National Urban Health Mission Research Articles

Provisioning Oral Health Care through Indian Public Health Standards, 2022

The Indian Public Health Standards (IPHS) were initially developed in 2007 to provide an effective and optimal level of quality health care in our country. IPHS was later revised in 2012, and more recently, in 2022. IPHS revised guidelines for 2022 take into account several new initiatives and programs, including Ayushman Bharat Health and Wellness Centers, the introduction of the National Urban Health Mission and Urban Primary Health Centers (polyclinics) in urban areas. These revised guidelines also make provision for the delivery of oral health services at each facility level. This review highlights the oral health-care services and delivery mechanisms mentioned in all the four volumes of IPHS revised guidelines 2022 under the headings of infrastructure, human resource, service provisions and essential drugs, diagnostics, and equipment required at all the levels of health care.

Performance assessment of Accredited Social Health Activists under National Urban Health Mission in Bengaluru

ObjectivesTo assess the performance of “Accredited Social Health Activist (ASHA)” under National Urban Health Mission (NUHM) in Bengaluru. The NUHM renews and deepens the commitment and recognizes that ASHA and Mahila Arogya Samiti (MAS) are critical components towards achieving health outcomes. There has not been a systematic approach to assess their performance and this study is the first of its kind in Bengaluru City. MethodsThe study was conducted in Bengaluru among 130 ASHAs selected using Stratified Random Sampling. A pretested semi-structured questionnaire was used to interview ASHA regarding her work (involving Antenatal Care (ANC) registrations, institutional delivery, home visits, immunization, sterilization, management of childhood illness, attending monthly meetings, etc.) and tracking the incentives that she had received for work in the past one year from the database. ResultsThe mean age of 130 study participants was 36.4 ± 6.4 years. 53.8% of the study participants had scored >75% for their performance and categorized as Grade A. Out of 130 study participants, 30 (23%) had maintained the record of their claim sheets of the incentives received and among which 26.7% had received 75–100% of incentive of their work. ConclusionThe present study concluded that majority of study participants had a good performance and had been categorized as Grade A. Very small percentage of study participants maintained their records. Financial incentives and an opportunity for more exposure to health services were the main reasons among the study participants for joining as an ASHA. They received induction training before joining work, but refresher training was inadequate.

Urban health in India: from smaller steps to a big leap

The focus on urban health in India was majorly lagging in the initial years post-independence except in some specific areas like family planning during the 1st and 2nd Five Year Plans (FYPs). The subsequent FYPs too for the next ten to fifteen years did not witness any shift in focus to the diverse health-related problems in urban areas. The National Rural Health Mission in 2005 had a primary focus on rural health, with some initiatives taken up to expand health services in urban areas. However, the major milestone in urban health was the launch of the National Urban Health Mission (NUHM) in 2013, wherein urban health in India got centre stage. The COVID-19 pandemic led to an accelerated response in strengthening the health systems across the country including health infrastructure in urban areas. Overall, it can be said that urban health in the country is currently undergoing major transitions. Despite there being several issues, the reforms for assured comprehensive primary health care services seem promising in improving the status of health in urban India. Convergence with key stakeholders and other sectors beyond health would be the key to bridging the gap in addressing social determinants of health, social protection for migrants and floating population and focusing on environmental protection. Such actions would leverage enhanced health access of urban poor to quality and equitable healthcare services. The paper focuses on government policies that began prioritising urban health, the limitations of present health systems, and the roadmap to construct a much-needed future foundation for improved health outcomes in urban India.

Core interventions contributing to the effectiveness of the National Urban Health Mission in India

Core interventions contributing to the effectiveness of the National Urban Health Mission in India

Home-based newborn care (HBNC) under the national health mission in urban India - A cross country secondary analysis.

