NATIONAL HEALTH MISSION
NATIONAL URBAN HEALTH MISSION (NUHM)

INTRODUCTION:

To address healthcare needs of urban population, particularly urban poor, the Ministry of Health & Family Welfare has formulated National Urban Health Mission (NUHM) as a Sub-Mission under an over-arching National Health Mission (NHM) during the 12th Five Year Plan. National Urban Health Mission (NUHM) was approved by the Union Cabinet on 1st May, 2013 for providing equitable and quality primary health care services to the urban population with special focus on slum and vulnerable sections of the Society. NUHM seeks to improve the health status by facilitating their access to quality primary healthcare.

The National Urban Health Mission therefore aims to address the health concerns of the urban poor through facilitating equitable access to available health facilities by rationalizing and strengthening of the existing capacity of health delivery for improving the health status of the urban poor.

In Rajasthan, NUHM was launched in December 2014 by Honorable Chief Minister. The state has identified 61 cities for implementing NUHM in phased manner. 33 District headquarters (HQ) cities like 3 (million cities), 20 cities (between 01 lakh to 10 lakhs population) & 10 cities (between 50000 to 01 lakh population) were selected in financial year 2014-15. Out of these 3 Districts (Dungarpur, Pratapgarh, Sirohi) have population less than 50000 but as they are District HQ hence they have taken up in this plan.

The National Urban Health Mission has high focus on:-

i. Urban poor population living in listed and unlisted slums
ii. All other vulnerable population such as homeless, rag pickers, street children, construction workers and other temporary migrants.
iii. Public health thrust on sanitation, clean drinking water & vector control etc.
iv. Strengthening public health capacity of urban local bodies.

The norms for urban health facilities under NUHM are as below:

i. For every 2.5 lac population : 1 urban CHC*
ii. For every 50000 population : 1 urban PHC
iii. For every 10000 population : 1 ANM
iv. For every 300 households : 1 Urban ASHA
v. For every 50 - 100 households : 1 Mahila Arogya Samiti (MAS)

Components of NUHM:

A. Service Delivery Infrastructure

NUHM envisages setting up of service delivery infrastructure which is largely absent in cities/towns to specially address the healthcare needs of urban poor and provides:-

i. Urban – Primary Health Centre (U-PHC):

New U-PHCs are planned as per gap analysis, as per norm of one U-PHC for approximately 50,000 urban population for providing preventive, promotive primary healthcare services and basic lab diagnosis, drug /contraceptive dispensing services, counseling for all communicable and non- communicable diseases etc.
Total 105 existing dispensaries are upgraded in urban PHC and 140 new Urban PHCs are planned to be newly constructed in the state.

Services at Urban PHCs:

    1. OPD service for 6 hours in a day and 6 days per week as per the timings specified by the State Government along with 2 hours of OPD on Sunday as well as on national holidays as per the GoR norms (Annexure ‘B’).
    2. Care in pregnancy and child-birth, Neonatal and infant health care services, Childhood and adolescent health care services including immunization, Family planning, Contraceptive services and Other Reproductive Health Care Service
    3. Lab Investigations and Drug Dispensing as per MNJY & MNDY scheme respectively
    4. Management of Common Communicable Diseases and General Out-patient care for acute simple illnesses and minor ailments
    5. Screening and Management of Non-Communicable diseases including health education and promotion for life style related modifications
    6. National Health Programs
    7. Care for Common Ophthalmic and ENT problems
    8. Geriatric and palliative health care services
    9. Trauma care and emergency medical services(that can be managed at this level)
    10. Referral through 108/104 services to DH/SDH/Medical Colleges for complicated cases

      Human Resources at UPHC:
Sr. No
Category of staff
No of Post per UPHC
1 Medical Officer – Full Time 1
2 Medical Officer – Part Time (Specialist) Maximum 12 visits per month per UPHC
3 Staff Nurse 2
4 ANM 5
5 Pharmacist 1
6 Lab Technician 1
7 Accountant cum DEO 1
8 Support Staff 1
9 Public Health Manager 1

ii. Urban-Community Health Centre (U-CHC):

30 bedded UHCs are planned for providing inpatient care in cities with a population of above 5 lakhs. The Urban CHCs are designed to provide referral health care for cases from the Primary Health Centres level and for cases in need of specialist care approaching the centre directly. Total 13 Urban CHCs are planned in the state.

