Urban Health Mission1

No.
L 1907/1/2008-UH
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Annexure
NATIONAL URBAN
HEALTH MISSION
FRAMEWORK FOR
IMPLEMENTATION
MINISTRY OF HEALTH AND FAMILY WELFARE
GOVERNMENT OF INDIA
OCTOBER 2012
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TABLE OF CONTENTS
S.No. Chapter Page No.
1 Executive Summary 3
2 The Urban Health Context – A Situation Analysis 12
3 Key Public Health Challenges in Urban Areas 31
4 Defining the Poor in Urban Areas 37
5 NUHM- Goals, Objectives, Strategies and Outcomes 38
6 Convergent Action in Urban Areas 45
7 Institutional Arrangements for Implementation 57
8 Broad Norms for NUHM Interventions 79
9 Financial Resource Needs for NUHM 83
10 Planning Process of NUHM 86
11 Appraisal and Approval Process of NUHM 87
12 Role of the Non Governmental Sector in NUHM 89
13 Role of Regulation and Defining Standards 90
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I - EXECUTIVE SUMMARY
1.1 As per Census 2001, 28.6 crore people live in urban areas. The urban population
has increased to 37.7 crore in 2011. Urban growth has led to rapid increase in number of
urban poor population, many of whom live in slums and other squatter settlements. As
per Census 2001, 4.26 crore people lived in slums spread over 640 towns/ cities having
population of fifty thousand or above. In the cities with population one lakh and above,
the 3.73 crore slum population (in 2001) was expected to reach 7.66 crore by 2011, thus
putting greater strain on the urban infrastructure which is already overstretched. As per
the United Nations projections, if urbanization continues at the present rate, then 46%
of the total population will be in urban regions of India by 2030. While the Jawahar Lal
Nehru Urban Renewal Mission is beginning to tackle the urban infrastructure issues,
urban health issues need immediate attention, especially in the context of the urban
poor. It also needs attention from a public health perspective.
1.2 As per Census 2011, population of India has crossed 121 crores with the urban
population at 37.7 cores which is 31.16% of the total population.
1.3 Despite the supposed proximity of the urban poor to urban health facilities their
access to them is severely restricted. This is on account of their being “crowded out”
because of the inadequacy of the urban public health delivery system. Ineffective
outreach and weak referral system also limits the access of urban poor to health care
services. Social exclusion and lack of information and assistance at the secondary and
tertiary hospitals makes them unfamiliar to the modern environment of hospitals, thus
restricting their access. The lack of economic resources inhibits/ restricts their access to
the available private facilities. Further, the lack of standards and norms for the urban
health delivery system when contrasted with the rural network makes the urban poor
more vulnerable and worse off than their rural counterpart. Many components of the
National Rural Health Mission cover urban areas as well. These include funding
support for the Urban Health and Family Welfare Centres and Urban Health Posts,
funding of National Health Programmes like TB, immunization, malaria, etc., urban
health component of the Reproductive and Child Health Programme including support
for Janani Suraksha Yojana in urban areas, strengthening of health infrastructure like
District and Block level Hospitals, Maternity Centres under the National Rural Health
Mission, etc. The only limitation has been the fact that norms for urban area primary
health infrastructure were not part of the NRHM proposal, setting a limit to support for
basic health infrastructure in urban areas, under the NRHM. Municipal Corporations,
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Municipalities, Notified Area Committees and Nagar (Town) Panchayats were not units
of planning under NRHM, with their own distinctive normative framework.
1.4 The urban poor suffer from poor health status. As per NFHS III ( 2005-06) data
under 5 Mortality Rate (U5MR) among the urban poor at 72.7, is significantly higher
than the urban average of 51.9, More than 46% of urban poor children are underweight
and almost 60% of urban poor children miss total immunization before completing 1
year. Poor environmental condition in the slums along with high population density
makes them vulnerable to lung diseases like Asthma, Tuberculosis (TB) etc. Slums also
have a high-incidence of vector borne diseases (VBDs) and cases of malaria among the
urban poor are twice as high as other urbanites.
1.5 In order to effectively address the health concerns of the urban poor population,
the Ministry proposes to launch a National Urban Health Mission (NUHM). The
Mission Steering Group of the NRHM will be expanded to work as the apex body for
NUHM also. Every Municipal Corporation, Municipality, Notified Area Committee,
and Town Panchayat will become a unit of planning with its own approved broad
norms for setting up of health facilities. The separate plans for Notified Area
Committees, Town Panchayats and Municipalities will be part of the District Health
Action Plan drawn up for NUHM. The Municipal Corporations will have a separate
plan of action as per broad norms for urban areas. The existing structures and
mechanisms of governance under NRHM will be suitably adapted to fulfill the needs of
NUHM also.
1.6 The planning process as per broad approved norms for urban areas will be
started in all Municipal Corporations, Municipalities, NACs and Town Panchayats in
the current financial year. The District Health Society will function as the coordinating
body at the district level for urban health also. Urban Health Mission will be
implemented through the Health Department in the urban local bodies except the very
large ones where in the view of the State Government this can be handed over to the
Municipal Corporation or any other urban local body. In such cases, a society will be
formed and registered in the concerned urban body for implementing urban health
activities, which will receive funds from the State Health Society. SHS and the society
formed in the designated urban local body will enter into a bipartite MOU regarding
the implementation of NUHM and periodical reporting and review of the progress.
1.7 The treatment of seven metropolitan cities, viz., Mumbai, Newe Delhi, Chennai,
Kolkata, Hyderabad, Bengaluru and Ahmedabad will be different. These cities are
expected to manage the NUHM through their Municipal Corporations directly. Funds
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will be transferred to them through the State Health Society on the basis of their PIPs
approved by the GoI.
1.8 Planning process in urban areas will be more complex as in many cases capacity
building for public health activities needs to be taken up in urban local bodies. Also, the
possibility of seeking partnerships with the non-governmental sector needs to be
explored very closely as urban areas have the advantage of large scale presence of non
governmental providers of health care. The planning process will also have to
undertake large scale community level activities. The identification and involvement of
Non Governmental organizations in community processes will have to be developed in
the preparatory planning process itself. The initiatives under the National Urban Health
Mission will seek to strengthen the public health thrust in urban local bodies, besides
providing for cost of health care for the urban poor. The focus of the National Urban
Health Mission will clearly be on alleviating the distress and duress of the urban poor
in seeking quality health services.
1.9 Thus during the Mission period all 779 cities with a population of above fifty
thousand and all the district and state headquarters (irrespective of the population size)
would be covered. This will be in partnership with the NRHM’s efforts so far to ensure
that there is no duplication of services. Urban areas with population less than 50,000
will be covered through the health facilities established under the National Rural
Health Mission (NRHM).
1.10 The NUHM would have high focus on:
1.10.1 Urban Poor Population living in listed and unlisted slums

1.10.2 All other vulnerable population such as homeless, rag-pickers, street
children, rickshaw pullers, construction and brick and lime kiln workers,
sex workers, and other temporary migrants.
1.10.3 Public health thrust on sanitation, clean drinking water, vector control,
etc.
1.10.4 Strengthening public health capacity of urban local bodies.
1.11 The National Urban Health Mission therefore aims to address the health
concerns of the urban poor through facilitating equitable access to available health
facilities by rationalizing and strengthening of the existing capacity of health delivery
for improving the health status of the urban poor. This will be done in a manner to
ensure that well identified facilities are set up for each segment of target population,
which can be accessed conveniently. Partnerships with all efforts made for community
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buildings under various urban area programmes will be accessed to ensure full
utilization of created infrastructure. Similarly, the communitisation process will draw
heavily on the existing community organizations and self – help groups developed
through other initiatives.
1.12 Acknowledging the diversity of the available facilities in the cities, flexible city
specific models led by the urban local bodies would be needed. The NUHM will
leverage the institutional structures of NRHM for administration and operationalisation
of the Mission. It will also establish synergies with other programmes with similar
objectives like JnNURM, SJSRY, and ICDS to optimize the outcomes.
1.13 The National Urban Health Mission will provide flexibility to the States to
choose which model suits the needs and capacities of the states to best address the
healthcare needs of the urban poor. Models will be decided through community led
action. For strengthening the extant primary public health systems, NUHM based on
the key characteristics of the existing urban health delivery system proposes a broad
framework rationalizing the available manpower and resources, improving access
through a communitised risk pooling mechanism and enhance participation of the
community in planning and management of the health care service delivery by
ensuring a community link volunteer (urban Accredited Social Health Activist-ASHA
Link Workers from other programs like JnNURM, ICDS etc.) and establishment of Rogi
Kalyan Samitis (RKS), ensuring effective participation of urban local bodies and their
capacity building along with key stakeholders, and by making special provision for
inclusion of the most vulnerable amongst the poor, development of e-enabled
monitoring system. The quality of the services provided will be constantly monitored
for improvement (IPHS/ Revised IPHS for Urban areas etc.).
1.14 All the services delivered under the urban health delivery system through the
Urban-PHCs and Urban-CHCs will be universal in nature, whereas the outreach
services will be targeted to the target groups (slum dwellers and other vulnerable
groups). Unlike rural areas, Sub-centres will not be set up in the urban areas as
distances and mode of transportation are much better here. Outreach services will be
provided through the Female Health Workers (FHWs), essentially ANMs with an
induction training of three to six months, who will be headquartered at the Urban
PHCs. These ANMs will report at the U-PHC and then move to their respective areas
for outreach services (including school health) on designated days. They will be
provided mobility support for providing outreach services. On other days, they will
conduct Immunization and ANC clinics etc. at the U-PHC itself.
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1.15 Empowerment of community through awareness generation, whereby they are

able to demand services from the Health System will be an important area of emphasis
in the NUHM. An effort to ensure a change in the health seeking behavior of the
community where they get into the habit of accessing the health facilities rather than
expecting everything at their doorsteps will be made.
Diagram: Urban Health Care Delivery Model
Referral
Public or
empanelled
Secondary/
Tertiary private
Providers --------------------
Urban Health Centre (One for
about 50,000 population Primary
including 25-30000 slum Level
population)
Strengthened existing Public Health Health Care
Care Facility for extending services
FFFFF
Facility
to unserved areas
FFLthousand slum population)*
--------------------
Community Outreach Service
Community
(Outreach points in government/ public domain Empanelled
private services provider) school health services Level
Urban Social Health Activist(200-500 HH)

* This may be adapted flexibly based on spatial situation of the city
Mahila Arogya Samiitee (20-100HH)
1.16 The NUHM would encourage the effective participation of the community in
planning and management of health care services. It would promote a community
health volunteer - Urban Social Health Activist (ASHA) or Link Worker (LW) in urban
poor settlements (one ASHA for 1000-2500 urban poor population covering about 200 to
500 households); ensure the participation by creation of community based institutions
like Mahila Arogya Samiti (50-100 households) and Rogi Kalyan Samitis. However, the
States will have the flexibility to take the work of motivating community from the
Mahila Arogya Samitis (MAS) and in that case recruiting an ASHA may not be
necessary. The performance-based incentives can be credited to the account of MAS in
that case, which can be used to enhance the revolving fund or distributing some
honorarium to the most active members. Existing women groups under the JnNURM
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etc. and other like structures can be adopted for implementation of NUHM. Self-help
groups of women made under programmes of urban development department etc. can
also play the role of MAS.
1.17 NUHM would proactively reach out to urban poor settlements by way of regular
outreach sessions and monthly health, sanitation and nutrition day. States would be
encouraged to involve NGOs to facilitate communitization process, build the capacity
of ASHA and MAS and carryout IEC/BCC activities. It mandates special attention for
reaching out to other vulnerable sections like construction workers, rag pickers, sex
workers, brick kiln workers, rickshaw pullers and street children. This could be done
through the public healthcare systems or through PPP or other innovative models
deemed suitable by the states. ANM will also be provided with mobility support to
reach out the un-reached area and vulnerable population with outreach session.
Communication facility in the form of Closed User Group (CUG) will be made
available.
1.18 The NUHM would provide annual grant of Rs.5000 to the MAS every year. This
amount can be used for conducting fortnightly/monthly meetings of MAS, sanitation
and hygiene, meeting emergency health needs etc. To build the capacity of MAS
quarterly orientation workshops on the subject of the Group organization, governance
and management of the group, Leadership skills etc. would be organized in the first
year, and thereafter once a year.
1.19 In case, ASHA is recruited, she will be required to organize orientation meetings
of the MAS or else, this work can be handed over to NGOs also.
1.20 The National Urban Health Mission would leverage as far as possible the
institutional structures of the NRHM at the National, State and District level for
operationalisation of the NUHM. However, in order to provide dedicated focus to
issues relating to Urban Health the institutional mechanism under the NRHM at
various levels would be strengthened for NUHM implementation.
1.21 The National Urban Health Mission would promote the role of the urban local
bodies in the planning and management of the urban health programmes. The NUHM
would also incorporate and promote transparency and accountability by incorporating
elements like health service delivery charter, health service guarantee, concurrent audit
at the levels of funds release and utilization.
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1.22 NUHM would aim to provide a system for convergence of all communicable and
non-communicable disease programmes including HIV/AIDS through integrated
planning at the City level. The objective would be to enhance the utilization of the
system through the convergence mechanism, through provision of a common platform
and availability of all services at one point (U-PHC) and through mechanisms of
referrals. The existing IDSP structure would be leveraged for improved surveillance.
The management, control and supervision systems however would vest within the
respective divisions but urban component /funds within the programmes would be
identified and all services will be sought to be converged /located at U-PHC level.
Appropriate convergences and mechanisms for co-locations and strengthening would
be sought with the existing systems of AYUSH at the time of operationalisation. NUHM
will not provide for contractual staff of AYUSH as is the case with NRHM.
1.23 NUHM will specifically address the peculiarities of urban health needs, which
constitutes non-communicable diseases (NCDs) as a major proportion of the burden of
disease. The primary health care system being envisaged under NUHM will screen,
diagnose and refer the cases of chronic diseases to the secondary and tertiary level
through a system of referral. Hence, strengthening of healthcare facilities in secondary
and tertiary care also needs substantial upgradation.
1.24 The effective implementation of the above strategies would require skilled
manpower and technical support at all levels. Hence the National Urban Health
Mission would ensure additional managerial and financial resources at all levels.
1.25 The urban areas need a thrust on enhancing public health capacity of urban local
bodies. The NUHM will systematically work towards meeting the regulatory,
reformatory, and developmental public health priorities of urban local bodies. It will
promote convergent and community action in partnership with all other urban area
initiatives. Vector control, environmental health, water, sanitation, housing, all require a
public health thrust. NUHM will provide resources that enable communitization of
such processes. It will provide resources that strengthen the capacity of urban local
bodies to meet public health challenges.
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Urban Health Care Facilities
U-CHC
Inpatient facility, 30 -50 bedded (100
bedded in metros)
For every
*Only for cities with a population of
2.5 lakh above 5 lakhs
population (5
lakh for metros)
U-PHC
MO I/C - 1
2nd MO (part time) - 1
Nurse - 3
LHV - 1-2
Pharmacist - 1
For every 50,000
population ANMs - 3-5
Public Health Manager/ Mobilization
Officer – 1
Support Staff - 3
M & E Unit - 1
1 ANM
For every 10,000
population Outreach sessions in area of
every ANM on weekly basis
200- 500 HHs

