Programme Implementation Plan 2013-14 NATIONAL ...nuhm.upnrhm.gov.in/urban/pip/bhadohipip.pdfBhadohi City Program Implementation Plan National Urban Health Mission Prepared by District

Bhadohi City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

DPMU/NUHM/Sant Ravidas Nagar (Bhadohi)/PIP/2013-14 Page 2

District Health Society, Sant Ravidas Nagar (Bhadohi)

2013 - 14

Programme Implementation Plan 2013-14

NATIONAL URBAN HEALTH MISSION

Sant Ravidas Nagar (Bhadohi)


PREAMBLE

With the launch of National Urban Health Mission, the health status of urban

population in general and of the poor and other disadvantaged sections in

particular will be attempted to be improved. 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.

As per census 2011, Sant Ravidas Nagar had an urban population of 229,302

of which males were 120,510 and remaining 108,792 were females. Sex Ratio

in urban region of Sant Ravidas Nagar (Bhadohi) district is 902 as per 2011

census data. Similarly urban child sex ratio in Sant Ravidas Nagar (Bhadohi)

district was 918 in 2011 census. Child population (0-6) in urban region was

34,845 of which males and females were 18,163 and 16,682. Average urban

literacy rate in Sant Ravidas Nagar (Bhadohi) district as per census 2011 is 62

%. In actual number 142,276 people are literate in urban region of which males

and females are 82,830 and 59,446 respectively.

The health indicators for Sant Ravidas Nagar (Bhadohi) show 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.

The NUHM planning for this financial year based on the data and available

information at city level and hoping that we will initiate the process very

systematically so that we can make the difference in improvement of quality life

of urban people specially by reaching the unreached areas.

DPM-NHM Nodal NUHM Chief Medical Officer District Magistrate

Sant Ravidas Nagar Sant Ravidas Nagar Sant Ravidas Nagar Sant Ravidas Nagar


TABLE OF CONTENT

Preamble 2

Acknowledgement 3

Acronyms 4

City Profile 5-15

Health Scenario 15-23

Key Issues 23-24

Strategies, Activities & Work plan under NUHM 24-27

Programme Management Arrangements 27-29

City level targets & indicators 29-31


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

http://urbanindia.nic.in/programme/ud/integrateddevelopment.pdf

http://urbanindia.nic.in/programme/ud/integrateddevelopment.pdf


National Urban Health Mission- Programme Implementation Plan

Sant Ravidas Nagar (Bhadohi) 2013-14

1. Sant Ravidas Nagar (Bhadohi) Profile

History of Sant Ravidas Nagar (Bhadohi)

This place gets its name from Bhar Raj of the region which had Bhadohi as its capital. There are

several mounds and old tanks that have been named after the Bhar rulers, an off-shoot of Kannauj

kingdom. By the fifteenth century the Bhar were overpowered by Maunas Rajputs with Sagar Rai as

the first head of the clan, and his grandson, Jodh Rai received it as azamindari sanad (deed)

from Shah Jahan. However around 1750 AD due to nonpayment of land revenue arrears, Raja

Pratap Singh of Pratapgarh, in lieu of his paying the arrears gave the entire pargana to Balwant

Singh of Benaras, subsequently he received it directly under a sanad from Nawab Shuja-ud-

Daula of Awadh under British influence in 1770 AD, and it remained with Benaras till 1947. During

the rule of Akbar, Bhadohi was made a dastur and included in the sarkar of Allahabad. In 1911

Bhadohi came under first Maharaja of the newly created princely state of Benares ruled by Maharaja

Prabhu Narayan Singh.

Sant Ravidas Nagar is known as the Carpet city as it is home to the largest hand-knotted carpet

weaving industry hubs in South Asia. The Indian Institute of Carpet Technology, the only Institute of

its kind in Asia was established here by the Ministry of Textiles in 2001.

Bhadohi district is biggest carpet manufacturing centre in India. It is known for its hand-knotted

carpet. The Mirzapur-Bhadohi region is the largest handmade carpet weaving cluster, engaging

around 3.2 million people in the industry. Bhadohi employs 22 lakh rural artisans. Carpet weaving in

the region dates back to the 16th century during the reign Akbar.The carpets of the region received

the Geographical Indication tag, which means carpets manufactured in nine districts of the region,

Bhadohi, Mirzapur,Varanasi,Ghazipur, Sonebhadra,Kaushambi, Allahabad, Jaunpur and Chandauli

would be tagged with `handmade carpet of Bhadohi`. Well known carpet types from Bhadohi include

cotton Dhurry, Chhapra Mir carpets, Loribaft, Indo Gabbeh.

