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Urban Health Care System in India

Urban Health Care System in India

National Urban Health Mission

National Urban Health Mission (NUHM) was approved by the Union Cabinet on 1st May, 2013 as a sub-mission under an overarching National Health Mission (NHM) for providing equitable and quality primary health care services to the urban population with special focus on slum and vulnerable sections of the Society.

NUHM seeks to improve the health status by facilitating their access to quality primary healthcare. NUHM covers all the cities and towns with more than 50000 population and district and state headquarters with more than 30000 population.

Urban Health programme is being implemented through Urban Local Bodies (ULBs), in seven metropolitan cities, viz., Mumbai, New Delhi, Chennai, Kolkata, Hyderabad, Bengaluru and Ahmedabad. For the remaining cities, the State Health department decides whether the Urban Health Programme is to be implemented through health department or any other urban local body.

Urban health infrastructure

The health care infrastructure in urban areas consists of the Community Health Centres and Primary Health Centres.

Population norms for urban health infrastructure

  • Community Health Centres - 2,50,000 population (5 Lakh for metros)
  • Primary Health Centres - 50,000 population

Urban Primary Health Center

In order to provide comprehensive primary healthcare services, the National Urban Health Mission aims to establish Urban Primary Healthcare Centers, not as a stand-alone health facility, but as a hub of preventive, promotive and basic curative healthcare for its catchment population.

Within its catchment area, the UPHC is responsible for providing the primary health care and public health needs of the population. The U-PHC is located preferably closer to slum or similar habitations.

The hours of operation may be such so as to enable the urban working population to conveniently access the UPHC services. States may opt for any suitable timing, providinng 8 hours of services, which are convenient to the community. It is recommended that the UPHC operates preferably from12 noon to 8 pm or in dual shifts (i.e. 8am to 12pm and 4pm to 8pm); Dual shift timing of UPHC could be flexible with the ability to be modified according to the catchment communities.

The package of services envisaged at UPHC inclusive of preventive, promotive, curative, rehabilitative and palliative care. Further, in order to strengthen Comprehensive Primary Health Care across the country through “Ayushman Bharat-HWCs”, states are upgrading their Primary Health Care centers as Health and Wellness Centres (HWCs).

Urban Community Health Centres (U-CHCs)

Urban Community Health Centre (U-CHC) is set up as a referral facility for every 4-5 U-PHCs. The U-CHC caters to a population of 250000 to 5 Lakhs. For the metro cities, UCHCs may be established for every 5 lakh population with 100 beds. In addition to primary health care facilities, it provides inpatient services, medical care, surgical facilities and institutional delivery facilities. It is a 30-50 bedded facility.

Urban - Health and Wellness Centres

In order to ensure delivery of Comprehensive Primary Health Care (CPHC) services, existing U-PHCs would be converted to Health and Wellness Centres (HWC). Services could also be provided/ complemented through outreach services, Mobile Medical Units, health camps, home visits and community-based interaction, but the principle should be a seamless continuum of care that ensures equity, quality, universality and no financial hardship.

Status of urban health care infrastructure

As on 31st March 2019, there are 5190 U-PHCs are functional in the country. Out of these U-PHCs a total of 1734 PHCs has been upgraded as HWCs. There is a shortfall of about 44.4% of U-PHCs as per the urban population norms. About 70% of UPHCs are located in the government buildings, 27% located in the rented buildings and 3% are located in the rent free buildings

As on 31st March 2019, there are 350 U-CHCs functional in urban areas of the India. About 96% of U-CHCs are located in government buildings and 4% in rented buildings.

There are 16820 HW (female)/ ANM available at the PHCs & SCs level in urban areas. There are 4457 Doctors, 3549 Pharmacists, 1933 Lab Technicians and 5938 Staff nurses available at U-PHCs. As far as vacancy is concerned there is a vacancy of 16.9% of HW (F)/ ANMs at PHCs & SCs level. There is a vacancy of 19.1% of Doctors, 21.4% of Pharmacists, 29.8% of Lab Technicians and 21.7% of Staff nurses at the U-PHCs. At U-PHC level shortfall has been observed in all the posts. There is a shortfall of 44.3% ANMs at PHCs & 57 SCs. There is a shortfall of 16.7% of Doctors, 24.3% of Pharmacists, 50.9% of Lab Technicians and 22.2% of Staff nurses at U-PHCs.

At U-CHCs there are 1017 Specialists, 713 GDMOs, 192 Radiologists, 468 Pharmacists, 447 Lab Technicians and 4618 Staff nurses available at U-CHCs. There is a vacancy of 36.9% of Specialists, 28.8% of GDMOs, 30.2% of Radiographers, 13% of Pharmacists, 17.3% of Lab Technicians and 17.6% of Staff nurses at U-CHCs. There is shortfall of 45.8% of total specialist, 24.6% of GDMOs, 48% of Radiographers, 16% of Pharmacists, 13.4% of Lab Technicians and 21.3% of Staff nurses at U-CHCs.

Source : Rural Health Statistics 2018-19, Ministry of Health and Family Welfare

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