Implementation of National Urban Health Mission (NUHM) Joint

Implementation of National Urban Health Mission (NUHM) Joint

Implementation of National Urban Health Mission (NUHM) Joint Secretary (Urban Health) Ministry of Health & Family Welfare Government of India 13.5.2019 About NUHM National Urban Health Mission (NUHM) was approved on 1st May, 2013 as a sub-mission of National Health Mission (NHM) Aims to establish and strengthen primary healthcare delivery in urban areas with focus on slums and vulnerable population. Cover cities/ towns with population above 50,000 & District Head Quarters above 30,000 population De-congesting secondary/tertiary care facilities (DH/SDH/CHC) Robust Comprehensive Primary Health Care services in urban areas So far , more than 1000 cities/ towns covered under NUHM HWC/ U-PHCs - Fulcrum of Preventive, Promotive and Curative services in cities closer to the communities 1591 HWCs made operationalized against 3299 U-PHCs approved

Poor Maternal and Child health Indicators among Urban poor (NFHS-III) Under 5 Mortality is 72.7 among urban poor significantly higher than the urban average of 51.9 56% deliveries among the urban poor take place at home Several health indicators among urban poor are worse than rural areas: 60% urban poor children do not receive complete immunization compared to 58% in rural areas 47.1 % urban poor children <3 are under-weight as compared to 45% of rural children 59% of woman (15-49 age group) are anemic as compared to 57% in rural Key NFHS-4 Facts (Urban)- India Institutional delivery in Public Health Facility46.2.1% JSY benefits to mothers21.4% Full Immunisation Coverage-63.9% Breastfed within one hour of birth-42.8% Anaemia in 15-49 age gp-45.7% Children between 6-59

months anaemic-55.9% NFHS-4 Indicators Indicators Urban Rural Total Infant and Child Mortality Rates (Per 1,000 Live Births) Infant Mortality Rate (IMR) 29 46 41 Under-Five Mortality rate (U5MR)

34 56 50 Delivery care (For births in the 5 Years before the survey) Institutional births (%) 88.7 75.1 78.9 Institutional Births in Public facility (%) 46.2 54.4

52.1 61.3 62.0 Child Immunization Children age 12-23 months fully immunized (BCG, measles and 3 doses each of polio and DPT (%) 63.9 NFHS-4 Indicators Indicators Urban Rural

Total 42.8 41.1 41.6 Pregnant Women age 15-49 years who are anaemic (<11.0g/dl) (%) 45.7 52.1 50.3 All women age 15-49 years who are anaemic (%) 50.8 54.2 53.0 Child Feeding Practices and Nutritional Status of Children Children under age 3 years breastfed within one hour of birth (%) Anaemia among Children and Adults Key urban health indicators (NSSO 71st round) Indicators % of hospitalized cases using public facility % of non-hospitalized cases using public facility Urban Rural 32

42 20 25 9620 9840 18919 15804 Non-hospitalized expenditure (Rs.) OOPE per non-hospitalized ailing person (Rs.) PUBLIC OOPE per non-hospitalized ailing person (Rs.) PRIVATE Core Strategies- NUHM

Creation of new facilities Rationalization and strengthening existing urban primary health structures Deployment of MOs, Paramedical Staff at U-PHCs / U-CHCs, Engagement of ANMs Selection of ASHAs and Formation of MAS Involvement of ULBs in planning, implementation and monitoring of the program Convergence with all National Health Programs and other Ministries Capacity building of ULBs/ Medical and Paramedical staff/ASHA, MAS Use of ICT For better service delivery, improved surveillance and monitoring 8 NUHM: Service Delivery Mechanism UrbanCHC 30-50 bedded in cities 2.5lakh populatio n 100 bedded

for more than 500,000 populatio n in metros UrbanPHC For every 50,000 urban populatio n Comprehe nsive primary healthcar e service Outreach Sessions

For slum and vulnerabl e populatio n, routine UHNDs and special outreach sessions Mahila Arogya Samiti For every 50 100 household s in slums and

among vulnerabl e communit ies BCC & Health Promotion Implementation of NUHM For six mega cities, namely Mumbai, Kolkata, Chennai, Bengaluru, Hyderabad and Ahmedabad, implementation is through respective Urban Local Bodies (ULBs), For the remaining cities,

health department is the Primary implementation Agency for NUHM 1067 Cities covered under NUHM 9 big States covering 70% cities of total cities approved d han k r Jha -22 Expected Outcomes of NUHM Providing comprehensive quality health care to the

urban poor and vulnerable through UPHCs/UCHCs Special focus on health issues in urban areas- NCDs, Mental health, substance abuse etc. Outreach through UHNDs and special outreach sessions to address specific community health needs Mapping of urban vulnerable population- in catchment area of U-PHC Provision of services under all National Health

