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Mau City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

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TABLE OF CONTENT

Preamble 3

Acknowledgement 4

Acronyms 5

City Profile 6-18

Health Scenario 19-25

Key Issues 26-27

Strategies, Activities & Work plan under NUHM 27-33

Programme Management Arrangements 33-35

City level targets & indicators 36

NATIONAL

URBAN HEALTH

MISSION

Programme Implementation Plan

of

Mau 2013-14

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PREAMBLE

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.

Mau with a population of 22,05,170 (Census: 2011), is one of the districts in Uttar Pradesh

(UP). The current sex ratio for the urban areas is 946 females per thousand males which is an

area of grave concern. The AHS-2010-11 reports that institutional deliveries are around % in

the city and the IMR is 71 % (AHS 2011-12) with MMR at 385 (AHS 2011-12) which again is a

matter of concern. Complete immunization status of the district is around % (AHS 2010-11)

and if we see the 3+ANC, it is as low as % (AHS-10-11) at the district level. Unmet need for

family planning services at the district level is (AHS-10-11) and if we further examine the data,

% is for limiting and % for spacing methods.

The health indicators for Mau 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, surveys 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.

HUP – PFI deserves a very special mention for providing generous technical support in

preparation of City PIP.

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Dr. Nand Lal Yadav Dr Kumudlata Srivastava (IAS)

Chief Medical Officer District Magistrate

Mau Mau

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ACKNOWLEDGEMENT

Considerable efforts have been made by the team in preparing this Project Implementation

Plan for Mau under the newly announced National Urban Health Mission. This has been

possible through dedication, perseverance and hard work. This exercise of planning would not

have been complete without the help and support of the team.

We do not have hesitation in saying that this work would not have come up without the

valuable support and continuous encouragement of Dr Kumud Lata Srivastava (IAS), District

Magistrate, Mau. Her great confidence in team and spurred us into action.

My special gratitude goes to Dr. Nand Lal Yadav, Chief Medical Officer, Mau, a dynamic and

enthusiastic professional. He has always been a source of great encouragement for us. The

initiation and completion of this work has been possible due to his sincere and able guidance,

expertise, precious opinion, keen attention, constructive suggestions and constant help. His

critical reading of all the parts of the work has helped shape the NUHM planning in its present

form.

I express my gratefulness to Shri. Amit Kumar Ghosh, IAS, Mission Director, National Health

Mission & Mr. Shashank Vikram, IFS, Additional Mission Director, NUHM for overarching

support and building the thoughts in our mind.

I owe my sincere gratitude to Dr. M. R. Gautam (General Manager), Dr. Usha Gangwar,

(Deputy General Manager-NUHM) and HUP-PFI who have helped us immensely by providing

relevant information and valuable suggestions. This planning work got accomplished with their

valuable support and eagerness to help.

I am privileged to have such good city level team especially Shri Arvind Kumar Srivastava

(Div.PMU), Shri. Ravindra Nath (DPM NRHM), who have supported and helped in contributing

their great efforts towards planning of this city level plan under the NUHM.

I would also like to appreciate the precious help and motivation which I received from

government line department - DUDA, ICDS, Nagar Municipal Corporation, Education

department, CMS & DTO.

Last but not the least; I would like to thanks all those people who were involved in the planning

process directly or indirectly.

Dr. Brij Kumar

Add. CMO (RCH), Mau

September 2013

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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

Mau 2013-14

1. Mau Profile

Many myth are popular regarding history of MAU district, .In common opinion MAU is considered as Turkish word , which means "GARH" , "PADAV" , "CHAVANI" . No historical records are available regarding habitance of Mau. A little description is given in the historical book of Jiyaudeen Barni that Akbar the Great passed through Mau, in its way towards Allahabad.

During the period of Freedom Struggle the residents of Mau had given their full support to the movment. Mahatma Gandhi came here in Doharighat on 3rd october 1939. In salt law breaking movement many persons of Mau had actively taken part,some of them are as follows : Umrav Singh , Shiv Saran Rai, Satrai Singh , Haidwar Singh, Kalpnath Shukl, Ram chandra Pandey,Krishna Madhav Lal, Ibrahim Khan,Vishwanath Prasad,Ram Palat Rai,Sita Ram Arya, Ram Davar Singh, Mangala Rai, Nana Saheb Marwari, Dalsingar Pandey, Chotu Ram,Gaya Prasad,Raj Daras Rai, Ram Dev Rai, Raj Narayan Rai, Jaganath Prasad, Chikaru Rai,Mahesh Rai,Bhagirath Rai etc.

