Hathras City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

Page | 2

City Heath Action Plan (2013-14)

National Urban Health Mission

District - HATHRAS

Dr. R.P. Singh Surya Pal Gangwar (IAS) Chief Medical officer District Magistrate Hathras Hathras

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TABLE OF CONTENT

Approval of DHS 3

Acknowledgement 4

Acronyms 5

City Profile 6-17

Health Scenario 18

Key Issues 18-19

Strategies, Activities & Work plan under NUHM 19-25

Programme Management Arrangements 26-27

City level targets & indicators 28-29

District Health Society Hathras (Uttar Pradesh)

To, Mission Director National Health Mission 19-A, Vishal Complex, Vidhan Sabha Marg Lucknow (Uttar Pradesh)

Subject:- Submission of City Health Action Plan (under NUHM) for the F.Y. 2013-14.

Respected Sir,

This is to certify that City Health Action Plan for National Urban Health Mission activities proposed in F.Y. 2013-14 prepared by the District Health Authorities with Active involvement of all stakeholders has integrated the health and health facilities improvement

need of the Hathras City.

The NUHM planning for this financial year based on the data, surveys and available information at city level and hoping that we will initiate the process very systemat-ically so that we can make the difference in improvement of quality life of urban people specially by reaching the unreached areas.

The plan was discussed in the District Health Society, suggestions were incorpo-

rated and approved.

Date :-................... Surya Pal Gangwar (I.A.S.)

District Magistrate / Chairman

Hathras

It is our pleasure to present the City Health Action Plan for HATHRAS city for the

year 2013-14. The City Health Action Plan seeks to set goals and objectives for the district

health system and delineate implementing processes in the present context of gaps and op-

portunities for the Hathras district health team.

National Urban Health Mission aims to improve the health status of urban population

in general and the poor and other disadvantaged sections in particular. This would be made

possible by facilitating equitable access to quality health care through a revamped primary

public health care system, targeted outreach services and involvement of the community and

urban local bodies. Under the scheme, the government proposes to strengthen and enhance

the health care service delivery in urban areas with targeted focus on urban poor and the

disadvantaged.

The health indicators of Hathras are way behind in so many aspects and the launch of

National Urban Health Mission, the efforts for improving the health parameters will

complement towards betterment of urban population and in particular to the urban poor &

slum dwellers.

We are very glad to share that City Health Action Plan is combined & dedicated efforts

of the team of health professionals, representatives of other development partners and oth-

er NGOs of Hathras. we are also thankful to other developmental heads like ICDS, DUDA, Na-

gar Palika Parishad, & Education for providing us the valuable data & suggestions which were

critical for the document.

The critical efforts of District PMU team are worth mentioning. Without their con-

sistent & regrious efforts collection & compilation of data would not have been possible. We

also would like to thank the Divisional PMU & SPMU officials for providing vital inputs and

support to fill up the relevant annexure, physical & financial sheet along with the entire

preparation of City Health Action Plan development

. We are sure that the plan will set a definite direction and give us an impact to embark

on our mission.

Dr. Ram Pratap Singh Surya Pal Gangwar (IAS) Chief Medical Officer District Magistrate

Hathras Hathras

ACKNOWLEDGEMENT

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Acronyms

ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

AWC Aanganwari Center

AWW Aanganwari Worker

BSGY Bal Swasthya Guarantee Yojna

BSUP Basic services for urban poor

BSA Basic Shiksha Adhikari

CDPO Child Development Project Officer

DH District Hospital

DHS District Health Society

DUDA District Urban Development Authority

ICDS Integrated Child Development Scheme

IDSMT

Integrated Development of Small & Medium Towns

IDSP Integrated Diseases Surveillance Program

IHL Individual House level

IMR Infant Mortality Rate

KFA Key Focus Area

LHV Lady Health Visitor

LT Lab Technician

MAS Mahila Arogya Samiti

MMR Maternal Mortality Ratio

NHM National Health Mission

NPP Nagar Palika Parishad

NPSP National Polio Surveillance Program

NRHM National Rural Health Mission

NUHM National Urban Health Mission

OD Open Drainage

RSAP Remote Sensing Application Center

UA Urban Agglomeration

UCHC Urban Community Health Center

UFWC Urban Family Welfare Center

UHI Urban Health Initiative

UHP Urban Health Post

UPHC Urban Primary Health Center

SAM Severely acute Malnourishment

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National Urban Health Mission- Programme Implementation Plan

Hathras 2013-14

1. Hathras Profile

Hathras is a city and a municipal board in Hathras district (formerly Mahamaya Nagar

district) in the Indian state of Uttar Pradesh. It is the headquarters of the district that

was created on 3 May 1997 by incorporating parts of Aligarh, Mathura and Agra dis-

tricts. It forms a part of Aligarh Division. Mahamaya Nagar district was recently re-

named Hathras. Hathras lies within the Braj region in Central or Middle Doab, associ-

ated with the epic Mahabharata and Hindu theology. The principal spoken language is

Hindi. Its dialect Braj Bhasha which is closely related to Khariboli is spoken in this re-

gion. Hathras fall under the Brij region of Northern India and was famous for its Indus-

trial, Literature related, and cultural activities as a part of Aligarh .Historically and ac-

cording to Purans Hathras can be of the age of Mahabharata. Because old folk tales

and archaeological remains prove it. The Freedom struggle started by Raja Dayaram

continued untill India became free in which many people of Hathras participated. On

October 19, 1875, the train between Hathras Road and Mathura Cantonment was

started. Malla vidya (the art of wrestling) is an old hobby of people of Hathras who’s

remains can still be seen today in the form of “Bagichis”(small Gardens) and “Akha-

ras”(the place where people use to exercise and practice wrestling etc.).In the memory

of Swami Vivekanand’s first arrival at Hathras a Shilalekh was established at Hathras

city Railway Station, which reveals that Swami Vivekanand has given the name

Sadanand to his first disciple who was the station master of Hathras city Railway sta-

tion . Kanya Gurukul at Sasni played a great role in spreading the reputation of this dis-

trict. Many girls of different states obtain their graduate and postgraduate education

dependent on Indian culture. Similarly newly established Mangalaytan is developing as

a world famous Jain pilgrimage .This pilgrimage is situated on Hathras – Aligarh road in

the Sasni tehsil of this district.

