GOR thrust on Urban Health Towards Improved access

GOR thrust on Urban Health Towards Improved access to quality health services for Urban Poor

Demographic Indicators- Rajasthan Total Population (Millions) n Urban Population (Millions) n % Population in Urban areas n No. of Urban poor population (lac) n Decadal growth rate (1991 -2001) n Urban population growth (19912001) n No. of million cities n No. of Towns with over 1 lac population n Population below poverty line in urban areas (lacs) n % Population below poverty line. In Urban areas. In Rural areas n -56. 5 13. 2 23. 4 47. 5 28. 3 - 31. 5 1 17 26. 8 - 32. 9 18. 7 -

City wise Slum population % n n n n Jaipur Jodhpur Ajmer Bikaner Kota Bharatpur Udaipur Alwar 15. 87 -18. 10 24. 78 18. 51 21. 98 14. 42 11. 52 6. 12 - 29% of the state slum dwellers are residing in Jaipur

Strategic interventions for Urban Health n n n Creation of Tier-I urban health institutions covering 50, 000 urban slum population. Aid post for sizable no. of urban slum population ( less than 50, 000). Linking with Tier II institutions (Dist. hospitals Satellite hospital, referral hospitals) for referrals. Referral transport from Tier I institution for complicated delivery cases. Creation of local health and sanitation committees.

Proposed Urban RCH Centres and Aid Posts District Ajmer Udaipur Bharatpur No. of Health post 5 5 2 No. of Aid post 2 0 1 Alwar Jaipur Bikaner Kota Jodhpur Total 2 14 5 5 5 43 1 3 2 3 1 13

Urban RCH Centres Goals and Objectives- Aims to improve the health status of the urban poor community by provision of quality Primary Health Care services Decentralized health facilities by ensuring 1 Urban Health Post at 50, 000 population in cities (including existing infrastructure and manpower) Type of Services- Out patient services and referral services Target Population – Poor & Under Served Population n Inaccessible and Migrating Populations n People with limited economic means & with less access to resources n People live in temporary shelters n People working in construction sites n BPL people Districts – Ajmer, Alwar, Bharatpur, Jaipur, Jodhpur, Kota, Bikaner and Udaipur Number of Urban Health Centres in 8 districts -43

Staffing Pattern per Urban RCH Centre Medical Officer General Physician (Preferably Female) LHV (Staff Nurse) Nurse II grade ANMs (4 in no. ) Laboratory Technician Class IV Safai Karamchari (part time)

Services to be provided at the Urban RCH Centre n n n n n Antenatal care (urine and blood testing, TT immunization, IFA supplements, nutrition counseling, early registration, weighing, blood pressure, position of the baby, check against danger signals and identification of high-risk pregnancies, Referral for Institutional deliveries) Postnatal care, Referral for institutional deliveries Child Health services including Immunization Services under national Programmes like DOTS, NMCP, etc. Family planning including IUD, NSV & referral for terminal methods Lab services Treatment of minor ailments including RTI/STI Depot holder services for contraceptive and ORS, Promoters/Education and help ANMs for outreach services through social community/link volunteers. Referrals to be undertaken at the nearest public sector health facility.

Activities to be undertaken by NGOs n n n Signing of MOUs Identification of suitable Rented place for Urban Health Centre and establishing set up in identified slum area Recruitment of Staff as per guidelines for Urban Health Centre Procurement of Equipments and furniture NGO to conduct Community Needs Assessment Survey to identify the targets for delivery services cont…. .

n n n Identification and Updation of the Slum lists with mapping Delivery of Primary Health Care Services (Regular OPD services with Antenatal, postnatal care and immunization), Treatment of RTI/STI , lab services, family planning services Referral for institutional deliveries Demand generation of services in the slum areas with regular IEC / BCC activities Regular and focused Outreach sessions with record keeping and tracking fortnightly in identified and needy slum areas by ANMs.

Performance Indicators n n n n n No. of pregnant women given ANC, PNC services No. of children fully immunized No of cases referred for institutional deliveries No of cases covered under national programs like DOTS , NMCP No of cases of IUD insertion, NSV camps and sterilization camp No of cases of OPD including RTI/STI cases No of beneficiaries using contraceptives and ORS Details of Outreach activities conducted by ANMs and link volunteers No of cases availing Lab investigation services Details of IEC activities conducted

Expected Outcomes Achieving 100% Immunization among children n 100 % tetanus to pregnant women n Achieving IFA tablets distribution to all pregnant women n Achieving 80 % institutional deliveries in the slum areas through referrals n

Role of CMHOs n n Ensuring quality primary health services through Urban RCH centres as per the operational guidelines Regular monitoring of the functioning of Centres by NGOs Conducting Monthly district level meetings with paramedical and medical officers and Urban RCH Centre staff to discuss the key issues strategies and updation of the services for the Urban poor On going supportive supervision to the NGOs

Details of Operational Costs for running an Urban RCH Centre Category of Personnel (Each health center) No. of post sanctioned Monthly expenditure Annual Expenditure Medical Officer, General Physician (Preferably Female) 1 8000/- pm 96000 LHV (Staff Nurse) 1 6500/- pm 78000 Nurse II grade 1 4500/- pm 54000 ANMs 4 3500/-pm 16800 Laboratory Technician 1 3500/-pm 42000 Class IV 1 2500/-pm 30000 Safai Karamchari (part time) 1 1000/-pm 12000

Category (Each health center) Monthly expenditure Annual Expenditure Electrical, Water, Building Charges etc. including rent of the Centre 10000/- pm 120000 Drugs 30000/- pm 360000 Training 800/- pm 10000 IEC material 2000/-pm 25000 Office Expenses 1500/-pm 20000 Equipments Non recurrent 70000 Furniture Non recurrent 50000 Total amount for one Urban RCH Centre given to NGOs for a year comes to Rs 1135000