There is a paucity of evidence in the coverage of the home-based newborn care (HBNC) program delivered through the National Urban Health Mission (NUHM). Hence, an analysis was undertaken to identify gaps and progress in its implementation and inform policy and strategies to achieve universal access to newborn services. The study aimed to evaluate and understand the status of the HBNC program in urban areas of India through a health systems approach. Cross-sectional intra-country study was undertaken based on facility records and supporting literature available in the public domain. After categorizing the states into four groups, the programme's status in urban areas was analysed and presented in median and interquartile ranges. Statistical significance in the difference between the medians across the groups was checked using the Kruskal Wallis test. Overall, the median full HBNC coverage was less than one-fifth (< 20%) of the total reported live births (P = 0.17). Excepting the union territories (UTs), the median coverage was found to be less than one-fifth (< 20%) of the reported institutional deliveries (P = 0.16) and more than half (> 50%) of the reported home deliveries (P = 0.83) in urban areas. The differences in the medians across the groups were not statistically significant. The differential coverage calls for strengthening referral linkages to specialized newborn care facilities, ensuring skilled personnel at varying levels of facilities, and improving the engagement of frontline workers in urban communities under the NUHM.

Effects of COVID-19 on maternal, child healthcare (MCH) services in slums: lessons from India

BackgroundThe study aims to understand the effect of COVID lockdown on MCH for slum dwellers and coping mechanisms adopted in Indore and Agra, India. Slum women's perspectives on seeking, delaying, avoiding healthcare in COVID-19, barriers and facilitators were explored.MethodsIn-person qualitative interviews were conducted in slums in Sept-Oct 2020 with mothers who had deliveries; pregnant women needing ante-natal care; mothers with children <2 yrs needing immunization during COVID lockdown. 30 mothers requiring these MCH services during April -June 2020 (lockdown phase) were interviewed. We chose qualitative study over quantitative as a shorter and useful precedent to replicate in similar situations.ResultsGovt. and most private hospitals refused non-COVID services during lockdown.; Police restricted movement on roads. Being on COVID duty, frontline health functionaries were not doing outreach health sessions. Women missed ante-natal check-up, Iron Folate, Tetanus toxoid; Demand side challenges included fear of COVID infection, lack of money due to livelihood loss; Home deliveries by self, neighbors were resorted to; Maternal, neonatal deaths ensued; Children missed immunization e.g., Measles, DPT. Few peri-urban slum families visited nearby rural health facility for delivery. Some families borrowed money from community saving's groups for delivery in private hospitals. Few families visited low-cost private doctor/nurse for immunization of pregnant mother, children.ConclusionsDemand and supply side factors led to pregnant women and children not receiving care during lockdown. Peri-urban slum families should be encouraged to link with nearby rural health facility for MCH services during COVID-19 or similar situations. Govt. partnering with private providers near slums will help access during challenging times. Promoting community savings groups as mandated under National Urban Health Mission can enable slum families borrow with ease when in need.Key messages Government health system should set up emergency (e.g., mobile clinic) MCH services for future epidemic, disaster, should partner with private doctors/nurses near slums.Rural health infrastructure serving nearby peri-urban slums formally recognized by Govt. despite separate jurisdictions is an approach adaptable in LMIC cities.

Does engagement with frontline health workers improve maternal and child healthcare utilisation and outcomes in India?

BackgroundPoor Maternal and Child Health (MCH) outcomes pose challenges to India’s ability to attain Goal-3 of the Sustainable Development Goals (SDGs). The government of India strengthened the existing network of frontline health workers (FHWs), under its National Rural Health Mission in 2005 and subsequent National Urban Health Mission in 2013 as a strategy to mitigate the shortage of skilled health workers and to provide affordable healthcare services. However, there is a lack of robust national-level empirical analysis on the role of maternal engagement with FHWs in influencing the level of maternal and child health care utilisation and child health outcomes in India.MethodsUsing data from the nationally representative Indian National Family Health Survey (NFHS) 2015–2016, this paper aims to investigate the intensity of engagement of FHWs with married women of child-bearing age (15–49 years), its influence on utilisation of maternal and child healthcare services, and child health outcomes. Our empirical analyses use multivariate regression analyses, focusing on five maternal and child health indicators: antenatal care visits (ANC) (4 or > 4 times), institutional delivery, full-immunisation of children, postnatal care (PNC) (within 2 days of delivery), and child survival.ResultsOur analysis finds that maternal engagement with FHWs is statistically significant and a positive predictor of maternal and child health care utilisation, and child survival. Further, the level of engagement with FHWs is particularly important for women from economically poor households. Our robustness checks across sub-samples of women who delivered only in public health institutions and those from rural areas provides an additional confidence in our main results.ConclusionsFrom a policy perspective, our findings highlight that strengthening the network of FHWs in the areas where they are in shortage which can help in further improving the utilisation of maternal and child healthcare services, and health outcomes. Also, the role of FHWs in the government health system needs to be enhanced by improving skills, working environment, and greater financial incentives.