Geographical location

Sant Ravidas Nagar is located between four major districts of Jaunpur in the north, Varanasi in the

West, Mirzapur in the South and Allahabad to the East. The distance from Sant Ravidas Nagar

to Varanasi is approximately 45 km and takes about sixty minutes by car. Sant Ravidas Nagar is

80 km from Allahabad. It is close to the holy river Ganges (which is about 29 km from the city area).

There are quite a few good temples in Sant Ravidas Nagar like the famous Hariharnath temple and

Sitamadhy Temple.

http://en.wikipedia.org/wiki/Rajputs

http://en.wikipedia.org/wiki/Zamindari

http://en.wikipedia.org/wiki/Shah_Jahan

http://en.wikipedia.org/wiki/Pratapgarh,_Uttar_Pradesh

http://en.wikipedia.org/wiki/Pargana

http://en.wikipedia.org/wiki/Benaras

http://en.wikipedia.org/wiki/Shuja-ud-Daula

http://en.wikipedia.org/wiki/Shuja-ud-Daula

http://en.wikipedia.org/wiki/Awadh

http://en.wikipedia.org/wiki/Allahabad


District Profile

Description Total Rural Urban

Population 1,578,213 1,348,911 229,302

Male 807,099 686,589 120,510

Female 771,114 662,322 108,792

Sex Ratio 955.41 964.66 902.76

Child Sex Ratio 901.64 899.05 918.46

Literates 910,146 767,870 142,276

Male Literates 546,782 463,952 82,830

Female Literates 363,364 303,918 59,446

Average Literacy 57.67 56.93 62.05

Male Literacy 60.08 60.42 58.22

Female Literacy 39.92 39.58 41.78


Health Indicators1

Description Total Rural Urban

Crude Birth Rate 25.3 26.6 17.1

Crude Death Rate 7.5 7.9 5.1

Natural Growth Rate 17.8 18.7 12

Infant Mortality Rate 80 80 82

Neo-natal Mortality Rate 58 60 41

Under Five Mortality Rate (U5MR) 109 110 102

City profile

As per Census 2011, Sant Ravidas Nagar (Bhadohi) had a population of 94,620 comprising of

49,639 males and 44,981 females. Males constituted 52% of the population and females 48%. As of

2001 India census, Bhadohi had a population of 74,439. Bhadohi has an average literacy rate of

62%, higher than the national average of 69.5%; with 68% of the males and 55% of females are

literate. 15% of the population is under 6 years of age. There were 13,274 households as per

Census 2011 and the decadal growth in population has been 14.81%. The city of Gyanpur is the

district headquarters.

Density of Sant Ravidas Nagar (Bhadohi) district for 2011 is 1531 people per sq. km. Sant Ravidas

Nagar (Bhadohi) district covers 1056 square kilometers of areas. In comparison to the national sex

ratio of 940 as per latest Census 2011, the sex ratio in Bhadohi, was 906 per 1000 male as per

Census 2011.

Description Total %

Population 94,620

Male 49,639 52

Female 44,981 48

1 AHS

http://en.wikipedia.org/wiki/Census

http://en.wikipedia.org/wiki/Gyanpur


Sex Ratio 906.16

Child Sex Ratio 923.12

Literates 58,470 62

Male Literates 33,769 58

Female Literates 24,701 42

Table 1: Demographic Profile

Total Population of city (in lakhs) 0.95

Slum Population (in lakhs) 0.37

Slum Population as percentage of urban population 38.95

Number of Notified Slums 21

Number of slums not notified -

No. of Slum Households 7352

No. of slums covered under slum improvement programme (BSUP, IDSMT,etc.) 21

Number of slums where households have individual water connections* 720

Number of slums connected to sewerage network* 3

Number of slums having a Primary school 14

No. of slums having AWC 62

No. of slums having primary health care facility 0

Urban Governance

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

infrastructure and services. While, the Bhadohi NPP, Bhadohi Jal Sansthan, Bhadohi Development

Authority and UP Jal Nigam (UPJN) are the key urban 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.

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.


Housing

Bhadohi has witnessed a radial growth. The position of the City as the only large urban centre

amidst a number of small towns in the surrounding districts makes it an attractive destination for job

seekers and people in need of education and health facilities. One of the features of the city’s growth

has been an increase in the number of slums but disagreements about the definition of slums and

about data hamper efforts to address service delivery challenges in these areas.