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Table.1: Hathras District and Hathras City in Census 20111

Description Hathras District

2011

Hathras City

2011

Actual Population 1564708 137509

Male 836127 73376

Female 728581 64133

Population Decadal Growth

rate

17.12%

Density/km2 850

Sex Ratio (Per 1000) 871 874

Child Sex Ratio (0-6 Age) 865 834

Average Literacy (%) 71.59 79.06

Male Literacy (%) 82.38 83.88

Female Literacy (%) 59.23 73.58

1.1. Hathras City

As per provisional reports of Census India, population of Hathras in 2011 is 137,509; of which male and female

are 73,376 and 64,133 respectively. Although Hathras city has population of 137,509; its urban / metropolitan

population is 161,289 of which 86,028 are males and 75,261 are females.

In education section, total literates in Hathras city are 95,524 of which 53,918 are males while 41,606 are f e-

males. Average literacy rate of Hathras city is 79.06 percent of which male and female literacy was 83.88 and

73.58 percent.

The sex ratio of Hathras city is 874 per 1000 males. Child sex ratio of girls is 834 per 1000 boys.

Total children (0-6) in Hathras city are 16,686 as per figure from Census India report on 2011. There were

9,096 boys while 7,590 are girls. The child forms 12.13 % of total population of Hathras City.

1 2011 census (P)

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Table 2: Demographic profile of Hathras City

Total Population of city (in lakhs) 143020 Source: Census 2011

Slum Population (in lakhs) 61000 Source: DUDA

Slum Population as percentage of urban popula-

tion 44.36%

Number of Notified Slums Nil Source: DUDA

Number of slums not notified 34 Source: DUDA

No. of Slum Households 12200 Source: DUDA

No. of slums covered under slum improvement

programme (BSUP, IDSMT,etc.) NIl

Number of slums where households have individ-

ual water connections* NA

Number of slums connected to sewerage net-

work* NA

Number of slums having a Primary school

11 Source: BSA Deptt.

No. of slums having AWC 34 Source: ICDS Hathras

No. of slums having primary health care facility 34

Table 3: Population, Literacy Rate & Sex Ratio – Hathras City2

Description Total Male Female

Population 137509 73,376 64,133

Literates 95,524 53,918 41,606

Children (0-6) 16,686 9,096 7,590

Effective Literacy Rate

(7+Population) %

79.06 83.88 73.58

Sex ratio 874

Child Sex ratio 834

2 Census of India, 2011

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1.4 Urban Poor & Slums3

The UP Slum Areas (Improvement and Clearance) Act, 1962, considers an area a slum if the majority of build-

ings in the area are dilapidated, are over-crowded, have faulty arrangement of buildings or streets, narrow

streets, lack ventilation, light or sanitation facilities, and are detrimental to safety, health or morals o f the in-

habitants in that area, or otherwise in any respect unfit for human habitation. It mentions factors such as re-

pairs, stability, extent of dampness, availability of natural light and air, water supply; arrangement of drainage

and sanitation facilities as considerations. Based on the definition, estimates of slum population vary, so much

so that the Census 2001 originally did not report any slums and then later revised its findings. DUDA follows

the definition as stated in the UP Slum Areas (Improvement & Clearance) Act 1962; SUDA/UNCHS do not fol-

low this definition but define poverty in terms of vulnerability as does Oxfam.

DUDA’s estimation of slum population is a conservative increase over the Census estimation. However, An au-

thorized slum is one where there is security of tenure with the cluster being either an outcome of a govern-

ment resettlement programme or being located on private/own land. Unauthorized settlements are those

that have emerged on available vacant plots, mainly railway land or on encroached areas. Slum clusters on the

riverbanks or on drains are classified as unauthorized.

3 State of Urban Health in Uttar Pradesh, 2006

S. No. Name of Slums Population

1 Odhpura 1924

2 Nagala Tandula 1386

3 Khoda Hajari 2333

4 Iglas Adda Nai basti 2000

5 Sri nagar 2500

6 madhu Garhi 753

7 Kailash Nagar 244

8 Ramanpur 859

9 Garhi Khandari 3409

10 Naya Nagla Siddharth Nagar 1023

11 Moh. Kharni, Moh. Santoshi 477

12 Moh. Karr 750

13 Ganeshganj, Atal tal 826

14 Bhoorapeer, Baghmoola 1189

15 Nagala Belan Sah 3008

16 Kila Gate 189

17 Nagala Arkenia 545

18 Kila Khai 394

19 Moh. Shiyal 1273

20 Moh. Shiyal Kheda 1068

21 Moh. Chamad Gate 164

22 Moh. Ayea pur Khurd 314

23 Moh. Kanchan Nagar 492

24 Nagla Bhoja 1341

25 Nagala Tika 806

26 Nagala Minya 944

27 Aiyyapur Kalan 5550

28 Nabipur Khurd 2848

29 Moh. Maiyan 655

30 Navipur kalan 3839

31 Moh. Sadabad Gate 594

32 Moh. Nai ka Nagala 7432

33 Lala Ka nagla 6735

34 Bala patti 3139

The rapidly growing urban population poses great challenge to the efforts of the state government

towards improving the health of the urban poor.

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1.5 Urban Governance4

There are multiple agencies responsible for urban governance and provision and management of infrastru c-

ture and services. While, ICDS, DUDA, Nagar Palika Parishad Hathras and UP Jal Nigam (UPJN) are the key ur-

ban service providers, other agencies include the Housing Board, Central and State Public Works Departments

(CPWD and PWD), Transport Department, Industries Department and the Department of Environment. There

is significant overlap of roles and responsibilities and fragmentation in service provision and management of

infrastructure, which makes it difficult to hold institutions accountable and to coordinate.

