. Name of Slums Population

34 Kothi Kaisth 930

35 Mohan ki madiya 1567

36 Gulab badi 4634

37 Loha mandi 1043

38 Fakkad pura 2093

39 Katra Vilochan 2610

40 Rail mandi east 2070

41 Sarougi bazar 1154

42 Saryai kham 830

43 Home ganj 1291

44 Katra Pukta 922

45 Mahlai tola 1094

46 Girdharipura 1465

47 Brijraj nagar 223

48 Indra nagar 335

49 Sanjay Gandi Marg 360

50 Ambdeker nagar 362

51 Purana Bhanthana 1764

52 Tilakhushal pur 835

53 Lohiya nagar 722

54 Yadav nagar 710

55 Anvarganj 454

Planning & Mapping-

Distt. Etawah has urban population of 3.66 lakhs & it has about 85 slums having

population about 0.73 Lakhs. NUHM will be covered 55 Slums. Mapping has been done by Urban Development department so no budget has been proposed

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Programme management-

Districts Heath Society will be the implementing authority for NUHM under the

leadership of the District Magistrate. District Program Management Units have been

further strengthened to provide appropriate managerial and operational support for

the implementation of the NUHM program at the district level.

Fund flow mechanisms have been set up and separate accounts will be opened

at in the district for receiving the NUHM funds.

Urban Health will be included as a key agenda item for review by the District

Health Society with participation of city level urban stakeholders.

An Additional / Deputy CMO has been designated as the nodal officer for NUHM

at the district level. The District Program Management Unit will co-opt

implementation of NUHM program in the district and the District Program

Manager will be overall responsible for the implementation of NUHM. To support

this the following additional staff and funds are proposed for strengthening the

District Program Management Units for implementing NUHM:

a. Urban Health Coordinator, Accountant and Data Entry Operators

according to the following norms:

District total Urban

population

Additional Staff Proposed

1lakh to 10lakhs 1 Urban Health Coordinator,1 Accountant and 1 Data Entry

Operator

b. District Programme Manager will be nodal for all NUHM activities so extra

incentive and budget for 1 laptop to each DPM has been proposed for

DPM for undertaking NUHM activities.

c. A onetime expense for computers, printer and furniture for the above staff

has been budgeted along with the recurring operations expenses.

d. Onetime expenses have been budgeted for up-gradation of the office of

Additional/ Deputy CMO and District Programme management Unit.

The City Program Management Committee will function as an Apex Body for

management of the City Health Plan, which will lead to delivery of Maternal,

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Newborn, Child Health and Nutrition (MNCHN) and water, sanitation and hygiene

(WASH) services to the urban poor and will work towards the following objectives:

1. Establish a forum for convergence of city level stakeholders for the delivery of

MNCHN and WASH services to the urban poor.

2. Serve as the nodal body for the planning and monitoring of MNCHN and

WASH service delivery to the urban poor.

3. Provide a forum for exploring, reviewing and approving PPP initiatives and

innovations to address the gaps in MNCHN and WASH service delivery to the

urban poor.

The structure proposed for the City Coordination Committee:

Chairperson - DM

Convener - CMO

Members – Health - ACMO-Urban

Member – ICDS - CDPO

Member – Nagar Nigam - Sum Improvement Officer

Member – Water & Sanitation- Sup. En. / Ex.En. Jalkal Vibhag,

Nagar Nigam

Member DUDA & UD - Project Officer

Members – School Education- BSA & DIOS

Members – Dev. Partners - Partners working in urban health

sector (HUP)

Coordinator - Lead Dev. Partner

Review Meetings at UPHC and City Level

Nature of Meeting Periodicity Meeting Venue

Participants

Mahila Aarogya Samiti Meeting

Once a month for each MAS

Slum ANM, HV, Community Organizer, Social Mobilization officer

Review meeting with

Link workers and MAS representatives

Once a month UPHC All ANMs, PHN, LMO,

Community Organizer, Social Mobilization officer

Meeting of UPHC

Coordination Committee

Once a month UPHC LMO, PHN/Community

Organizer, Social Mobilization officer, representative from 2nd tier facility, and reps.

From other departments

Meeting with CMO & UH Program

Coordinator

Once a month CMO Office

CMO, Program Coord., Asst. Program Coordinator, LMO/

PHN/ Community Organizer, Social Mobilization officer

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City Task Force Meeting

Once in two months

DM’s office

CMO, Program Coord. UH, Various departments’ reps. , private partners, NGOs

Convergence –

Intra-sectoral convergence is envisaged to be established through integrated planning for implementation of various health programmes like RCH, RNTCP,

NVBDCP, NPCB, National Mental Health Programme, National Programme for Health Care of the Elderly, etc. at the city level. Inter-sectoral convergence with

Departments of Urban Development, Housing and Urban Poverty Alleviation, Women & Child Development, School Education, Minority Affairs, Labour will be established through city level Urban Health Committees headed by the District

Collector.

