More than 2 million births annually among the urban poor and the health indicators in this group are poor. 56% deliveries among the urban poor take place at home
The lack of economic resources limits access to the available private facilities. at the secondary and tertiary hospitals makes them unfamiliar to the modernenvironment of hospitals, thus restricting their access.
Despite the supposed proximity of the urban poor to urban health facilities their access to them is severely restricted. This is on account of their being when contrasted with the rural network makes the urban poor more vulnerable and worse off than their rural counterpartMany components of the National Rural Health Mission cover urban areas as well. These include funding support for the Urban Health and Family Welfare Centres and Urban Health Posts, funding of National Health Programmes like TB, immunization, malaria, etc., urban health component of the Reproductive and Child Health Programme including support for JananiSurakshaYojana in urban areas, strengthening of health infrastructure like District and Block level Hospitals, Maternity Centres under the National Rural Health Mission, etc.
This will be done in a manner to ensure well identified facilities are set up for each segment of target population which can be accessed as a matter of right.
to hand over management of NUHM to cities/towns where sufficient capacity exists with Urban Local Bodies.
1.system in the cities by strengthe9ing, revamping and rationalizing urban primary health structure2. through community based groups: MahilaArogyaSamitees (MAS)3. for improving access improved surveillance and monitoring
. of the NUHM. However, in order to provide dedicated focus to issues relating to Urban Health the institutional mechanism under the NRHM at various levels would be strengthened for NUHM implementation.1. would be strengthened by incorporating additional government and non government and urban stakeholders , professionals and urban health experts.2.
under NRHM with additional stakeholder members.
which may be AWW centres, clubs, community premises set up under the JNNURUM , Sub Health Posts set up in IPP cities ,municipal premises etc, or even her own residence.in place should be instituted through the local NGO at the PUHC level.3. for more effective coordination and mentoring, preferably located at the mentoring NGO.
, with flexibility for state level adjustments, 1. , depending upon the size and concentration of the slum population.
including ULB maternity homes, state government hospitals and medical colleges, apart from private hospitals to act as referral points for different types of healthcare servicesapart from District/Sub-District Hospitals
National Urban Health Mission
National Urban Health
Dr Utpal Sharma
Post Graduate Student
Dr Jutika Ojah
Department of Community Medicine
Gauhati Medical College
There has been a considerable rise of urbanization in the country
over the last decade.
Census 2011 data showed, for the first time since Independence,
the absolute increase in population was more in urban areas that in
As per Census 2001, 28.6 crore people live in urban areas. The
urban population has increased to 37.7 crore in 2011
At present, rural population in India is 68.84 per cent (down from
72.19 per cent in 2001 Census) as against 31.16 per cent urban
As per UN projections, if urbanization continues at the present
rate, then 46% of the total population will be in urban regions of
India by 2030.
Influx of migrants,
Rapid growth of populations,
Expansion of the city boundaries
Parallel rise in slum populations and urban poverty.
Of the 370 million urban dwellers, over 100 million
are estimated to live in slums and face multiple
health challenges on the fronts of
Non communicable diseases
All-India population growing at 2 per cent, urban
population at 2.75 per cent, large cities at 4 per cent
and slums at 5-6 per cent.
More than 2 million births annually amongst urban poor;
around 56% deliveries of them taking place at home.
U- 5 Mortality at 72.7 among urban poor is significantly higher
than the urban average of 51.9
60% urban poor children do not receive complete immunization
compared to 58% in rural areas.
About 47.1 % urban poor <3 children are under-weight as
compared to 45% of the children in rural areas
About 59% of the woman (15-49 age group) are anemic as
compared to 57% in rural India.
In addition, several health indicators among the urban poor are
significantly worse than their rural counterparts.
Lack of information and assistance
Expensive private healthcare facilities
Perceived unfriendly treatment at government
Emotionally securer environment at home
Non-availability of caretakers for other siblings in the
event of hospitalization
―Crowded out‖ because of the inadequacy of the
urban public health delivery system.
Ineffective outreach and weak referral system
Lack of standards and norms for the urban health
Norms for urban area primary health
infrastructure were not part of the NRHM
……..limiting the basic health infrastructure in
urban areas, under the NRHM.
Further, no systematic investments and efforts have been
made to improve health care in urban areas.
There has been a history of underinvestment with a project
based approach instead of comprehensive strategy.
Public Health Network in urban areas is inadequate and
functions sub optimally with a lack of
Weak referral system and
In-adequate attention to public health.
