Indian Health Ministry has proposed a new National Urban Health Mission (NUHM) on the lines of the NRHM in order to focus on the health challenges in towns and cities.
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. NUHM seeks to improve the health status particularly of slum dwellers and other disadvantaged sections by ensuring equitable access to quality health care through a revamped public health system.
The National Family Health Survey-3 revealed that under-five mortality rate was 73 for every 1000 live births among the urban poor as against 48 among other city residents. Another estimate showed that one in 10 children born in the slums did not see their fifth birthday while less than half were immunised. Of the 2.25 million annual births among urban poor, more than 50 per cent were home based. Nutrition levels of urban poor children are also alarmingly low with 54 percent under five children estimated stunted and 47 per cent underweight. About two-thirds of the urban poor households have no toilets and 40 per cent lack water supply.
NUHM will be launched with focus on slums and other urban poor. At the State level, besides the State Health Mission and State Health Society and Directorate, there would be a State Urban Health Programme Committee.
At the district level, similarly there would be a District Urban Health Committee and at the city level, a Health and Sanitation Planning Committee.
At the ward slum level, there will be a Slum Cluster Health and Water and Sanitation Committee.
For promoting public health and cleanliness in urban slums, the Eleventh Five Year Plan will also encompass experiences of civil society organizations (CSO) working in urban slum clusters. It will seek to build a bridge of NGO–GO partnership and develop community level monitoring of resources and their rightful use. NUHM would ensure the following:
• Resources for addressing the health problems in urban areas, especially among urban poor.
• Need based city specific urban health care system to meet the diverse health needs of the urban poor and other vulnerable sections.
• Partnership with community for a more proactive involvement in planning, implementation, and monitoring of health activities. • Institutional mechanism and management systems to meet the health-related challenges of a rapidly growing urban population.
• Framework for partnerships with NGOs, charitable hospitals, and other stakeholders.
• Two-tier system of risk pooling: (i) women’s Mahila Arogya Samiti to fulfil urgent hard-cash needs for treatments; (ii) a Health Insurance Scheme for enabling urban poor to meet medical treatment needs.
NUHM would cover all cities with a population of more than 100000. It would cover slum dwellers; other marginalized urban dwellers like rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street children, construction site workers, who may be in slums or on sites.
The existing Urban Health Posts and Urban Family Welfare Centres would continue under NUHM. They will be marked on a map and classified as the Urban Health Centres on the basis of their current population coverage. All the existing human resources will then be suitably reorganized and rationalized. These centres will also be considered for upgradation.
Inter-sectoral coordination mechanism and convergence will be planned between the Jawaharlal Nehru National Urban Renewal Mission (JNNURM) and the NUHM.
The main features of the Mission include city-specific planning based on the spatial mapping of slums and slum-like habitations to cover urban poor and use of the available resources and partnering with private providers to fill public health delivery gaps.
The Mission envisages USHAs and Mahila Arogya Samitis to improve access of urban poor to public and private health services. Although proposed for launch in the 11th Plan period, the NUHM remained delayed on account of bureaucratic hassles. The Mission would help improve the health indicators of urban poor.