In 1938 Jai Bahadur Singh had looted the train in piprideeh with his mates Krishna Dev Rai , Jamin Ali , Udai Narayan Dubey , Keshav Shukla , Beekeshvar Dutt , Jaganath Mishra,Tej Pratap Singh.

During 1942 Quit India Movement the mob was collected against the outrage of Madhuban Police Station Officer ; Collector Navlate was present there,he ordered to fire on the mob. Many persons were killed & injured on spot. In memory of shaheed of above said event a monument was built on the same place in Madhuban.

Mau was an important township of Azamgarh district before its creation .On 19th Nov. 1988 it was made district, largerly due to the effort of Late Kalpnath Rai , who was M. P. from Ghosi Parliamentary seat.

The local language of Mau is peculiar in its flavour , it includes the slang of Bhojpuri

Persian, Turkish & Irani. The main Industrial setup here is of cloth making by powerloom due

to presence of a large number of weavers in the district . Sari, Lungi & other clothes being

prepared here nowadays and are exported to various states of India and also to various

countries.

1.1 Mau District

As per census 2011, the urban population of Mau district is 4,99,784 which is over .25 percent

of the total state’s urban population. About 23 % population of Mau is urban. The urban sex

ratio is 948 females per 1000 males. The average literacy rate in Mau urban is 79.28 percent,

84.81% for males and 73.45% for females.

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Table.1: Mau District and Mau Urban in Census 2011

Description Mau District 2011 Mau Urban

2011

Actual Population 2,79,060 4,99,784

Male 1,43,273 2,56,497

Female 1,35,787 2,43,287

Population Decadal

Growth rate

Density/km2 1287 1287

Sex Ratio (Per 1000) 948 948

Child Sex Ratio (0-6 Age) 952 952

Average Literacy (%) 79.28 79.28

Male Literacy (%) 84.81 84.81

Female Literacy (%) 73.45 73.45

1.2. Mau City

Mau City is one of the most populated cities in Uttar Pradesh. As per provisional reports of

Census India1, population of Mau City is 2,79,060. The sex ratio of Mau City is 948 per 1000

males, whereas Child sex ratio is 952 per 1000 boys.

The effective literacy rate of the city in 2011 is 79.28%. The male effective literacy rate is 84.81

and the female effective literacy rate is 73.45 percent.

Table 2: Demographic profile of Mau City

Total Population of city (in lakhs) 2,78745 Source: Census 2011

Slum Population (in lakhs) 64,330

Slum Population as percentage of urban

population 23.05%

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Number of Notified Slums 143 Source: DUDA

Number of slums not notified 0 Source: RSAC

No. of Slum Households 44,132 Source: RSAC

No. of slums covered under slum improvement

programme (BSUP, IDSMT,etc.) 37

Number of slums where households have

individual water connections* NA

Number of slums connected to sewerage network* 0

Number of slums having a Primary school

143 Source: BSA Deptt.

No. of slums having AWC 300 Source: ICDS Lucknow &

BSUP

No. of slums having primary health care facility 8

Table 3: Population, Literacy Rate & Sex Ratio – Mau City

Description Total Male Female

Population 2,79,060 1,43,273 1,35,787

Literates 2,19,321 1,20,278 99,043

Children (0-6) 40,651 20,820 19,831

Effective Literacy Rate

(7+Population) %

79.28 84.81 73.45

Sex ratio 948

Child Sex ratio 952

1.4 Urban Poor & Slums

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

majority of buildings 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 of the inhabitants in that area, or otherwise in any

respect unfit for human habitation. It mentions factors such as repairs, 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

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& Clearance) Act 1962; SUDA/UNCHS do not follow this definition but define poverty in terms

of vulnerability as does Oxfam.

