NUHM: National Urban Health Mission in India
National Urban Health Mission (NUHM) was approved in 2013 as a sub-mission of the National Health Mission, aiming to provide comprehensive health services in urban areas with a population above 50,000. The mission covers cities, towns, and district headquarters and focuses on establishing primary healthcare systems through Urban Primary Health Centers (UPHCs) and Health and Wellness Centers (HWCs). NUHM also emphasizes community mobilization, mapping urban health facilities, addressing social determinants, and promoting convergence with stakeholders. The mission aims to improve key health indicators such as child mortality rates, institutional births, and child immunization, with implementation mechanisms through Urban Local Bodies and State Health Departments.
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13thCRM National Urban Health Mission (NUHM) Preeti Pant Joint Secretary(NUHM) Health & Family Welfare Government of India 16th Oct , 2019
NUHM National Urban Health Mission (NUHM) was approved on 1st May, 2013 as a sub-mission of National Health Mission (NHM). Covers Cities/ Towns with population above 50,000 and District Head Quarters above 30,000 population , So far 1067 cities and towns covered under NUHM No of UPHCs functional -4586 No of HWCs Approved- 3300 No of HWCs functional- 2372 (72%) Funds released to the State/UTs/ULBs
NUHM 5000 No of UPHCs functional -4586 No of HWCs Approved- 3300 No of HWCs functional- 2372 (72%) 4586 4500 3300 (72%) 4000 3500 2372 (72%) 3000 2500 2000 1500 1000 500 0 No. of U-PHCs functional No. of HWCs approved No. of HWCs functional
Implementation Mechanism Through the ULBs in 7 Metropolitan Cities of Ahmedabad, Bengaluru, Chennai, Delhi, Hyderabad, Kolkata and Mumbai Through the State Health Department /ULBs as per the State Health Dept.
Outcomes Establishment of Primary Healthcare system - providing comprehensive quality health services through UPHCs/UCHCs , outreach and special outreach Mapping of (i) urban health facilities, (ii) mapping /assigning of vulnerable and poor population in slums; Targeted outreach and robust referral mechanism Expanded range of services in HWCs/UPHCs apart from RCH Each UPHC-HWC to be developed as a DOTS Centre Community mobilisation through ASHA and MAS Addressing Social Determinants and convergence with other stakeholders
Comparison-Key Health Indicators (NFHS-4) Indicators Urban Rural Total Infant and Child Mortality Rates (Per 1,000 Live Births) Infant Mortality Rate (IMR) Under-Five Mortality rate (U5MR) Delivery care (For births in the 5 Years before the survey) Institutional births (%) Institutional Births in Public facility (%) Child Immunization Children age 12-23 months fully immunized (BCG, measles and 3 doses each of polio and DPT (%) 29 34 46 56 41 50 88.7 46.2 75.1 54.4 78.9 52.1 63.9 61.3 62.0 7
Comparison-Key Health Indicators (NFHS-4) Urban Rural Total Blood Sugar Level Women Blood sugar level - high (>140 mg/dl) (%) 6.9 5.2 5.8 Blood sugar level - very high (>160 mg/dl) (%) 3.6 2.3 2.8 Men Blood sugar level - high (>140 mg/dl) (%) 8.8 7.4 8.0 Blood sugar level - very high (>160 mg/dl) (%) 4.4 3.5 3.9 Hypertension High NCD Burden in Urban Women Slightly above normal 7.3 6.5 6.7 Moderately high 1.6 1.3 1.4 Men Slightly above normal 11.4 9.8 10.4 Moderately high 2.7 2.0 2.3
Physical Progress :Service Delivery Trend - HMIS 2. ANC Registration 1. OPD Attendance 33 Cr 35 46 Lac 50 44 Lac 27 Cr 45 30 35 Lac 24 Cr 40 25 31 Lac 35 19 Cr 30 20 21 Lac 25 11 Cr 15 20 15 10 10 5 5 0 0 2014-15 2015-16 2016-17 2017-18 2018-19 2014-15 2015-16 2016-17 2017-18 2018-19 Source: NHM HMIS Portal for FY 2018-19 9
Financial Progress (2013-14 to 2019-20 ) Rs. in crore Overall utilization is 68% against available funds 5491 5383 2650 Total Releases Proportionate State Share Total Expenditure Releases are updated till date and Expenditure is updated upto 30.06.2019(provisional)