Improving Public Health Care in India through Urban Primary Health Centres-Trends, Progress and Concerns

Focus of primary health care always stood over rural health, as a result the attention on health needs of the urban deprived is constantly marginalised. Rapid urbanization imparted a serious concern over urban health and to address the health concerns of the urban poor, Government of India launched National Urban Health Mission. NUHM envisages service delivery through a network of Urban Primary Health Centres and serve the health needs of poor and vulnerable in the urban area. The implementation of the Mission and UPHC sensured a systematic representation of urban health needs of the deprived. However the activities of the urban health centres in most of the Indian states lacks adequate support, makes a barrier in their effective service delivery. Proper governance and allocation of resources is the urgent need of the hour to empower the functioning of the urban health care system in the country.

Disasters and Exemplified Vulnerabilities in a Cramped Public Health Infrastructure in India

The varied connotations to the term ‘Development’ are been channeled through perception. The perception of a political stakeholder differs from that of a rich-businessman, and again, from those who are lesser endowed. There is a pressing need for the government, to identify and maintain checks and balances between exploitative and responsive governance. The extension of the healthcare sector is an integral part of this holistic growth, while the customer base has largely financed the industry; the obligation on the hand of government needs to increase. The out of pocket spending by patients covers the finances of the sector by 64.2%. (NSSO, 2014 report). The lesser amount of government spending in the healthcare system is a drawback and has effects on the Industry in a negative frame in a large manner, only 28.6% of Total Health Expenditure is financed by Govt. of India and therefore, calls for the need for better financing mechanisms in the country in the form of insurance schemes and a smoother flow of the already existing policies and frameworks. In the debate of private v/s public hospitals, the paper presents reasons that create a barrier on effective utilization of benefits provided, and further constructs the viewpoint that though expensive, private healthcare services provide more assurance to the population in general. The over-crowding of these public institutions in times of epidemics or otherwise, is a self-indication of the dearth of infrastructure and the kind of impacts the interventions has had in terms of alleviating such grievances. The several debates that I have tried to analyze and interpret include those of the intersections the individuals of the country and the lawmakers have crossed in terms of developmental projects and whether these promises hold true in terms of concrete reality. The depth of understanding and entering these discussions is only a gateway to more pertinent questions of whether the present infrastructure has dwindled due to disasters in the past? Are we actually moving to building resiliency or is it just a mock-up present on paper only? The paper reflects qualitatively on several government reports on health and the state of the hospitals presented within various contexts of Disasters in the past. The analysis of the National Rural Health Mission, National Urban Health Mission and various others programs initiated by the Government of India and the scope that it has to remove the present day struggled faced by an over-crowded and pressurized public sector healthcare structure.

TREND AND PROJECTION OF MODERN CONTRACEPTIVE PREVALENCE RATE IN INDIA FOR FP2020 COMMITMENT

Introduction: Worldwide, India was the first country to introduce a National Programme for Family Planning in 1952. Following its memorable inception, the Family Planning project has experienced numerous changes as far as approach and real program usage. Now India has committed in the London summit 2012 for family planning programme or interventions. Family planning programme or interventions will be performed as the main component of Universal Health Coverage. It will be achieved through the largest public health programme in the world, the National Rural Health Mission (NRHM) and as well as National Urban Health Mission (NUHM). And also, India is focusing on SDG, by 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes, as imitated in Sustainable Development Goal 3.7. &#x0D; Objective: First objective is to analyses the current trend of mCPR and project it for FP2020 and second to analyze the increase in the number of users under FP2020 as per the commitment to increase additional 48 million users. &#x0D; Materials &amp; Method: We performed a secondary analysis on the data given by FP2020’s website. Which provides us information and resources on the global partnership designed for everyone working to advance access to modern contraceptives for all girls and women who want them. &#x0D; Result and conclusion: The result has estimated that the mCPR will rise to 55 percent in 2020 from 53 of 2012. But if we want to achieve the target of 175.39 (127 million users till 2012 and additional user of 48 million till 2020, which comes out to be 175 million) then we will have to increase the mCPR to 68 percent. Then only we will be able to achieve that. Otherwise the target looks unrealistic to achieve.