Table 6: Urban Governance and Service delivery institutions

City Level

Nagar Palika Parishad,

Hathras

Local level governance; Primary Collection of Solid Waste; Maintenance of

Storm Water Drains; Maintenance of municipal roads; Allotment of Trade Li-

censes under the Prevention of Food Adulteration Act; O&M of internal se w-

ers and community toilets; Street lighting; O&M of water supply and sewerage

assets; Collection of water tariff

District Urban Development

Authority (DUDA)

Implementing agency for plans prepared by SUDA.

Responsible for the field work relating to community development – focusing

on the development of slum communities, construction of community toilets,

assistance in construction of individual household latrines, awareness genera-

tion etc.

State Level

UP Jal Nigam (UPJN)

Water supply and sewerage including design of water supply and sewerage

networks. In the last two decades ‘pollution control of rivers’ has become one

of their primary focus areas

State Urban Development

Authority (SUDA)

Apex policy-making and monitoring agency for the urban areas of the state.

Responsible for providing overall guidance to the District Urban Development

Authority (DUDA) for implementation of community development pro-

grammes

UP Awas Vikas Parishad

(UPAVP)

Nodal agency for housing in the state. Involved in planning, designing, con-

struction and development of almost all types of urban development projects

in the state. Autonomous body generating its own resources through loans

from financial institutions

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UP State Transport Corpora-

tion (UPSTC)

Provides intra-city and state wide public transport; maintenance of buses, bus

stands

Public Works Department

(PWD)

Construction of main roads and transport infrastructure including construction

and maintenance of Government houses and Institutions

State Tourism Department

(STC)

Promotion of tourism

Archaeological Survey of In-

dia (ASI)

Maintenance of heritage areas and monuments

UP Pollution Control Board

(UPPCB)

Pollution control and monitoring especially river water quality and regulating

industries

Town and Country Planning

Department (TCPD)

Preparation of Town Plans including infrastructure for the state (rural and ur-

ban)

Office of District Magistrate

Hathras

Coordination of activities of various institutions

1.6 Access to Public Facilities5

Infrastructure development has not been commensurate with the growth of the city and there are problems

confronting the city in terms of access and coverage in key infrastructure sectors – water supply, sewerage,

housing, drainage, and transport. Overall service levels are inadequate and the situation is worse for the urban

poor.

S.No

.

Name of

Urban

Slums

Slums

Popula-

tion

Water Supply Sanitation Toilets Waste Water Disposal

Sources

of water

in the

slums

Source

use for

drink-

ing

(Y/N)

No. of

house

holds

depend-

ent

Quali-ty Rat-

ing

Individu-al Toilets

Shared Toi-lets

Communi-ty Toilets

With

Sewer-

age net-

work

With

open

drai

n

Wit

h

soak

pit

With

sep-

tic

tank

1 2 4 5 6 7 8 9 10 11 12 13 14 15

1 Odhpura 1924

nagar Pali-ka supply, India Mar-ka 2 hand pump &

submersi-ble

Yes 385

Yes Yes Yes - Yes - Yes

2 Nagala Tandula 1386

Same as above

Yes 277

Yes Yes Yes

- Yes - Yes

3 Khoda Hajari 2333

Same as above

Yes 467 Yes Yes

Yes - Yes - Yes

4 Iglas Adda Nai basti 2000

Same as above

Yes 400 Yes Yes

Yes - Yes - Yes

5 Sri nagar 2500

Same as above

Yes 500 Yes Yes

Yes - Yes - Yes

6 madhu Garhi 753

Same as above

Yes 151 Yes Yes

Yes - Yes - Yes

7 Kailash Na-gar 244

Same as above

Yes 49 Yes Yes

Yes - Yes - Yes

8 Ramanpur 859

Same as above

Yes 172 Yes Yes

Yes - Yes - Yes

9 Garhi Khandari 3409

Same as above

Yes 682 Yes Yes

Yes - Yes - Yes

10 Naya Nagla Siddharth Nagar 1023

Same as above

Yes 205 Yes Yes

Yes - Yes - Yes

11

Moh. Khar-

ni, Moh. Santoshi 477

Same as above

Yes 95 Yes Yes

Yes - Yes - Yes

Page | 15

12 Moh. Karr 750

Same as above

Yes 150 Yes Yes

Yes - Yes - Yes

13

Ganesh-

ganj, Atal tal 826

Same as above

Yes 165 Yes Yes

Yes - Yes - Yes

14 Bhoo-rapeer,

Baghmoola 1189

Same as above

Yes 238 Yes Yes

Yes - Yes - Yes

15 Nagala Belan Sah 3008

Same as above

Yes 602 Yes Yes

Yes - Yes - Yes

16 Kila Gate 189

Same as above

Yes 38 Yes Yes

Yes - Yes - Yes

17 Nagala Arkenia 545

Same as above

Yes 109 Yes Yes

Yes - Yes - Yes

18 Kila Khai 394

Same as above

Yes 79 Yes Yes

Yes - Yes - Yes

19 Moh. Shiyal 1273

Same as above

Yes 255 Yes Yes

Yes - Yes - Yes

20 Moh. Shiyal

Kheda 1068

Same as above

Yes 214 Yes Yes

Yes - Yes - Yes

21

Moh.