Services at Urban CHC:

• OPD Services and IPD Services
• Specialty services: General Medicine, Obstetrics & Gynaecology and Paediatrics
• Dental services
• Emergency Services
• Lab Investigations and Drug Dispensing as per MNJY & MNDY scheme respectively
• National Health Programmes

Human Resources at UCHC:

Sr. No
Category of staff
No of Post per UPHC
1 Specialist – Physician
1
2 Specialist - Obstetrician & Gynecologist
1
3 Specialist - Pediatrician
1
4 Medical Officers
2
5 Dentist
1
6 Staff Nurse
6
7 Pharmacist
1
8 Lab Technician
1
9 X – Ray Technician
1
10 Accountant
1
11 Accountant cum DEO
1
12 Support Staff

3

13 Ward Boy
5

iii. Outreach services:

NUHM has provision of conducting outreach services (outreach camps and Urban Health Nutrition Days) for targeted groups particularly slum dwellers and the vulnerable population for providing preventive and promotive healthcare services at the household and community level.

Outreach camps:

• One outreach camp per urban PHC per month in vicinity of slum areas or in vulnerable areas
• Advance planning is necessary in order to organize need base camps
• Specialists and other required staff may be hired, if needed
• Services : Health check up, RCH services, NCD screening, Basic lab investigations, drugs dispensing etc

Urban Health Nutrition Days (UHND):

One outreach camp per month per UPHC is planned in the state to provide preventive, promotive & basic curative services like - Immunization, ANC, Nutrition counseling, Health education etc by ANM at AWC/Community Center/any appropriate community space.

iv. Health Kiosks:

In unserved slum and vulnerable areas where infrastructure is not available, health kiosks are planned in such areas. It is a prefabricated structure which will be used to provide basic primary health care services by ANM. Total 36 Health Kiosks are planned in the state. Key Features of Health Kiosk are as follows:

• ANM of nearby PHC will be posted at Kiosk
• Preferable timings: 8 AM-12 PM and from 4 PM-8 PM or subjected to population need
• Services at Kiosks:

    • Antenatal and Postnatal Care
    • Immunization
    • Pregnancy detection through Nischay tests-(Urine Pregnancy Tests)
    • Screening for Non Communicable Diseases such as Hypertension & Diabetes
    • Adolescent Health Promotion with focus of life skills, body physiological changes, menstrual hygiene etc
    • IEC & BCC etc.

v. Mobile Medical Unit:

      • The National Urban Health Mission (NUHM) has provision of Mobile Medical Units (MMUs) to provide a range of health care services for populations living in slum and un-served areas mainly with the objective of taking healthcare service delivery to the doorsteps of these populations. Total 4 MMUs are planned in the State.
      • Mobile Medical Units are envisaged to provide primary healthcare care services for common diseases including communicable and non-communicable diseases, RCH services, carry out screening activities and provide referral linkage to appropriate higher faculties
      • In addition, the MMU is also expected to:
        - Provide point of care diagnostics: Blood glucose, pregnancy testing, urine microscopy, albumin and sugar, Hb, Height/Weight, vision testing etc
        - Screening of population over age of 30 for Hypertension, Diabetes and Cancers and undertake follow-ups during the monthly visits

B. Community Process:

Targeted interventions envisaged under NUHM for the slum dwellers and urban poor population are as follows:

1. Urban ASHA

  • One frontline community worker (ASHA) serves as an effective and demand–generating link between the health facility and the urban slum population. Each urban ASHA has a well-defined service area of about 1000-2,500 beneficiaries/ approx 300 households. Total 4672 urban ASHAs are sanctioned in the state.
  • The role of an ASHA is that of a community level care provider. This includes a mix of tasks: facilitating access to health care services, building awareness about health care entitlements especially amongst the poor and marginalized, promoting healthy behaviour and mobilizing for collective action for better health outcomes and meeting curative care needs as appropriate to the organization of service delivery in that area and compatible with her training and skills.Her major roles and responsibilities would be as follows:
  • ASHA will take steps to create awareness on social determinants and entitlements related to health and other related public services. She would provide information to the community with special focus on the vulnerable groups, on determinants of health such as nutrition, basic sanitation and hygienic practices, healthy living and working conditions, information on existing health services and facilities and the need for timely use of health services.
  • She will counsel community on birth preparedness, importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract Infection and Sexually Transmitted Infection (RTIs/STIs), care of the young child, National Health Program services, substance abuse, prevention of domestic violence and sexual violence.
  • She will work with the Mahila Arogya Samiti to promote convergent action by the committee on social determinants of health and take action to increase access of vulnerable groups for various public services.
  • The ASHA will fulfill her role through five activities:
    a. Home Visits
    b. Supporting UHNDs & Outreach Camps
    c. Visiting Health facilities
    d. Promoting MAS
    e. Records management

2. Mahila Arogya Samiti (MAS)

MAS in one of the key interventions under National Health Mission aimed at promoting community participation in health at all levels, including planning, implementing and monitoring of health programmes. MAS is expected to take collective action on issues related to Health, Nutrition, Water, Sanitation and social determinants at the slum level. It is envisaged as being central to ‘local collective action’, which would gradually develop to the process of decentralized health planning.
One MAS covers approx 50-100 households and act as community based peer education group in slums. MAS has been formed to facilitate community mobilization, monitoring and referral with focus on preventive and promotive care and facilitating access to identified facilities. Total 4708 MAS has been formed in 61 cities of Rajasthan. NUHM has provision to provide untied grant of Rs. 5000 per MAS per year.

Formation of MAS:
The ASHA and the ASHA facilitator/ Community organizer play a key role in the process of MAS formation. Various steps involved in the formation of MAS are depicted below:
Step I: Constitution of a team at the slum level
Step II: initial meetings with slum women
Step III: identification of active and committed women
Step IV: Formation of MAS and selection of its offi¬ce bearer

Office Bearers of MAS
Chairperson:
MAS members will unanimously elect the chairperson of the group, who will:
a. Be responsible for ensuring that MAS meetings are held regularly on a monthly basis and ensure smooth coordination among members
b. Represent the MAS and voice concerns of the area during interface with service providers and representatives of various government departments.

Member Secretary:
ASHA will be the Member Secretary of MAS. As the member secretary of the MAS, she will:
a. Fix the schedule and venue for monthly meetings of the MAS and ensure monthly meetings with participation of all members.
b. Draw attention of the MAS on specific constraints and achievements related to health status of the community and enable appropriate planning.
c. Ensure utilization of untied fund as per the decisions taken by MAS through regular disbursal of funds jointly with the Chairperson and undertake regular update of the cashbook.
d. Work with the Chairperson for preparation of annual statement of expenditure (SOE) and utilization certificates (UCs).

Top ten activities to focus under NUHM

  1. Mapping of urban vulnerable populations and understanding their special needs
  2. Service delivery to urban poor and vulnerable population through proximal U-PHCs and U-CHCs
  3. Outreach through Urban Health and Nutrition Days (UHND) and Special Outreach Camps to address special and community specific health needs.
  4. Improving ambience, signage, patient amenities, infection prevention protocols should be prioritized at U-PHCs & U-CHCs
  5. Defined reporting mechanism under various health programs. Maintenance of requisite records and registers at urban health facilities.
  6. Special focus on urban specific health needs such as Non - communicable Diseases – diabetes, hypertension, cardiovascular conditions, substance abuse, mental health etc. in addition to routine RMNCH+A services.
  7. Robust and assured referral mechanism with systematic follow up by U-PHC of the referred cases (to FRUs and specialized services for NCDs etc.)- Integration of National Health Programs at the U-PHCs.
  8. Convergence with Urban Local Bodies (ULB), with clearly defined roles for the State Health Department and the ULB in NUHM implementation for each city
  9. Financial strengthening under NUHM- Registration and transfer of funds under NUHM through PFMS, formation and registration of RKS et
  10. Implementation of Public Private Partnerships where public services are weak and innovations to improve service delivery with limited resources.

For more information contact : Dr Hemlata Yadav 9785399861