An epidemiological study regarding availability and utilization of public health care services in slum in Amritsar city

Background: Low level of education of the slum dwellers along-with poor socio- economic status and pathetic environmental conditions lead to their poor health indicators. Since the National Urban Health Mission (NUHM) was launched in 2013, the health services are still in their initial stages. Assessment of the availability as well as the utilization of health care services of the urban slums is the need of the hour.Methods: The cross-sectional study was conducted in randomly selected slum in Amritsar city. All the houses were enumerated and visited by the interviewer herself. The eldest adult member of the family was selected as key respondent and written, informed consent was obtained. Predesigned questionnaire was used to collect the data which was then compiled and analyzed using statistical tests.Results: Out of the total respondents, one third respondents had knowledge about the government health center nearby (statistically significant) while out of these, only one third utilized the services at the center (statistically non-significant). Almost half of the respondents had knowledge about the medical camps and out of these, two-thirds utilized the services at medical camps.Conclusions: Overall utilization of services is poor. More respondents were aware of the medical camps than the static government health facility and utilization of medical camps was also more. So the static health services under NUHM need to be further strengthened.

Basthi Dawakhana of Hyderabad: The first Urban Local Body led community clinics in India.

Basthi Dawakhana initiative was launched by the Greater Hyderabad Municipal Corporation (GHMC) in Telangana state of India, in April 2018. This article documents, reviews, and analyzes the key design aspects of Basthi Dawakhana, delve into why such clinics are important for strengthening primary health care in Indian cities and urban settings, and proposes a few strategies for implementation effectiveness. In the main text of the article, evolution of urban health services, national urban health mission in India, and Mohalla clinics of Delhi has been provided. The implementation challenges and potetnial solutions for scaling up Basthi Dawakhana have been discussed. The author argues that Basthi Dawakhana initiative is aligned with the 73rd and 74th amendments in the Constitution of India, which transferred the responsibilities for primary care and public health to the Urban Local Bodies (ULBs). The article concludes that Basthi Dawakhana are arguably the first ULB-led community clinics initiative and an opportunities for ULBs in India to lead efforts to strengthen primary healthcare. These Dawakahna along with Mohalla Clinics, can serve platform to reform urban primary healthcare services and advance universal health coverage (UHC) in the country.

Awareness and client satisfaction of the services providedunder National Urban Health Mission in an Urban PrimaryHealth Center coming under Bruhath Bengaluru MahanagaraPalike - A cross sectional study

Background Though there has been health care facilities at reachable distance due to various reasons people have not been utilizing the services to the full extent. Thus Government of India launched National Urban Health Mission NUHM as a sub-mission of National Health Mission on 1st May 2013. It provided the necessary Human Resources on contractual basis for betterment of health-care services. As it has been 5 years since implementation of NUHM this study is done to assess the awareness and client satisfaction of general public about the services provided and also to recognize the key areas which needs improvement.Objectives To assess the awareness and client satisfaction of the services provided by the Urban Primary Health Centre under NUHM. Methodology Study Design Community based Crosssectional study. Study area Urban field practice area of BMCRI Bengaluru Study Units Households coming under selected Urban Primary Health Center of BBMP. Study period was from 01092018 to 30112018. Sampling method used was systematic Random sampling. Sample size Based on the study conducted by Suresh Kumar Ray at al the sample size calculated as 345. Data collection and Analysis A face validated semi-structured questionnaire administered by interview method and Statistical analysis was done using SPSS version 20.0.Results Out of 347 households surveyed 48 167 were availing the services from UPHC. Public were aware of individual components of NUHM services to different extent. Among those availing facilities 70 118 of the households were satisfied about the health care services provided by UPHC. Among the remaining 30 49 they were unhappy about waiting time for OPD consultation 46 23 and also about distance at which health-care facilities are available 29 14. The households wanted to have more information about availability of various schemes and services provided.Conclusion Though it has been five years since the implementation of NUHM only 48 were availing the service from UPHC Sidhaiah Road and only 36 were aware of all the facilities provided under NUHM.nbsp

Internal migrants' experiences with and perceptions of frontline health workers: A nationwide study in 13 Indian cities.