Urban local bodies-

NUHM would promote active participation of ULBs in the planning & management of urban health programme. Funds will flow to the Distt. Health society Intra sectorial convergence is envisaged to be established through integrated planning for

implementation of various health programmes like RCH, RNTCP, NVBDCP, and NPCB. Inter- sectorial convergence with department of urban development, housing

& urban poverty alleviation, women & child development, school education, minority affairs, labour will be established through city urban health committees headed by the municipal chairmen/DM. In 1st phase 0f 13-14 orientation of 1 ULBs is proposed

for 6 months (Oct 13- March14)

Training of ANM & Paramedical Staff/MO-

ANMs may be engaged as per the norm of one ANM for 10,000 urban Population.

As there is no provision for Sub Centres under NUHM, they will be co-located within existing health facilities (like urban health posts, UFWCs, etc.) till the urban PHCs become functional. They would have a clearly defined area of operation where they

will be conducting outreach sessions, as per the norms under NUHM. Creation of Sub Centres has not been proposed under NUHM. Outreach services will be

provided through Female Health Workers (FHWs)/ Auxiliary Nursing Midwives (ANMs) headquartered at the UPHCs. Additional ANMs would be engaged as per the norm of one ANM for about 10,000 urban populations. Etawah town population

has of 3.66 Lakh so that 30 ANMs & 12 Staff nurse will be required. We except to train 100% ANM & Staff nurse in FY 2013-14.

Orientation of MAS

Process could be initiated for formation of Mahila Arogya Samitis (MAS) as per the

norm of one MAS for 50-100 households in the KFAs (as per the processes suggested in the NUHM “Framework for Implementation”; sections 7.14.2.1 through to 7.14.2.4). Mahila Arogya Samitis will act as community based groups in KFAs,

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involved in community mobilization, monitoring and referral. Existing communi ty based institutions (CBO) could be utilized for the purpose. NUHM would provide

untied grants and capacity building support to MAS / CBO.

Mahila arogya samiti will consist per 80 household or 480 slum population therefore total MAS to be done is 74 and for the first six months we are expecting 50% of the MAS to be formed and oriented.

Selection & Training of ASHA

ASHAs may be engaged as per the norm of one ASHA for 200-500 households in slums. ASHA would serve as an effective and demand–generating link between the

health facility and the urban slum population. However, DHS has the flexibility to either engage ASHA or entrust the responsibilities to MAS/any other community based organisation (CBO). Link Workers engaged presently under Urban RCH or

any other programme (either supported by central government or by local government) may be continue to work under the same terms and conditions, but

designated as ASHA and no additional ASHA may be deployed in such areas

We expect 100 % of the ASHAs (Total is 37) to be trained in the first 6 Months

UHNDs- ANMs would provide preventive promotive health care services to house

holds through routine immunization.

Total 294 UHND sessions will be held in 105 AWC in 6 months period

Special outreach camps in slums/ vulnerable areas.Expasion of services through

outreach to children by covering at least all govt schools & AWW center. O ther

schools located in the slums would also be covered. During such session screening

for birth defects, disease, disability &deficiency would be carried out &follow up

actions would be initiated.

Total 156 session other than UHND session have been planned in 6 months

School Health Services

School health program under NUHM has been an important component to provide

not only the preventive and curative services to children but also to ensure their

contribution in overall health development of the urban communities. It is envisaged

that the active involvement of children in the program will enable them to be a

change agent for themselves as well as communities by taking home good

knowledge and practices in terms of preventive health care activities. It is planned

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that children will be engaged through innovative and creative actions to make the

learning entertaining and educational.

Objective: To evolve innovative ways to involve children in preventive health care

activities to make them a change agent for them and their families.

Urban PHC (UPHC)

1) One urban primary health centre (UPHC) may be planned for every 50-60

thousand population. In case there is existing infrastructure of UHP, etc., it may

be upgraded and strengthened as UPHC. Where none exists, new UPHCs will

have to be established. The new UPHCs will be located as close to KFAs as

possible and the catchment population needs to be clearly defined. This will

facilitate the provision of primary care services in measurable terms.

2) The OPD timings of the UPHC should cover the evening hours (up to 8 pm). It

may be covered in one afternoon-evening shift. But UPHCs with higher case

load (of more than 150 OPD per day) may run two shifts., the provision for 2

Staff Nurses will be used innovatively like one for general and RCH services,

the second for non-communicable diseases.

City Level Indicators and Targets

Processes & Inputs

Indicators Number Proposed

(2013-14)

Community Processes

1. Number of Mahila Arogya Samiti (MAS) to be formed * 37

2. Number of MAS members to be trained * 370

3. Number of Accredited Social Health Activists (ASHAs) to be selected and trained *

74

Health Systems

4. Number of ANMs to be recruited * 30

5. No. of Special Outreach health camps to be organized

in the slum/HFAs *

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6. No. of UHNDs to be organized in the slums and vulnerable areas *

49

7. Number of UPHCs to be made operational * 6

8. Number of UCHCs to be made operational *

9. No. of RKS to be created at UPHC and UCHC * 6

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