Table 5: Selected indicators of slum conditions in Mau

Characteristic Percentage of people/families

Water Supply Facilities

Individual tap 13.1%

Community tap 34.5%

Others 6.06%

Sanitation

Individual toilet facility 76.25%

Community toilet facility 16.5%

Others 27.25%

Employment

Employed 9.78%

Unemployed 7.97%

Self employed 81.91%

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GIS Map and Listing of Slums in Mau as Per RSAC

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S. No. Name of Slums Population

1 Pardha 2260

2 Bakwal 1655

3 Galibpur 1692

4 Barpur 1196

5 Rastipur 1080

6 Musardah 913

7 Rampur Chakiya 352

8 Salempur 756

9 Bhiti 2443

10 Tajopur 1832

11 Sultanpur 1234

12 Khawajajahanpur 906

13 Bhuati 913

14 kha.north south Tola 763

15 Chakkanungoyan 732

16 Chandrabhanpur 840

17 Aurangabad 1296

18 Ghoradalal ke bari 972

19 Nizamuddinpura 2447

20 Puradarjanrai 891

21 Khatiktola Pachim 502

22 Chamar Tola Pachim 1401

23 Pura Agrawal 992

24 Mata Pokhra (Dasai Ka pokhra) 471

25 Bari Pokhra 835

26 Bhaktawarganj 2450

27 Bhatkuwa Patti Dayaram 1356

28 Astupura 939

29 Sahadaupura 1872

30 Chak Mehdi 972

31 Rahjaniya 450

32 Kasim Pokhri 1898

33 Devparwa 1551

34 Nandu Pokhra 350

35 Bhatkuwa Patti Singh Rai 1550

36 Madanpura Golwa 995

37 Hakikatpura 1494

38 Achar 992

39 Hattimadari 360

40 Emaliya 1475

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S. No. Name of Slums Population

41 Bunkar Kaloni 978

42 Pyarepura 971

43 Rajaram Ka Pura 374

44 Ahladpura 1012

45 Mirjamehdi 781

46 Paharpura 1494

47 Hafizabad 1398

48 Maliktola 886

49 Domanpura East West 2111

50 Munsipura 549

51 Pathantola 1278

52 Allauddinpura 376

53 Kasimpura 406

54 Prema Rai 334

55 Bari Kamhariya 654

56 Husainpura 882

57 Mirzahadipura 781

58 Vishwanatpura 871

59 Jamalpura 667

60 Domanpura Goluwa 725

61 Prem Nagar Chakiya 334

62 Khedupura Malin 707

63 Hardaspur 1926

64 Pasibasti 416

65 Kinnipur Harijan Basti 870

66 Rajbhar Basti 947

67 Ambedkar Nagar 1210

68 Hanuman Nagar 553

69 Dobi Basti Bhiti 730

70 Mallah Toli Bhiti 552

71 Dandeypar 600

72 Sirbanhi 820

73 Harikeshpura 845

74 ballipura 988

75 Dabgaurpura 857

76 Brahman Tola Uttar 590

77 Chamar Tola Uttar 330

78 Katuwa Pura 450

79 Khattiktola Uttar 628

80 Pura Cheda 363

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S. No. Name of Slums Population

81 Bahir Bagga 380

82 Aurangabad Nadipara 425

83 Sikatiya 1020

84 Kulhar Nadipar 1995

85 Pura Baksi 990

86 Pura Lakshi Rai 1296

87 Dasai pokhra 742

88 Chamar Tola Dachin 303

89 Dachin Tola 1298

90 Bhadesra 2289

91 Katuwa Pura Pachim 972

92 Mustafabad 896

93 Emilya Chandmari 2012

94 Katra 1209

95 Mugalpura 972

96 Yusufpura 1365

97 Bharhu Ka Pura 892

98 Mutfarkat 1330

99 Pura Bhkam 2530

100 Malik Tahirpura 2330

101 Nyaz Mohmmadapura 2210

102 Hasan Makksani 932

103 Bh0jumman Doyan 2578

104 Jayhan Aasikpura 772

105 Pura Changa 972

106 Pura Niyaz 771

107 Pura Dankbir 1878

108 Kajitola 1089

109 Bulakipura 2503

110 Purabindu Rai 1553

111 Chittunpura 2807

112 Raghunath Pura 3372

113 Shekhdamunpura 1292

114 Chanpura 1153

115 Domanpura 3423

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 Governance

There is a one municipal corporation (Nagar Palika Parisha Mau) responsible for urban

governance and provision and management of infrastructure and services. Other agencies like

Housing Board, Central and State Public Works Departments (CPWD and PWD), Transport

Department, Industries Department and the Department of Environment are also contribute in

development of Mau. 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 Mau Local level governance; Primary Collection of Solid Waste;

Maintenance of Storm Water Drains; Maintenance of municipal

roads; Allotment of Trade Licenses under the Prevention of

Food Adulteration Act; O&M of internal sewers 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

generation etc.

UP State Transport Corporation

(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

UP Pollution Control Board (UPPCB) Pollution control and monitoring especially river water quality

and regulating industries

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1.6 Access to Public Facilities

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.

