To help urban poor go to health facilities after working hours, urban primary health centres, planned under the National Urban Health Mission (NUHM), will function from noon to 8 p.m. Out-patient departments at standard health facilities worked only in the morning; when patients had to go to work, visiting a doctor or hospital would mean losing a day’s salary, Anuradha Gupta, Additional Secretary, Ministry of Health and Family Welfare, said. Another important feature of the NUHM was the inclusion of urban-centric issues: domestic violence, sexual exploitation, HIV/AIDS, trafficking, and child and drug abuse, and gender-related matters. “These are broadly urban issues, but need to be addressed,” Ms. Gupta told The Hindu. For this, the NUHM would work in coordination with non-governmental and civil society organisations.
The NUHM, approved recently by the Cabinet, will run parallel to the National Rural Health Mission (NRHM). Reproductive and child health programmes apart, it will address communicable and non-communicable diseases, especially State-specific diseases such as sickle-cell and flourosis.
The Ministry of Health and Family Welfare started the programme on Monday, urging the States to map out slums and unlisted clusters in cities and the health facilities available there in order to identify the gaps in services, and to appoint a nodal officer for coordination. The Ministries of Housing and Urban Poverty Alleviation and Urban Development will play an important role in the implementation.
Close to 40 per cent of India’s population will live in urban centres by 2026, with 25 per cent of them being poor, and 10 per cent vulnerable such as rag-pickers, rickshaw-pullers and homeless children. This population has restricted access to facilities such as health care, housing, and sanitation, resulting in communicable and non-communicable diseases.
Statistics suggest under 5 mortality at 72.7 among urban poor is significantly higher than the urban average of 51.9, 56 per cent deliveries among the urban poor take place at home and several health indicators are worse than rural areas like 60 per cent do not receive complete immunisation, 47 per cent urban poor children are under-weight as compared to 45 per cent in rural areas and 59 per cent women (15-49 age group) are anaemic as compared to 57 per cent in rural. Even child survival in the urban poor is shamefully low with 1.3 children dying before reaching the age of five years.
In phases, the NUHM will cover all cities and towns with a population of over 50,000. Primary health centres will be set up near slums and low-income neighbourhoods. The government is open to roping in the private sector. There will be no health sub-centres. Accredited Social Health Activists will be recruited and Auxiliary Nurse Midwives drafted, one for every 1,000-2,500 slum population (200-500 slum households).