% of Utilization of Funds under NUHM since inception 74% 68% 66% 51% 31% 17% 1% 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 Expenditure from 2013-14 to 2017-18 is based on audit reports and for FY 2018-19 and 2019-20 (1st quarter) on FMR (Provisional)
Expanded service delivery Filling up HR vacancies &Training Reporting on HMIS/HWC Portal & IT systems Observations during Field Visit UPHC to HWC Drugs & Expanding Diagnostics - Branding and IEC activities Community Mobilisation and Outreach
Observations during field visit Comprehensive Primary Health Care Outreach Services /Community Mobilisation (ASHA/MAS) CBAC Form filling NCD Services Fixed Days/Other Days UH ND/Special Outreach >30 years/Family Folders Training Data Reporting Referral NCD Trg/VIA Trg HWC Portal/NCD App/HMIS& RCH Portal Specialized Services
Observations during field visit Health System Strengthening Quality Assurance Infrastructure Drugs and Diagnostics ULB/Govt/Rented/New Construction EDL and No of Tests NQAS/Kayalalp/SSS/Mera Aspatal Supportive Supervision and Monitoring Convergence with other Stakeholders Training/Innovation Service delivery/community Process State and District level ULB/Ward Members
Finance Bank Accounts of all the UPHCs operational e-transfer of Funds to the UPHCs/UCHCs- untied grants, other expenses Registration and transfer of funds under NUHM through PFMS Rogi Kalyan Samitis formed/constituted for the UPHCs
Each CRM Team to: Visit 2 UPHCs (one HWC) in the City/ District - use Checklist Visit one Routine / Special Outreach being held. Interact with the Community, ASHAs recruited, MAS constituted under NUHM/ULB functionary Spend at least 1 day (either in the beginning or at the end) In Metro cities and State Capital - on NUHM Implementation
Checklists 4 Checklists- 2Facility level, 1State level and 1Community level; UPHC-HWC Checklist Information to be obtained from UPHCs /HWCs Community level Checklist Informationto be obtained from the Community, MAS, ASHAs and ANMs UCHC Checklist - Information to be obtained from UCHCs State level Checklist - to be used for obtaining information on Urban Health from the State
UPHCs-HWCs Coverage : Population of the catchment area/Slum population/ Distance of the nearest slum Human Resources and Training : Availability of MO/ SN/ ANM/LT/Pharmacist Specialist for evening OPDs/Special Outreach Training in NCD /VIA/National Health Programmes Physical Infrastructure : Govt or Rented Building/PPP mode Cleanliness, Citizen Charter, Toilets, water, electricity Drug Supplies , Consumables and equipments/maintenance Diagnostics : Number of tests/ Type - Hub &Spoke, PPP, In house Service Delivery : Expanded range of 12 services; IEC and BCC activities Outreach Services and Community Processes : UHND and special outreach, ASHA and MAS IT Facilities : Computer/Internet facility/Tablets/Smart phones Wellness Activity : Yoga and any other wellness activities Equipments : EDL/Indenting Mechanism/Essential
Community level ASHA Status : Sanctioned vs In position Training Screened for NCD Activities (CBAC form filling, nutrition counseling etc ) Incentives Community (Urban areas): Citizens perspective Interactions with community (Family folders, home visit by ASHA etc) ULBs/Ward Members Yoga & Wellness activities Mahila Arogya Samiti (MAS) Status: Constitution Training Screened for NCD Monthly review meetings Mechanism for fund flow & utilisation ANM : Responsibilities Tablets available Training Screened for NCD CBAC form filling, nutrition counseling Outreach
States for 13thCRM Sl No State No of Cities covered under NUHM 1. 2. 3. 4. 5. 6. 7. 8. 9. Andhra Pradesh Bihar Chhattisgarh Delhi Gujarat Jharkhand Madhya Pradesh Manipur Meghalaya 74 25 19 1 68 22 66 3 4
States for 13thCRM Sl No State No of Cities covered under NUHM 10. Mizoram 2 Nagaland 5 11. 12. Odisha 36 13. Rajasthan 61 14. Tamilnadu 87 15. Uttar Pradesh 131 16. Uttrakhand 9
