13 th CRM National Urban Health Mission NUHM

13 th CRM National Urban Health Mission (NUHM) Preeti Pant Joint Secretary(NUHM) Health & Family Welfare Government of India 16 th Oct , 2019

NUHM • National Urban Health Mission (NUHM) was approved on 1 st May, 2013 as a sub-mission of National Health Mission (NHM). • Covers Cities/ Towns with population above 50, 000 and District Head Quarters above 30, 000 population , • So far 1067 cities and towns covered under NUHM • No of UPHCs functional -4586 • No of HWCs Approved- 3300 • No of HWCs functional- 2372 (72%) • Funds released to the State/UTs/ULBs

NUHM 5000 4586 4500 4000 3500 3300 (72%) 2372 (72%) 3000 2500 2000 1500 1000 500 0 No. of U-PHCs No. of HWCs functional approved No. of HWCs functional • No of UPHCs functional 4586 • No of HWCs Approved 3300 • No of HWCs functional 2372 (72%)

Implementation Mechanism • Through the ULBs in 7 Metropolitan Cities of Ahmedabad, Bengaluru, Chennai, Delhi, Hyderabad, Kolkata and Mumbai • Through the State Health Department /ULBs as per the State Health Dept.

Outcomes • Establishment of Primary Healthcare system - providing comprehensive quality health services through UPHCs/UCHCs , outreach and special outreach • Mapping of (i) urban health facilities, (ii) mapping /assigning of vulnerable and poor population in slums; • Targeted outreach and robust referral mechanism • Expanded range of services in HWCs/UPHCs apart from RCH • Each UPHC-HWC to be developed as a DOTS Centre • Community mobilisation through ASHA and MAS • Addressing Social Determinants and convergence with other stakeholders

Comparison-Key Health Indicators (NFHS-4) Indicators Urban Rural Total 29 46 41 Under-Five Mortality rate (U 5 MR) 34 Delivery care (For births in the 5 Years before the survey) 56 50 Institutional births (%) 88. 7 75. 1 78. 9 Institutional Births in Public facility (%) 46. 2 54. 4 52. 1 61. 3 62. 0 Infant and Child Mortality Rates (Per 1, 000 Live Births) Infant Mortality Rate (IMR) Child Immunization Children age 12 -23 months fully immunized (BCG, measles and 3 doses each of polio and DPT (%) 63. 9 7

Comparison-Key Health Indicators (NFHS-4) Urban Rural Total Blood Sugar Level Women Blood sugar level - high (>140 mg/dl) (%) 6. 9 5. 2 5. 8 Blood sugar level - very high (>160 mg/dl) (%) 3. 6 2. 3 2. 8 Blood sugar level - high (>140 mg/dl) (%) 8. 8 7. 4 8. 0 Blood sugar level - very high (>160 mg/dl) (%) 4. 4 3. 5 3. 9 Slightly above normal 7. 3 6. 5 6. 7 Moderately high 1. 6 1. 3 1. 4 Slightly above normal 11. 4 9. 8 10. 4 Moderately high 2. 7 2. 0 2. 3 Men Hypertension Women High NCD Burden in Urban Men

Physical Progress : Service Delivery Trend - HMIS 1. OPD Attendance 35 27 Cr 30 24 Cr 25 19 Cr 20 15 2. ANC Registration 33 Cr 11 Cr 50 44 Lac 45 40 30 25 35 Lac 31 Lac 35 46 Lac 21 Lac 20 10 15 5 5 10 0 0 2014 -15 2015 -16 2016 -17 2017 -18 2018 -19 Source: NHM HMIS Portal for FY 2018 -19 2014 -15 2015 -16 2016 -17 9 2017 -18 2018 -19

Financial Progress (2013 -14 to 2019 -20 ) Rs. in crore Overall utilization is 68% against available funds 5491 5383 2650 Total Releases Proportionate State Share Total Expenditure Releases are updated till date and Expenditure is updated upto 30. 06. 2019(provisional)

% of Utilization of Funds under NUHM sinception 66% 74% 68% 51% 31% 17% 1% 2013 -14 2014 -15 2015 -16 2016 -17 2017 -18 2018 -19 2019 -20 Expenditure from 2013 -14 to 2017 -18 is based on audit reports and for FY 2018 -19 and 2019 -20 (1 st quarter) on FMR (Provisional)