HOUSING CHARACTERISTICS Indicators

Households living in a Pucca House (%) 87.1

Households living in a Owned House (%) 89.9

Households having improved source of Drinking Water (%) 92.5

Households treating water to make it safer for drinking (%) 0.3

Households having access to toilet facility (%) 77.1

Households sharing toilet facility (%) 20

Households having access to electricity (%) 95.3

Households using Electricity (%) 92.1

Households using Firewood/Crop Residues/Cow Dung Cake (%) 43.4

Households using LPG/PNG (%) 47.7

Households having a separate Kitchen (%) 44.1 Households having Computer/laptop with or without Internet Connectivity (%) 8.8

Households having Telephone/Mobile (%) 77.2

HOUSEHOLD CHARACTERISTICS

Average Household Size 6.3

2. Health Infrastructure and scenario

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 urban family welfare centers, health posts, 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.


Sl.

No.

Name & type of

facility (DH,

Maternity Home,

CHC, other ref.

hospital UFWC,

UHP

PHC,Dispensary

etc.)

Managing

Authority

(Municipal

Council,

State Health

Department,

facilities

functioning

on PPP

basis)

Location

of Health

facility

Population

covered by

the facility

Services

provided

Human

Resources

available –

list type

and number

of HR

available

i.e. ANM,

LT, SN,

MOs,

Specialists

etc.

No. and

type of

equipment

available:

X-ray

machine,

USG,

autoclave

etc.

1. MCH

D.H.GYANPUR

State Health

Dep.

Gyanpur 1654214 Speciali.

Services

MO-16, SN-

3, LT-2,

ANM-1

X-ray

machine,

USG

2. MBS BHADOHI State Health

Dep.

BHADOHI 345654 Speciali.

Services

MO-14, SN-

1, LT-1,

ANM-1

X-ray

machine

3. UHP NRHM BHADOHI 94620 Pre.

Services

LMO-1, SN-

1,

N.A.

The data given in the table above reveals inadequacy of primary health care services. 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 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

Health/Morbidity Profile of the City:

Sl. No. Name of Disease/ cause of morbidity (e.g. COPD,

trauma, cardiovascular disease etc.)

Number of cases

admitted in 2012

1. Injuries and Trauma 80

2. Self inflicted injuries/suicide 0

3. Cardiovascular Disease 475

4. Cancer (Breast cancer) 56

5. Cancer (cervical cancer) 70

6. Cancer (other types) 25

7. Mental health and depression 35

8. Chronic Obstructive Pulmonary Disease (COPD) 12

9. Malaria 8


10. Dengue 0

11. Infectious fever (like H1N1, avian influenza, etc.) 110

12. TB 18

13. MDR TB 5

14. Diarrhea and gastroenteritis 15

15. Jaundice/Hepatitis 12

16. Skin diseases 22

17. Severely Acute Malnourishment (SAM) 6

18. Iron deficiency disorder 42

19. Others (Typhy.) 120

The above table reflects the health/ morbidity profile of the Chitrakoot 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.

Based on the results of AHS the health scenario of city (proxy by the urban part of the district) is

presented as below.

Morbidity and Health issues

Description AHS 2010-11

Number of disable persons (1000,000 population)

Person 885

Male 1252

Female 477

Number of Injured Persons by type of Treatment received (Per 100,000 Population)

Severe

Person 191

Male 198

Female 183

Major

Person 191

Male 297

Female 73

Minor

Person 642

Male 890

Female 367


Persons Suffering from any kind of Acute Illness (Per 100,000 Population)

Diarrhea/Dysentery

Person 365

Male 396

Female 330

Acute Respiratory Infection (ARI)

Person 104

Male 132

Female 73

Fever (All Types)

Person 1302

Male 1220

Female 1394

Any type of Acute Illness

Person 2344

Male 2307

Female 2384

Taking treatment from Any Source (%)

Person 94.8

Male 97.1

Female 92.3

Taking treatment from Government Source (%)

Person 16.4

Male 13.2

Female 20

Having Any kind of Symptoms of Chronic Illness (Per 100,000 Population)

Person 5000

Male 4351

Female 5723

sought Medical Care (%)

Person 78.5

Male 82.6

Female 75

Diagnosed for (Per 100,000 Population)

Any kind of Chronic Illness

Person 816

Male 527

Female 1137

Diabetes

Person 4688

Male 4054

Female 5393

Hypertension

Person 243


Male 132

Female 367

Tuberculosis (TB)