Chamad Gate 164

Same as above

Yes 33 Yes Yes

Yes - Yes - Yes

22 Moh. Ayea

pur Khurd 314

Same as above

Yes 63 Yes Yes

Yes - Yes - Yes

23 Moh. Kan-chan Nagar

492

Same as above

Yes 98 Yes Yes

Yes - Yes - Yes

24 Nagla Bhoja 1341

Same as above

Yes 268 Yes Yes

Yes - Yes - Yes

25 Nagala Tika 806

Same as above

Yes 161

Yes Yes Yes

- Yes - Yes

26 Nagala Minya 944

Same as above

Yes 189 Yes Yes

Yes - Yes - Yes

27 Aiyyapur Kalan 5550

Same as above

Yes 1110 Yes Yes

Yes - Yes - Yes

28 Nabipur Khurd 2848

Same as above

Yes 570 Yes Yes

Yes - Yes - Yes

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29 Moh. Mai-yan 655

Same as above

Yes 131 Yes Yes

Yes - Yes - Yes

30 Navipur kalan 3839

Same as above

Yes 768 Yes Yes

Yes - Yes - Yes

31 Moh. Sa-dabad Gate 594

Same as above

Yes 119 Yes Yes

Yes - Yes - Yes

32 Moh. Nai ka Nagala 7432

Same as above

Yes 1486 Yes Yes

Yes - Yes - Yes

33 Lala Ka nagla 6735

Same as above

Yes 1347 Yes Yes

Yes - Yes - Yes

34 Bala patti 3139

Same as above

Yes 628 Yes Yes

Yes - Yes - Yes

1.7 Health Infrastructure

Government Facilities: Unlike in the rural areas, where the health department has a wide network of

primary health care facilities providing reproductive and child health services, the urban slums lack

basic health infrastructure and outreach services. Thus, they are often bypassed even by national

programmes providing immunization, safe motherhood and family planning services. The sparse

health coverage provided by health facilities like- District Level Hospitals, MD TB Hospital, urban

Health Post and maternity homes in cities is used more for emergencies and curative services. Often

these facilities are far from their service area, poorly staffed, with inadequate space and supply of

medicines and equipment. Urban local bodies like municipal corporations and nagar panchayats are

also expected to provide health care, but resource scarcity restricts them to only providing sanitation

services. NGOs and private trusts are also few and far between.

Table 8: Government Health Facilities in Hathras

Sl. No.

Name & type of facility (DH, Maternity Home, CHC, other ref. hospital UFWC, UHP PHC,Dispensary etc.)

Managing Au-thority (Munici-pal Council, State Health Department, facilities func-tioning on PPP basis)

Location of Health facility

Popula-tion covered by the facility

Services pro-vided

Human Re-sources availa-ble – list type

and number of HR available i.e. ANM, LT,

SN, MOs, Spe-cialists etc.

No. and type of

equipment available: X-ray ma-

chine, USG, autoclave

etc.

1. District Male Hospital

State Health De-

partment

Hathras City

1564708 Emegency & General sur-gery etc.

List Annexed X-ray ma-chine, USG

2. District Fe-male Hospital

State Health De-

partment

Hathras City

728581 Deliv-ery,ANC, PNC,Immunization,FP,MTP Etc.

List Annexed X-ray ma-chine, USG

3 MDTB Hospital State Health De-

partment

Hathras City

_ Overall Traetmet of TB patient

List Annexed X-ray ma-chine,

4 Urban Health Post

NRHM Hathras City

143020 Immuniza-tion, Deliv-ery,ANC, PNC, Etc.

List Annexed _

The data given in the table above reveals inadequacy of primary health care services. The first tier health facil i-

ties were planned for a population of 50000 but as a result of rapid population growth they are currently serv-

ing a population much more than that. The situation gets compounded due to lack of adequate infrastructure,

equipments and medicines. The staff mainly Doctors and ANM is also inadequate. The high population- staff

Page | 18

ratio results in poor service coverage with some areas being entirely unserved. From the above assessment it

becomes evident to consider the poor health indicators for deciding the norms of staff population ratio. Uttar

Pradesh has eight medical colleges and one post-graduate institute which offer tertiary and super-specialty

health services.

Private Health Facilities:

Private Facilities: Table 9: Private health facilities in Hathras:

S.No. Name of City / Nagra Palika

Name of heath facility with address

1. Hathras Suchitra Hospital Jalesar Road, hathras

2. Hathras Saraswati Hosapital & Research center, Beniganj

3. Hathras Vashneya Nursing Home, Near Ram Darwar Temple, Talab x-ing, Hathras

4. Hathras Agra Hospital, Near Bus Stand, Hathras

5. Hathras Gavar Hospital & research Center, PO Lane Hathras

6. Hathras Sri ram Hospital, Aligarh Road Hathras

7. Hathras Bansal Surgical & Maternity Home opp. Chintaharan Mandir, Hathras

8. Hathras Jha Nursing Home Madhu garhi, hathras

9. Hathras Krishna Nurshing Home opp. Chinta Haran mandir, hathras 10. Hathras Prem raghu Hospital & Maternity Home Gijrauli, Hathras

11. Hathras Gulati Nursing Home, PO Lane hathras

12. Hathras Sujata Hospital, Mathura Road, madhu garhi, hathras

13. Hathras Aman Children Hosital, Purana Mill compound, hathras

14. Hathras Khetan Netra Chikitsalaya, City station road, hathras

15. Hathras Sahni Nursing home Kila gate hathras

16. Hathras Shanti Nursing Home , palika bazar hathras

17. Hathras RDGD, Lifecare Hospital, Purana Mill Compound, hathras

24 Hathras Deep hospital, Mathura Road, Madhugarhi, hathras

First and Second Tier Health Services

The Government of Uttar Pradesh has committed itself to make provisions for health care services to its pop u-

lation. Though the efforts have been rural centric some efforts have also been made to i mprove the delivery

of primary health care services to the population living in urban areas. It has established D Type health centers

and dispensaries for providing family welfare services and OPD facilities. The Urban Local bodies and Depart-

ment of Health and Family Welfare are the two main stakeholders for managing these services. In urban areas

of UP, first tier health services are available through D-type health centers, the family welfare centre, health

post and PP centers6. Second tier health services are provided in urban areas through District Male and Female

or Combined Hospitals.

