Outcome

The NUHM would strive to put in place a sustainable urban health delivery system for addressing the health concerns of the urban poor. The NUHM proposes to measure results at different levels with a long term as well as intermediate term view.

    1. Process/ Throughput level indicators:

  • Number cities/population where Mission has been initiated

  • Number of City specific urban health plans developed and operationalised

  • Number of U-PHCs with outreach made operational

  • Number of Cities/population with all slums and facilities mapped

  • Number of Slum/ Cluster level Health and Sanitation Day

  • Number of MAS formed

  • Number of U-PHCs with Programme Managers

  • Number of ASHAs trained and functioning


    1. Output level indicators:

  • Increase in OPD attendance

  • Increase in BPL referrals from U-PHCs/ referral availed

  • Increase in institutional deliveries as percentage of total deliveries

  • Increase in complete immunization among children < 12 months

  • Increase in case detection for malaria through blood examination

  • Increase in case detection of TB through identification of chest symptomatic

  • Increase in referral for sputum microscopy examination for TB

  • Increase in number of cases screened and treated for dental ailments

  • Increase in ANC check-up of pregnant women

  • Increased Tetanus toxoid (2nd dose) coverage among pregnant women

  • Strengthened civil registration system to achieve  100% registration of  births and deaths

 Impact level focus on urban poor:

Reduce IMR by 40 % (in urban areas) �C National Urban IMR down to 20 per 1000 live births by 2017

  •   40% reduction in U5MR and IMR

  • Achieve universal immunization in all urban areas.

Reduce MMR by 50 %

  • 50% reduction in MMR (among urban population of the state/country)

  • 100% ANC coverage (in urban areas)

  • Achieve universal access to reproductive health including 100% institutional delivery

  • Achieve replacement level fertility (TFR 2.1)

  • Achieve all targets of Disease Control Programmes


        1. Implementation Strategies

    1. UPHC

  • Functional for a population of around approximately 50,000-60,000, the U-PHC may be located preferably within a slum or near a slum within half a kilometer radius, catering to a slum population of approximately 25,000-30,000, with provision for OPD from 12 noon to 8 pm in the evening. The cities, based upon the local situation may establish a U-PHC for 75,000 for areas with very high density and can also establish one for around 5,000-10,000, slum population for isolated slum clusters.

  •  At the U-PHC level services provided will include OPD (consultation), basic lab diagnosis, drug /contraceptive dispensing, apart from distribution of health education material and counseling for all communicable and non communicable diseases. In order to ensure access to the urban slum population at convenient timings, the U-PHC may provide services from 12 noon to 8 pm in the evening. It will not include in-patient care.

  • It will be staffed by two doctors, one regular and one on a part time basis. Apart from that there will be 3 staff nurses, 1 pharmacist, 1 lab technician, 1 LHV and 4-5 ANMs (depending upon the population covered), apart from clerical and support staff and one Programme Manager for supporting community mobilization, behavior change communication, capacity building efforts and strengthening referrals.

  • To further strengthen the delivery of services cities can also engage the services of specialist doctors to provide services periodically at U-PHC based on needs on reimbursement basis. U-PHC can also serve as collection centre for diagnostic tests in partnership with empanelled private diagnostic centres.

  • The option of co-locating the AYUSH centre with U-PHC may also be explored, thus enabling the placement of AYUSH doctor and other AYUSH paramedic staff in the U-PHC.

  • The situation analysis showed that at present there are various types of primary health care facilities (UHP/UFWC/ Dispensary) with different service guarantee and human resource norms. There has been no reorganization/expansion of these schemes for a long period. With the launching of NUHM, all of these existing programmes/schemes will automatically cease to exist. The existing infrastructure available under these schemes would be rationalized and aligned with the new IPHS.

  • Under NUHM a uniform health care service deliver mechanism with IPHS norms will be developed and the states are encouraged to adopt these norms for U-PHCs.

  •  Maximum effort would be made to strengthen the already existing public health care infrastructure in urban areas. Existing SDH/CHC etc. would be upgraded and strengthened.

  • Where there are no government health facilities, new public health facilities would be established. All the U-PHCs would be set up in Govt. buildings. Partnership with other government facilities like Railways, Army, ESIC and Public Sector Units could also be explored for strengthening the delivery of services.

  • The government facilities strengthened as U-PHC will also be provided annual financial support in the form of Rogi Kalyan Samiti/ Hospital Management Committee Fund of Rs. 50,000 per U-PHC per year, with the amount being proportional to the population covered (@ Re.1.00 per head, i.e. a U-PHC covering 40,000 population will get Rs.40, 000 and a U-PHC covering 75,000 population will be getting Rs. 75,000 per year).