Person 642

Male 297

Female 1027

Asthma/Chronic Respiratory Disease

Person 226

Male 297

Female 147

Arthritis

Person 503

Male 626

Female 367

Getting Regular Treatment (%)

Person 49.3

Male 54.5

Female 44.9

Getting Regular Treatment from Government Source (%)

Person 11.1

Male 10.1

Female 11.9

Health indicators for urban as per AHS 2010-11

FERTILITY

Total Fertility Rate (TFR) -

Women aged 20-24 reporting birth of order 2 & above (%) 35.9

birth of order 3 & above (%) 46.8

Women with two children wanting no more children (%) 39.7

Median age at first live birth of Women aged 15-49 years 22.5

Median age at first live birth of Women aged 25-49 years 21.5 Women age 15-19 who were already mothers or pregnant at the time of the survey (%) 46.7

Mean number of children ever born to aged 15-49 3.8

Mean number of children surviving to Women aged 15-49 3.2

Mean number of children ever born to Women aged 45-49 6

Live Births taking place after an interval of 36 months (%) 45

ABORTION to EMW 15-49 Years (%)

Pregnancy resulting in abortion 3

Women who received any ANC before abortion 42.9

Married Women who went for Ultrasound before abortion 28.6

Average Month of pregnancy at the time of abortion 3.9

Abortion performed by skilled health personnel (%) 57.1

Abortion taking place in Institution (%) 57.1


Currently Married Pregnant Women aged 15-49 registered for ANC (%) 57.7

FAMILY PLANNING PRACTICES (CMW AGED 15-49 YEARS)

Current Usage

Any method (%) 41.6

Any modern method (%) 30.6

Female sterilization (%) 16.8

Male sterilization (%) 2.3

Copper-T/IUD (%) 2

Pills (%) 1.8

Condom/Nirodh (%) 6.8

Emergency Contraceptive Pills (%) 0.6

Any traditional method (%) 11

Periodic abstinence (%) 6.9

Withdrawal (%) 2.4

LAM (%) 1

UNMET NEED

Unmet need for Spacing (%) 15.3

Unmet need for Limiting (%) 8.8

Total Unmet need (%) 24

Maternal Health Care

ANTE NATAL CARE

Mothers who received any antenatal check-up (%) 75.7

Mothers who had antenatal check-up in first trimester (%) 36.9

Mothers who received 3 or more antenatal care (%) 33.6

Mothers who received at least one tetanus toxoid (TT) injection (%) 73.8

Mothers who consumed IFA for 100 days or more (%) 7

Mothers who had Full Antenatal Check-up (%) 3.7

Mothers who received ANC from Govt. Source (%) 41.4

Mothers whose Blood Pressure (BP) taken (%) 22.4

Mothers whose Blood taken for Hb (%) 15.9

Mothers who underwent Ultrasound (%) 20.6

DELIVERY CARE

Institutional Delivery (%) 45.3

Delivery at Government Institution (%) 18.2

Delivery at Private Institution (%) 27.1

Delivery at Home(%) 51.9

Delivery at home conducted by skilled health personnel (%) 42.3

Safe delivery *(%) 52.8

Caesarean out of total delivery taken place in Government Institutions (%) 2.6

Caesarean out of total delivery taken place in Private Institutions (%) 27.6

Less than 24 hrs. stay in institution after delivery (%) 78.4

Mothers who received Post-natal Check-up within 48 hrs. of delivery (%) 70.1

Mothers who received Post-natal Check-up within 1 week of delivery (%) 70.1

Mothers who did not receive any post-natal Check-up (%) 29.9

New borns who were checked up within 24 hrs. of birth (%) 67.6


JANANI SURAKSHA YOJANA (JSY)

Mothers who availed financial assistance for delivery under JSY (%) 12.1

Mothers who availed financial assistance for institutional delivery under JSY (%) 26.8 Mothers who availed financial assistance for government institutional delivery under JSY(%) 61.5

IMMUNIZATION (%)

No of Children age 12-23 months 58.3

Children aged 12-23 months who have received BCG 60

Children aged 12-23 months who have received 3 doses of Polio vaccine 40

Children aged 12-23 months who have received 3 doses of DPT vaccine 36.7

Children aged 12-23 months who have received Measles vaccine 38.3

Children aged 12-23 months Fully Immunized 28.3

Children who have received Polio dose at birth 51.7

Children who did not receive any vaccination 36.7

Children Vitamin A dose during last six months 23 Children (aged 6 months) who received IFA tablets/syrup during last 3 months (%) 3.3

