National Urban Health Mission

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National Urban Health Mission
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Frame work

1. Introduction
2. Objective and key strategies of urban health
   programme
3. Services delivery model
4. Institutional mechanisms at different levels
5. Role of urban local bodies
6. Public private partnership
7. Monitoring and evaluation plan
8. Sustainability
9. Funds for UH Programme
10. Operationalization of UHP
11. Salient features

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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

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2-3-4-5 phenomenon(3).
Growth rate()
countrys population 2
Urban India 3
mega cities 4
slum populations 5
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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

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ICDS coverage in urban slums

• Total 7,32,960 AWCs in 2005 in the country, only
  62,407 are located in and serving the urban
  areas.
• Experiences of some of the NGOs as well as
  government run UH Programmes have shown that a
  focus on building community-provider linkages
  through community based volunteers can help to
  improve the community demand and usage of primary
  services.
• It further improves adoption of desired
  health-seeking behaviour and practices by the
  community.

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Health Scenario in the Urban Slums

• Urban settlements are amongst the worlds most
  life threatening environments(8).
• Inevitably, challenging living conditions
  undermine the capacity of care takers to provide
  optimal care for the estimated 2 million children
  born each year among the urban poor population
  (based on fertility rate of 3 for a population of
  67 million).
• Under-5, infant and neonatal mortality rates are
  considerably higher among the urban poor as
  compared to National and State averages(9).
• The urban poor neonate in India comes into the
  world with certain distinct disadvantages (10)
• Almost 6 out of 10 are delivered at home in the
  slum environment
• About 50 are likely to be Low Birth Weight
• Only 18 are breast fed immediately after being
  born.

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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

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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

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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

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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

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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

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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)

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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).

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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.

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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 lt50,000 will be
  covered through the health facilities established
  under NRHM
• Mega cities - 7
• Million-plus cities (more than 10 lakhs) 40

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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.

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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.

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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 Model
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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

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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

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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.

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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.

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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

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Roles responsibilities of ASHA

• Identify target beneficiaries and support ANM in
  conducting outreach sessions
• Promote formation of Womens 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.

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Womens Health Committee

• Process of promotion of Womens Health Committee

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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.

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• IPHS/ Revised IPHS for Urban areas etc
• Quality of the services provided will be
  constantly monitored for improvement
• Strengthen IDSP
• Convergence with AYUSH practitioners