So…….here we are….
seriousness of the
problem, urban health
was taken up as a thrust
area for the 12th Five
The National Urban
Health Mission (NUHM)
will be launched as a
separate mission for
urban areas with focus
on slums and other
Slums: The five deprivations
The United Nations Human Settlements
Programme (UN-Habitat) defines a slum
household as one that lacks one or more
of the following:
Access to safe water
Access to improved sanitation
Security of tenure
Durability of housing
Sufficient living area
Slums: Census 2011 defination
Consists of all cluster of 20-25 households
or more with the following criteria:
Roof material using any material
other than concrete.
Potable water source not
available within the premises
of the house.
Latrines not available within
the premises of the house.
Absence of drainage or open drainage.
What we are
The NUHM therefore aims to address the health concerns
of the urban poor
Facilitating equitable access to available health facilities
Strengthening of the existing capacity of health delivery
The existing gaps to be filled up through partnership with
NGOs & CBOs.
Planning process to undertake large scale community
The NUHM would have high focus
Urban Poor Population living in listed and unlisted
All other vulnerable population such as
Construction and brick and lime kiln workers
Other temporary migrants.
Public health thrust on sanitation, clean drinking
water, vector control, etc.
Strengthening public health capacity of urban local
Mission would aim to improve the health status of
the urban poor particularly the slum dwellers and
other disadvantaged sections, by facilitating
Equitable access to quality health care through a
revamped public health system
Partnerships with NGOs
Community based risk pooling and insurance
.....with the active involvement of the urban local
Synergizing the mission with the existing progammes
having similar objectives to NUHM.
All cities with >50,000 population.
All the district and state headquarters
(irrespective of the population size).
Urban areas with < 50,000
population to be covered by NRHM.
So far to ensure that there is no duplication
Seven mega cities will be treated differently — their
municipal corporations will implement NUHM.
In other cities, District Health Societies will be
responsible for NUHM implemetation.
Flexibility- given to states
In the 12th Plan period NUHM and NRHM will be
…….may be merged in the 13th Plan period or later.
The budget allocation in the 12th Plan period is
envisaged to be approximately Rs 30,000 Crores.
States contribution will be 25% (NRHM — 85:15).
In the 12th Plan, 25% state contribution shared
between states and the Urban Local Bodies (ULBs).
For calculation, it is assumed that state share would
be 15% and ULBs share 10%.
Improving the efficiency of public health
Promotion of access to improved health care at
Strengthening public health through preventive and
Increased access to health care through community
risk pooling and health insurance models
IT enabled services (ITES) and e-governance
Capacity building of stakeholders
Prioritizing the most vulnerable amongst the poor
Ensuring quality health care services
The NUHM institutional structures….. at the
National, State and District level for operation.
The Mission Steering Group under the Union
...The EPC under the Secretary (H&FW)...
...The NPCC under the Mission Director
At the State level, the State Health Mission under the
The State Health Society under the Chief Secretary and...
...the State Mission Directorate.
At the City level, the States may either
decide to constitute a separate..
City Urban Health Missions/ Societies or....
...use the existing structure of the DHS /
The Mission provides flexibility to the
states to choose the best suited model
Every ULB will become will become a unit of
planning with its own approved broad norms for
setting of health facilities.
These separate plans will be part of DHAP drawn
District plan will now be called Integrated DHAP
covering both Urban and Rural population
Municipal corporations will have separate plan of
action as per broad norms for urban areas.
Urban Health Delivery
All the services delivered under the mission will be
based on identification of the target groups.
Through distribution of Family/ Individual Health
Provision of primary health care in Urban health
delivery mode is basically through:
USHA (At community Level)
Primary Urban Health Centre
Urban & Rural health care
80,000-1.2 lakh pop
5 Lakh pop
1 village=1500 pop
200-500 HH; 1000-2500 popl
Urban Social Health
An USHA will be posted for every 200-500 households
Maintain IPC with the families and the Mahila Arogya
Samities (MAS) for which they are earmarked.
The USHA , preferably be a woman resident of the slummarried/widowed/ divorced
Preferably in the age group of 25 to 45 years.
Should be literate with formal education up to class eight
subjected to relaxation.
Chosen through a rigorous community driven process
involving ULB Counsellors, community groups, self help
groups, Anganwadis, ANMs.
The USHA would be delivering outreach
services in the vicinity of the door steps of the
Suitable place for USHA may be arranged in the
slums for optimization of health outcomes.
Role of NGOs….
A proposed USHA mentoring system.
Support and coordinating the activities of the USHA.
Community Organiser for 10 USHA
The Community organizer along with ANM – be
Mentoring and Management team at the slum level for
Mahila Arogya Samitee (MAS)
A community based federated group of around 20 to 100
Acts as community based peer education group, involves in
community monitoring and referral.
Each of the MAS may have 5-20 members with an elected
Chairperson and Treasurer, supported by USHA.
The mobilization of the MAS facilitated by NGO, working along
with the USHA
The group focuses on:
Health and hygiene behaviour change promotion
Facilitating access to identified facilities
Community risk pooling.
