Implementation of National Urban

Health Mission (NUHM)

Joint Secretary (Urban Health)

Ministry of Health & Family Welfare
Government of India
13.5.2019
 About NUHM
• National Urban Health Mission (NUHM) was approved on 1st May,
2013 as a sub-mission of National Health Mission (NHM)
• Aims to establish and strengthen primary healthcare delivery in urban
areas with focus on slums and vulnerable population.
• Cover cities/ towns with population above 50,000 & District Head
Quarters above 30,000 population
• De-congesting secondary/tertiary care facilities (DH/SDH/CHC) –
Robust Comprehensive Primary Health Care services in urban areas
• So far , more than 1000 cities/ towns covered under NUHM
• HWC/ U-PHCs - Fulcrum of Preventive, Promotive and Curative
services in cities closer to the communities

• 1591 HWCs made operationalized against 3299 U-PHCs approved

Poor Maternal and Child health Indicators among Urban poor
(NFHS-III)

Under 5 Mortality is 72.7 among urban poor significantly higher

than the urban average of 51.9
56% deliveries among the urban poor take place at home
Several health indicators among urban poor are worse than rural
areas:
60% urban poor children do not receive complete immunization
compared to 58% in rural areas
47.1 % urban poor children <3 are under-weight as compared to
45% of rural children
59% of woman (15-49 age group) are anemic as compared to
57% in rural
 Key NFHS-4 Facts (Urban)- India

 Institutional delivery in Public  Anaemia in 15-49 age gp-45.7%

Health Facility-46.2.1%
 Children between 6-59
 JSY benefits to mothers-21.4% months anaemic-55.9%
 Full Immunisation Coverage-
63.9%
 Breastfed within one hour of
birth-42.8%
 NFHS-4 Indicators
Indicators Urban Rural Total
Infant and Child Mortality Rates (Per 1,000 Live Births)
Infant Mortality Rate (IMR) 29 46 41
Under-Five Mortality rate (U5MR) 34 56 50

Delivery care (For births in the 5 Years before the survey)

Institutional births (%) 88.7 75.1 78.9
Institutional Births in Public facility (%) 46.2 54.4 52.1
Child Immunization
Children age 12-23 months fully 63.9 61.3 62.0
immunized (BCG, measles and 3 doses
each of polio and DPT (%)
 NFHS-4 Indicators

Indicators Urban Rural Total

Child Feeding Practices and Nutritional Status of Children
Children under age 3 years breastfed 42.8 41.1 41.6
within one hour of birth (%)

Anaemia among Children and Adults

Pregnant Women age 15-49 years who 45.7 52.1 50.3
are anaemic (<11.0g/dl) (%)

All women age 15-49 years who are 50.8 54.2 53.0
anaemic (%)
 Key urban health indicators (NSSO – 71st round)

Indicators
Urban Rural
% of hospitalized cases using public facility
32 42
% of non-hospitalized cases using public facility
20 25
Non-hospitalized expenditure (Rs.)
OOPE per non-hospitalized ailing person (Rs.) – 9620 9840
PUBLIC
OOPE per non-hospitalized ailing person (Rs.) –
PRIVATE 18919 15804
 Core Strategies- NUHM

Creation of new facilities

Rationalization and strengthening existing urban primary health structures

Deployment of MOs, Paramedical Staff at U-PHCs / U-CHCs, Engagement of ANMs

Selection of ASHAs and Formation of MAS

Involvement of ULBs in planning, implementation and monitoring of the program

Convergence with all National Health Programs and other Ministries

Capacity building of ULBs/ Medical and Paramedical staff/ASHA, MAS

Use of ICT For better service delivery, improved surveillance and monitoring

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 NUHM: Service Delivery Mechanism

Outreach Mahila
Urban-CHC Urban-PHC
Sessions Arogya Samiti
• For every • For slum • For every 50
• 30-50 50,000 and – 100
bedded in urban vulnerable households
cities population population, in slums and
2.5lakh • Comprehen routine among
population sive primary UHNDs and vulnerable
• 100 bedded healthcare special communitie
for more service outreach s
than sessions • BCC &
500,000 Health
population Promotion
in metros
 Implementation of NUHM

For six mega cities,

namely Mumbai,
Kolkata, Chennai,
Bengaluru, Hyderabad
and Ahmedabad,
implementation is
through respective Urban
Local Bodies (ULBs), For the remaining cities,
health department is
the Primary
implementation Agency
for NUHM
1067 Cities covered under NUHM
9 big States covering
70% cities of total
cities approved

d
rkhan
Jha -22
 Expected Outcomes of NUHM

 Providing comprehensive quality health care to the urban poor and

vulnerable through UPHCs/UCHCs
 Special focus on health issues in urban areas- NCDs, Mental health,
substance abuse etc.
 Outreach through UHNDs and special outreach sessions to address
specific community health needs
 Mapping of urban vulnerable population- in catchment area of
U-PHC
 Provision of services under all National Health Programmes at the
UPHC level
 Address social determinants of health through intersectoral
convergence.
 Physical Progress under NUHM-
India- as per QPR (ending December, 2018)
 1. Year wise Progress of HR/U-PHC/ASHA/MAS
100% 95%
91%
90% 88%
80% 82%
80% 75%
72%
70% 66% 66%
60%
60% 55%
52%
50%
0.41
40%