6 Ministry of Health and Family Welf are. 2005 Annual Report 2003-04. New Delhi : MoHFW.

Page | 19

2 .Health Scenario

Table 10: Disease/Cause of Morbidity Data : Hathras

Sl. Name of Disease/ Cause of Morbidity (e.g. COPD, Trau-

ma, Cardiovascular Disease etc.)

Number of cases admit-

ted in 2012 Source of Data

1 Injuries and Trauma Not Available IDSP

2 Self inflicted injuries/suicide Not Available

3 Cardiovascular Disease 174 IDSP

4 Cancer (Breast cancer) Not Available

5 Cancer (cervical cancer) Not Available

6 Cancer (other types) Not Available

7 Mental health and depression 0 IDSP

8 Chronic Obstructive Pulmonary Disease (COPD) 722 IDSP

9 Malaria 236 IDSP

10 Dengue Not Available

11 Infectious fever (like H1N1, avian influenza, etc.) Not Available

12 TB

13 MDR TB Not Available

14 Diarrhea and gastroenteritis 2611 IDSP

15 Jaundice/Hepatitis 0 IDSP

16 Skin diseases Not Available

17 Severely Acute Malnourishment (SAM) Not Available

18 Iron deficiency disorder Not Available

19 Others Not Available

(Source: IDSP, TB & District Hospital)

The above table reflects the health/ morbidity profile of the Hathras city. As there are three sources of data,

the city planning team has approached all three sources for getting most authenticated as well as updated

data. So, data from IDSP, TB clinic and District hospital were taken and mentioned in the above table.

3. Key Issues

The Eleventh Plan had suggested Governance reforms in public health system, such as Performance linked i n-

centives and Devolution of powers and functions to local health care institutions and making them responsible

for the health of the people living in a defined geographical area. NRHM’s strategy of decentralization, PRI i n-

volvement, integration of vertical programmes, inter-sectoral convergence and Health Systems Strengthening

has been partially achieved. Despite efforts, lack of capacity and inadequate flexibility in programmes forestall

effective local level Planning and execution based on local disease priorities.

Page | 20

In order to ensure that plans and pronouncements do not remain on paper, NUHM UP would strive for system

of accountability that shall be built at all levels, reporting on service delivery and system, district health soci e-

ties reporting to state, facility managers reporting on health outcomes of those seeking care, and territorial

health managers reporting on health outcomes in their area. Accountabi lity shall be matched with authority

and delegation; the NUHM shall frame model accountability guidelines, which will suggest a framework for

accountability to the local community, requirement for documentation of unit cost of care, transparency in

operations and sharing of information with all stakeholders. The state will incorporate the core principles of

The National Health Mission of Universal Coverage, Achieving Quality Standards, Continuum of Care and De-

centralized Planning.

Following would be the issues for the cities to address: City Health Planning, Public Private Partnership, Con-

vergence, Capacity Building, Migration, Communitization, Strengthen Data, Monitoring and Supervision,

Health Insurance, Information Dissemination and Focus on NCDs/ Life-Style Diseases.

After considering the available data, city scenario and analysis, the City planning team has identified issues at

both service delivery & demand generation level. Following are the details of issues which would be addressed

through NUHM at the city level:

1) Need of community volunteers (ASHAs) for taking up the community mobilization activities

2) Need of Mahila Arogya Samiti (MAS- a group of 10-12 women) for wider spread of information/ rights

and entitlements

3) Strengthening of ANC, PNC & identification of high risk pregnancies at community level

4) Home based care of neonates at community level

5) Promotion of institutional deliveries

6) Health education for all, especially for adolescent group

7) Complete immunization of pregnant women & children

8) Needs to strengthen the existing health care facilities by recruiting human resources

9) Need assessment of community in health scenario

10) Need a better convergence with other programs and wider determinants

11) Need of training & capacity building of human resources

12) Need of Strengthened program management structure at district level

13) Need of intensive baseline survey to start the community processes and identifying local needs

14) Involvement of local bodies in decision making and managing the program locally

15) Gap analysis of HR & recruitment

16) Promotion of family planning methods through basket of choice approach & counselling.

17) Management of communicable & non- communicable diseases

18) Strengthening AYUSH

19) Constitution of BSGY team for urban areas.

20) Identification & management of SAM children

Page | 21

4. Strategies, Activities and Work plan

This section describes detailed strategies, activities and work plan of Urban areas of Hamirpur district. The key

overarching strategies under NUHM for 2013-14 include data based planning, strengthening of management

and monitoring systems at the state and district level, improving the primary health care delivery system and

community outreach through ASHAs, MAS and Urban Health and Nutrition Days(UHNDs).

The key activities at the district level will include strengthening UPHCs for provision of primary health care to

urban poor, deploying trained human resource at urban health centres, convergence with key urban stake-

holders, sensitization of ULBs on their role in urban health, , community outreach through selection, training

and support to ASHAs and MAS, conducting UHNDs and outreach camps to get services closer to the commu-

nity and reach complete coverage of slum and vulnerable populations.

With the aim to improve the health parameters of urban population in the city, structures and strategies as

recommended for the NUHM in its framework will be adopted and operationalized rapidly over the years.

4.1 Planning and Mapping exercise :

4.1.1 Listing and Mapping of Households in slums and Key Focus Areas

One of the most important component of plan will be listing and mapListing and mapping of households will

provide accurate numbers for population, their family size and composition residing in slums. Currently, esti-

mates of population residing in slums are available from District Urban Development Agency (DUDA) and N a-

tional Polio Surveillance Project as the immunization micro plans (under NPSP) provide updated estimates of

slum and vulnerable populations and are expected to be fairly complete. The current plan for covering slums is

based on the currently available data of urban population of each city.

Once the Urban ASHAs are deployed they will list all households and fill the Slum Health Index Registers (SHIR)

including the number and details of family members in each household. This data will be compiled for city and

will provide the population composition of slums and key focus areas. This will also help the urban ASHA know

her community better and build a rapport with the families that will go a long way in helping her advocate for

better health behaviours and link communities to health facil ities under the NUHM. It is expected that once

the household mapping is completed in cities, the number of Urban ASHAs will be reviewed and adjusted up-

wards or downwards and the geographical boundaries of the coverage area for each Urban ASHA would be

realigned. This is due to the reason that the actual population may be higher or lower than the original esti-

mate used for planning.