Community Health Volunteer
(1000-2500
(ASHA/ASHA/LW)
population)
50-100 HHs Mahila Arogya Samiti

(250-500
population)
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States/ UTs wise Urban and Slum Population in India 2001
Percentage of slum
population to total
Number
Population of
of cities/
S. India/States/ Total urban cities/ towns Total Slum Population
towns
No. UTs population reporting Population of cities/
reporting Urban
slums towns
slums Population
reporting
slums
1 2 3 4 5 6 7
India 640 283,741,818 184,352,421 42,578,150 15.0 23.1
1 Andhra 77 20,808,940 16,090,585 5,187,493 24.9 32.2
Pradesh
2 Assam 7 3,439,240 1,371,881 82,289 2.4 6
3 Bihar 23 8,681,800 4,814,512 531,481 6.1 11
4 Chattisgarh 12 4,185,747 2,604,933 817,908 19.5 31.4
5 Goa 2 670,577 175,536 14,482 2.2 8.3
6 Gujarat 41 18,930,250 12,697,360 1,866,797 9.9 14.7
7 Haryana 22 6,115,304 4,296,670 1,420,407 23.2 33.1
8 Jammu & 5 2,516,638 1,446,148 268,513 10.7 18.6
Kashmir
9 Jharkhand 11 5,993,741 2,422,943 301,569 5 12.4
10 Karnataka 35 17,961,529 11,023,376 1,402,971 7.8 12.7
11 Kerala 13 8,266,925 3,196,622 64,556 0.8 2
12 Madhya 43 15,967,145 9,599,007 2,417,091 15.5 25.2
Pradesh
13 Maharashtra 61 41,100,980 33,635,219 11,202,762 27.3 33.3
14 Meghalaya 1 454,111 132,867 86,304 19 65
15 Orissa 15 5,517,238 2,838,014 629,999 11.4 22.2
16 Punjab 27 8,262,511 5,660,268 1,159,561 14 20.5
17 Rajasthan 26 13,214,375 7,668,508 1,294,106 9.8 16.9
18 Tamil Nadu 63 27,483,998 14,337,225 2,866,893 10.4 20
19 Tripura 1 545,750 189,998 29,949 5.5 15.8
20 Uttar Pradesh 69 34,539,582 21,256,870 4,395,276 12.7 20.7
21 Uttarakhand 6 2,179,074 1,010,188 195,470 9 19.3
22 West Bengal 59 22,427,251 15,184,596 4,115,980 18.4 27.1
23 A&N Island 1 116,198 99,984 16,244 14 16.2
24 Chandigarh 1 808,515 808,515 107,125 13.2 13.2
25 Delhi 16 12,905,780 11,277,586 2,029,755 15.7 18
26 Pondicherry 3 648,619 513,010 73,169 11.3 14.3
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2 - THE URBAN HEALTH CONTEXT – A SITUATION ANALYSIS

Table 2.1: THE URBAN CONTEXT
Census 2001 28.6 Crore in urban areas 430 towns with 1,00,000
4.26 Crore people in slums and more population
Projected figures 35.7 Crore urban population in 46% population will be
2011 urban by 2030
43.2 Crore urban population in Growth of urban
2021 population is double of
7.66 Crore urban slum rural population
population in 2011
Table 2.2: ANNUAL POPULATION GROWTH RATE
ALL INDIA 2%
URBAN INDIA 3%
MEGA CITIES 4%
SLUM POPULATION 5-6%
Table 2.3: URBAN AREAS COVERED UNDER N.U.H.M
TOWN PANCHAYATS
NOTIFIED AREA COMMITTEES
MUNICIPALITIES
MUNICIPAL CORPORATIONS
Table 2.4: CITIES COVERED UNDER N.U.H.M
MEGA CITIES 7 – GREATER MUMBAI, KOLKATA,

DELHI, CHENNAI, BENGALURU,
HYDERABAD, AHMEDABAD
MILLION PLUS CITIES 40
CITIES WITH POPULATION BETWEEN 1- 552

10 LAKHS
CITIES WITH POPULATION BETWEEN 604
50,000 TO 1 LAKH
* The number of cities has been estimated based upon projections using the Census 2001
data.
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Box 2.1: HEALTH CONDITION OF THE URBAN POOR
◙ U5MR of 72.7 against urban average of 51.9

◙ 46% underweight children among urban poor – urban average – 32.8%
◙ 46.8% women with no education; urban average 19.3%
◙ 44.4% institutional deliveries; urban average – 67.5%
◙ 71.4% anaemic among urban poor; urban average – 62.9%
◙ 18.5% urban poor have access to piped water supply; urban average – 50%
◙ 60% miss total immunization before completing one year.
◙ Poor environmental condition with high population density – lung diseases, TB, etc.
◙ Poor access to safe water and sanitation – water-borne diseases, diarrhea, dysentery
◙ High incidence of vector borne diseases among urban poor
Table 2.5: Cause of Death in Rural & Urban Areas
Source: Report on Causes of Deaths in India (2001-2003), based on SRS, RGI, India
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Table 2.6: Age-wise causes of Death (%), Urban India
0-4 5-14 15-24 25-69 70+

years years years years years
Cardiovascular Diseases --- --- 7.6 32.8 34.7
Malignant and other
neoplasms --- 3.8 5.3 11.3 5.6
COPD, Asthma and other
respiratory diseases --- --- --- 7.7 10.6
Tuberculosis --- --- 8.1 7.7 2.9
Senility --- --- --- --- 14.3
Diarrheal diseases 13.2 17.4 --- --- 5
Unintentional injuries: Other 3.1 14.7 11.2 3.6 4.5
Symptoms signs and ill-
defined conditions 3.6 5.9 8.4 4.3 3.8
Digestive diseases 3.5 5.8 ---
Respiratory infections 19.5 8.3 --- --- ---
Perinatal Conditions 35.7 --- --- --- ---
Other infectious and parasitic
diseases 8.8 12.4 4.3 --- ---
Congenital anomalies 5.2 --- --- --- ---
Nutritional deficiencies 3.1 --- --- --- ---
Malaria 1.2 5.9 3.5 --- ---
Fever of Unknown origin 1.2 --- --- --- ---
Motor Vehicle Accidents --- 4.4 11.8 3.7 ---
Intentional self harm --- 3.2 13.1 --- ---
Maternal Conditions --- --- 3.7 --- ---
Genito-Urinary diseases --- --- --- 3.3 2.8
Diabetes Mellitus --- --- --- 2.8 3.4
Source: Report on Causes of Deaths in India (2001-2003), based on SRS, RGI, India
Table 2.7: STATES WITH HIGHEST AND LOWEST RATES OF URBAN POVERTY
HIGHEST RATES OF URBAN POVERTY LOWEST RATES OF URBAN POVERTY

BIHAR – 43.7% NAGALAND – 4.3%
ORISSA – 37.6% HIMACHAL PRADESH- 4.6%
MADHYA PRDESH-35.1% MIZORAM – 7.9%
UTTAR PRADESH- 34.1% PUDUCHERRY – 9.9%
*Source; Expert group – Planning Commission- 2009.
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Box 2.2: Findings of some studies regarding urban areas
 The estimated prevalence of coronary heart disease is around 3-4% in rural areas
and 8-10% in urban areas among adults older than 20 years, representing a
twofold rise in rural areas and a six fold rise in urban areas over the past four
decades. [Responding to the threat of chronic diseases in India: K. Srinath
Reddy, Bela Shah, Cherian Varghese, Ambumani Ramadoss, The Lancet, October
2005];
 The age adjusted incidence rates in men vary from 44 per 100000 in rural
Maharashtra to 121 per 100,000 in Delhi [National Cancer Registry Programme of
ICMR];
 Prevalence of diabetes in adults estimated to be 3.8% in rural areas and 11.8% in

urban areas [ICMR – Recent surveys];
 Prevalence of hypertension has been reported to range between 20-40% in urban

adults and 12-17% among rural adults [Lancet 2005; Global burden of
hypertension – Analysis of world wide data];
 66.6 lakh cases of Asthma in urban areas in India in 2011 – to rise to 73.2 lakhs
cases to 2016;
 Dental caries more prevalent in urban areas;
 Higher rates of traffic accidents in urban areas;
 Higher rates of domestic violence in cities;
 High incidence of mental health cases [Reddy and Chandra Shekhar 1998];
 Drugs, Tobacco and alcohol abuse in urban areas
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Box 2.3: Current status of the private sector in India
The private sector consists largely of sole practitioners or small nursing homes having
1-20 beds, serving an urban and semi-urban clientele and focused on curative care.
A survey of the qualified provider markets in eight middle-ranging districts:
Khammam (AP), Nadia (WB), Jalna (MH), Kozhikode (Kerala), Ujjain (MP), Udaipur
(RJ), Vaishali (BH) and Varanasi (UP) showed (National Commission on Macro
Economics and Health; 2005):
1. A highly skewed distribution of resources — 88% of towns have a facility compared

to 24% in rural areas, with 90% of the facilities manned by sole practitioners.
2. The private sector has 75% of specialists and 85% of technology in their facilities.
3. The private sector account for 49% beds and an occupancy ratio of 44% whereas the
occupancy rate is 62% in the public sector.
4. 75% of service delivery for dental health, mental health, orthopedics, vascular and
cancer diseases and about 40% of communicable diseases and deliveries are provided
by the private sector.
An overview of the private sector:
1. Serious supply gaps and distributional inequities;
2. Need for uniform standards and treatment protocols;
3. Need for cost controls and quality assurance mechanisms;
4. Regulations to protect consumer interests and enforcement systems;
5. Supporting the NGO/charitable or the third sector, which has the capability to
provide reasonable quality care at affordable rates and the potential to serve the poor in
under-served areas if appropriately incentivized and supported.
[[
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2.1 Expenditure on Health Care
2.1.1 As per consumer expenditure data, households spend 5-6% of their total
expenditure and 11% of non-food consumption expenditure on health. Data also show
an increasing growth rate of 14% per annum in household health spending. It may be
noted that almost half the spending was just on outpatient care.
2.1.2 There are wide variations in household spending across states. While Kerala
spends an average of Rs. 2548 ( 2004-05 current prices) per capita per annum,
households in Bihar, one of the poorest and most backward state spent Rs. 1021 per
capita per annum accounting for 90% of the total health expenditure in the state during
the year 2004-05.
2.1.3 A survey of households conducted by the IIHMR, Jaipur (IIHMR 2000) showed
that a married woman in the age group of 15-49 years spent an average of Rs 400 for
RCH services (amounting to 10 days wage), with urban households spending Rs 604
and rural households about Rs 292. The study also showed that the reluctance of
women for institutional deliveries and the persistently high proportion of domiciliary
deliveries is driven by cost factors : delivery in a public hospital costs an average of Rs
601, private hospital about Rs 3593, while home only Rs 93. The major item of
expenditure was also found to be drugs, which constituted 62%.
2.1.4 Drugs are one of the three cost drivers of the health care system. On the demand
side, drugs and medicines form a substantial portion of the out-of-pocket (OOP)
spending on health by households in India. Estimates from the National Sample Survey
(NSS) for the year 1999-2000 suggest that about half of the total OOP expenditure is on
drugs. In rural India, the share of drugs in the total OOP is estimated to account for
nearly 83%, while in urban India, it is 77%. The share of drugs in the total inpatient
treatment in rural and urban India is around 56% and 47%, respectively for the same
period.
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2.2 The Urban Poor and the Private Health Sector
2.2.1 The burgeoning 80 million urban poor in India struggle for basic services like
housing, water and sanitation. The links between these contextual forces and health
outcomes is manifest not only in the striking differentials in health among urban poor
and non-poor groups but in health indicators of the urban poor which are comparable
to, and in many cases, worse off than, the poor living in rural areas of the country.
Despite the presence of a vast public health network, in the absence of urban primary
health care services, the private sector assumes prominence in the health seeking
behaviour of this sub-population. One of the largest private healthcare sectors in the
world, it encompasses a wide range of players.
2.2.2. The private sector that the poor access may be thought of consisting of three
wings:
2.2.2.1 the fully-organized-and-fully qualified;
2.2.2.2 the fully qualified private providers that operate in less than well to do
neighborhoods where the slum population too go; and
2.2.2.3 the ‘less-than-fully-qualified’ practitioners in the slum.
2.2.3 The last group comprises practitioners who are either untrained or minimally
trained in any system of medicine or trained in one system and practice another. It is
estimated that these untrained, unlicensed practitioners in the country outnumber
qualified medical doctors by at least 10:1.
2.2.4 Although a large majority of them operate in rural areas, urban areas too are
witnessing increasing numbers of these untrained practitioners as we see in the report.
[Health of the Urban Poor and Role of Private Practitioners: The Case of a Slum in Delhi
– Nupur Barua, Jens Seeberg, Chandrakant S. Pandav, Centre for Community Medicine,
AIIMS in collaboration with ICCIDD, New Delhi, 2009]
2.3 Public Sector Provisioning for health care in urban areas
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2.3.1 While the Constitution mandates the role of urban local bodies in the
management of primary health care, there are a variety of models in the country today.
Teams from the Ministry were sent to a diversity of States and urban situations to
understand the management of health care in urban areas at present. The Table below
captures the key findings.
2.4 City wise description of health care system
Group Cities Type of Health Gaps and Constraints

care System of
the ULBs
A IPP CITIES Three tier Inequitable spatial distribution of

structure facilities with multiple service
Mumbai, comprising of providers
Bengaluru, UHP/ UFWC
Hyderabad and Unsuitable timings and distance
Dispensary/ from urban poor areas,
Delhi,
Maternity Overload on tertiary institutions
Kolkatta, Homes/ and and under utilized primary
Tertiary / institutions primarily due to weak
Chennai Super-speciality referral system.
Hospitals.
Non integrated service delivery
Community with focus mostly on RCH
level volunteers. activities, very few lab facilities,
Presence of vast shortage of medicines, drugs,

network of equipment, limited capacity of
private health care professionals and
providers demotivation.
/NGOs and Skewed priority to the tertiary
Charitable sector by the ULBs,
trusts
High turnover of medical
professionals, issues of career
progression, incentives and
salaries, disconnect between
doctors on deputation and
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care System of
the ULBs
municipal doctors
Limited community linkages and

outreach
Limited identification of the urban

poor for health
In many instances the first

interface is with non-qualified
medical practitioners
B Surat, UHP/UFWCs, The Health care delivery

