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