4.1.2 Facility Survey for gaps in infrastructure, HR, equipment, drugs and consumables

Facility survey will be carried out in the public facilities to assess the gaps in infrastructure, human resource,

equipment, drugs and consumables availability as against expected patient load. Further planning, particularly

for UCHCs, will be based on these gaps. This work will be outsourced to a research agency. Development Part-

ners like Health of the Urban Poor project will technically support this effort.

Page | 22

4.1.3 Baseline Survey

The state envisions monitoring progress in health indicators in urban areas and among urban poor over the

period of implementation of NUHM. This proposed Baseline survey will generate data on the health and relat-

ed indicators which will be reviewed during the course of implementation of the program to assess the i mpact

of implementation and necessary course corrections can accordingly be made and use of resources can be

optimised.

4.2 Program Management:

4.2.1 City level establishments and HR : One urban health Cell (UHC) will be established at district level with

adequate infrastructural and HR arrangements. A total of Rs 5.5 Lakhs will be required for the setup of the cell.

This cost includes basic furniture, ACs, computer peripherals, minor renovation work and laptop support to

DPMU. One Urban Health Coordinator (UHC) and one data operator will be appointed and to be based in dis-

trict headquarter. Apart from this some provisions have been made in budge for UHC to initiate the process.

Provision of an accountant has also been made in budget. Running cost for the cell has also been provisioned

in the budget

4.3 Training and Capacity Building:

Various training program will be organized for ULB, Medical and Paramedical staff, Urban ASHAs and MAS of

the city to capacitate them on the issue. One time orientation program will be organized for Municipal officials

in the beginning. 21 ANM will be trained in which 5 ANMs and 2 staff nurses will be taken from each of the

three UPHCs. For entire training package for ANM, Rs 5000 is provisioned for each of the ANMs. Likewise 6

medical officers will be given training on the expenses of Rs 10000 per medical officer . There are 60 MAS

groups in the cities. These MAS groups will be trained by the experts. To work in the 34 sums of the Hathras

city, 30 Urban ASHAs will be selected and oriented on the program and work responsibilities. The trainings

will have to be followed by periodic refresher trainings to keep these frontline health workers motivated.

NUHM will engage with development organisations to develop the training modules and facilitate the trai n-

ings

4.3.1 Stakeholders Sensitization and Orientation:

One city level workshop will organized by DPMU covering all stakeholders of government, private facilities,

NGOs and other to orient them on urban health intervention and expected support. This workshop will be o r-

ganized at district headquarter level.

4.3.2 Quarterly multi-sectoral convergence meeting:

Strong convergence with programs and departments is an important aspect of the program. Meeting with these departments and program officials will be organized at district level to facilitate and strengthen coordi-nation and convergence in urban health mission program. Such programs are RCH, RNTCP, NVBDCP, NPCB, National Mental Health Programme, National Programme for Health Care of the Elderly, etc. at the city level.

Page | 23

Similarly various Departments like Urban Development, Housing and Urban Poverty Alleviation, Women & Child Development, School Education, Minority Affairs, Labour will be called for the convergence meeting.

4.4. Strengthening of health facilities

4.4.1 Setting up Urban Primary Health Centre (U-PHC) –

During the first year of implementation of the program, the one existing urban health posts and two new will

be attempted to be strengthened. One existing UPHC is running in government building which will require

renovation. One time renovation cost of Rs 10 Lakhs has been proposed in the budget. Two new Urban PHCs

will be opened in rented premise on the rent of Rs 15000 per month.

4.4.2. Data entry operator for UPHC:

One HMIS/MCTS operator will be appointed/ deputed at UPHC level on each of the centres. All basic

infrastructures like computer, printer and table chair will be made available on each of the UPHCs. Operating

cost is also mentioned in the budget

4.4.3 Urban Health and Nutrition Day (UHND):

Health and nutrition day will be organized at every slum level every month. A provision of Rs 1500 has been

made for each of the UHND for six months.

4.4.3. Special Outreach health camps for vulnerable population:

One health camp will be organized every month in identified vulnerable communities on per 10000

population. These special outreach camps will reach to the most vulnerable communities of the slums and

provide them door step health services.

4.4.4 Provision of ANMs/LHV on contractual basis:

5 ANMS will be selected for each of the Urban PHCs. Total 15 ANMs will be selected. Salary of the ANMs will

be as per the NRHM guideline. Monthly travel support to these ANMs/LHVs will be provided as per NRHM

norms.

4.5. Medical officers, paramedical and nonclinical staffs provisioning:

Two MOICs will be deputed as MO at UPHCs to provide their expert services to slum population. Two staff

nurses, one pharmacist and one Lab Technician will also be posted at each of the PHCs. Three support staff

will be appointed to help in functioning of the Urban Primary Health Centres. Budgetary provisions for the

same have been made in budget.

4.6. IEC materials support:

4.6.1. ASHA Kit Flip Book, Slum HIR, Bag, ID, Pen-

Each of the ASHAs will be given IEC support and for this a provision of Rs 2000 per ASHA has provisioned.

Under IEC support as a package consisting of kit, flip book. Slum HIR, Bag, ID and pen will be given to every

Urban ASHAs.

4.6.2. UPHC Citizen's charter, ED List, Immunization Schedule, Signage

For one time expenses on UPHC citizens charter, ED list, Immunization schedule and signage related work, a

provision of Rs 20000 has been made in budget.

Page | 24

4.6.3. Safe Motherhood Booklet, MCP Card etc.

1500 set of safe motherhood booklet and MCP cards will be printed per UPHC area covering 50,000city slum

population.