Dispensary / infrastructure is better planned
Thane, Maternity and managed due to personal
Ahemdabad Homes / initiative of the ULBs. However
Tertiary the aforesaid constraints remain.
Hospitals.
C Agra UHP/UFWC / Dependent on State support for

a few Maternity health activities in the cities
Indore Homes
Weak fiscal capacity of the ULBs to
Patna Presence of plan for urban health.
Chengelpet private
providers Health low on priority of ULBs
Madhyamgram except in Madhyamgram
, Few NGOs and
Charitable Poor availability of doctors and
Bhuwaneshwar trusts staff in facilities. Few found
relocated to secondary and tertiary
Udaipur, facilities. Poor state of
infrastructure in the facilities
Jabalpur,
Cuttack
Guwahati
Raipur
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care System of
the ULBs
D Ranchi, UFWC/ UHP Non-existent urban local body
Large presence
of Charitable
and NGOs Limited State level initiatives
2.5 Central Assistance for primary health care

[
2.5.1 The process of developing a health care delivery system in urban areas has not as
yet received the desired attention. The Tenth Plan Document observes that ‘unlike the
rural health services there have been no efforts to provide well-planned and organized
primary, secondary and tertiary care services in geographically delineated urban areas.
As a result, in many areas primary health facilities are not available; some of the
existing institutions are underutilized while there is over-crowding in most of the
secondary and tertiary centres’.1
2.5.2 The Government of India in the First Five Year Plan established 126 urban clinics
of four types to strengthen the delivery of Family Welfare services in urban areas. In
1976 these were reorganized into three types by the Department with a staffing pattern
as indicated in the table below; at present there are 1083 centres functioning in various
states and UTs2. An amount of Rs. 520.40 crores has been proposed in the XIth Plan for
sustaining the already ongoing activities and payments for heads like salary.
1
Planning Commission, Government of India ; Tenth Plan Document (2002-2007, Volume II)
2
MOHFW, GOI : Annual Report on Special Schemes, 1999-2000,
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Table 2.8: Types of Urban Family Welfare Centres (UFWC)
Category Number Popn. Covered UFWC Staffing Pattern

(in ‘000)
Type I 326 10-25 ANM (1) / FP Field Worker Male (1)
FP Ext. Edu./LHV (1) in addition to

Type II 125 25-50
the above
MO – Preferable Female (1), ANM

Type III 632 Above 50
and Store Keeper cum Clerk (1)
TOTAL 1083
Source: MOHFW, GOI: Annual Report on Special Schemes, 2000
2.5.3 On the recommendations of the Krishnan Committee, under the Revamping

scheme in 1983, the Government established four types of Urban Health Posts (UHP) in
10 States and Union Territories with a precondition of locating them in slums or in the
vicinity of slums. The main functions of the UHPs are to provide outreach, primary
health care, and family welfare and MCH services. The table below details the
manpower along with the population coverage of health posts. At present there are 871
health posts in various states and UTs3, functioning not very satisfactorily. An amount
of Rs. 438.44 crore has been proposed in the XIth Plan for sustaining the already
ongoing activities and payments for heads like salary.
Table 2.9: Types of Urban Health Posts (UHP)
Category Number Population Staffing Pattern

covered
Type A 65 Less than 5000 ANM (1)
ANM (1), Multiple Worker – Male

Type B 76 5,000 – 10,000
(1)
Type C 165 10,000 – 20,000 ANM (2), Multiple Worker – Male
3
MOHFW, GOI : Annual Report on Special Schemes, 1999-2000,
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Category Number Population Staffing Pattern

covered
(2)
Lady MO (1), PHN (1), ANM (3-4)

Type D
565 25,000 – 50,000 Multiple Worker – Male (3-4),
Class-IV Women (1)
TOTAL 871
Source: MOHFW, GOI: Annual Report on Special Schemes, 2000
2.5.4 The Indian Institute of Population Studies (IIPS) undertook an evaluation of the
functioning of UHP and UFWCs and came out with the following findings, as shown in
box below:
Box 2.4: IIPS evaluation of the UFWC and UHP scheme: Key findings4
• In terms of functioning, 497 (30%) UHPs and UFWCs were ranked good,
540 (35%) were average and 492(32%) as below average or poor.
• Weak Referral Mechanism
• Provision of only RCH services
• Inadequate trained staff
• In 30% of the facilities the sanctioned post of Medical Officer is vacant/
others mostly relocated.
• Lack of equipments, medicines and other related supplies
• Unequal distribution of facilities among states e.g. in Bihar one centre
covers 1, 10,000 urban poor while in Rajasthan average population
coverage is 5535.
• Irregular and insufficient outreach activities by health workers
2.5.5 The implementation mechanism of most of the programmes except for the
UFWC and UHP schemes of GOI is through the district institutional and planning
mechanism. Therefore resources get disaggregated in terms of districts and not cities.
4
Indian Institute of Population Studies 2005; National Report on Evaluation of functioning of UHPs/UFWCs in India
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Implementation in cities thus appears to be fragmented and patchy. As such the

absence of institutional/ planning mechanisms in cities therefore restricts
institutionalized access of the urban poor to the programmes.
2.6 The India Population Project (IPP) V and VIII
2.6.1 Due to rapid growth of urban population, efforts were made in the metropolitan
cities of Chennai, Bengaluru, Kolkata, Hyderabad, Delhi and Mumbai for improving the
health care delivery in the urban areas through World Bank supported India Population
Projects (IPP). Under the program 479 Urban Health Posts , 85 Maternity Homes and
244 Sub Centers were created, in Mumbai & Chennai as part of IPP V and in Delhi,
Bengaluru, Hyderabad and Kolkata as part of IPP VIII.
2.6.2 These, to a limited extent, resulted in enhanced service delivery and also better
capacity of urban local bodies to plan and manage the urban health programmes in
these cities. They are presently however, facing shortage of manpower and resources.
An examination of extended IPP VIII project in Khammam town of Andhra Pradesh has
also identified management issues like lack of financial flexibility/ long term financial
sustainability, and lack of need based management models as constraints which need to
be redressed in any urban health initiative5.
2.7 Key characteristics of the extant situation
2.7.1 THE DIVERSITY OF THE URBAN SITUATION
2.7.1.1 The urban health situation in the cities is characterized by marked

diversities in the organization of health delivery system in terms of provisioning
of health care services, management, availability of private providers, finances
etc. In cities like Mumbai, Kolkata, Chennai, Bengaluru, Ahmedabad, etc, it is
primarily the urban local bodies (ULBs) in line with the mandate of the 74th
Amendment, which are managing the primary health care services. However in
many cities like Delhi, along with the urban local body i.e. the Municipal
Corporation of Delhi (MCD), New Delhi Municipal Corporation (NDMC), Delhi
Cantonment Board and other parastatal agencies along with the State
Government jointly provide primary health care services. In cities like Patna,
Ranchi, Agra, Bhopal, Meerut, Indore, Guwahati despite the presence of ULBs,
5
ECTA Working Papers 2000/31 ; Urban Primary Health Systems : Management Issues, September 2000
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the provision of primary health services still vests with the State Government
through its district structures.
Box 2.5: STUDY IN CONTRAST: BRIHAN MUMBAI MUNICIPAL

CORPORATION AND MIRA BYANDAR MUNICIPAL CORPORATION IN
MAHARASHTRA*
The Brihan Mumbai Municipal Corporation (BMC), with a population of 1.19

crore (2001) and a slum population of about 60 lakh, is the largest Municipal
Corporation in India, and a major provider of public health-care services at Mumbai. It
has a network of teaching hospitals, Municipal General Hospitals and Maternity
Homes across Mumbai. Apart from these there are Municipal Dispensaries and Health
Posts to provide outpatient care services and promote public health activities in the
city. However, Mira Byandar Corporation at the outskirts of Mumbai city and growing
at a decadal growth rate of 196% from 1991-2001(from 1.75lakh to 5.20 lakh) with 40%
slum population has only first tier structures, namely 7 Urban Health Posts and 2
PHCs( to be shortly transferred from the Zilla Parishad) , in the government system.
However as informed there are approximately 1000 beds in the private sector in this
city.
On the one hand there is a BMC with a 900 crore health budget (9% of total BMC
Budget of which 300 crore is on medical education), many times the health budget of a
some of the smaller states, and on the other, there is another Corporation still
struggling to emerge from the rural - urban continuum. While ADC heading the health
division of BMC is a very senior civil servant, the Chief Health Officer of Mira Byandar
Corporation is a recently regularized doctor with around three years experience in the
Corporation.
For the ADC of BMC, major health areas requiring policy attention apart from
financial assistance from the Centre relate to guidelines for system improvement for
health delivery esp. vis a vis issues of Town Planning, land ownership, governance,
recruitment structures, reservation policies, migrants, instability of slums, high
turnover of workforce in Corporations which often come in the way of providing
health care to the poor along with the challenge of getting skilled human resources,
which despite repeated advertisements still remain vacant in BMC. There are 8-9%
vacancies in the municipal cadres of ANM.
The chief concern of the Mira Byandar Corporation on the other hand is to
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construct a 200 bedded Hospital, as a Municipal Hospital offers high visibility and also
because the poor find it difficult to access the private facility due to high cost of services
and therefore are referred to Mumbai which is 40 km away.
* Observations on field visit to cities in September 2007 for stakeholder consultation by officials
of MoHFW
2.7.2 WEAK CAPACITY OF URBAN LOCAL BODIES TO MANAGE

PRIMARY HEALTH CARE
2.7.2.1 Two models of service delivery are seen to be prevalent in urban areas. In
states like Uttar Pradesh, Bihar and Madhya Pradesh health care programmes are
being planned and managed by the State government; the involvement of the
urban local bodies is limited to the provisioning of public health initiatives like
sanitation, conservancy, provision of potable water and fogging for malaria. In
other states like Karnataka, West Bengal, Tamil Nadu and Gujarat the health care
programmes are being primarily planned and managed by the urban local
bodies. In some of the bigger Municipal bodies like Ahmedabad, Chennai, Surat,
Delhi and Mumbai the Medical/Health officers are employed by the local body
whereas in smaller bodies, health officers are mostly on deputation from the
State health department. Though bigger corporations demonstrate higher
capacity to manage their health programmes, there is still scope to further build
their capacity. During consultations, officers of even large corporations like
Mumbai mentioned that large numbers of urban poor remain underserved by
health care. The situation in most cities also revealed that there was a lack of
effective coordination among the departments that lead to inadequate focus on
critical aspects of public health such as access to clean drinking water,
environmental sanitation and nutrition.
2.7.2.2 Though bigger corporations demonstrate improved capacity to manage

their heatlh programmes, there is still a need to build their capacity. The IPP VIII
Project Completion Report (IPPCR) has also emphasized the capacity and
commitment of political leadership as one of the critical factors for the efficacy of
the health system. In Kolkata, strong political ownership by elected
representatives has played a positive role in the smooth implementation of the
project and sustainability of the reforms introduced. On the other hand, in Delhi,
despite efforts by the project team, effective coordination between different
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agencies and levels could not develop a common understanding on improving

service delivery and promoting initiatives crucial for sustainability. The
experiences in Hyderabad and Bengaluru were mixed, but mostly driven by a
few committed individuals.
2.7.2.3 The situation in most cities also revealed that there was a lack of effective
coordination among the departments that lead to inadequate focus on critical
aspects of public health such as access to clean drinking water, environmental
sanitation and nutrition.
2.7.3 DATA INADEQUACY IN PLANNING
2.7.3.1 Urban population, unlike the rural population, is highly heterogeneous.