Table 7: Housing Characteristics

INDICATOR %

Households living in a Pucca House (%) 37.4

Households living in a Owned House (%) 97.6

Households treating water to make it safer for drinking (%) 10.2

Households having access to toilet facility (%) 19.2

Households sharing toilet facility (%) 10.6

Households having access to electricity (%) 46.7

Households using Electricity (%) 46.7

Households using Firewood/Crop Residues/Cow Dung Cake (%) 84.4

Households using LPG/PNG (%) 12.5

Availability of Kitchen 92.2

Households having a separate Kitchen (%) 39.1

Households having Computer/laptop with or without Internet Connectivity (%)

1.1

Households having Telephone/Mobile (%) 72.5

1.8 Water Resources

Nagar Palika Parishad Mau resposible for water supply in city. City have many water tank in

various areas.

1.9 Sewerage and Sanitation Facilities

Mau has seen no major investment in sewage infrastructure. Taking into consideration the

service latrines, latrines discharging into nallas, existing public toilets and open defecation

about 40% of the population do not have access to adequate sanitation. Informal sewers

connecting a few households and discharging into nearby open drains are also seen. The

existing main network therefore is for the most part not able to handle additional load leading to

the sullage being discharged directly into the River Tamsa. In many places the sewers have

been choked by the disposal of solid waste in them as well as encroachment in sections. This

does not allow complete cleaning of the network and aggravates the problem of discharge.

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The lack of current data and information on assets severely impacts planning. While in the

newly developed and developing areas, networks are being provided by developers,

coordination with the state planning process is tenous.

1.10 Health Infrastructure

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.

First and Second Tier Health Services

The Government of Uttar Pradesh has committed itself to make provisions for health care

services to its population. Though the efforts have been rural centric some efforts have also

been made to improve 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 Department 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 centers2. Second tier health services are provided in urban areas

through District Male and Female or Combined Hospitals.

Table12: Health Structure in Mau

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.)

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1 DH Mau State Health Department

Narai Bandh Mau

499784 All Health Facilities Provided

ANM 0, LT 3, SN 11, MO 18, Specialists 14

1 X-ray, 1 USG, 1 autoclave

2 DWH Mau State Health Department

Bal Neketan

Chauraha Mau

499784

Maternal

Health, Family Planning

Female Sterlization,

Immunisation,

ANM 2, SN 2, LT 2, MO 2, Specialists

3

NA

3 UHP N.R.H.M. Bharhu Ka Pura Mau

8798 Family planning, Immunisation

ANM 1, SN 1, MO 1

NA

4 UHP N.R.H.M.

Choti

Mahraniya Mau

5297

Family

planning, Immunisation

ANM 1,

SN 1, MO 1

NA

5 Fatima Hospital

Private Near Ghazipur Tiraha Mau

278745 All Health Facilities Provided

10 MO, SN 8, ANM 8, LT 4, Specialists 5

1 X-ray, 1 USG, 1 autoclave

6 Railway Hospital

Railway

Near Railway Station Mau

25467

All Health

Facilities Provided

2 MO, 3 SN, ANM

3, LT 1, Specialists

1

1 X-ray, 1

USG, 1 autoclave

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

tier health facilities were planned for a population of 50000 but as a result of rapid population

growth they are currently serving a population of more than 75000. 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. Uttar Pradesh has eight medical colleges and one post-graduate institute

which offer tertiary and superspecialty health services.

Private Health Care providers

A large network of private providers exists along with a large number of public sector providers.

The total number of private sector doctors is estimated at 5,874 (Registered and unregistered

all inclusive). The Dai’s (TBAs) are estimated at 2,697 (Trained and untrained) Commercial

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outlets including medical shops, pharmacies etc. Unlike the distribution of public sector

providers, the highest concentration of the private providers is in the western region. The

distribution of health providers understandably has strong bearing on the health care in U.P.

Regions with lower concentration of medical providers (in proportion to population) have lower

maternal and child health care coefficient and higher unmet need for family planning services. .

2.1 Amenities and Living Conditions

About 97% households were living in their own houses. About 63% were still living in Kutcha or

Semi Pucca houses. Though almost all households had access to improved sources of

drinking water, but 10% were treating water to make it safer.

Whereas 11% were sharing toilets, still about 7% were defecating in open. About 48% had

access to electricity. Though 13% were using LPG for cooking, 84% were still using fire

wood/dung cakes/ crop residues for cooking. As high as 73% had telephones/ mobiles and

1.1% even had computers.