The role of frontline health workers is crucial in strengthening primary health care in India. This paper reports on the extent of services provided by frontline health workers in migrants' experiences and perceptions of these services in 13 Indian cities. Cluster random sampling was used to sample 51055 households for a quantitative survey through interviewer-administered questionnaires. Information was sought on the receipt of health workers' services for general health care overall (from the head/other adult member of the household) and maternal and immunization services in particular (from mothers of children <2years old). Purposively, 240 key informants and 290 recently delivered mothers were selected for qualitative interviews. Only 31% of the total respondents were aware of the visits of frontline health workers, and 20% of households reported visits to their locality during past month. In 4 cities, approximately 90% of households never saw health workers in their locality. Only 20% of women and 22% of children received antenatal care and vaccination cards from frontline health workers. Qualitative data confirm that the frontline health workers' visits were not regular and that health workers limited their services to antenatal care and childhood immunization. It was further noted that health workers saw the migrants as"outsiders." These findings warrant developing migrant-specific health-care services that consider their vulnerability and living conditions. The present study has implications for India's National Urban Health Mission, which envisions addressing the health care needs of the urban population with a focus on the urban poor.

Urban health: Needs urgent attention.

Urban population in our country has increased at an annual rate of 2.7% during the last decade and it is estimated that by 2031, there would be about 600 million people living in urban India. The fast pace of urbanization has come to stay with increasing proportion of urban poor and vulnerable with health indicators much worse than their rural counterparts. The need to provide health care to urban poor has been emphasized in the past in various health committees' reports and National 5-year Development Plans, but no significant dent was made to improve the urban health scenario of the country. The National Urban Health Mission launched in May 2013 provides us a concrete mechanism to address special health needs of urban population with focus on urban poor. There is a strong need to set up primary healthcare system in urban areas and systematically deal with urban health challenges in terms of vector-borne diseases, rising incidence of noncommunicable diseases, air pollution and acute respiratory infections, road traffic accidents, trauma, and injuries. The initiatives to address these challenges do not remain confined to health sector alone but also need to be supported by sectors other than health such as social welfare, women and child development, road transport and highways, school education, drinking water, and sanitation. We really need to address wider and social determinants of health to effectively improve the urban health scenario.

Examining the changing health care seeking behavior in the era of health sector reforms in India: evidences from the National Sample Surveys 2004 & 2014

BackgroundHealth policy formulations in India have witnessed a shift from a reactive approach to a more proactive approach over the last decade. It is therefore important to understand the effectiveness of recent national health policies (such as the National Rural Health Mission and the National Urban Health Mission) in addressing the varied needs of the heterogeneous population of India.MethodsWe use datasets from the National Sample Surveys carried out in 2004 and 2014 to understand the change in the health seeking behavior as a result of these policies. The choice of health care facilities and the associated expenditures are compared through descriptive analyses. A multinomial logistic regression is used to identify the significant parameters which contribute towards the share of health care providers in India. The health status of two economically disparate Indian states (Bihar and Kerala) are also compared through specific metrics of performance.ResultsIt is seen that due to increased availability of facilities in close proximity, both rural and urban residents prefer to avail of those facilities which will result in minimization of transportation cost. The effectiveness of national health policies is found to vary on a regional scale. Literacy and health status have a strong correlation, thereby reinforcing that Bihar still lags far behind Kerala in terms of access to equitable health care.ConclusionTherefore, a hierarchical system, incorporating medical pluralism and tailor-made policies targeted at diverse health care demands, needs to be put in place to achieve Goal 3 of the Sustainable Development Goals as decreed by the United Nations, i.e., “health for all”.