Programmes at the UPHC level Address social determinants of health through intersectoral convergence. Physical Progress under NUHMIndia- as per QPR (ending December, 2018) 1. Year wise Progress of HR/U-PHC/ASHA/MAS 100% 91% 90% 88% 82% 80% 80%

75% 70% 60% 95% 72% 66% 66% 55% 52% 60% 50%

0.41 40% 30% 0.24 0.22 20% 10% 0% HR U-PHC ASHA MAS

* Information not available for U-PHCs for year 2014-15 14 2. Human Resource Total Staff Clinical& Paramedical staff Program management staff Approved37597 Approved36182 Approved1415

In-position28008(75% ) In-position26829 (74%) In-position1179 (83%) 3. Operationalization of U-PHCs/U-CHCs 4578/4831 (95%) U-PHCs made functional 134/170 (90%) U-CHCs made functional 4. Health &Wellness Centres- urban areas So, far 1591 HWCs have been made operationalized

5. Community Process ASHAs engaged 62005/70493 (88%) MAS formed 79692/96854 (82%) RKS formed 2998/4578 (66%) 6. Service Delivery Trend - HMIS Chart Title Total children (9 to 11 months) Fully Immunised Total ANC Registration

44 31 35 46 26 35 21 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 54% increase in OPD from FY 2014-15 to 2018-19 33 27 17

2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 48% increase in OPD from FY 2014-15 to 2018-19 Data as reported by Urban Health Facilities (Public,Physical,Active) on HMIS portal. Comparison of FY 2016-17 & 201718 Data as on 24-08-2018 Title OPDChart attendance 33 27

24 19 11 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 66% increase in OPD from FY 2014-15 to 2018-19 Data as reported by Urban Health Facilities (Public,Physical,Active) on HMIS portal. Comparison of FY 2016-17 & 201718 Data as on 11.5.2019 Financial Progress under NUHM- India Financial Progress of NUHM in India since inception (2013-14 to 2018-19 Overall utilization is 72% against available funds 5085 4764 2260

Total Releases Proportionate State Share Total Expenditure Releases are updated till date and Expenditure is updated upto 31.03.2019(provisional) % of Utilization of Funds under NUHM since inception (India) 72% 66% 51% 31% 17% 1% 2013-14 2014-15

2015-16 2016-17 2017-18 2018-19 Expenditure from 2013-14 to 2017-18 is based on audit reports and for FY 2018-19 on FMR (Provisional) Priority Areas I. Key Activities Capacity Development/training of service delivery and program management staff on - NUHM orientation - HWC training - Training under all National Health Programmes Strengthening of U-PHCs as Health and Wellness Centres (HWCs) in urban areas

Enhanced fixed day Specialist services at U-PHC/HWC for dental, eye, skin, mental health care etc. Quality certification of health facilities Extension of Kakayalp and SSS in urban areas Utilizing MAS present in Slum areas for health promotion / awareness /follow-up/ vector control/ NCD/TB cases etc. Population based screening for hypertension, diabetes and cancers (oral, breast and cervix) 24 Continued. Immunisation activities in urban area- Identify gaps and recommend actions etc. Integration of RNTCP activities in urban areas with Designated Microscopy Centers (DMCs) established at UPHCs and made operational as Treatment Centres of RNTCP Provision of sanitary napkins, awareness on menstrual hygiene and safe disposal of sanitary napkins in urban areas Integration of all National Health programs like RCH Immunization, NCDs, NVBDCP etc. with NUHM at all

facilities in urban areas Leveraging Medical colleges to strengthen & support NUHM implementation. Improving coordination mechanisms between Departments and Urban Local Bodies (ULBs) State Regular and quality data reporting of health facilities on HMIS portal25 II. Strengthening Financial Management systems Bank Accounts of all the UPHCs to be opened Registration and transfer of funds under NUHM through PFMS including ULBs e-transfer of Funds to the UPHCs/UCHCs- untied grants, other expenses The formation and registration of RKS for all the UPHCs Recent Publications Guidelines, Manuals and Frameworks developed

various Mapping topics1)on Vulnerability 2) Records &Registers for U-PHCs 3) Capacity building framework 4)Extension of kayakalp in urban areas 5)Orientation Training Module 6)Module RFP and SLA to operate U-PHC 7)ANM Handbook 8)Quality standards for Brochures on Thematic U-PHCs areas- Brand module 9)NUHM session in 1) Thrust areas under NUHM 5) Human10)Outreach Resource under

urban areasProcess 2) Community NUHM Financial Management guideline 3)11)NUHM Quality Assurance 6) Collaboration with Medical 4) IEC/BCC Colleges 7) Inter Sectoral Convergence under NUHM Manual/Guidelines developed under NUHM 7 Brochures developed

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