  • The recurrent cost support provided to U-PHCs of Rs.20 lakh per year, would include cost of all contractual staff in the U-PHC.

  •  In addition, ANMs and LHVs are supported separately (and these may be contractual posts.

    1. Accredited Social Health Activist (ASHA) 

  • Each slum/community would have one frontline community worker called ASHAASHA similar to ASHA under NRHM, covering about 1000-2,500 beneficiaries, between 200-500 households based on spatial consideration, preferably co-located at the Anganwadi Centre functional at the slum level, for delivery of services at the door steps. She would remain in charge of each area and serve as an effective demand�Cgenerating link between the health facility (Urban Primary Health Centre) and the urban slum populations. She would maintain interpersonal communication with the beneficiary families and individuals to promote the desired health seeking behavior. They will be responsible to the Mahila Arogya Samitis (community groups) for which they are designated.

  • Wherever possible the existing community workers under other schemes like JnNURM, SJSRY etc. may be co-opted under NUHM. ASHAASHA

  • The ASHA would be a woman resident of the slum, preferably in the age group of 25 to 45 years. The ASHA should also be literate with formal education up to class tenth, which may be relaxed only if no suitable person with this qualification is available. ASHA would be chosen through a rigorous community driven process involving ULB Counselors, community groups, self-help groups, Anganwadis, ANMs. A team of five facilitators may be identified in each U-PHC catchment area with the help of an NGO, through a consultative process, for facilitating the selection of the ASHA. The facilitators would preferably be from local NGOs; community based groups, Anganwadi or Civil Society Institutions. In case none of these is available in the area, the officers of other Departments at the slum level/local school teachers may be taken as facilitators. The selection process for ASHA in NRHM may be suitably modified to the urban context as per the local condition and adopted for selection of the ASHAs.

  • The ASHA would help the ANM in delivering outreach services in the vicinity of the doorsteps of the beneficiaries. Preferably some suitable identified place for ASHA may be arranged in the slums which may be AWW centres, clubs, community premises set up under the JnNURM, Sub Health Posts set up in IPP cities, municipal premises etc, or even her own residence.

  • An ASHA mentoring system on the lines of NRHM may be put in place involving dedicated community level volunteers/professionals preferably through the local NGO at the U-PHC level, for supporting and coordinating the activities of the ASHA. The states may also consider the option of 1 Community Organizer for 10 ASHAs for more effective coordination and mentoring, preferably located at the mentoring NGO. The Community organizer along with the ANM may be designated as the mentoring and management team at the slum level for the ASHAs.

Essential services to be rendered by the ASHA may be as follows:

  •  Active promoter of good health practices and enjoying community support.

  • Facilitate awareness on essential RCH services, sexuality, gender equality, age at marriage/pregnancy; motivation on contraception adoption, medical termination of pregnancy, sterilization, spacing methods. Early registration of pregnancies, pregnancy care, clean and safe delivery, nutritional care during pregnancy, identification of danger signs during pregnancy; counseling on immunization, ANC, PNC etc. act as a depot holder for essential provisions like Oral Re-hydration Therapy (ORS), Iron Folic Acid Tablet (IFA), chloroquine, Oral Pills & Condoms, etc.; identification of target beneficiaries and support the ANM in conducting regular monthly outreach sessions and tracking service coverage.

  • Facilitate access to health related services available at the Anganwadi/Primary Urban Health Centres/ULBs, and other services being provided by the ULB/State/ Central Government.

  • Formation and promotion of Mahila Arogya Samitis in her community.

  • Arrange escort/accompany pregnant women and children requiring treatment to the nearest Urban Primary Health Centre, secondary/tertiary level health care facility.

  • Reinforcement of community action for immunization, prevention of water borne and other communicable diseases like TB (DOTS), Malaria, Chikungunya and Japanese Encephalitis.

  • Carrying out preventive and promotive health activities with AWW/ Mahila Arogya Samiti.

  • Maintenance of necessary information and records about births & deaths, immunization, antenatal services in her assigned locality as also about any unusual health problem or disease outbreak in the slum and share it with the ANM in charge of the area.

  • In return for the services rendered, she would receive a performance based incentive. For this purpose a revolving fund would be kept with the ANM at the U-PHC (in the PHC account), which would be replenished from time to time, based on Utilisation Certificate/Statement of Expenditure. The following performance based incentive package is suggested subject to modifications by the State.


 
 
 
Designed By : UHI-India