4.6.4.Family health card, Wall painting and NUHM Hording:

Family card for every household of the slum will be printed and used for health services. This card will be

printed for 12200 families residing in the cities. One wall painting will also done at e ach of the 225

Anganwari Centres. One big hording of NUHM will be printed and installed which will cost Rs 20000.

4.7. Community Processes:

The process of listing of households in the KFAs, mapping of KFAs and health facilities and baseline survey of

the KFA households will help determine the scope and extent of services required for targeting of the urban

poor. A deliberate effort will be made to identify the vulnerable poor on the basis of their residence status,

occupational status and social status, besides other micro-level indicators, which will further help focusing the

health care services to the most deserving.

4.7.1 Mahila Arogya Samiti (MAS)-

60 Mahila Arogya Samitis will be strengthened in Hathras city. For this purpose orientation cum traning pro-

gram will be organized with these groups to make them aware of the NUHM and become the active player in

mobilization and communication. MAS will act as community based peer education group in slums, involved in

community mobilization, monitoring and referral with focus on preventive and promotive care, facilitating

access to identified facilities and management of grants received. Existing community based institutions could

be utilized for this purpose. City planning team is proposing formation of only one MAS under each ASHA in

the first year and the identification of the remaining planned MAS will be undertaken in the subsequent years.

4.7.2 ASHA

On the basis of ASHA working in rural areas, ASHA for urban areas will be selected and trained on community

health issues. It is proposed that 30 ASHA at urban level will be selected to work in 34 slums of Hathras cove r-

ing average 1500-2000 population. For reaching out to the households ASHAs (frontline community worker)

would serve as an effective and demand–generating link between the health facility and the urban slum popu-

lation. An honorarium of Rs 2000 per month has been proposed in budget.

4.7.3 Outreach services –

Outreach services will be provided to the slum areas and KFAs through ANMs who would be responsible for

providing preventive and promotive healthcare services at the household level through regular visits and ou t-

reach sessions. Each ANM will organize a minimum of one routine outreach session .

To cover vulnerable population of urban slums, Special outreach sessions (for slum and vulnerable population)

will be organized on every 10000 population every month in partnership with other health professionals (doc-

tors/ pharmacist/ technicians/ nurses – government or private). Total 10 special outreach health sessions will

be organized at slum level in Hathras city in 6 months of intervention. It will include screening and follow-up,

basic lab investigations (using portable /disposable kits), drug dispensing, and counselling. The outreach ses-

sions (both routine and special outreach) could be organized at designated locations mentioned in the afore-

said in coordination with ASHA and MAS members

Page | 25

4.8. Convergence with programs and departments:

Intra-sectoral convergence is envisaged to be established through integrated planning for implementation of

various health programmes like RCH, RNTCP, NVBDCP, NPCB, National Mental Health Programme, National

Programme for Health Care of the Elderly, etc. at the city level. Inter-sectoral convergence with Departments

of Urban Development, Housing and Urban Poverty Alleviation, Women & Child Development, School Educa-

tion, Minority Affairs, Labour will be established through city level Urban Health Committees headed by the

Municipal Commissioner/ Deputy Commissioner/ District Collector.

Six monthly Activity plan of Hathras City is given below:

Activity Plan under NUHM for the state and cities

Act. No.

Activity

Responsibility Months : October'13 - March'14 Remarks

State level

City level O

ct.

No

v.

De

c

Ja

n

Fe

b

Ma

r

1

Establishment of Platform for Conver-gence at state level

Circular to be issued from state level to all their dis-trict level nodal officers

2 Preparation & Finalization of Guidelines for City Coord. Committee/ City Pro-gram Management Committee

These will be one time activities and will apply across the state

3 Preparation & Finalization of Guidelines for Urban ASHAs

4 Preparation & Finalization of Guidelines for Mahila Arogya Samiti

5 Preparation & Finalization of Guidelines for UHND

6 Preparation & Finalization of Guidelines for Outreach sessions/ School Health Programs

7 Preparation & Finalization of Job De-scriptions for all district level NUHM positions

8 Preparation & Finalization of Guidelines for PPP

9 Induction of state level staff for Urban Health Cell

10 Induction of city level staff for Urban Health program

11 Meeting of DHS for establishment of City Program Management Committee (UH)

12 Sensitization of new probable members on NUHM

13 Identification of NGOs for their role un-der NUHM

14 Establishment & orientation of City Program Management Committee (UH)

Page | 26

15

Identification of groups, collectives formed under various govt. programs (like NHG under SJSRY, self help groups etc.) for MAS

16 Organize meetings with women in slums where no groups could be identi-fied

17 Formation and restructuring of groups as per MAS guidelines

18 Orientation of MAS members

18 Selection of ASHAs

18a - Selection of local NGOs for ASHA selec-tion facilitation

18b - Listing of local community members as facilitators by NGOs

18c - Listing of probable ASHA candidates and finalize selection

19 Convergence meeting with govt. Stake-holders

20 Mapping & listing exercise (for health facilities and slums)

20a - Mapping of all urban health facilities (public & pvt.) for services

To continue in 2014-15

20b - Mapping of slums (listed and unlisted)

To continue in 2014-15

20c - Houselisting of slums/ poor settlements

To continue in 2014-15

21 Planning for strengthening of health facilites/ services

- Health Facility Assessment (of public facilities including listing of public facility wise infra & HR requirement)

To continue in 2014-15

22 Baseline survey of urban poor/ slums (KFAs)

(to determine vulnerability, morbidity pat-tern & health status)

23 Meetings of RKS for all the public health facilites under NUHM

24 Identification of alternate/ suitable loca-tions for UPHCs under various urban devp. Programs

To continue in 2014-15

25 Strengthening of public health facilities

- Selection, training and deployment of HR in pub. health facilities

To continue in 2014-15

26 IEC activities

27 Outreach camps & UHNDs (from existing UHPs)

28 Empanelment of Private Health Facili-ties for health care provisioning

To continue in 2014-15

29 Involvement of CSR activities

Page | 27

5. Programme Management Arrangements:

Districts Heath Society will be the implementing authority for NUHM under the leadership of the District Mag-

istrate. District Program Management Units have been further strengthened to provide appropriate manage-

rial and operational support for the implementation of the NUHM program at the district level.