Most published data does not capture the heterogeneity, as the Standard of
Living Index does often not disaggregate it. It therefore masks the health
condition of the urban poor. The informal or often illegal status of low income
urban clusters results in public authorities not having any mandate to collect
data on urban poor population. This often reflects in health planning not being
based on community needs. It was seen that mental health, which was an
observable problem of the urban slums, was not getting reflected in the city data
profile. Most cities visited were found lacking in city-specific epidemiological
data, inadequate information on the urban poor and illegal clusters, in-adequate
information on existing health facilities esp. in the private sector. Data collection
at the local /city level is therefore necessary to correctly comprehend the status
of urban health and to assess the urban community needs for health care
services.
2.7.4 MULTIPLICITY OF SERVICE PROVIDERS AND DYSFUNCTIONAL

REFERRAL SYSTEMS
2.7.4.1 The multiplicity of service providers in the urban areas, with the ULBs
and State Governments jointly provisioning even primary health care, has led to
a dysfunctional referral system and a consequent overload on tertiary hospitals
and underutilized primary health facilities. Even in states where ULBs manage
primary health care with secondary and tertiary levels in the State domain, there
are problems in referral management. Similar observations have also been made
in IPP VIII completion report which states that multiplicity of agencies providing
health services posed management and implementation problems in all project cities: In
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Delhi, there were coordination problems for health service among different
agencies, such as Municipal Corporation of Delhi (MCD), New Delhi Municipal
Corporation (NDMC), Delhi Cantonment Board, Delhi Jal Board (DJB), Delhi
Government, and Employees State Insurance (ESI) Corporation. Similarly, in
Hyderabad, coordination of the project with secondary and tertiary facilities
under different managements constrained effective referral linkages. Bengaluru
and Kolkata had fully dedicated maternity homes in adequate numbers that
facilitated better follow-up care. However, even in these two places, linkages
with district and tertiary hospitals, not under the control of the municipalities,
remained weak.
2.7.5 WEAK COMMUNITY CAPACITY TO DEMAND AND ACCESS

HEALTH CARE
2.7.5.1 Heterogeneity among slum dwellers due to in-migration from different

areas, instability of slums, varied cultures, fewer extended family connections,
and more women engaged in work, has led to lesser willingness and fewer
occasions to build urban slum community as a strong collective unit, which is
seen as one of the major public health challenges in improving access. Even the
migratory nature of the population poses a problem in delivery of services.
Similar concerns have also been raised in the IPP VIII completion report which
states lack of homogeneity among slum residents, coming from neighboring
states/countries to the large metropolitan cities, made planning and
implementation of social mobilization activities very challenging.
2.7.6 STRENGTHENING COMMUNITY CAPACITY INCREASES

UTILIZATION OF SERVICES
2.7.6.1 The Urban Health programmes in Indore and Agra have demonstrated
that the process of strengthening community capacity either through Link
worker or a Community Based Organization (CBO) helps in improving the
utilization of services. The IPP VIII project has also demonstrated that the use of
female voluntary health workers viz. Link workers, Basti Sewikas etc. selected
from the local community played an important role in extending outreach
services to the door steps of the slums which helped in creating a demand base
and ensuring people’s satisfaction. It was also observed that the collective
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community efforts played an important role in improving access to drinking

water, sanitation, nutrition services and livelihood.
2.7.6.2 During the field visits there was consensus during all discussions that
some form of community linkage mechanism and collective community effort
was an important strategy for improving health of the urban poor. However, this
strategy also had to be area specific as it would succeed in stable slums and not
where slums were temporary structures under constant threat of demolition.
2.7.7 LARGE PRESENCE OF FOR PROFIT AND NOT FOR PROFIT PRIVATE
PROVIDERS
2.7.7.1 The urban areas are characterized by presence of large number of for
profit/not for profit private providers. These providers are frequently visited by
the urban poor for meeting their health needs. The first interface for OPD
services for the urban poor in many cities visited was the private sector, chiefly
due to inadequacy of infrastructure of the public system and inconvenient
working hours of the facilities. Partnership with private/charitable/NGOs can
help in expanding services as was evident in Agra where NGO managed health
care facilities were reaching out to large un-served areas. Even in Bengaluru, the
management of health facilities had been handed over to NGOs. In several IPP
VIII cities partnerships with profit/not for profit providers has helped in
expanding the services. Kolkata had the distinction of implementing the
programme through establishment of an effective partnership with private
medical officer and specialists on a part time basis, fees sharing basis in different
health facilities resulting in ensuring community participation and enhancing the
scope of fund generation. Andhra Pradesh has completely outsourced service
delivery in the newly created 191 Urban Health Posts in 73 towns to NGOs. The
experimentation, it appears, has been quite satisfactory with reduced cost.
2.7.8 FOCUS ON RCH SERVICES AND INADEQUATE ATTENTION TO

PUBLIC HEALTH
2.7.8.1 The existing health care service delivery mechanism is mostly focused on
reproductive and child health services, while the recent outbreaks of Dengue and
Chikungunya in urban areas and the poor health status of urban poor clearly
articulate the need for a broad based public health programme focused on the
urban poor. It stresses upon the need to effectively infuse public health focus
along with curative services. The urban health programmes in Surat and
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Ahmedabad have been able to effectively integrate the two aspects. There is also
need to integrate the implementation of the National programmes like National
Vector Borne Disease Control Programme (NVBDCP), Revised National
Tuberculosis Control Programme(RNTCP), Integrated Disease Surveillance
Project ( IDSP), National Leprosy Elimination Programme (NLEP) , National
Mental Health Programme (NMHP), National Deafness Control Programme
(NDCP) , National Tobacco Control Programme (NTCP)and other
Communicable and Non communicable diseases for providing an effective urban
health platform for the urban poor. The urban poor suffer an equally high
burden of ‘life style” associated diseases due to high intake of tobacco (both
smoking and chewing) and alcohol. The limited income coupled with very high
out-of-pocket expenditure on substance abuse creates a vicious cycle of poverty
and disease. There is also the added burden of domestic violence and stress.
Studies also indicate the need for early detection of hypertension in the urban
poor, as it is a common cause of stroke and other cardio- neurological disorders.
2.7.8.2 The high incidence of communicable diseases emphasizes the need for
strengthening the preventive and promotive aspects for improved health of
urban poor. It also becomes critical that the outreach of services, which have an
important bearing on health like safe drinking water, environmental sanitation,
protection from pollutants, and nutrition services is improved.
2.7.9 LACK OF COMPREHENSIVE STRATEGY TO ENSURE EQUITABLE

ACCESS TO THE MOST VULNERABLE SECTIONS
2.7.9.1 Though the urban health programmes have a mandate to provide

outreach services as envisaged by the Krishnan Committee, at present very
limited outreach activities were being undertaken by the ULBs. It is only the IPP
cities, which were conducting some outreach activities as community Link
workers were employed to strengthen demand and access. Limited outreach
activities through provision of link volunteers under RCH were visible in Indore,
Agra, Ahmedabad and Surat.
2.7.9.1 Another challenge facing the urban health programmes is inadequate

methodology for identification of the most marginalized poor. None of the cities,
except Thane, which had a scheme for rag pickers, had any operational strategy
for the highly vulnerable section.
3 - KEY PUBLIC HEALTH CHALLENGES IN URBAN AREAS
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3.1 A list of key public health challenges in urban areas and possible responses from
the National Urban Health Mission is listed below:
Table 3.1: Public Health Challenges & Possible Responses
KEY PUBLIC HEALTH POSSIBLE RESPONSES UNDER THE

CHALLENGES IN URBAN AREAS NATIONAL URBAN HEALTH
MISSION
1. Poor households not knowing where to The biggest challenge is to connect every
go to meet health need household to health facilities. The role of
the slum level Community Worker ( like
the Honorary Health Worker in Kolkata
slums) is a possible intervention. The
Community Worker becomes the first
point of contact for any health need. She
has the authority to connect households
to health facilities. A health facility or
health personnel is responsible for a
certain number of households.
2. Weak and dysfunctional public system A detailed review of the existing
of outreach arrangements to identify the causes for
dysfunctional/functional systems. The
investments under NUHM could be to
provide a responsive public system –
service guarantees well defined and well
recognized by all.
3. Contaminated water, poor sanitation. Work towards a possible public health
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bill that sets standards for provision of

basic entitlements like water and
sanitation facilities. Provide resources to
communities to ensure action at their
end to prevent contamination/ maintain
cleanliness. Work with urban local
bodies to increase access to functional
toilets.
4. Poor environmental health, poor Work with urban local bodies to set
housing standards for environmental sanitation,
set up systems of waste disposal, basic
housing systems, etc. Work towards a
rights and entitlement based approach
though a public health bill.
5. Unregistered practitioners first point of Develop systems of accrediting private
contact – use of irrational and unethical not fully qualified practitioners if they
medical practice do basic specially designed courses for
them, which gives them some level of
acceptable competence. Make them
work under the supervision of
government doctors. Special thrust on
rational drug use and ethical practice.
Making local practitioners do more of
preventive and promotive health.
6. Community organizations helpless in Establish vibrant community
health matters organizations at slum level, under the
umbrella of the urban local body,
wherever feasible. Co-opt community
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leaders like members of Self Help

Groups, women’s groups, etc. Provide
untied grants to local community
organizations to carry out community
led action for public health. JNURM is
providing the hardware but in the
absence of effective community action,
the hardware will be of little sustainable
use. Community led action for public
health encompassing all the wider
determinants of health, is needed.
(nutrition, water, sanitation, education,
housing, women’s empowerment, skill
development, etc. ).
7. Weak public health planning capacity Re-orient existing staff of urban local
in urban local bodies bodies to understand public health
challenges better.
8. Large private sector but poor cannot Develop systems of accrediting private
access them practitioners for public health goals.
These could be for a range of services.
Need for transparency in developing
protocols, and costs. Community
organizations to exercise key role in roll-
out of such partnerships. Non
Governmental Organizations to build
capacity in community organizations to
handle such partnerships.
9. Problems of targeting the poor on the Many urban poor households do not
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basis of BPL card have BPL card. How to reach every poor
household and provide special
entitlements at public costs to them for
secondary and tertiary care. It will not be
possible to provide free cancer treatment
for all. Naturally there is a need for
identifying the poor. NUHM to develop
criteria for such identification on the
basis of a wider understanding of
poverty as not only income or
nutritional poverty.
10. No convergence among wider Creating common institutional
determinants of health arrangements to ensure that the same
community organization, under the
umbrella of urban local body, is
responsible for all the wider
determinants – water, sanitation,
nutrition, health care, education, skill
development, housing, etc.
11. No system of counseling and care for Adolescents face multiple problems in
adolescents urban areas. Need to mobilize local
youth for community led public health
action. Need to attend to special needs of
adolescent girls to make them cope with
physiological changes.
12. Over congested secondary and tertiary Need to generate awareness through
facilities and under underutilized MAS and community workers in every
primary care facilities. slum so that people know clearly where
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the household has to be sent. Need

based referrals are the only way of
decongesting.
13. Problem of drug abuse and alcoholism Urban life is demanding and leads to
living with stress of all kinds. Problems
of drugs and alcoholism, tobacco use,
etc. need strong public health
interventions.
14. Many slums not having primary health Creating new public health
care facility infrastructure using community
buildings, mobile medical units based on
fixed schedules where infrastructure
cannot be created.
15. High incidence of domestic violence Need for Counselors in Bastis to help in
many behavior change and gender
relation issues.
16. Multiplicity of urban local bodies, State Need for clarity of responsibilities for
government, etc. management of health urban health. Setting up of an over-
needs of urban people arching urban local body level health
mission for convergent action.
17. No norms for urban health facilities. Need to develop clear norms for primary
health care service guarantees for urban
areas.
18. No concerted campaigns for behavior Need for concerted campaigns for
change behavior change to enforce public health
thrust. Problem of malaria, dengue,
Chikanguniya in urban areas.
Counseling services for well-being of
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households.
19. Problems of unauthorized settlements Developing health care facilities in the
framework of law for such areas.
4 – DEFINING THE POOR IN URBAN AREAS
4.1 Targeting is a difficult process in informal economies. Income data is unreliable.
Mere targeting by slum residence is also faulty as there are many slums that are not
even notified. Targeting is needed, especially for secondary and tertiary care to all. It
can be provided free only to those who cannot afford it otherwise. Primary health care
through Urban PHCs will be universally available to all citizens residing in urban areas.
Outreach services will be provided on a targeted basis for the slum and other
vulnerable population.
4.2 How to define the urban poor? Considering that urban areas have a constant
stream of migration, the process of issuing BPL cards does not keep pace with the
migration of poor people from rural to urban areas, in search of a livelihood. As a
consequence, many poor households are also not necessarily in slums. This means that
mere spatial targeting will also not suffice.
4.3 This calls for a household survey through community organizations/ NGOs
under the supervision of urban local bodies, to define the urban poor. This necessarily
has to be through a communitized process and must also take note the vulnerability of
the households in terms of the assets that it possesses. There will be a need to get away
from mere income poverty or mere calorie based poverty line. The urban poor will have
to be defined and selected based on a household survey through community validation
and transparency. It has to take note of vulnerability in the context of urban life. It will
also have to take note of assets possessed and state of access to basic public services.
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4.4 The NUHM will make use of surveys of urban poor done under various
government programmes. However, it will subject all such listings to a household
survey and a public disclosure of names of households before the Mahila Arogya Samiti
(MAS) or Ward level ULB unit.
5 - NUHM – GOALS, OBJECTIVES, STRATEGIES, OUTCOMES
5.1 GOAL
The National Urban Health Mission would aim to improve the health status of the
urban population in general, but particularly of the poor and other disadvantaged
sections, by facilitating equitable access to quality health care through a revamped
public health system, partnerships, community based mechanism with the active
involvement of the urban local bodies.
5.2 CORE STRATEGIES
The exigencies of the situation as detailed in the aforesaid chapters merit the
consideration of the strategies given below. These strategies may be implemented
mainly by strengthening the existing public health systems. In some big cities where
credible private sector or other public sector exists, partnerships may be developed with
them through (i) public private partnerships i.e. with private service providers or with
NGOs/faith based organizations, and (ii) through public-public partnerships, i.e.
partnership with Railways hospitals, ESIC, Public sector companies hospitals etc. An
optimal mix of these strategies can be included in the existing planning and
implementation framework of the state to augment the urban health care system. The
decision as to which is the best mix for the state may be taken by the state in the best
interests of the urban poor. In case of partnerships, clear guidelines as defined later
should be in place with monitoring by the state.
5.2.1 Improving the efficiency of public health system in the cities by

strengthening, revamping and rationalizing existing government primary
urban health structure and designated referral facilities
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5.2.1.1 The situational analysis has clearly revealed that most of the existing
primary health facilities, namely, the Urban Health Posts (UHPs) /Urban Family
Welfare Centres (UFWC)/ Dispensaries are functioning sub- optimally due to
problems of infrastructure, human resources, referrals, diagnostics, case load,
spatial distribution, and inconvenient working hours. The NUHM therefore
proposes to strengthen and revamp the existing facilities into an “Urban Primary
Health Centre” with outreach and referral facilities, to be functional for every
50,000 population on an average. 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
(covering approximately 50,000 urban population, including slums), providing
preventive, promotive and non-domiciliary curative care (including consultation,
basic lab diagnosis and dispensing).
5.2.1.2 The NUHM would improve the efficiency of the existing system by
making provision for a need based contractual human resource, equipments and
drugs. Provision of Rogi Kalyan Samiti is also being made for promoting local
action. To further strengthen the delivery of specialised OPD care, the cities, if
need arises, can utilize the services of specialist on weekly basis. The provision of
health care delivery with the help of outreach sessions in the slums would also
strengthen the delivery of health care services. On the basis of the GIS map the
referrals would also be clearly defined and communicated to the community
thus facilitating their easy access.
5.2.1.3 The eligibility criterion for resource support under the Mission however
would be rationalization of the existing public health care facilities and human
resources in addition to mapping of unlisted slums and clusters.
5.2.1.4 The existing UHP/ UFWCs are already being supported through planned
grant. With the launching of NUHM, all of these existing programmes/schemes
will automatically cease to exist. Hence all the existing staff in this scheme
(Urban Health Posts, Urban Family Welfare Centers) should be rationalized.
5.2.1.5 Based on GIS mapping, the cities would identify existing public sector
health facilities to act as referral points for different types of healthcare services
like maternal health, child health, diabetes, trauma care, orthopaedic
complications, dental surgeries, mental health, critical illness, deafness control,
cancer management, tobacco counseling / cessation, critical illness, surgical cases
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etc. NUHM would provide strengthening support as per the city PIP subject to
approval at appropriate levels.
5.2.2 Promotion of access to improved health care at household level through

