Urban Health Problems and National Urban Health Mission
Urban Health Problems and National Urban Health Mission
Learning objectives At the end of the class the student will • Enumerate the health problems prevalent in urban area • Enlist the focus of services of NUHM • Explain the strategies under NUHM for health care delivery • Enlist the functions carried out at Urban PHC • Explain the health care delivery in NUHM • Explain the structure and functions of Mahila Arogya Samiti
Urbanization • Progressive • Census 2011: absolute increase in population more in urban area • Rural population down from 72% (2001) to 68% (2011) • By 2030: 46% of the population will be in urban areas
Slum • Highly populated urban residential area consisting mostly of closely-packed, decrepit housing units in a situation of deteriorated or uncompleted infrastructure, inhabited primarily by impoverished persons - UN Habitat, 2007
Slum Lacking in one or more of the following five amenities: 1) Durable housing 2) Sufficient living area 3) Access to improved water 4) Access to improved sanitation facilities 5) Secure tenure (de facto or de jure and protection against forced eviction)
• Slum population growing: 7% annually • Poor health status • Environmental pollution • Outbreak of water borne diseases, VBDs • Increase in STI/HIV • NCDs, accidents • Mental health problems
• Migration • Expansion of city boundaries usurping agricultural land • Health indicators much below national indicators • Poor public health network • Lack of manpower, equipments/drugs • Weak referrals and linkages • 12 th Five Year Plan recognizes this: NUHM
National Urban Health Mission • • Sub-mission of National Health Mission Set up during 11 th five year plan (2008 -12) Meet health needs of urban poor Primary health care approach NUHM Coverage: - All state capitals and District HQs - 779 cities/towns with population > 50, 000
Focus of NUHM • Urban population living in slums • Vulnerable population of cities • Public health thrust on sanitation, clean drinking water, vector control • Strengthen urban local bodies • NUHM is managed through municipal corporation in the 7 Metro cities
Strategies • Strengthen urban primary health structure ü Urban health centers ü Evening OPD ü Comprehensive health care ü Need based equipment, drugs ü Outreach health sessions in slums • Strengthen community participation
Urban Primary Health Center • Near slum: covers population 50 to 60 K people • Functions: ü Medical care: OPD from 12 to 8 pm ü RMNCH+A services ü National health programs ü Referral services ü Basic laboratory services ü Non-communicable diseases ü Counseling services
Outreach services • Female Health Workers (FHWs): ANMs with 36 months training • FHWs will be posted at Urban PHCs • ASHA for 1000 -2500 population, Link Worker in urban poor settlements • Mahila Arogya Samiti
Services by ASHA 1) Active promoter of good health practices 2) Facilitate awareness on RCH services: - age at marriage, - contraception, - early registration of pregnancy, - nutritional care, IFA, AWC benefits - ORS 3) Depot holder of select drugs and supplements
4) Formation of MAS 5) Escort for pregnant women and sick children 6) Immunization and implementation of programs 7) Record of vital events, immunization, ANCs, any unusual health event/outbreak in the community 8) Treat minor ailments
Referral Unit: Urban CHC A satellite hospital for 4 -5 U-PHCs Population covered: 2, 50, 000 Inpatient services with 30 -40 beds In metro cities, U-CHC for every 5 lakh population • Medical and minor surgical care • Institutional deliveries • •
Urban Health Care Facilities in NUHM U-CHC (2. 5 lakhs) IP facility, 30 -50 beds, Cities >5 lakhs U-PHC (50 K) MO (1), part time MO (1), Nurses (3), LHV (1), Pharmacist (1), ANMs (3 -5), PH Manager (1), Support staff (3), M & E unit (1) ANM (10 K) ASHA/ LW (1 K to 2. 5 K) MAS (250 to 500)
Targets • Reduce IMR and U-5 MR by 40% by 2017 • Universal immunization • Reduce MMR by 50% and 100% ANC coverage • TFR: 2. 1 which is replacement level fertility • Achieve all targets of the disease control programs
Functions of Mahila Arogya Samiti • • • Focus on preventive and promotive care Act as peer education group Facilitate access to facilities Risk pooling by health insurance Annual grant of Rs. 5000/- every year
Community risk pooling • Women from MAS save money • One time seed money (Rs. 25/household) from Government • From this pool: money utilized for other purposes • For unforeseen health expenditure of member/family
What we are doing? • Mo. U with District Health and Family Welfare • Involvement in organizing special outreach camps - Specialists • Evening clinic
Summary
- Slides: 22