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. However, depending on the spatial distribution of the slum population, the population covered by a U-PHC may vary from 50000 for cities with sparse slum population to 75,000 for highly concentrated slums. The U-PHC may cater to a slum population between
  25000- 30000, providing preventive, promotive and non-domiciliary curative care (including consultation, basic lab diagnosis and dispensing). 

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).

As on 31st March 2022, there are 6118 U-PHCs are functional in the country.

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. As on 31st March 2022, there are 584 U-CHCs functional in urban areas of the India.

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. All the U-PHCs are targeted to be converted into HWCs.  

Universal CPHC is planned to be provided through Urban Health and Wellness Centres (Urban HWCs) and Polyclinics, by providing support for setting up of 11,024 Urban HWCs (UHWCs) in close collaboration with Urban Local Bodies under PM-ABHIM from FY 2021-22 to FY 2025-26. Such Urban HWCs would enable decentralized delivery of primary health care services closer to people, thereby increasing reach of the public health systems to the vulnerable and marginalized. 

Status of urban health care infrastructure

As on 31st March 2022, there are total 6118 U-PHCs functional in India and there is a shortfall of 39.7% of U-PHCs as per the urban population norms. About 63.9% of U-PHCs are located in the government buildings, 26.9% located in the rented buildings and 9.2% are located in the rent free buildings.

Similarly, there are 584 U-CHCs functional in the country as on 31st March 2022. About 93.7% of U-CHCs are located in government buildings, 2.1% in rented buildings and 4.3% are located in the rent free buildings.

There are 21501 HW (female)/ ANM available at the PHCs level in urban areas. There are 7315 Doctors, 5029 Pharmacists, 4361 Lab Technicians and 9467 Staff nurses available at UPHCs. As far as vacancy is concerned there is a vacancy of 13.4% of HW (F)/ ANMs at PHCs level. There is a vacancy of 18.8% of Doctors, 16.8% of Pharmacists, 16.8% of Lab Technicians and 19.1% of Staff nurses at the U-PHCs. At U-PHC level shortfall has been observed in all the posts. There is a shortfall of 35.5% ANMs at PHCs. There is a shortfall of 5.0% of Doctors, 24.5% of Pharmacists, 29.1% of Lab Technicians and 1.2% of Staff nurses at U-PHCs.

At U-CHCs there are 1278 Specialists, 1568 GDMOs, 358 Radiographers, 840 Pharmacists, 902 Lab Technicians and 6121 Staff nurses available at U-CHCs. Also, there are 294 Anaesthetists and 52 Eye Surgeons available at U-CHCs as on 31st March 2022. There is a vacancy of 37.6% of Specialists, 25.6% of GDMOs, 32.2% of Radiographers, 18.0% of Pharmacists, 19.1% of Lab Technicians and 19.3% of Staff nurses at U-CHCs. There is shortfall of 46.9% of total specialist, 14.7% of GDMOs, 49.3% of Radiographers, 3.9% of Pharmacists, 7.2% of Lab Technicians and 5.3% of Staff nurses at U-CHCs

Source : Rural Health Statistics 2021-22, Ministry of Health and Family Welfare