community based groups : Mahila Arogya Samitis
5.2.2.1 The ‘Mahila Bachat Gat’ scheme in Maharashtra and urban health
initiatives in Indore and Agra have demonstrated the efficacy of women led
thrift/self help groups in meeting urgent cash needs in times of health
emergency and also empowering them to demand improved health services.
5.2.2.2 In view of the visible usefulness of such women led community/ self help
groups; it is proposed to promote such community based groups for enhanced
community participation and empowerment in conjunction with the community
structures created under the Swarna Jayanti Shahari Rojgar Yojana (SJSRY), a
scheme of the Ministry of Urban Development which seeks to provide
employment to the urban poor. Under the Urban Self Employment Programme
(USEP) of the scheme there are provisions for Development of Women and
Children in Urban Areas (DWCUA) groups of at least 10 urban poor women and
Thrift Credit Groups (TCG), which may be set up by groups of women. There is
also provision for informal association of women living in mohalla, slums etc to
form Neighborhood Groups (NHGs) under SJSRY who may later federate
towards a more formal Neighborhood Committee (NHC). Such existing
structures under SJSRY may also federate into Mahila Arogya Samiti, (MAS) a
community based federated group of around 50-100 households, depending
upon the size and concentration of the slum population, with flexibility for state
level adjustments, and be responsible for health and hygiene behavior change
promotion and facilitating community risk pooling mechanism in their coverage
area. The urban Accredited Social Health Activist (ASHA) , detailed in the
following pages, may provide the leadership to the Mahila Arogya Samiti. Each
of the MAS may have a committee of 5-20 members with an elected
Chairperson/ Secretary and other elected representative like Treasurer. The
mobilization of the MAS may also be facilitated by a contracted agency/NGO,
working along with the ASHA responsible for the area.
5.2.3 Strengthening public health through innovative preventive and promotive

action
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5.2.3.1 Urban Poor face greater environmental health risks due to poor sanitation,
lack of safe drinking water, poor drainage, high density of population etc. There
is a significant correlation between morbidity due to diarrhea, acute respiratory
infections and household hygiene behavior, environmental sanitation, and safe
water availability. Thus strengthening preventive and promotive action for
improved health and nutrition and prevention of diseases will be a major focus
of the Mission. The Mission would also provide a framework for pro-active
partnership with NGOs/civil society groups for strengthening the preventive
and promotive actions at the community level. The ASHA, in coordination with
the members of the MAS would promote proactive community action in
partnership with the urban local bodies for improved water and environmental
sanitation, nutrition and other aspects having a bearing on health.
5.2.3.2 The urban areas, due to presence of multiple health service providers,
presence and access to technology and relatively higher awareness and demand
of health services in the community, provide with opportunities to develop
innovative strategies. Hence NUHM provides for some untied funds at all levels
for developing need based innovative strategies for improved service delivery
and public health action.
5.2.4 Increased access to health care through creation of revolving fund
5.2.4.1 As substantiated by various studies (" Morbidity and Treatment of Ailments"

NSS Report Number- 441(52/25.0/1) based on 52nd round) the urban poor incur high
out-of- pocket expenditure often leading to indebtedness and impoverishment.
To mitigate this risk, it is proposed to encourage Mahila Arogya Samitis to “save
for a rainy day” for meeting urgent health needs.
5.2.5 IT enabled services (ITES) and e- governance for improving access improved
surveillance and monitoring
5.2.5.1 Various studies (Conditions of Urban Slums, 2002, NSSO Report Number
486(58/0.21/1) based on 58th round) have shown that the informal status and
migratory nature of majority of the urban poor, compromises their entitlement
and access to health services. It also poses a challenge in tracking and
provisioning for their health care.
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5.2.5.2 Studies have also highlighted that the private providers, which the
majority of the urban poor access for OPD services, remain outside the public
disease surveillance network. This leads to compromised reporting of diseases
and outbreaks in urban slums thereby adversely affecting timely intervention by
the public authorities.
5.2.5.3 The availability of ITES in the urban areas makes it a useful tool for
effective tracking, monitoring and timely intervention for the urban poor. The
NUHM would provide software and hardware support for developing web
based HMIS for quick transfer of data and required action. Mobile telephony will
be used for data gathering and follow ups.
5.2.5.4 The States would also be encouraged to develop strategies for affecting an
urban disease surveillance system and a plan for rapid response in times of
disasters and outbreaks. It is envisioned that the GIS system envisioned would
be integrated into a disease surveillance and reporting system on a regular basis.
This system would also be synchronized with the IDSP surveillance system.
5.2.6 Capacity building of stakeholders
5.2.6.1 It was observed that except for a few, provisioning of primary health care
was low on priority for most of the urban local bodies with many Counselors
showing a clear proclivity for development of tertiary facilities. This skewed
prioritization appears to have clearly affected the primary health delivery system
in the urban local bodies, also adversely affecting skill sets of the workforce and
limiting technical and managerial capacities to manage health. NUHM thus
proposes to build managerial, technical and public health competencies among
ULBs/ Medical and Paramedical staff/ Private Providers/ Community level
structures and functionaries of other related departments.
5.2.7 Prioritizing the most vulnerable amongst the poor
5.2.7.1 It is seen that a fraction of the urban poor who normally do not reside
in slum, but in temporary settlements or are homeless, comprise the
most disadvantaged section. Under the NUHM special emphasis
would be on improving the reach of health care services to these
vulnerable groups among the urban poor, falling in the category of
destitute, beggars, street children, construction workers, coolies,
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rickshaw pullers, sex workers, street vendors and other such migrant
workers. Outreach services would target these segments consciously,
irrespective of their formal status of residentship etc.
5.2.8 Ensuring quality health care services
5.2.8.1 NUHM would aim to ensure quality health services by a) defining Indian
Public Health Standards suitably modified for urban areas wherever required b)
defining parameters for empanelment/regulation/accreditation of non-
government providers, c) developing capacity of public and private providers for
providing quality health care, d) encouraging the acceptance and enforcement of
local public health acts d) ensuring citizen charters in facilities e) encouraging
development of standard treatment protocols.
5.3 OUTCOMES
The NUHM would strive to put in place a sustainable urban health delivery system for
addressing the health concerns of the urban poor. The NUHM proposes to measure
results at different levels with a long term as well as intermediate term view.
5.3.1 Process/ Throughput level indicators:
5.3.1.1 Number cities/population where Mission has been initiated
5.3.1.2 Number of City specific urban health plans developed and

operationalised
5.3.1.3 Number of U-PHCs with outreach made operational
5.3.1.4 Number of Cities/population with all slums and facilities mapped
5.3.1.5 Number of Slum/ Cluster level Health and Sanitation Day
5.3.1.6 Number of MAS formed
5.3.1.7 Number of U-PHCs with Programme Managers
5.3.1.8 Number of ASHAs trained and functioning
5.3.2 Output level indicators:
5.3.2.1 Increase in OPD attendance
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5.3.2.2 Increase in BPL referrals from U-PHCs/ referral availed
5.3.2.3 Increase in institutional deliveries as percentage of total deliveries
5.3.2.4 Increase in complete immunization among children < 12 months
5.3.2.5 Increase in case detection for malaria through blood examination
5.3.2.6 Increase in case detection of TB through identification of chest

symptomatic
5.3.2.7 Increase in referral for sputum microscopy examination for TB
5.3.2.8 Increase in number of cases screened and treated for dental ailments
5.3.2.8 Increase in ANC check-up of pregnant women
5.3.2.10 Increased Tetanus toxoid (2nd dose) coverage among pregnant women
5.3.2.11 Strengthened civil registration system to achieve 100% registration of

births and deaths
5.3.3 Impact level focus on urban poor:
5.3.3.1 Reduce IMR by 40 % (in urban areas) – National Urban IMR down to 20
per 1000 live births by 2017
5.3.3.1.1 40% reduction in U5MR and IMR
5.3.3.1.2 Achieve universal immunization in all urban areas.
5.3.3.2 Reduce MMR by 50 %
5.3.3.2.1 50% reduction in MMR (among urban population of the

state/country)
5.3.3.2.2 100% ANC coverage (in urban areas)
5.3.3.3 Achieve universal access to reproductive health including 100%

institutional delivery
5.3.3.4 Achieve replacement level fertility (TFR 2.1)
5.3.3.5 Achieve all targets of Disease Control Programmes
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6 – CONVERGENT ACTION IN URBAN AREAS
6.0.1 The NRHM provides scope for innovations at the district level. These have
resulted in development of need based innovative strategies resulting in expansion of
services and greater access of those services especially by the poorest communities.
6.0.2 Some of the innovations coming out under NRHM are very encouraging and
paving way for many more similar initiatives. The use of radio technology for capacity
building of ASHAs (in Assam), promotion of high end diagnostic services in medical
colleges and establishment of regional diagnostic centers through public private
partnerships (PPP) and promoting easy availability of generic drugs in shops through
PPPs are some of such innovations.
6.0.3 The urban areas, due to presence of multiple health service providers, access to
technology and relatively higher awareness and demand of health services in the
community, provide the opportunities to develop innovative strategies. Hence NUHM
provides for some untied funds at all levels for carrying out these activities. Some of the
areas of innovation are listed below. This list is illustrative and not exhaustive.
6.1 SUGGESTED SLUM LEVEL INNOVATIONS
6.1.1 Community monitoring
6.1.2 Creating mentoring groups/support structures for MAS/ASHA through

NGO/CBOs
6.1.3 “Healthy Mother”, “Healthy Infant” competitions

[
6.2 SUGGESTED U-PHC LEVEL INNOVATIONS
6.2.1 Involving private practitioners for special drives on immunization,

diabetes, etc.
6.2.2 Involving schools for public health action like “slum cleaning (safai
abhiyan)”, health promotion, etc.
6.2.3 Special programs for adolescent health
6.3 SUGGESTED CITY LEVEL INNOVATIONS
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6.3.1 Innovations with ICT (Information and Communication Technology) like

‘sms’ based health promotion, touch screen kiosks, PDAs for outreach
workers.
6.3.2 “Help-lines” for general health advise / medical emergencies
6.3.3 Review/monitoring of quality, regularity of services through NGOs
6.3.4 Identification and management/rehabilitation of malnourished children

(with special focus on girl child) and Nutrition Resource Centres
6.3.5 Special Strategies for addressing anaemia among women and girls
6.3.6 Special strategies for addressing anemia, malnutrition and neonatal

mortality
6.4 SUGGESTED STATE LEVEL INNOVATIONS
6.4.1 Operations/Action research/special studies
6.4.2 Resource Centres/Units at State or city levels for urban health data,
program lessons, and other information
6.4.3 Empanelment of hospitals/doctors for defined specialised services
6.4.4 Innovations for addressing adverse sex ratio
6.5 SUGGESTED NATIONAL LEVEL INNOVATIONS
6.5.1 Human Resource development, training, capacity building, Resource

Centres/Units for urban health data, program lessons, & other information and
additional support to national health programmes at all levels e.g.
6.5.1.1 Maternal/infant death audit
6.5.1.2 Disease outbreaks in case of natural disasters like floods
6.5.1.3 Mass injury/trauma cases because of fire in slums, riots, etc.
6.5.1.4 Epidemiological surveys/research
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6.6 IMPROVING SANITATION AND WATER SERVICES
6.6.1 It is important to focus on infra-structural facilities in terms of access to safe and

adequate water supplies and sanitation facilities for combating various infectious
diseases in children residing in urban slums.
6.6.2 Studies have shown that non-availability of piped water and absence of flush
toilets are associated with increased incidence of infant deaths from diarrhea. Hence, it
is vital to expand availability of water and sanitation facilities to the urban population
to effectively address mortality and morbidity associated with diarrhea.
6.7 ADDRESSING COMMUNITY BEHAVIOURS PERTINENT TO THE

CAUSATION OF CHILDHOOD ILLNESSES IN URBAN SLUMS
6.7.1 Appropriate hygiene behaviors can play a critical role in minimizing the
frequency of infectious diseases, and can possibly reduce the risk of malnutrition in
children. In India and in developing regions it is recognized that if community water
supply and sanitation programs are undertaken in isolation, without action to integrate
these with promotion and education on hygiene and sanitation within the community
(particularly the home and its immediate surroundings), the health benefits from these
programs will not commensurate with the investment made. Evidence shows hand
washing could prevent more than one million deaths a year from diarrheal diseases 6.
Therefore, improvement of water supplies needs to be integrated with other
interventions, such as sanitation and health education, which focus on better
environmental hygiene and personal cleanliness.
6.7.2 Health seeking behavior: Behavior promotion strategies addressing community

beliefs focusing on environment-related issues such as hand washing, feeding practices,
health seeking and appropriate prenatal and new born care are paramount7.
6
Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review.
The Lancet Infectious Dis 2003; 3: 275-281.
7
Determinants of Childhood Mortality and Morbidity in Urban Slums in India; Shally Awasthi, Siddharth Agarwal,
Indian Paediatrics, Vol 40, December17, 2003
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6.8 COMMUNITY PARTICIPATION IN PREVENTION AND TREATMENT