The MAS will be provide with an annual untied grant of Rs 5000.
Urban Primary Health Center
Functional for a population of around 50,000
Located preferably within a slum or a half km radius,
Catering a population of approximately 20000-30000,
With provision for evening OPD also.
Flexibility One UHC for 75,000 for densely populated areas or…. and
One UHC for around 5000-10,000 for isolated slum clusters.
Facilities provided are:
Non-domicilliary curative care including consultation
Basic lab diagnosis and dispensing.
It will ordinarily not include in-patient care.
Co-locating the AYUSH centre with UHC
Making way for placement of AYUSH doctor and
other AYUSH paramedic staff in the UHC.
NUHM will not provide for contractual staff of AYUSH as
is the case with NRHM.
For a non-functional government health
facility, required staff may be posted from:
Medical institutes or state government (on
......Contractual appointments from the private
Human Resource at UPHC
2* (1 regular and 1
Public Health Manager/ Community Mobilisor 1
4-5** Depending upon
Secretarial Staff including for account
keeping and MIS
Existing hospitals in the area, will be empanelled /accredited
For empanelled government facilities, RKS /HMS will be
funded, which will be utilized for providing cash-less
Referral services will be cash-free for the beneficiary
….financed by community health insurance or voucher
scheme as per the PIP developed for the city.
Collaboration with local Medical Colleges for strengthening
the training support and supplement HR at the PUHC level.
Urban Community Health Centre (U-CHC) are proposed
to be set up as a satellite hospital for every 4-5 U-PHCs.
Cater to a population of 2,50,000.
Provide in patient services and a 30-50 bedded facility.
The U-CHCs would be set up in cities with a population
of above 5 lakhs, wherever required.
They will be in addition to the existing facilities (SDH/DH)
to cater to the urban population in the locality.
For the metro cities, the U-CHCs may be established for
every 5 lakh population with 100 beds.
The U-CHC would provide medical care, minor surgical
facilities and facilities for institutional delivery.
Community Risk Pooling
The NUHM would promote Community Health risk pooling
and health insurance …..
……….as measures for protecting the poor form
improvising effect of out of pocket expenses.
The members of MAS would be encouraged to save money
on monthly basis for meeting the health emergencies.
The group members would themselves decide the norms
and rate of interest.
The Mission would provide seed money of Rs 5000 to the
The Mission also proposes incentives to the group on the
basis of the targets achieved for strengthening the savings.
Community Health Insurance
To ensure access of identified families to quality medical care for
Identified urban poor families, for a maximum of five members
Smart Card: Individual/Family Health Suraksha Cards to be proof of
eligibility and to avoid duplication
Implementing Agency: Preferably ULBs, state for smaller cities
Up to a maximum of Rs.600 per family as subsidy by the central govt.
Additional cost, if any, may be contributed by state/ULB/beneficiary
Coverage for hospitalisation/surgical procedures
Coverage of surgical care on a day care basis
Pre-existing conditions: Diseases, including maternal and childhood
conditions and illness, to be covered, subject to minimal exclusion
Monitoring & Evaluation
The Monitoring and evaluation framework would be
based on triangulation of information.
The three components would be
Community Based Monitoring
A web based Urban HMIS for reporting and feedback
To ensure evaluation of the urban health
programme three surveys namely:
Baseline at the beginning of the programme,
Mid line or concurrent evaluation and
End line evaluation would be conducted in each city.
The Urban Health Society along with the Urban Health Mission
would regularly monitor the progress and provide feedback.
Similarly the State level Society and Mission would also monitor
The Health Service Guaranteed would be translated Charter and
be displayed at the facility level.
Making available all the information to the community through
Wall journals and circulars
Guidelines……. to empower the community to enforce accountability.
The RTI would be a major instrument in ensuring accountability.
The practice of Concurrent audit may be introduced right from the
All the funds/ untied grants would be audited on a monthly basis
and report of which would be made public
National Urban Health Mission Framework For Implementation
Ministry Of Health And Family Welfare Government Of India ;May 2013
National Urban Health Mission; Meeting the Health Challenges of the
urban Population especially the Urban Poors(With special focus on
Urban Slums); Urban Health Division, Ministry of Family
Welfare, Government of India 2008-2012
Urban Health Division, Ministry of Family Welfare, Government of
India. National Urban Health Mission(2008-2009):Jul 2008
Annual Report,2006-07:towards better Health in Underserved Urban
Settlements, Urban Health Resource Centre
Urban Health Division, Ministry of Health & Family
Welfare, Government of India; Health of the Urban Poor in India Key
Results from the National Family Health Survey, 2005 – 06
The Technical Group On Population Projections. Population
Projections For India And States 2001-2026.May 2006:8.