Expanded service delivery Observations during Field Visit Reporting on HMIS/HWC Portal & IT systems Branding and IEC activities Filling up HR vacancies &Training UPHC to HWC Communit y Mobilisatio n and Outreach Drugs & Expanding Diagnostic s-

Observations during field visit Comprehensive Primary Health Care NCD Services Outreach Services /Community Mobilisation (ASHA/MAS) Fixed Days/Other Days UH ND/Special Outreach Training Data Reporting NCD Trg/VIA Trg HWC Portal/NCD App/HMIS& RCH Portal CBAC Form filling >30 years/Family Folders Referral Specialized Services

Observations during field visit Health System Strengthening Infrastructure • ULB/Govt/Rented/New Construction Training/Innovation Service delivery/community Process Drugs and Diagnostics EDL and No of Tests Supportive Supervision and Monitoring State and District level Quality Assurance NQAS/Kayalalp/SSS/Mera Aspatal Convergence with other Stakeholders ULB/Ward Members

Finance • Bank Accounts of all the UPHCs operational • e-transfer of Funds to the UPHCs/UCHCs- untied grants, other expenses • Registration and transfer of funds under NUHM through PFMS • Rogi Kalyan Samitis formed/constituted for the UPHCs

Each CRM Team to: • Visit 2 UPHCs (one HWC) in the City/ District - use Checklist • Visit one Routine / Special Outreach being held. • Interact with the Community, ASHAs recruited, MAS constituted under NUHM/ULB functionary • Spend at least 1 day (either in the beginning or at the end) In Metro cities and State Capital - on NUHM Implementation

Checklists 4 Checklists- 2 Facility level, 1 State level and 1 Community level; • UPHC-HWC Checklist – Information to be obtained from UPHCs /HWCs • Community level Checklist – Information to be obtained from the Community, MAS, ASHAs and ANMs • UCHC Checklist - Information to be obtained from UCHCs • State level Checklist - to be used for obtaining information on Urban Health from the State

UPHCs-HWCs • • • Coverage : Population of the catchment area/Slum population/ Distance of the nearest slum Human Resources and Training : Availability of MO/ SN/ ANM/LT/Pharmacist Specialist for evening OPDs/Special Outreach Training in NCD /VIA/National Health Programmes Physical Infrastructure : Govt or Rented Building/PPP mode Cleanliness, Citizen Charter, Toilets, water, electricity Drug Supplies , Consumables and Equipments : EDL/Indenting Mechanism/Essential equipments/maintenance Diagnostics : Number of tests/ Type - Hub &Spoke, PPP, In house Service Delivery : Expanded range of 12 services; IEC and BCC activities Outreach Services and Community Processes : UHND and special outreach, ASHA and MAS IT Facilities : Computer/Internet facility/Tablets/Smart phones Wellness Activity : Yoga and any other wellness activities

Community level ASHA Status : ü Sanctioned vs In position ü Training ü Screened for NCD ü Activities (CBAC form ü filling, nutrition counseling etc ) ü Incentives Community (Urban areas): ü Citizens perspective ü Interactions with community (Family ü folders, home visit by ASHA etc) ü ULBs/Ward Members ü Yoga & Wellness activities Mahila Arogya Samiti (MAS) Status: ü Constitution ü Training ü Screened for NCD ü Monthly review meetings ü Mechanism for fund flow & utilisation ANM : ü Responsibilities ü Tablets available ü Training ü Screened for NCD ü CBAC form filling, nutrition counseling

States for 13 th CRM Sl No State No of Cities covered under NUHM 1. Andhra Pradesh 74 2. Bihar 25 3. 4. Chhattisgarh Delhi 19 1 5. Gujarat 68 6. Jharkhand 22 7. Madhya Pradesh 66 8. 9. Manipur Meghalaya 3 4

States for 13 th CRM Sl No State No of Cities covered under NUHM 10. Mizoram 2 11. Nagaland 5 12. Odisha 36 13. Rajasthan 61 14. Tamilnadu 87 15. Uttar Pradesh 131 16. Uttrakhand 9

Thanks