OF CHILDHOOD ILLNESSES
6.8.1 There is an urgent need to empower communities to take control of their health
by strengthening their participation in identifying their own maternal and child health
needs and identifying measures to address them.
6.8.2 This can be achieved by training basti level women groups which could serve as
a platform for counseling and behavior promotion focusing on health education about
environment-related issues. These women groups could also strengthen linkage with
service providers, thereby increasing utilization of services, coverage of left outs and
dropouts and improved referrals.
6.9 FOCUS ON ALL ASPECTS OF PUBLIC HEALTH
6.9.1 The existing health care service delivery mechanism is mostly focused on
reproductive and child health (RCH) services, while the recent outbreaks of Dengue
and Chikungunya in urban areas and the poor health status of urban poor clearly
articulate the need for a broad based public health programme focused on the urban
poor. It stresses upon the need to effectively infuse public health focus along with
curative services.
6.9.2 The situation in most cities also reveals that there is a lack of effective
coordination among the departments that leads to inadequate focus on critical aspects
of public health such as access to clean drinking water, environmental sanitation and
nutrition.
6.10 Inter and Intra Sectoral Coordination
NUHM will promote both inter sectoral as well as intra sectoral convergence to avoid
duplication of resources and efforts. The convergent actions can be grouped as:-
 Convergence with the National Disease Control Programmes
 Convergence with other departments of Ministry of Health and Family Welfare
 Convergence with other Ministries
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6.10.1 CONVERGENCE WITH NATIONAL DISEASE CONTROL

PROGRAMMES
6.10.1.1 NUHM would aim to provide a system for convergence of all

communicable and non communicable disease programmes at the city level through
integrated planning - both annual and prospective, sharing of funds and human
resources and joint monitoring and evaluation.
6.10.1.2 NUHM would bring all the disease control programs like RNTCP, IDSP,
NVBDCP, NPCB etc. under the umbrella of City Health Plan so that preventive,
promotive and curative aspects are well integrated at all levels.
6.10.1.3 The objective of convergence would be optimal utilization of resources

and ensuring availability of all services at one point (U-PHC) thereby, enhancing their
utilization by the urban population. The existing IDSP structure would be leveraged for
improved surveillance.
6.10.2 CONVERGENCE WITH OTHER DEPARTMENTS OF MOHFW
6.10.2.1 DEPARTMENT OF AYUSH
6.10.2.1.1 NUHM would also strive to revitalize local health traditions and
mainstream AYUSH to strengthen the Public Health System at all levels. The following
areas for convergence with the Department of AYUSH have been identified:-
(i) Co-location of an existing AYUSH dispensary in Urban PHCs/CHCs,

wherever feasible, so as to provide clear choices to people to avail services
under one system or other.
(ii) AYUSH drugs to be regularly supplied by the state government.
(iii) AYUSH doctor posted would essentially practice his own system. However
he may additionally provide basic emergency services in absence of
allopathic doctor and participate in national health programmes.
(iv) Specialized AYUSH treatment facilities like Panchkarma, Ksharsutra to be

made available by AYUSH department in Urban PHCs/CHCs.
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(v) Department of AYUSH to support Govt. AYUSH hospitals and dispensaries

at the district /sub district level.
(vi) Life style clinics of AYUSH for preventive and promotive health care to be
established at the District Hospitals.
(vii) AYUSH doctors engaged at the Urban PHCs/CHCs would be given adequate
training on current diagnostic techniques, emergency medicine, IUCD
insertions and treatment approaches on a regular basis.
6.10.2.1.2 However, no provision of funds will be made separately for

mainstreaming of AYUSH activities under NUHM. Funds and manpower available
with the AYUSH departments of the Central/ State Govt. will be utilized.
6.10.2.2 DEPARTMENT OF AIDS CONTROL:
6.10.2.2.1 Convergence between NUHM and NACP will help in early detection,
effective surveillance and timely intervention by means of:
(i) Universal HIV screening will be made an integral part of ANC checkup. The
health and nutrition days would be utilized for rapid blood tests and positive
cases would be referred to ICTCs for confirmation.
(ii) Counselors, ANMs and ASHA/Link workers at the U-PHC would be trained
for counseling on RTI, PPTCT, ANC, nutrition and spacing between births.
The training for RTI and PPTCT counseling will be provided by the
respective State AIDS Control Society.
(iii) Testing kits to be made available at the Urban PHCs/CHCs by NACO.
(iv) Distribution of condoms and IEC materials for promoting safe sexual
practices will be done at the Urban PHCs.
(v) All HIV positive patients will be tested for T.B. and vice-versa.
6.10.2.3 DEPARTMENT OF HEALTH RESEARCH:
6.10.2.3.1 Convergence of NUHM with the Department of Health Research (DHR)

will help to bring modern health technology to people by:
(i) Encouraging innovations related to diagnostics, treatment methods and

vaccines;
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(ii) Translating the innovations into products/ processes by facilitating

evaluation/ testing in synergy with other departments of MOHFW and
(iii) Introducing these innovations into public health service
6.10.2.3.2 For promoting innovations some funds will be provided to the states
every year under a separate budget head.
6.10.3 CONVERGENCE WITH SCHEMES OF OTHER MINISTRIES
6.10.3.1 MINISTRY OF URBAN DEVELOPMENT AND MINISTRY OF HOUSING

AND URBAN POVERTY ALLEVIATION
6.10.3.1.1 Convergence with Jawaharlal Nehru National Urban Renewal Mission

(JnNURM):
6.10.3.1.1.1 Basic Services to the Urban Poor (BSUP), which is a sub mission of
JnNURM mandates the provision of health services to the urban poor via a seven point
charter, namely security of land tenure, affordable shelter, water, sanitation, education,
health and social security.
6.10.3.1.1.2 Under the Sub- Mission on Basic Services to the Urban Poor (BSUP),
convergence would be sought through the following:
(i) City will be the unit of planning for health and allied activities.
(ii) The City Health plan would also be shared for prioritization of actions
at the City level. Similarly the City Development Plans (CDPs) of
JnNURM cities (Basic Services component) would also be taken into
account for avoiding duplication of efforts and resources.
(iii) Under JnNURM at the city level as part of the City development plans
GIS based physical mapping of the slums is being undertaken. The
City level planning process would also leverage the GIS based
mapping wherever completed.
(iv) The community level institutions such as MAS may also be utilized by
the implementation mechanism of JnNURM.
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6.10.3.1.1.3 The guidelines for the Integrated Housing and Slum Development
Programmes (IHSDP) include the following under the admissible components:
(i) The community centers being created under IHSDP will be used
as sites for conducting fixed outreach session.
(ii) Under the admissible components of IHSDP Community

primary health care center buildings can be provided. This
mechanism can be used for establishing new urban primary
health centres for un-served urban poor population.
6.10.3.1.1.4 Under the BSUP and IHSDP mandatory reforms at the urban local body
level are proposed. The same can be reinforced by NUHM also for strengthening the
role of urban local bodies in cities where the BSUP and IHSDP are being implemented.
Identification of slums and updating of the lists can also be made part of the mandatory
reforms.
6.10.3.1.2 Convergence with Rajiv Awas Yojana (RAY):
6.10.3.1.2.1 Rajiv Awas Yojana aims at creating a slum free India by bringing existing
slums within the formal system and enabling them to avail the same level of basic
amenities as the rest of the town.
6.10.3.1.2.2 Convergence of RAY and NUHM would be sought through the following:
(i) The City Health Plans under NUHM can be incorporated into the
slum free city and state plans of action under RAY.
(ii) GIS based physical mapping of the slums and the spatial
representation of the socio-economic profile of slums (Slum MIS) is
being undertaken under RAY. This will also be useful for
development of city health plans.
6.10.3.1.3 Convergence with Swarn Jayanti Shahri Rozgar Yojana (SJSRY):
The community level structures being proposed under NUHM can be strengthened by
effectively aligning them with the SJSRY structures.
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(i) Community organizer for about 2000 identified families under SJSRY
can be co-opted as ASHA.
(ii) Neighborhood Groups which are informal associations of woman
living in mohalla or slum or neighborhood representing 10 to 40
urban poor or slum families and Development of Women and
Children in Urban Areas (DWCUA) Groups under SJSRY may be
federated into Mahila Arogya Samitis (MAS).
(iii) Neighborhood Committee (NHC) is a more formal association of
women from the above neighborhood groups. Representatives from
other sectoral programmes in the community like ICDS supervisor,
school teacher, ANM etc. are also its members. These may be
coterminous with the MAS. Alternatively, State/District can choose to
make them function as MAS.
(iv) Project officer in-charge of the project responsible for managing
community level structures may be involved in planning and
identification of urban poor.
6.10.3.1.4 Convergence with North Eastern Region Urban Development Programme

(NERUDP):
6.10.3.1.4.1 Ministry of Housing & Urban Poverty Alleviation has project proposals
for the North Eastern States in the following identified areas:
(i) Housing projects (predominantly for the urban poor)

(ii) Poverty alleviation projects
(iii) Slum improvement/up gradation projects
Funds under this provision are non-lapsable and unspent balances under this provision
in a financial year are pooled up in the non-lapsable central fund meant for these States,
and are governed by the Department of Development of North Eastern Region
(DoNER). Hence, in the north eastern states, NUHM can develop synergy and mobilize
funds from this programme.
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6.10.3.2 MINISTRY OF WOMEN AND CHILD DEVELOPMENT
(i) MAS/ASHA in coordination with the ANM to organize Community

Health and Nutrition day in close coordination with the Anganwadi
worker (AWW) on lines of NRHM.
(ii) MAS/ ASHA to support AWW/ANM in updating the cluster/ slum

level health register.
(iii) Outreach session also to be organized in the Anganwadi centers

located in slums or nearby.
(iv) Organization level health education activities at the AW Centre.
(v) AWW and MAS to work as a team for promoting health and nutrition
related activities.
6.10.3.3 MINISTRY OF HUMAN RESOURCE DEVELOPMENT
6.10.3.3.1 Convergence with School Health Programme:
6.10.3.3.1.1 School Health Programme helps in advocating healthy behavioral

practices and imparting awareness about preventive and curative health measures to
the school going children. This awareness further percolates to households and families
of the students. Therefore School Health Programme in cities can help the National
Urban Health Mission to achieve its goals and objectives by reaching out to a large
section of the community in a cost effective manner.
6.10.3.3.1.2 In urban areas, the scheme would cover Government or private schools
located in slums (U-PHC catchment) or government schools near slums which slum
children attend. The major components of School Health Programme are:
(i) Health Education (H.E.) Activities, creating awareness about hygiene,

prevention of Vector Borne Disease Nutrition/Balanced Diet, Oral
Rehydration etc.
(ii) Medical examination of primary school children for eye ailment, nutrition,
and others
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(iii) Treatment of minor ailments such as de-worming, anaemia, skin diseases at

school itself
(iv) Special In-patient care at identified hospitals and referral services
(v) Control of communicable diseases through Immunization
(vi) Training of teachers for early identification of symptoms
(vii) To advise children and school health authorities regarding importance of safe
drinking water and good environmental sanitation etc.
6.10.3.3.2 Convergence with Adolescent Reproductive and Sexual Health (ARSH):
6.10.3.3.2.1 Under ARSH, once a week adolescent clinic will be organized at the
Urban PHC. During this teen clinic health education and counseling will be provided to
the adolescent girls for promoting menstrual hygiene, prevention of anaemia,
prevention of RTIs/STIs, counseling for sexual problems etc.
6.10.3.4 MINISTRY OF MINORITY AFFAIRS
6.10.3.4.1 Convergence with Multi Sectoral Development Programme (MsDP):
6.10.3.4.1.1 Under this scheme, 90 minority districts have been identified throughout
the country which are relatively backward and are falling behind the national average
in terms of socio-economic and basic amenities indicators. The programme aims at
improving the socio-economic parameters of basic amenities for improving the quality
of life of the people residing in rural and semi-urban areas.
6.10.3.4.1.2 District specific plans are prepared for provision of better infrastructure
for school and secondary education, sanitation, pucca housing, drinking water and
electricity supply, besides beneficiary oriented schemes for creating income generating
activities. In addition, creation of basic health infrastructure and ICDS centres is also
eligible for inclusion in the plan.
6.10.3.4.1.3 So, in the towns covered under MsDP, NUHM can leverage the health
infrastructure and Anganwadi centres created under this programme for provision of
health care services to the urban poor population.
6.10.3.5 OTHER AREAS OF SYNERGY

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6.10.3.5.1 MEMBER OF PARLIAMENT LOCAL AREA DEVELOPMENT

SCHEME (MPLADS):
All members of parliament (MPs), members of legislative assemblies (MLAs) and

municipal councilors (MCs) receive area development fund which can be mobilized for
creation of health facilities in underserved urban areas and also for procurement of
equipments, Mobile Medical Units and ambulances etc.
6.10.3.5.2 CORPORATE SOCIAL RESPONSIBILITY (CSR):
Around 2 percent of the total profit of all corporate sector companies is earmarked for
social development under CSR. This fund can also be mobilized for health sector
through efforts of MOHFW and the State Govts. Department of Public Enterprise (DPE)
for public sector and Ministry of Corporate Affairs for the private sector can emerge as
important players.
7 - INSTITUTIONAL ARRANGEMENTS FOR IMPLEMENTATION
7.1 The National Urban Health Mission would leverage the institutional structures
of the NRHM at the National, State and District level for operationalisation of the
NUHM. However in order to provide dedicated focus to issues relating to Urban
Health the institutional mechanism under the NRHM at various levels would be
strengthened for NUHM implementation.
7.2 At the central level, the Mission Steering Group under the Union Health
Minister, the Empowered Programme Committee under the Secretary (H&FW), and the
National Programme Coordination Committee under the Mission Director will be
responsible for providing overall guidance and taking important decisions.
7.3 For effective implementation and monitoring of NUHM, a National Programme

Management Unit (NPMU) will be set up at the central level. The NPMU will also be
expected to provide technical assistance to the Urban Health Division of the Ministry.
7.4 At the state level, for improving the Program Management under NUHM, a State
Program Management Unit (SPMU) will be set up, which would essentially be an
extension of the NRHM SPMU, with a separate Urban Health Cell, reporting to the
State Mission Director. The staff at the SPMU- Urban Health Cell may be as proposed
below:
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(i) State Urban Health Program Manager

(ii) State Urban Health MIS Manager
(iii) State Urban Health Finance Manager
(iv) State Urban Health Consultant ( M&E and Community Participation)
7.5 In addition to the above, at the City level the States may either decide to
constitute a separate City Urban Health Missions/ City Urban Health Societies or use
the existing structure of the District Health Society / Mission under NRHM with
additional stakeholder members.
7.6 At the city level, the management of NUHM activities may be coordinated by a
City level Urban Health Committee headed by the District Magistrate/ Additional
District Magistrate/Sub Division Magistrate based on whether the city is a district
headquarters or a sub-division headquarter. This would help ensure better coordination
with municipal departments like sanitation, water, waste management, especially in
times of response to disease outbreaks/epidemics in the city.
7.7 Further for enhancing the Program Management, a City Program Management
Unit (CPMU) may be established. The staff at the City PMU level may be as proposed
below:
(i) Urban Health Data Manager.