Children whose birth weight was taken (%) 21.7

Children with birth weight less than 2.5 Kg. (%) 25.7

CHILDHOOD DISEASES

Children suffering from Diarrhoea (%) 14

Children suffering from Diarrhoea

79.3 who received HAF/ORS/ORT (%)

Children suffering from Acute Respiratory Infection (%) 10.1 Children suffering from Acute Respiratory Infection who sought treatment (%) 95.2

Children suffering from Fever (%) 30

Children suffering from Fever who sought treatment (%) 93.5

Child Feeding practices and nutritional status of children (%)

Children under 3 years breastfed within one hour of birth 33.6 Children (aged 6-35 months) exclusively breastfed for at least six months (%) 35.7

Water 66.4

Animal/Formula Milk 81.1

Semi-Solid mashed food 32

Solid (Adult) Food 28.7

Vegetables/Fruits 27 Average month of receiving foods other than other than breast milk for children under 3 years

Water 2.1

Animal/Formula Milk 1.7

Semi-Solid mashed food 4.6

Solid (Adult) Food 6.9

Vegetables/Fruits 6.9

BIRTH REGISTRATION

Birth registered (%) 47.3


Children whose birth was registered and received birth certificate (%) 8.7

AWARENESS ON HIV/AIDS

Women who are aware of HIV/AIDS (%) 86.3

Women who are aware of RTI/STI (%) 82.3

Women who are aware of HAF/ORS/ORT (%) 98.4

Women who are aware of danger signs of ARI/Pneumonia (%) 92.6

3. Key Issues

The Eleventh Plan had suggested Governance reforms in public health system, such as

Performance linked incentives 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 involvement, 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.

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 societies reporting to state, facility managers reporting on health outcomes of those

seeking care, and territorial health managers reporting on health outcomes in their area.

Accountability 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 Decentralized

Planning.

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

Partnership, Convergence, 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

because unmet need for family planning is high in Lucknow

17) Management of communicable & non- communicable diseases

18) Strengthening AYUSH

19) Constitution of BSGY team for urban areas.

20) Identification & management of SAM children

4. Strategies, Activities and Work plan

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 convergence with key urban stakeholders,

sensitization of ULBs on their role in urban health, strengthening UPHCs for provision of primary

health care to urban poor, community outreach through selection, training and support to ASHAs

and MAS, conducting UHNDs and outreach camps to get services closer to the community 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 operationalised

rapidly over the years.

4.1. Listing and Mapping of Households in slums and Key Focus Areas

Listing and mapping of households will provide accurate numbers for population their family size and

composition residing in slums. Currently, estimates of population residing in slums are available from

District Urban Development Agency (DUDA) and National 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 ASHA 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 behaviors and link communities to health

facilities under the NUHM. It is expected that once the household mapping is completed in cities, the

number of ASHAs will be reviewed and adjusted upwards or downwards and the geographical

boundaries of the coverage area for each ASHA would be realigned. This is due to the reason that

the actual population may be higher or lower than the original estimate used for planning.


4.2. 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 Partners like Health of the Urban Poor project will technically support

this effort.

a. 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 related indicators which will be reviewed during the course of implementation of the

program to assess the impact of implementation and necessary course corrections can accordingly

be made and use of resources can be optimized.

b. Training and Capacity Building

ULB, Medical and Paramedical staff, Urban ASHAs and MAS will be trained. The trainings will have

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

NUHM will engage with development organizations to develop the training modules and facilitate the

trainings.

c. Monitoring & Evaluation

The M&E systems would also capture qualitative data to understand the complexities in health

interventions, undertake periodic process documentation and self evaluation cross learning among

the Planning Units to be made more systematic.

The Monitoring and Evaluation framework would be based on triangulation of information. The three

components would be Community Based Monitoring, HMIS for reporting and feedback and external

evaluations.

d. Strengthening of health facilities

Urban - Primary Health Centre (U-PHC) –

During the first year of implementation of the program, the existing urban health posts will be

attempted to be strengthened. Towards this, the UHPs existing in rented accommodations will be

shifted to adequately larger premises which would help in rendering the mandated services. A

provision of Rs. 10,000/- per month per UPHC is being proposed for immediate service provision

capacity enhancement, but over the period of time the said rented accommodations will be shifted to

owned premises for sustained services. Accommodations belonging to other stakeholder

government line departments will be explored and then adopted after entering into necessary

agreements/ arrangements with the said department.

e. Targeted intervention for urban poor –

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.

f. Mahila Arogya Samiti (MAS)-

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.

g. ASHA-

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 population. Each link

worker/ASHA would have a well-defined service area of about 1000-2,500 beneficiaries/ between

200-500 households based on spatial consideration.