30%
0.24 0.22
20%

10%

0% HR U-PHC ASHA MAS

* Information not available for U-PHCs for year 2014-15

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 2. Human Resource

Clinical& Program
Total Staff Paramedical management
staff staff

Approved- Approved- Approved-

37597 36182 1415

In-position- In-position-
In-position-
28008(75% 26829
1179 (83%)
) (74%)
 3. Operationalization of U-PHCs/U-CHCs

4578/4831 (95%) U-PHCs 134/170 (90%) U-CHCs made

made functional functional
4. Health &Wellness Centres- urban areas

So, far 1591 HWCs have been made operationalized

 5. Community Process

ASHAs engaged
62005/70493
(88%)

MAS formed RKS formed

79692/96854 2998/4578
(82%) (66%)
 6. Service Delivery Trend - HMIS

Chart Title Total children (9 to 11 months) Fully

Total ANC Registration
Immunised

44 Lakh 46 Lakh 35 Lakh 33 Lakh

35 Lakh 26 Lakh 27 Lakh
31 Lakh
21 Lakh 17 Lakh

2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

54% increase in OPD from FY 2014-15 to 2018-19 48% increase in OPD from FY 2014-15 to 2018-19

Data as reported by Urban Health Facilities (Public,Physical,Active) on HMIS portal. Comparison of FY 2016-17 & 2017-
18 Data as on 24-08-2018
 OPDChart
attendance
Title

33 cr
27.26 cr
24 cr
19.12 cr
11.19 cr

2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

66% increase in OPD from FY 2014-15 to 2018-19

Data as reported by Urban Health Facilities (Public,Physical,Active) on HMIS portal. Comparison of FY 2016-17 & 2017-
18 Data as on 11.5.2019
Financial Progress under NUHM- India
 Financial Progress of NUHM in India since inception
(2013-14 to 2018-19

Overall utilization is 72% against available

funds

5085
4764

2260

Total Releases Proportionate State Share Total Expenditure

Releases are updated till date and Expenditure is updated upto 31.03.2019(provisional)
 % of Utilization of Funds under NUHM since inception
(India)

72%
66%

51%

31%

17%

1%
2013-14 2014-15 2015-16 2016-17 2017-18 2018-19

Expenditure from 2013-14 to 2017-18 is based on audit reports and for FY 2018-19 on FMR (Provisional)
 Priority Areas
I. Key Activities

• Capacity Development/training of service delivery and program management

staff on
- NUHM orientation
- HWC training
- Training under all National Health Programmes
• Strengthening of U-PHCs as Health and Wellness Centres (HWCs) in urban
areas
• Enhanced fixed day Specialist services at U-PHC/HWC for dental, eye, skin,
mental health care etc.
• Quality certification of health facilities
• Extension of Kakayalp and SSS in urban areas
• Utilizing MAS present in Slum areas for health promotion / awareness
/follow-up/ vector control/ NCD/TB cases etc.
• Population based screening for hypertension, diabetes and cancers (oral,
breast and cervix)
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 Continued….
• Immunisation activities in urban area- Identify gaps and recommend
actions etc.
• Integration of RNTCP activities in urban areas with Designated
Microscopy Centers (DMCs) established at UPHCs and made operational
as Treatment Centres of RNTCP
• Provision of sanitary napkins, awareness on menstrual hygiene and safe
disposal of sanitary napkins in urban areas
• Integration of all National Health programs like RCH – Immunization,
NCDs, NVBDCP etc. with NUHM at all facilities in urban areas
• Leveraging Medical colleges to strengthen & support NUHM
implementation.
• Improving coordination mechanisms between State Departments and
Urban Local Bodies (ULBs)
• Regular and quality data reporting of health facilities on HMIS portal-

25
 II. Strengthening Financial Management systems

• Bank Accounts of all the UPHCs to be opened

• Registration and transfer of funds under NUHM through PFMS
including ULBs
• e-transfer of Funds to the UPHCs/UCHCs- untied grants, other
expenses
• The formation and registration of RKS for all the UPHCs
 Recent Publications
Guidelines, Manuals and Frameworks developed on various topics-
1) Vulnerability Mapping 2) Records &Registers for U-PHCs
3) Capacity building framework 4)Extension of kayakalp in urban areas
5)Orientation Training Module 6)Module RFP and SLA to operate U-PHC
7)ANM Handbook 8)Quality standards for U-PHCs
9)NUHM Brand module 10)Outreach session in urban areas
11)NUHM Financial Management guideline
Brochures on Thematic areas-
1) Thrust areas under NUHM 5) Human Resource under NUHM
2) Community Process 6) Collaboration with Medical
3) Quality Assurance Colleges
4) IEC/BCC 7) Inter Sectoral Convergence
under NUHM
Manual/Guidelines developed under NUHM
7 Brochures developed