Estimation of cost of services provided by Urban Health Centre of a medical college in North India

Introduction & Objective: Rapid urbanization is an emerging problem in India. Urban poor have adverse health indicators when compared to their rural counterparts. There is a need for understanding the allocation of costs for medical services effectively at primary care level. This study was planned to estimate the provider costs of an urban health centre (UHC) of a medical college in North India and was compared with the National Urban Health Mission standards. Methods: Cost analysis was done for the year 2015-16 using a six step process prescribed by World Health Organization. The costs were divided as capital and recurrent costs; fixed and variable costs and expressed in INR. Unit cost of services was estimated as the total annual cost per number of beneficiaries. Results: The total annual costs incurred by the urban health centre was Rs. 1,94,23,363.80 for the year 2015-16. Recurrent costs contributed most of the annual costs (57.3%) and capital costs contributed to 42.7% of the total annual costs. Most of the costs incurred by the centre were due to the salaries, land and building costs. Conclusion: It has been seen that most of the total cost incurred by the centre was not primarily related to health care provision directly. It is necessary to identify the gaps and make the services available by effectively allocating the resources.

Newborn healthcare in urban India.

The rapid population growth in urban India has outpaced the municipal capacity to build essential infrastructures that make life in cities safe and healthy. Local and national governments alike are grappling with the challenges of urbanization with thousands migrating from villages to cities. Thus, urbanization in India has been accompanied by a concentration of poverty and urban public healthcare has emerged as one of the most pressing priorities facing our country. Newborn mortality rates in urban settings are lower than rural areas, early neonatal deaths account for greater proportion than late neonatal deaths. The available evidence suggests that socio-economic inequalities and poor environment pose major challenges for newborn health. Moreover, fragmented and weak public health system, multiplicity of actors and limited capacity of public health planning further constrain the delivery of quality and affordable health care service. Though healthcare is concentrated in urban areas, delay in deciding to seek health care, reaching a source of it and receiving appropriate care affects the health outcomes disproportionately. However, a few city initiatives and innovations piloted in different states and cities have brought forth the evidences of effectiveness of different strategies. Recently launched National Urban Health Mission (NUHM) provides an opportunity for strategic thinking and actions to improve newborn health outcomes in India. There is also an opportunity for coalescence of activities around National Health Mission (NHM) and Reproductive, Maternal, Newborn and Child Health+Adolescent (RMNCH+A) strategy to develop feasible and workable models in different urban settings. Concomitant operational research needs to be carried out so that the obstacles, approaches and response to the program can be understood.

A Health Care Facility Allocation Model for Expanding Cities in Developing Nations: Strategizing Urban Health Policy Implementation

In a resource-constrained society in developing nations like India, the importance of health care infrastructure allocation is often undermined and overlooked. This paper aims to quantify the gap in accessing affordable health care facilities faced by the socio-economically weaker sections of society. Majority of the older cities in India have a central core and surrounding peri-urban areas, which were added later on to minimize the stress of urban expansion and to provide adequate infrastructure. This research states that installation of new facilities for catering to the growing needs of citizens in expanding cities is the need of the hour. We propose a novel technique for maximizing the health care coverage of the peri-urban areas by establishing the minimum number of new public health care facilities. Our aim is to suggest strategies for efficient implementation of policies such as the National Urban Health Mission and the National Health Policy. We considered Kolkata Municipal Corporation, India as a case study to assess our proposed methodology. The southern periphery, which was added in 1981 and has currently expanded again in 2015, is completely devoid of public health care facilities. Our optimization model showed that 13 new public facilities are required in the southern periphery, out of which five are extremely critical. The rise in health care coverage from 76.19 to 90.05 % by taking only the southern periphery into consideration shows the impact of the new facilities placed according to the proposed framework.

Urban Health in India

With rapid pace of urbanization, urban health has emerged as one of the most significant health themes of the decade in India. The increasing proportion of urban poor and vulnerable, with health indicators worse than their rural counterparts, face various social and financial barriers to accessing healthcare. While urban health has been emphasized over the years by various committees and five-year plans (described in detail in the article), there has been little concerted effort at the national level for providing comprehensive healthcare to the urban population, up until the launch of the National Urban Health Mission (NUHM) in 2013. As urban health infrastructure, developed under various schemes and projects in different states, is quite inconsistent across the country, covering the entire urban population with standardized services is a challenge for NUHM. Other challenges include crowding out of the urban poor from available urban facilities, multiple burden of diseases and vulnerability in urban areas and fostering coordination and convergence between various urban stakeholders including the private sector. This article describes the past and current policies on urban health, the current challenges for implementing urban health programmes in India and the way forward.