After extensive deliberations the state plans to designate the District Health Society under the chairman-

ship of the District Magistrate as the implementing authority for NUHM

Fund flow mechanisms have been set up and separate accounts will be opened at in the district for recei v-

ing the NUHM funds.

Urban Health will be included as a key agenda item for review by the District Health Society with particip a-

tion of city level urban stakeholders.

An Additional / Deputy CMO has been designated as the nodal officer for NUHM at the district level. The

District Program Management Unit will co-opt implementation of NUHM program in the district and the

District Program Manager will be overall responsible for the implementation of NUHM. To support this the

following additional staff and funds are proposed for strengthening the District Program Management

Units for implementing NUHM:

a. Urban Health Coordinator, Accountant and Data Entry Operators according to the fol lowing

norms:

District total Urban

population

Additional Staff Proposed

Less than 1 lakh 1 Data Entry Operator

1lakh to 10lakhs 1 Urban Health Coordinator,1 Accountant and 1 Data Entry Operator

10lakh to 20lakhs 2 Urban Health Coordinator,2 Accountants and 2 Data Entry Operators

20lakh to 30lakhs 3 Urban Health Coordinator , 3 Accountants and 3 Data Entry Operators

b. District Programme Manager will be nodal for all NUHM activities so extra incentive and budget

for 1 laptop to each DPM has been proposed for DPM for undertaking NUHM activities.

Page | 28

c. A onetime expense for computers, printer and furniture for the above staff has been budgeted

along with the recurring operations expenses.

d. Onetime expenses have been budgeted for up-gradation of the office of Additional/ Deputy CMO

and District Programme management Unit.

The City Program Management Committee will function as an Apex Body for management of the City

Health Plan, which will lead to delivery of Maternal, Newborn, Child Health and Nutrition (MNCHN) and water, sanitation

and hygiene (WASH) services to the urban poor and will work towards the fo llowing objectives:

1. Establish a forum for convergence of city level stakeholders for the delivery of MNCHN and WASH services to the

urban poor.

2. Serve as the nodal body for the planning and monitoring of MNCHN and WASH service delivery to the urban

poor.

3. Provide a forum for exploring, reviewing and approving PPP initiatives and innovations to address the gaps in

MNCHN and WASH service delivery to the urban poor.

The structure proposed for the City Coordination Committee :

Chairperson - DM/ Municipal Commissioner

Convener - CMO

Members – Health - ACMO-Urban

Member – ICDS - CDPO

Member – Nagar Nigam - Sum Improvement Officer

Member – Water & Sanitation - Sup. En. / Ex.En. JalKal Vibhag, Nagar Nigam

Member DUDA & UD - Project Officer

Member – ESIC - ESIC Hosp. Supdt.

Member – SPM - SPM Deptt, KGMU, Hathras

Members – School Education - BSA & DIOS

Members – Dev. Partners - Partners working in urban health sector ( HUP)

Coordinator - Lead Dev. Partner

Review Meetings at UPHC and City Level

Nature of Meeting Periodicity Meeting

Venue

Participants

Mahila Aarogya Samiti Meeting Once a month

for each MAS

Slum ANM, HV, Community Organizer, Social

Mobilization officer

Review meeting with Link work-

ers and MAS representatives

Once a month UPHC All ANMs, PHN, LMO, Community Organiz-

er, Social Mobilization officer

Meeting of UPHC Coordination

Committee

Once a month UPHC LMO, PHN/Community Organizer, Social

Mobilization officer, representative from

2nd tier facility, and reps. From other de-

partments

Meeting with CMO & UH Pro-

gram Coordinator

Once a month CMO Office CMO, Program Coord., Asst. Program Co-

ordinator, LMO/ PHN/ Community Organ-

Page | 29

izer, Social Mobilization officer

City Task Force Meeting Once in two

months

DM’s office CMO, Program Coord. UH, Various de-

partments’ reps. , private partners, NGOs

6. City Level Indicators & Targets

Processes & Inputs

Indicators Baseline (as applicable)

Number Proposed

(2013-14)

Number

Achieved

(2013-14)

Community Processes

1. Number of Mahila Arogya Samiti (MAS) to be formed * 0 60

2. Number of MAS members to be trained * 0 600

3. Number of Accredited Social Health Activists (ASHAs) to be selected and trained *

0 30

Health Systems

4. Number of ANMs to be recruited * 0 15

5. No. of Special Outreach health camps to be organized in the slum/HFAs *

0 10

6. No. of UHNDs to be organized in the slums and vulnera-ble areas *

0 217

7. Number of UPHCs to be made operational * 0 03

8. Number of UCHCs to be made operational * 0 00

9. No. of RKS to be created at UPHC and UCHC * 0 03

10. OPD attendance in the UPHCs 0 9000

11. No. of deliveries conducted in public health facilities 0 150

RCH Services

12. ANC early registration in first trimester 1695

13. Number of women who had ANC check-up in their first trimester of pregnancy

1695

14. TT (2nd dose) coverage among pregnant women 620

15. No. of children fully immunised (through public health facilities)

540

16. No. of Severely Acute Malnourished (SAM) children identified and referred for treatment

180

Page | 30

Processes & Inputs

Indicators Baseline (as

applicable)

Number

Proposed

(2013-14)

Number

Achieved

(2013-14)

Communicable Diseases

17. No. of malaria cases detected through blood examination -

18. No. of TB cases identified through chest symptomatic -

19. No. of suspected TB cases referred for sputum examina-tion

-

20. No. of MDR-TB cases put under DOTS-plus -

Non Communicable Diseases -

21. No. of Diabetes cases screened in the city -

22. No. of Cancer cases screened in the city -

23. No. of Hypertension cases screened in the city -