Table 12: Disease/Cause of Morbidity Data : Mau

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

Trauma, Cardiovascular Disease etc.)

Number of cases

admitted in 2012 Source of Data

1 Injuries and Trauma 960 CMO Office Mau

2 Self inflicted injuries/suicide Not Available CMO Office Mau

3 Cardiovascular Disease Not Available CMO Office Mau

4 Cancer (Breast cancer) Not Available CMO Office Mau

5 Cancer (cervical cancer) Not Available CMO Office Mau

6 Cancer (other types) Not Available CMO Office Mau

7 Mental health and depression Not Available CMO Office Mau

8 Chronic Obstructive Pulmonary Disease (COPD) Not Available CMO Office Mau

9 Malaria 2 CMO Office Mau

10 Dengue Not Available CMO Office Mau

11 Infectious fever (like H1N1, avian influenza, etc.) 119 CMO Office Mau

12 TB 1994 CMO Office Mau

13 MDR TB 7 CMO Office Mau

14 Diarrhea and gastroenteritis 1528 CMO Office Mau

15 Jaundice/Hepatitis 13 CMO Office Mau

16 Skin diseases Not Available CMO Office Mau

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17 Severely Acute Malnourishment (SAM) Not Available CMO Office Mau

18 Iron deficiency disorder 173 CMO Office Mau

19 Others 3952 CMO Office Mau

(Source: CMO Office Mau)

The above table reflects the health/ morbidity profile of the Mau city. As there is one source of

data, the city planning team has approached source for getting most authenticated as well as

updated data. So, data from District hospital were taken and mentioned in the above table.

2. 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

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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 Mau

17) Management of communicable & non- communicable diseases

18) Strengthening AYUSH

19) Constitution of BSGY team for urban areas.

20) Identification & management of SAM children

3. 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 operationalized

rapidly over the years.

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

Page | 22

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 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.

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.

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 optimised.

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 organisations to develop the training modules

and facilitate the trainings.

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.

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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. 15,000/- 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.

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.

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.

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.

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 counselling. The outreach sessions (both

Page | 24

routine and special outreach) could be organized at designated locations mentioned in the

aforesaid paras in coordination with ASHA and MAS members

Innovations –

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.

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 city level Urban Health Committees headed by the Municipal

Commissioner/ Deputy Commissioner/ District Collector.

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 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

3 Preparation & Finalization of Guidelines for Urban ASHAs

Page | 25

4 Preparation & Finalization of Guidelines for Mahila Arogya Samiti

across the state

5 Preparation & Finalization of Guidelines for UHND

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

7 Preparation & Finalization of Job Descriptions 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 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-

Page | 26

15

20c

- House listing of slums/ poor settlements

To continue in 2014-15

21 Planning for strengthening of health facilities/ 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 facilities 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

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4. 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.

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:

District total Urban

population

Additional Staff Proposed

1lakh to 10lakhs 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:

Page | 28

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.

Members – School Education - BSA & DIOS

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

Page | 29

5. 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) formed * 0 64 0

2. Number of MAS members trained * 0 640 0

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

0 32 0

Health Systems

4. Number of ANMs recruited * 0 25 0

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

0 28 0

6. No. of UHNDs organized in the slums and vulnerable areas * 0 114 0

7. Number of UPHCs made operational * 0 5 0

8. Number of UCHCs made operational * 0 0 0

9. No. of RKS created at UPHC and UCHC * 0 5 0

10. OPD attendance in the UPHCs 0 4500 0

11. No. of deliveries conducted in public health facilities 0 8340 0

RCH Services

12. ANC early registration in first trimester 0 8340 0

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

0 8340 0

14. TT (2nd dose) coverage among pregnant women 0 8340 0

15. No. of children fully immunised (through public health facilities) 0 8340 0

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

0 NA 0

Communicable Diseases 0

17. No. of malaria cases detected through blood examination 0 2 0

18. No. of TB cases identified through chest symptomatic 0 891 0

19. No. of suspected TB cases referred for sputum examination 0 5326 0

20. No. of MDR-TB cases put under DOTS-plus 0 7 0

Non Communicable Diseases

21. No. of Diabetes cases screened in the city 0 126 0

22. No. of Cancer cases screened in the city 0 N/A 0

23. No. of Hypertension cases screened in the city 0 N/A 0