The document discusses India's growing urbanization and the associated rise in urban poverty and health issues faced by urban poor populations. It outlines the key objectives and components of the proposed National Urban Health Mission (NUHM) to address these issues. The NUHM aims to strengthen urban primary health care and outreach, establish Mahila Arogya Samitees for community participation, and leverage technology for monitoring and surveillance. It focuses on improving access to care for urban poor communities, including slum residents.

1. Ms. Namita Batra Guin
Associate Professor
CHN Deptt.

2.  There has been a progressive rise of urbanization
in the country over the last decade.
 Provisional Census 2011 data showed that for the
first time since Independence, the absolute
increase in population was more in urban areas
that in rural areas.
 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 population.
 As per United nations projections, if urbanization
continues at the present rate, then 46% of the
total population will be in urban regions of
India by 2030.

3.  This urbanization brings with it influx of
migrants, rapid growth of populations,
expansion of the city boundaries and a
concomitant 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
sanitation, communicable and non
communicable diseases.

4.  There are 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.
 Under 5 Mortality at 72.7 among urban poor is
significantly higher than the urban average of
51.9.
 In addition, several health indicators among the
urban poor are significantly worse than their
rural counterparts.
 60% urban poor children do not receive complete
immunization compared to 58% in rural areas.

5.  47.1 % urban poor children <3 are under-weight
as compared to 45% of the children in rural areas
and 59% of the woman (15-49 age group) are
anemic as compared to 57% in rural India.
 The invisibility of the urban poor has contributed
to their systemic exclusion from the public
health care system.
 Lack of economic resources restricting their
access to private facilities, Illegal status, poor
environmental condition, overcrowding and
environmental pollution has further contributed
to their poor health status.

6.  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.
 The Public Health Network in urban areas is
inadequate and functions sub optimally with
a lack of manpower, equipments, drugs,
weak referral system and in-adequate
attention to public health.

7.  Recognizing the seriousness of the problem,
urban health will be taken up as a thrust
area for the 12th Five Year Plan.
 The National Urban Health Mission (NUHM)
will be launched as a separate mission for
urban areas with focus on slums and other
urban poor.

8.  Urban poor population living in listed and
unlisted slums.
 All the other vulnerable population such as
homeless, rag- pickers, street children,
rickshaw pullers, construction and brick kiln
workers, sex workers, any other temporary
migrants.
 Public health thrust on sanitation, clean
drinking water and vector control.
 Strengthening public health capacity of
urban local bodies (ULBs).

9.  Address the health concerns by facilitating
equitable access to available health facilities.
 Partnership with all efforts made for accessing
community building to ensure full utilization of
created infrastructure.
 Communitization process or community
particpation to draw heavily on the existing
community organizations and self-help groups
 Synergize the mission with the existing
progammes such as Jawahar Lal Nehru National
Urban Renewal Mission (JNNURM), Swarn Jayanti
Shahri Rozgar Yojana (SJSRY) and ICDS which
have similar objectives to NUHM.

10.  779 cities/towns (772 cities/towns + 7
metros), having a population of 50,000 or
more including all district headquarters.
 Towns having less than 50,000 population
 Seven mega cities (Mumbai, New Delhi,
Kolkata, Chennai, Bengaluru, Hyderabad,
Ahmedabad).

11.  Flexibility will be given to states to hand
over management of NUHM to cities/towns
where sufficient capacity exists with Urban
Local Bodies.
 In the 12th Plan period NUHM and NRHM will
be separate programmes which may be
merged in the 13th Plan period or later.

12.  The budget allocation for NUHM in the 12th
Plan period is envisaged to be approximately
Rs 30,000 Crores.
 States contribution of the total amount
released will be 25% (NRHM – 85:15).

13.  Improving the efficiency of public health
system in the cities by strengthening,
revamping and rationalizing urban primary
health structure
 Promotion of access to improved health
care at household level through community
based groups: Mahila Arogya Samitees (MAS)
 Strengthening public health through
preventive and promotive action
 Increased access to health care through
community risk pooling and health
insurance models

14.  IT enabled services (ITES) and e-governance
for improving access improved surveillance
and monitoring
 Capacity building of stakeholders
 Prioritizing the most vulnerable amongst
the poor
 Ensuring quality health care services

15.  The NRHM and NUHM will be two major sub
Missions of a larger National Health Mission.
 The Mission steering group of NRHM will
become Mission steering group of National
Health Mission.
 The National Programme Coordination
Committee of NRHM will now become NPCC
of National Health Mission.
 The additional secretary and Mission
Director of NRHM will become MD National
Health Mission, under whom both the sub
Missions will work.

16.  The states will be free to choose from Non
Governmental partnerships for public
health goals, Public Private Partnership
(PPP), strengthening the extent primary
public health systems, an optimal mix of
these or to propose other innovative models
best suitable to their state needs.
 The State Health Mission under the Chief
Minister, the State Health Society under the
Chief Secretary and the State Mission
Directorate would also be similarly
strengthened.

