NATIONAL URBAN HEALTH MISSION

Urban population in India

Urban population in India 31.2 % of total population Approx 37.7 Crore (Census 2011) -

increase from 26.1 Crore in Census 2001 Approx 7.5 Crore out of these live in urban slums Rule of 2-3-4-5 Decadal growth rate:

Total – 17.6%, Rural – 12.2%, Urban – 31.8% UN projection: with current rate of

urbanization, urban population will reach 46% by 2030

Health conditions of urban poors U5MR 72.7 vs urban average 51.9 46% underweight children vs urban average

32.8% 46.8% women with no education vs urban

average 19.3% 44.4% institutional deliveries vs urban average

67.5% 71.4% anaemic among urban poor vs urban

average 62.9% 18.5% urban poor with access to piped vs

urban average 50% 60% miss total immunization before

completing one year

Challenges of urban health care Poor households not knowing where to go to

meet health need Weak and dysfunctional public system of

outreach Contaminated water, poor sanitation Poor environmental health, poor housing Unregistered practitioners first point of contact –

use of irrational and unethical medical practice Community organizations helpless in health

matters

Challenges of urban health care Weak public health planning capacity in urban

local bodies Large private sector but poor cannot access

them Problems of targeting the poor on the basis of

BPL card No convergence among wider determinants of

health No system of counselling and care for

adolescents No concerted campaigns for behaviour change Problems of unauthorized settlements

Challenges of urban health care Over congested secondary and tertiary

facilities and under underutilized primary care facilities.

Problem of drug abuse and alcoholism Many slums not having primary health care

facility High incidence of domestic violence Multiplicity of urban local bodies, State

government, etc. management of health needs of urban people

No norms for urban health facilities

Rates of urban poverty

Bihar – 44% Orissa – 38% Madhya Pradesh – 35% Uttar Pradesh – 34%

Nagaland – 4.3% Himachal Pradesh – 4.6% Mizoram – 7.9% Puduchery – 9.9%

Access to health care

Inadequate public health care delivery system Severely restricted health care access (for urban

poor) lack of standards for urban health delivery

system makes the urban poor more vulnerable Poor environmental conditions – overcrowding,

poor housing, poor water and electricity availability result in high incidence of communicable diseases, asthma etc.

Higher rates of traffic accidents, domestic violence, mental health cases, drugs, tobacco and alcohol abuse

Primary Health Infrastructure in the Urban Areas• Grossly inadequate• Only one UFWC/HP per 148,413 urban population

in 2001 (based on a total of 1954 UFWCs & Health Posts for 285 million population).

• Though under India Population Project VIII (IPP-8) (1993 to 2002), 531 new facilities were constructed and 661 facilities were upgraded/renovated in Bangalore, Delhi, Hyderabad and Kolkata(6)

Water and Sanitation Services

Access to good quality water supply and sanitation facilities among the urban poor is very poor; about half of urban poor households do not receive water supply and about two-thirds do not have a toilet(13).

Current provisions

Many components of NRHM cover urban areas as well: Urban Health and Family Welfare Centres and Urban

Health Posts Funding of National Health Programmes like TB,

immunization, malaria, etc., Urban health component of the RCH Programmes

including support for Janani Suraksha Yojana Strengthening of health infrastructure like District

and Block level Hospitals, Maternity Centres under the National Rural Health Mission, etc.

Cities to be covered under NUHM Coverage: All 779 cities with a

population of above fifty thousand and all the district and state headquarters (irrespective of the population size)

Urban areas with population <50,000 will be covered through the health facilities established under NRHM Mega cities - 7 Million-plus cities (more than 10 lakhs) – 40

National Urban Health Mission The NUHM would focus on:

Urban Poor living in listed and unlisted slums Vulnerable population such as homeless,

rag-pickers, street children, rickshaw pullers, construction and brick and lime kiln workers, sex workers, and other temporary migrants.

Public health thrust on sanitation, clean drinking water, vector control, etc.

Strengthening public health capacity of urban local bodies.

Principles

Rationalizing and strengthening of the existing capacity of health delivery and full utilization of existing infrastructure

Utilize the diversity of the available facilities in the cities, flexible city specific models led by the urban local bodies

Communitization process to be built over existing community organizations and self – help groups developed through other initiatives.

Key Strategies

Improving access to FW and MCH services through renovation/up-gradation and re-organization of existing facilities

Strengthening of existing urban health infrastructure at 1st and 2nd tier

Improve quality of FW at all levels of health functionaries Appropriately & optimally involve NGOs and the private sector Increasing demand by IEC activities and enhancing communities

participation Convergence of efforts among multiple stakeholders, including the

private sector to improve the health conditions of the urban poor Effective linkages between communities and health delivery

systems. Strengthening Monitoring and Evaluation mechanisms

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Urban Health Care Delivery

Health services delivered under the urban health delivery system through the Urban-PHCs and Urban-CHCs will be universal in nature

Outreach services will be targeted to specific groups (slum dwellers and other vulnerable groups)

Sub-centres will not be set up 1 FHW (ANM) for 10,000 population; Outreach

sessions in area of every ANM on weekly basis FHW to be stationed at PHC; Mobility support

for outreach activities School Health Programmes

Urban PHC

MO In-charge - 1 2nd MO (part time) - 1 Nurse - 3 LHV - 1 Pharmacist - 1 ANMs - 3-5 Public Health Manager/ Mobilization

Officer – 1 Support Staff - 3 M & E Unit - 1

Urban CHC

For 2,50,000 population (5,00,000 for metros)

Inpatient facility, 30 -50 bedded(100 bedded in metros)

Only for cities with a population of above 5 lakhs

Renovation of existing referral facility or up-gradation of first tier facility shall essentially be the first choice

Support for local contractual arrangements for part time Specialist/ Medical Officer.

Second tier(Zonal Hospital)

– Renovation of existing referral facility or up-gradation of first tier facility shall essentially be the first choice

– Support for need based additional add on lab/indoor facilities.

– Equipment & furniture for services from the referral centres

– Need based drugs & supplies (over and above the supplies being made under other programmes/schemes)

– The strengthening of 2nd tier facilities shall be in line with the CHC norms proposed under NRHM.

Urban Health Care Delivery

Promote role of urban local bodies in the planning and management of urban health care

One ASHA for 1000-2500 population States to have flexibility of motivating Mahila

Arogya Samiti (MAS) for getting the work done

One MAS for 50-100 households Annual grant of Rs. 5000 to the MAS NGOs may also be given this responsibility

Roles & responsibilities of ASHA

• Identify target beneficiaries and support ANM in conducting outreach sessions

• Promote formation of Women’s Health Groups• Provide information to the community• Facilitate access to health and related services• Accompany pregnant women and children requiring

treatment/ admission• Facilitate development of a comprehensive health plan• Facilitate construction of community/ household toilets• Act as depot holder• Maintain necessary information and records.

Women’s Health Committee Process of promotion of Women’s Health Committee

Roles of the Mahila Arogya Samiti

• Support ASHA in tracking and monitoring coverage of key interventions

• Facilitate group counseling sessions• Support outreach camps by ensuring presence of target

group• The conveners or other designated representatives of

the group along with the respective Link Volunteer will attend meetings held at the UHC and provide feedback on service delivery.

• Collect, manage and utilize a Community Health Fund for meeting health emergencies in the slum and for sustaining health promotion efforts.

• Maintain BCC and IEC materials at a safe and easily accessible place in the community.

IPHS/ Revised IPHS for Urban areas etc Quality of the services provided will be

constantly monitored for improvement Strengthen IDSP Convergence with AYUSH practitioners