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

outreach session in her area every month.

Special outreach sessions (for slum and vulnerable population) will be organized once in a week in

partnership with other health professionals (doctors/ pharmacist/ technicians/ nurses – government

or private). It will include screening and follow-up, basic lab investigations (using portable

/disposable kits), drug dispensing, and counseling. The outreach sessions (both routine and special

outreach) could be organized at designated locations mentioned in the aforesaid paras in

coordination with ASHA and MAS members

i. Innovations –

i. PPP & CSR –

For Chitrakoot city a few innovative interventions would be planned. Interventions performed under

Public Private Partnership (PPP) arrangements and Corporate Social Responsibiltoy (CSR) will be

undertaken with the intent to evolve successful models for health care delivery to the urban poor.

ii. School Health Services

School health program under NUHM has been an important component to provide not only the

preventive and curative services to children but also to ensure their contribution in overall health

development of the urban communities. It is envisaged that the active involvement of children in the

program will enable them to be a change agent for themselves as well as communities by taking

home good knowledge and practices in terms of preventive health care activities. It is planned that

children will be engaged through innovative and creative actions to make the learning entertaining

and educational.

j. Convergence –

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 Education, Minority Affairs, Labour will be

established through DHS headed by the District Magistrate.

5. Activity Plan under NUHM

Act

.

No.

Activity

Months : October'13 - March'14 Remarks

City

level

Oct.

No

v.

Dec

Jan

Feb

Mar

1

Establishment of Platform for

Convergence at state level

Circular to be

isued from state

level to all their

district level

nodal officers

2

Preparation & Finalization of

Guidelines for City Coord.

Committee/ City Program

Management Committee

These will be

one time

activities and will

apply across the

state

3 Preparation & Finalization of

Guidelines for Urban ASHAs

4


Guidelines for Mahila Arogya

Samiti


Guidelines for UHND

6


Guidelines for Outreach

sessions/ School Health

Programs

7


Job Descriptions for all district

level NUHM positions


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 under NUHM

14

Establishment & orientation of

City Program Management

Committee (UH)

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 identified

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 selection 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. Stakeholders

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 pattern & health status)

23

Meetings of RKS for all the

public health facilites under

NUHM


24

Identification of alternate/

suitable locations 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

Facilities for health care

provisioning

To continue in

2014-15

29 Involvement of CSR activities

6. Programme Management Arrangements

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

District Magistrate. District Program Management Units have been further strengthened to provide

appropriate managerial 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

chairmanship 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 receiving the NUHM funds.

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

participation 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

following norms:

Chitrakoot Urban

population

Additional Staff Proposed

50 Thousand to 1lakh 1 Urban Health Coordinator,1 Accountant and 1 Data Entry

Operator

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.

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 following 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 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 Members – School Education - BSA & DIOS Members – Dev. Partners - Partners working in urban NGO's

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 workers and

MAS representatives

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

Organizer, 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 departments

Meeting with CMO &

UH Program

Coordinator

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

Coordinator, LMO/ PHN/ Community

Organizer, Social Mobilization officer

City Task Force

Meeting

Once in two

months

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

departments’ reps. , private partners,

NGOs


7. 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 36

2. Number of MAS members to be trained * 0 360

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

0 18

Health Systems

4. Number of ANMs to be recruited * 0 5

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

0 5

6. No. of UHNDs to be organized in the slums and vulnerable areas *

0 36

7. Number of UPHCs to be made operational * 0 1

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

9. No. of RKS to be created at UPHC and UCHC * 0 1

10. OPD attendance in the UPHCs 0 13500

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

RCH Services

12. ANC early registration in first trimester 256

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

256

14. TT (2nd dose) coverage among pregnant women 96


Processes & Inputs

Indicators Baseline (as

applicable)

Number

Proposed

(2013-14)

Number

Achieved

(2013-14)

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

220

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

6

Communicable Diseases

17. No. of malaria cases detected through blood examination

-

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

19. No. of suspected TB cases referred for sputum examination

90

20. No. of MDR-TB cases put under DOTS-plus 5

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 -

Chief Medical officer

Sant Ravidas Nagar (Bhadohi)

Documents

Programme Implementation Plan 2013-14 NATIONAL ...nuhm.upnrhm.gov.in/urban/pip/bhadohipip.pdfBhadohi City Program Implementation Plan National Urban Health Mission Prepared by District