17.  Every Municipal corporation, Municipality,
Notified Area Committee, and Town
Panchayat will become a unit of planning
with its own approved broad norms for
setting of health facilities.
 The municipal corporation will have
separate plan of action as per broad norms
for urban areas.

20.  An Urban Social Health Activist (USHA) will
be posted for every 200-500 households and
provide the leadership and promote the
Mahila Arogya Samitee.
 The USHA on the lines of ASHA, would
preferably be a woman resident of the slum–
married/widow/ divorced, preferably in the
age group of 25 to 45 years.
 She would be chosen through a rigorous
community driven process involving ULB
counsellors, community groups, self- help
groups, Anganwadis and ANMs.

21.  The USHA would actually be the nerve
centres for delivering outreach services in
the vicinity of the door steps of the
beneficiaries.
 The USHA may be preferably co-located with
the Anganwadi Centres located in the slums
for optimization of health outcomes.

22.  The NUHM proposes the creation of Mahila Arogya
Samitee (MAS) a community based federated group of
around 20 to 100 households, depending upon the
size and concentration of the slum population, with
flexibility for state level adjustments.
 MAS - acts as community based peer education group,
involved in community monitoring and referral.
 The MAS will have 5-20 members with an an elected
Chairperson and a Treasurer, supported by an USHA.
 This group would focus on health and hygiene
behaviour change promotion, facilitating access to
identified facilities and risk pooling.
 The MAS will be provided an annual united grant of Rs
5000 per year.

23.  The situational analysis has clearly revealed that
most of the existing primary health facilities,
namely the Urban Health Posts (UHPs) /Urban
Family Welfare Centres (UFWC)/ Dispensaries
are functioning sub- optimally due to problems
of infrastructure, human resources, referrals,
diagnostics, case load, spatial distribution, and
inconvenient working hours.
 The NUHM therefore proposes to strengthen and
revamp the existing facilities in to a "Primary
Urban Health Centre" with outreach and referral
facilities, to be functional for every 50,000
population on an average.

24.  The PUHC may cater to a slum population
between 20000- 30000, with provision for
evening OPD, providing preventive, promotive
and non-domiciliary curative care (including
consultation, basic lab diagnosis and dispensing)
 However, depending on the spatial distribution
of the slum population, the population covered
by a PUHC may vary from 5000 for cities with
sparse slum population to 75,000 for highly
concentrated slums.
 The NUHM would improve the efficiency of the
existing system by making provision for a need
based contractual human resource, equipments
and drugs.

25.  Rogi Kalyan Samiti will be made for
promoting local action.
 The provision of health care delivery with
the help of outreach sessions in the slums
would also strengthen the delivery of health
care services.
 On the basis of the GIS map the referrals
would also be clearly defined and
communicated to the community thus
facilitating their easy access.

26.  Creation of Sub Centers has not been
proposed. Outreach services will be provided
through Female Health Workers (FHWs)/ANMs
headquartered at the U-PHCs, utilizing
community halls, AWC, etc., as fixed points
for these services.
 Secondary and Tertiary level care and
referral services will be provided through
public or empanelled private providers.

27.  The NUHM would promote Community health risk
pooling and health insurance as measures for
protecting the poor from impoverishing effect of
out of pocket expenditure.
 To promote community risk pooling mechanism
the members of the MAS would be encouraged to
save money on monthly basis for meeting the
health emergencies.
 The group members themselves would decide
the lending norms and rate of interest.
 The NUHM would provide seed money of Rs. 5000
to the MAS .
 The NUHM also proposes incentives to the group
on the basis of the targets achieved for
strengthening the savings.

29.  To ensure access of identified families to quality
medical care
forhospitalization/surgeryBeneficiaries
 Identified urban poor families, for a maximum of
five members
 Smart Card/Individual or Family Health Suraksha
Cards to be proof of eligibility and to avoid
duplication with similar schemesImplementing
Agency:
 Preferably ULBs, possibly state for smaller
citiesPremium Financing
 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

31.  Studies have highlighted that the private
providers, which provide the majority of them
urban poor access for OPD services, remain
outside the public disease surveillance network.
 This leads to compromised reporting of diseases
and outbreaks in urban slums thereby adversely
affecting timely intervention by the public
authorities.
 The availability of ITES in the urban areas makes
it a useful tool for effective tracking, monitoring
and timely intervention for the urban poor.

32.  The NUHM would provide software and
hardware support for developing web based
HMIS for quick transfer of data and required
action.
 GIS system would be integrated into a system
of reporting alerts and incidence of diseases
on a regular basis.
 This system would also be synchronized with
the IDSP surveillance system.

33.  The Monitoring and evaluation framework
would be based on triangulisation of
information.
 • The three components would be
 (a) Community Based Monitoring
 (b) A web based Urban HMIS for reporting and
feedback and
 (c) external evaluations

34.  The District/ City Urban Health Society along
with the District/ City Urban Health Mission
would regularly monitor the progress and
provide feedback.
 Similarly the State level Society and Mission
would also monitor the progress.
 The practice of Concurrent audit will be
introduced right from the inception stage.
 All the funds/ untied grants would be
audited on a monthly basis and report of
which would be made public.