(ii) Urban Health Accounts Manager
(iii) Consultant (Epidemiologist)
7.8 The National Urban Health Mission would promote participation of the urban
local bodies in the planning and management of the urban health programmes.
7.9 For the seven mega cities, namely Delhi, Mumbai, Kolkata, Chennai, Bengaluru,
Hyderabad and Ahmedabad, the NUHM may be implemented through the respective
ULBs. For the remaining cities, health department would be the primary
implementation agency for NUHM. However, for cities/towns where capacity exists
with the ULBs, the states may decide to hand over the management of the NUHM to
them.
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7.10 A generic institutional model for a National / State/District/City level Urban

Health Mission and Society is illustrated, notwithstanding the flexibilities provided to
the states.
FIGURE 7.1 DIAGRAM: INSTITUTIONAL MODEL
7.11 The National Urban Health service delivery model would make a concerted
effort to rationalize and strengthen the existing public health care system in urban areas
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and promote effective engagement with the non-governmental sector (profit/not for
profit) for expanding reach to urban poor, along with strengthening the participation of
the community in planning and management of the health care service delivery.
7.12 The diagram below describes the components of the proposed urban health
service delivery model.
Diagram: Urban Health Care Delivery Model
Referral
Public or
empanelled
Secondary/
Tertiary private
Providers
--------------------
Urban Primary Health Centre
(One for about 50,000
population-25-30 thousand slum
Primary
population)* Level
Strengthened existing Public Health Health Care
Care Facility for extending services
Facility
to unserved areas
--------------------
Community Outreach Service
Community
(Outreach points in government/ public domain/ Empanelled
private services provider) school health services Level
Urban Social Health Activist(200-500 HH)

* This may be adapted flexibly based on spatial situation of the city
Mahila Arogya Samiitee (20-100HH)
7.13 The urban health delivery model would basically comprise of an Urban Primary
Health Centre for provision of primary health care with outreach and referral linkages
as elucidated below:
7.14 COMMUNITY LEVEL
7.14.1 Urban Accredited Social Health Activist (ASHA)
7.14.1.1 Each slum/community would have one frontline community worker

called ASHAASHA on the lines of ASHA under NRHM, covering about 1000-2,500
beneficiaries, between 200-500 households based on spatial consideration, preferably co-
located at the Anganwadi Centre functional at the slum level, for delivery of services at
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the door steps. She would remain in charge of each area and serve as an effective
demand–generating link between the health facility (Urban Primary Health Centre) and
the urban slum populations. ASHA would maintain interpersonal communication with
the beneficiary families and individuals to promote the desired health seeking behavior.
They will be responsible to the Mahila Arogya Samitis (community groups) for which
they are designated.
7.14.1.2 Wherever possible the existing community workers under other schemes
like JnNURM, SJSRY etc. may be co-opted under NUHM. ASHAASHA
7.14.1.3 The ASHA would be a woman resident of the slum, preferably in the age
group of 25 to 45 years. The ASHA should also be literate with formal education up to
class tenth, which may be relaxed only if no suitable person with this qualification is
available. ASHAASHA would be chosen through a rigorous community driven process
involving ULB Counselors, community groups, self-help groups, Anganwadis, ANMs.
A team of five facilitators may be identified in each U-PHC catchment area with the
help of an NGO, through a consultative process, for facilitating the selection of the
ASHA. The facilitators would preferably be from local NGOs; community based
groups, Anganwadi or Civil Society Institutions. In case none of these is available in the
area, the officers of other Departments at the slum level/local school teachers may be
taken as facilitators. The selection process for ASHA in NRHM may be suitably
modified to the urban context as per the local condition and adopted for selection of the
urban ASHAs.
7.14.1.4 The ASHA would help the ANM in delivering outreach services in the
vicinity of the doorsteps of the beneficiaries. Preferably some suitable identified place
for ASHA may be arranged in the slums which may be AWW centres, clubs,
community premises set up under the JnNURM, Sub Health Posts set up in IPP cities,
municipal premises etc, or even her own residence.
7.14.1.5 An ASHA mentoring system on the lines of NRHM may be put in place
involving dedicated community level volunteers/professionals preferably through the
local NGO at the U-PHC level, for supporting and coordinating the activities of the
ASHA. The states may also consider the option of 1 Community Organizer for 10
ASHAs for more effective coordination and mentoring, preferably located at the
mentoring NGO. The Community organizer along with the ANM may be designated as
the mentoring and management team at the slum level for the ASHAs.
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7.14.1.6 Essential services to be rendered by the ASHA may be as follows:
(i) Active promoter of good health practices and enjoying community support.
(ii) Facilitate awareness on essential RCH services, sexuality, gender equality, age
at marriage/pregnancy; motivation on contraception adoption, medical
termination of pregnancy, sterilization, spacing methods. Early registration of
pregnancies, pregnancy care, clean and safe delivery, nutritional care during
pregnancy, identification of danger signs during pregnancy; counseling on
immunization, ANC, PNC etc. act as a depot holder for essential provisions
like Oral Re-hydration Therapy (ORS), Iron Folic Acid Tablet (IFA),
chloroquine, Oral Pills & Condoms, etc.; identification of target beneficiaries
and support the ANM in conducting regular monthly outreach sessions and
tracking service coverage.
(iii) Facilitate access to health related services available at the

Anganwadi/Primary Urban Health Centres/ULBs, and other services being
provided by the ULB/State/ Central Government.
(iv) Formation and promotion of Mahila Arogya Samitis in her community.
(v) Arrange escort/accompany pregnant women and children requiring

treatment to the nearest Urban Primary Health Centre, secondary/tertiary
level health care facility.
(vi) Reinforcement of community action for immunization, prevention of water

borne and other communicable diseases like TB (DOTS), Malaria,
Chikungunya and Japanese Encephalitis.
(vii) Carrying out preventive and promotive health activities with AWW/ Mahila
Arogya Samiti.
(viii) Maintenance of necessary information and records about births & deaths,
immunization, antenatal services in her assigned locality as also about any
unusual health problem or disease outbreak in the slum and share it with the
ANM in charge of the area.
In return for the services rendered, she would receive a performance based incentive.
For this purpose a revolving fund would be kept with the ANM at the U-PHC (in the
PHC account), which would be replenished from time to time, based on UC/SOE. The
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following performance based incentive package is suggested subject to modifications by

the State.
TABLE 7.4: ASHA INCENTIVE CHART *
Proposed Activities
1 Organization of outreach sessions
2 Organization of monthly meeting of MAS
3 Attend monthly meeting at U-PHC
4 Organize Health & Nutrition day in collaboration with AWW
5 Organize community meeting for strengthening preventive and

promotive aspects
6 Provide support to Baseline survey and filling up of family Health

Register
7 Maintain records as per the desired norms like Household Registers,

Meeting Minutes, Outreach Camps registers
8 Additional Immunization incentives for achieving complete

immunization in among the children in her area of responsibility:
9. Incentives/compensation in built in national schemes for ASHA

under JSY, RNTCP, NVBDCP, Sterilization, Home Based Newborn
Care etc. and any other National programme
* This list is indicative but not exhaustive.
7.14.1.8 During the field visits it was observed that provision of a photo identity
card to the community volunteers greatly boosts their self esteem. The states/cities
can also explore the option of providing ASHAs with Photo ID card.
7.14.1.9 The Urban Local Body would provide the leadership to the selection
process of ASHA. The following process may be adopted:
(i) The ASHA will be selected through a community driven process led by
the Urban Local Body. To facilitate the selection process the District/ City
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level Mission would constitute a City Level ASHA Selection Committee

headed by the member of the urban local body. The CMO/CDMO; DPO-
ICDS; and PO of JnNURM; DUDA; SJSRY would be the members. The
District/ City level health mission can also decide to induct more
members from the NGO/ Civil society based on the local need. The City
Level ASHA Selection Committee would approve the names of the ASHA
proposed by the PUHC level facilitation committee. The selection
committee would also provide all the guidelines for the selection of
ASHA. The City Level ASHA Selection Committee would also be
responsible for Constitution of health facility/unit level ASHA selection
committees. It will monitor and provide all necessary support to carry out
the ASHA selection process including approval of the list of selected
ASHAs/LWs.
(ii) The Catchment area of the U-PHC would form the unit for selection
process. At the unit level a ASHA Facilitation Committee for proposing
the name of the ASHA to the City level Selection Committee would be
constituted. The U-PHC level committee would also monitor the whole
process and ensure that the selection process is as per the approved
selection process.
(iii) The Urban Local Body if appropriate may also involve local NGOs
working in urban areas in the selection process of the ASHA. As the
situation varies from city to city flexibility would be provided for need
based adoption of above process.
7.14.2 Mahila Arogya Samiti (MAS) –
7.14.2.1 MAS acts as community group, involved in community awareness,

interpersonal communication, community based monitoring and linkages with the
services and referral. The MAS may cover around 50- 100 households (HHs) with an
elected Chairperson and a Treasurer, supported by an ASHA. This group would
focus on preventive and promotive health care, facilitating access to identified
facilities and management of revolving fund. The following process may be adopted
for constitution of the MAS
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7.14.2.2 Constitution of Mahila Arogya Samiti:
To expand the base of health promotion efforts at the community level and to
build sustainable community processes, each ASHA will promote organized
collective efforts through a group of socially committed females from the
community itself. Present or past experiences of collective efforts in the slums
towards fulfillment of any objective will be explored. Women’s/ SHG groups
wherever present would be encouraged to expand their scope of work to address
health challenges in the community.
7.14.2.3 Process of promotion of Mahila Arogya Samiti:
7.14.2.3.1 Constitution of a team at slum level: The ASHA with support of NGO
field functionary(if any), AWW and ANM will constitute a team
7.14.2.3.2 Meetings with slum women: The team (ASHA and others) conduct a
series of meetings with women from the slum to understand the health conditions and
to sensitize the women to work towards improving the health of the men, women and
children in the slum It is generally observed that the initial meetings have a large
number of slum women attending mainly due to curiosity or with expectations to get
some benefits (monetary).
7.14.2.3.3 Identification of active and committed women: At least a gap of 1-2 weeks
is given between women to reflect, discuss with others and determine their
commitment to serve their slum community. Generally towards the 3rd or 4th meeting,
the numbers of women attending falls and only interested women come for the
meeting. Active, interested and committed women will be identified and over a period
of time, encouraged to work collectively on community issues to form the base of the
Mahila Arogya Samiti. It may be borne in mind that each community responds
differently and takes its own time to crystallize, and interventions would have to be
designed, keeping in alignment with the community
7.14.2.3.4 Suggested group size: The suggested norm for one group is 10-12
members over 50-100 families. The numbers will vary depending on the size of the slum
(e.g. in case of a small slum with 50 families, the Committee will be promoted over 50
families) and also the factors within the slum (e.g. different communities within a small
area).
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7.14.2.3.5 Promotion of MAS: The active women (10-12) identified then meet and
decide to work collectively as a group. They nominate office bearers, formulate rules
and regulations for the group and record proceedings of the meetings and start
functioning as a group.
7.14.2.4 Desired characteristics of members of Mahila Arogya Samiti:
7.14.2.4.1 Membership in the Women’s Health Committee may be guided by the

objectives and expected roles of this group. The membership in the group would be a
natural process, guided by the team of ASHA and others. Therefore the following
should not be seen as eligibility criteria. However the common features emerging in this
scene would be –
7.14.2.4.2. Woman with a desire to contribute to ‘well-being of the community’ and

with a sense of social commitment and leadership skills.
7.14.2.4.3 Woman’s age is not being kept as a barrier as the role of the woman in the
house and the community is either as a target beneficiary or as an influencing force.
7.14.2.4.4 If a group is being formed over a number of pockets of different

communities, membership from all such pockets shall be ensured.
7.14.2.4.5 If the slum has a presence or history of collective efforts (as a self help
group, DWCUA group, Neighborhood Group under SJSRY, thrift and credit group),
women involved in these efforts should be encouraged.
7.14.2.4.6 ASHA may be a member of this group, if the group desires so. She should
be conscious of her dual role in this context, and consciously encourage leadership.
7.14.2.5 Outreach session: ANM
7.14.2.5.1 Responsible for providing preventive and promotive healthcare services at

the household level through regular visits and outreach sessions. (i) Each ANM will
organize a minimum of one routine outreach session in her area every month. ii) special
outreach Medical/Health Camps (for slum and vulnerable population) – Once in a
week the ANMs covering slum/vulnerable populations would organize one special
outreach Medical/Health Camp 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 counseling.
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7.14.2.5.2 For improving the routine outreach services in the field ANMs would be
provided with mobility support of Rs. 500 per month, apart from a provision of
Rs.30,000 per ANM for the 12th Plan period, which may be used to supplement the
mobility support. 4-5 ANMs will be posted in each U-PHC depending upon the
population.
7.14.2.5.3 Outreach sessions will be planned to reach out to the vulnerable sections
like slum population, rag pickers, sex workers, brick kiln workers, street children and
rickshaw pullers.
7.14.2.5.4 The outreach sessions (both routine and special outreach) could be
organized at designated locations mentioned in the aforesaid paras in coordination with
ASHA and MAS members.
7.15 URBAN PRIMARY HEALTH CENTRE
7.15.1 Functional for a urban population of around approximately 50,000-60,000, the U-

PHC may be located preferably within a slum or near a slum within half a kilometer
radius, catering to a slum population of approximately 25,000-30,000, with provision for
OPD from 12 noon to 8 pm in the evening. The cities, based upon the local situation
may establish a U-PHC for 75,000 for areas with very high density and can also
establish one for around 5,000-10,000, slum population for isolated slum clusters.
7.15.2 At the U-PHC level services provided will include OPD (consultation), basic lab
diagnosis, drug /contraceptive dispensing, apart from distribution of health education
material and counseling for all communicable and non communicable diseases. In order
to ensure access to the urban slum population at convenient timings, the U-PHC may
provide services from 12 noon to 8 pm in the evening. It will not include in-patient care.
7.15.3 It will be staffed by two doctors, one regular and one on a part time basis. Apart
from that there will be 3 staff nurses, 1 pharmacist, 1 lab technician, 1-2 LHV and 4-5
ANMs (depending upon the population covered), apart from clerical and support staff
and one Programme Manager for supporting community mobilization, behavior change
communication, capacity building efforts and strengthening referrals.
7.15.4 To further strengthen the delivery of services cities can also engage the services
of specialist doctors to provide services periodically at U-PHC based on needs on
reimbursement basis. U-PHC can also serve as collection centre for diagnostic tests in
partnership with empanelled private diagnostic centres.
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7.15.5 The option of co-locating the AYUSH centre with U-PHC may also be explored,
thus enabling the placement of AYUSH doctor and other AYUSH paramedic staff in the
U-PHC.
7.15.6 The situation analysis showed that at present there are various types of primary
health care facilities (UHP/UFWC/ Dispensary) with different service guarantee and
human resource norms. There has been no reorganization/expansion of these schemes
for a long period. With the launching of NUHM, all of these existing
programmes/schemes will automatically cease to exist. The existing infrastructure
available under these schemes would be rationalized and aligned with the new IPHS.
7.15.7 Under NUHM a uniform health care service deliver mechanism with IPHS
norms will be developed and the states are encouraged to adopt these norms for U-
PHCs.
7.15.8 Maximum effort would be made to strengthen the already existing public health
care infrastructure in urban areas. Existing SDH/CHC etc. would be upgraded and
strengthened.
7.15.9 Where there are no government health facilities, new public health facilities
would be established. All the U-PHCs would be set up in Govt. buildings. Partnership
with other government facilities like Railways, Army, ESIC and Public Sector Units
could also be explored for strengthening the delivery of services.
7.15.10 The government facilities strengthened as U-PHC will also be provided

annual financial support in the form grants to Rogi Kalyan Samiti/ Hospital
Management Committee Fund of Rs. 2,50,000 per U-PHC per year.
7.15.11 The recurrent cost support provided to U-PHCs of Rs.20 lakh per year, would
include cost of all staff in the U-PHC (staff norms as per Annex-IV – Financing Pattern
of U-PHC).
7.15.12 The posts of ANMs and LHVs are supported separately (not included in
the Rs.20 lakh per year recurrent cost support) and these may be contractual posts to
begin with, but eventually need to be absorbed into the system, and liability of these
posts would be on the central government.
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7.16 REFERRAL UNIT:
7.16.1 Urban Community Health Centre (U-CHC) may be set up as a satellite hospital
for every 4-5 U-PHCs. The U-CHC would cater to a population of 2,50,000. It
would provide in patient services and would be a 30-50 bedded facility. U-CHCs
would be set up in cities with a population of above 5 lakhs, wherever required.
These facilities would be in addition to the existing facilities (SDH/DH) to cater
to the urban population in the locality.
7.16.2 For the metro cities, the U-CHCs may be established for every 5 lakh population
with 100 beds.
7.16.3 For setting up the U-CHCs the Central Govt. would provide only a one time
capital cost, and the recurrent costs including the salary of the staff would be borne by
the respective state governments.
7.16.4 The U-CHC would provide medical care, minor surgical facilities and facilities
for institutional delivery.
7.17 REFERRAL LINKAGES:
7.17.1 Existing hospitals, including ULB maternity homes, state government hospitals
and medical colleges, apart from private hospitals will be empanelled /accredited to act
as referral points for different types of healthcare services like maternal health, child
health, diabetes, trauma care, orthopedic complications, dental surgeries, mental health,
critical illness, deafness control, cancer management, tobacco counseling / cessation,
critical illness, surgical cases etc.
7.17.2 There might be different and multiple facilities for the different healthcare
services, depending upon type of hospitals available in the city.
7.17.3 Collaboration with District Hospitals/ Area Hospitals/ Sub District hospitals
and local Medical Colleges may be promoted for strengthening the training support and
supplement human resource at the U-PHC level.
7.17.4 Public Health laboratories will also be strengthened under NUHM for early
detection and management of disease outbreaks in urban concentrations.
7.17.5 Wherever public sector coverage is inadequate, reputed private sector

institutions may be considered. The empanelled/accredited facilities would be
reimbursed for the services provided as per the pre-decided rates, negotiated with them
at the time of empanelling/accrediting them and indicated in the city level urban health
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PIPs subject to approval at the appropriate level. This will not only ensure flexibility to
adapt to different conditions in different cities but also increase the range of options for
the beneficiaries.
7.18 SCHOOL HEALTH SERVICES
7.18.1 Schools can serve as nodal points for advocating healthy behavioral practices
and imparting awareness about preventive and curative health measures. This
awareness percolates to households and families of the students. It also ensures creation
of aware students who will be parents in the near future. Therefore School Health
Programme in cities can help the National Urban Health Mission to achieve its goals
and objectives by reaching out to a large section of the community in a cost effective
manner.
7.18.2 Over one fifth of our population comprises of children, aged 5-14 i.e., the age
group covering primary and secondary education. About 80% of these children are
enrolled in schools. Of those enrolled 65-85% are regularly attending school, for an
average of 200 days in a year. In urban areas, most of children who are attending
government run primary and secondary schools are coming from disadvantaged
sections of the urban population. Thus the bulk of the school age children are in schools
on majority of days in a year and are very easy to reach. There are around 6.25 crore
slum population in India (Census 2001). There will be approximately 1 crore urban poor
children going to schools from slums.
7.18.3 The school health programmes can gainfully adopt specially designed modules
in order to disseminate information relating to 'health' and 'family life'. This is expected
to be the most cost-effective intervention as it improves the level of awareness, not only
of the extended family, but the future generation as well.
7.18.4 In urban areas, the scheme would cover Government or private schools located
in slums (U-PHC catchment) or government schools near slums which slum children
attend.
7.18.5 School health programmes may consist of three related components; school
health services, school environment and health education. It aims at screening of all
primary school children for common ailments which include anaemia, worm infections,
night blindness, iodine deficiency diseases (goitre), ear discharge, scabies, pyoderma,
vision defects and dental problems.
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7.18.6 COMPONENTS OF THE SCHOOL HEALTH PROGRAMME
(i) Health Education (H.E.) Activities, creating awareness about hygiene,

prevention of Vector Borne Disease etc
(ii) Medical examination of primary school children for eye ailment, nutrition,
and others
(iii) Treatment of minor ailments such as de-worming, skin diseases at school

itself
(iv) Special In-patient care at identified hospitals and referral services
(v) Control of communicable diseases through Immunization
(vi) Training of teachers for early identification of symptoms
7.18.7 Partnership with NGOs for health education activities, liasioning with other
schools and monitoring the referral services could be done. Referral services have to be
emphasized because without a good functioning referral system school health services
cannot be successful in their objectives. The two way referral system, school-health
worker-medical officer at health centre/school health clinic-specialist shall be
established and be working. Teachers may be trained and equipped for recognition of
sickness/danger signals, for giving first aid/on the spot treatment and for referring the
children needing further care. For this purpose training programmes have to be
designed, ideally jointly with health functionaries (of appropriate levels) for present
teachers and suitable changes made in the training curricula for future teachers.
7.18.8 The states are implementing their existing school health programmes and the
scheme can be integrated with the School Health Programme under NUHM. The state
can take a lead in streamlining implementation of the programme with appropriate
budget allocation.
7.19 IMPROVING ACCESS TO VULNERABLE SECTION OF URBAN POOR
7.19.1 To target special interventions on the vulnerable groups in the cities, mapping of
the vulnerable groups (one time) would be undertaken. The vulnerable sections would
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include the rag pickers, destitute, beggars, street children, construction workers, coolies,
rickshaw pullers, sex workers, street vendors and other such migrant workers. It is also
envisaged that dedicated drug distribution centres be opened for the identified
concentration of vulnerable groups, through NGO/CSOs, which will have provisions
for emergency OTC drugs and contraceptives. Special attention would be paid to
organizing outreach sessions for these vulnerable communities. For targeted IEC/BCC
interventions, the details of which will be as per the city PIP, the provision is Rs.5 per
capita for the target urban vulnerable population (in line with the provision for
IEC/BCC under NRHM). This will also include community mobilization, identification
of recently settled urban poor families and support through NGO/CSO. The details of
this mobilization strategy will be as per the city PIP.
TABLE 17.1: Indicative Service Norms by levels of Service Delivery *
Services** Levels of service delivery
Community (Outreach) First point of Referral Centre -

service delivery (U- U- CHC (Specialist
PHC) services)
A. Essential Health Services
A1. Maternal Registration, ANC, identification of ANC, PNC, initial Delivery (normal
health danger signs, referral for management of and complicated),
institutional delivery, follow-up complicated management of
delivery cases and complicated
referral, Gynae/ maternal
Counseling and behavior management of health condition,
promotion regular maternal hospitalization and
health conditions, surgical
referral of interventions,
complicated cases including blood
transfusion.
A2. Family Counseling, distribution of Distribution of Sterilization

welfare OCP/CC, referral for sterilization, OCP/CC, IUD operations, fertility
follow-up of contraceptive related insertion, referral treatment
complications for sterilization,
management of
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PHC) services)
contraceptive
related
complications
A3. Child Immunization, identification of Diagnosis and Management of

health and danger signs, referral, follow-up, treatment of complicated
nutrition distribution of ORS, paediatric childhood illnesses, paediatric/neo-
cotrimoxazole post-natal referral of acute natal cases,
visits/counseling for newborn care cases/ chronic hospitalization,
illness surgical
interventions, blood
Identification and
transfusion
referral of neonatal
sickness
A4. RTI/STI referral, community level follow- Symptomatic Management of

(including up for ensuring adherence to Diagnosis and complicated cases,
HIV/AIDS) treatment regime of cases primary treatment hospitalization (if
undergoing treatment and referral of needed)
complicated cases
A5. Nutrition Height/weight measurement, Hb Diagnosis and Management of

deficiency testing, distribution of therapeutic treatment of acute deficiency
disorders doses of IFA, promotion of iodized seriously deficient cases,
salt, nutrition supplements to patients, referral of hospitalization
identified children and pregnant/ acute deficiency
lactating women cases
Treatment and
Promotion of breast feeding,
rehabilitation of
complementary feeding for
severe under-
prevention of under-nutrition
nutrition
A6. Vector- Slide collection, testing using Diagnosis and Management of

borne RDKs, DDT treatment, referral terminally ill cases,
diseases of terminally ill hospitalization
cases
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PHC) services)
Counseling for practices for vector

control and protection
A7. Mental Initial screening and Psychiatric and

Health referral neurological
services, including
hospitalization, if
needed
A7.1 Oral Diagnosis and Management of

Health referral complicated cases,
hospitalization (if
needed)
A7.2 Hearing Management of

Impairment/ complicated cases,
Deafness hospitalization (if
needed)
A8. Chest Symptomatic search and referral, Diagnosis and Management of

infections ensuring adherence to DOTs, other treatment, referral complicated cases
(TB/ treatment of complicated
Asthma) cases
A9. Cardio- BP measurement, symptomatic Diagnosis and Management of

vascular search and referral, follow-up of treatment and emergency cases,
diseases under-treatment patients referral during hospitalization and
specialist visits, surgical
interventions (if
needed)
A10. Diabetes Blood/urine sugar test (using Diagnosis and Management of

disposable kit), symptomatic treatment, referral complicated cases,
search and referral, of complicated hospitalization (if
cases needed)
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PHC) services)
A11. Cancer Symptomatic search and referral, Identification and Diagnosis,

follow-up of under-treatment referral, follow-up treatment,
patients of under-treatment hospitalization (if
patients and when needed)
A12. Trauma First aid and referral First aid , Case management
care (burns & emergency and hospitalization,
injuries) resuscitation, physiotherapy and
documentation for rehabilitation
MLC (if applicable)
and referral
A13. Other --- not applicable --- Identification and Hospitalization and
surgical referral surgical
interventions interventions
B. Other support services
B1. IEC/BCC IPC, Health Camps/fairs, Distribution of Distribution of

performing arts, wall/poster health education health education
writing, events (in schools, material material
women’s groups)
B2. Individual and group/family Patient/attendant Patient/attendant

Counseling counseling – counseling counseling
B3. Personal IEC on hygiene, community --- not applicable --- --- not applicable ---
& Social mobilization for cleanliness drives,
Hygiene disinfection of water sources, etc.
*Norms adapted from NCMH Report
** Services based on situational analysis
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TABLE 7.2: INDICATIVE NORMS FOR OPERATIONALISATION OF URBAN

PHC
(i) Accessibility
a. Preferably located near the slum to be served
b. Accessed by slum dwellers
(ii) Services
a. Medical care: OPD services: From 12 noon to 8 pm
b. Services as prescribed under RCH II
c. National Health Programmes
d. Collection and reporting of vital events and IDSP
e. Referral Services
f. Basic Laboratory Services
g. Counseling services
h. Services for Non Communicable Diseases
i. Social Mobilization and Community level activities
(iii) Basic Infrastructure
a. Consultation room, Dressing and treatment room, Medicine room
b. Medical equipments and instruments
(iv) Basic Staff
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TABLE 7.3: PROPOSED HUMAN RESOURCE AT URBAN PHC
# Staff Category Number
1 Medical Officer 2 (1 regular and 1

part time)
2 Staff Nurse 3
3 Pharmacist 1
4 Lab Technician 1
5 Public Health Manager/ Community 1

Mobilisor
6 LHV 1-2
Depending upon
number of ANMs
7 ANMs 4-5
* Depending upon the

population
8 Secretarial Staff including for account 2

keeping and MIS
9 Support staff 1
TABLE 7.4: INDICATIVE NORMS FOR OPERATIONALISATION OF URBAN

CHC
As the partnership for the referral unit would be need based, empanelment criteria can
be developed based upon the norms prescribed by the IPHS for hospitals. Some of the
suggested criteria can be
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a. Accessibility
i. The Hospital/ Nursing home to be easily accessible for the served

population.
ii. Willingness to provide services at the rates negotiated
b. Facilities :
i. As per IPHS norm for Hospitals locally adapted as per need
ii. Round the clock availability of services
c. Availability of Specialties services for which the partnership is being

entered. Some of them may be:
i. Obstetrics and Gynaecology

ii. Paediatrics
iii. General Surgery
iv. Ophthalmology
v. ENT
vi. Orthopaedics
vii. Dermatology
viii. CVD
ix. Endocrinology (Diabetes, Thyroid)
x. Mental Health
xi. General Medicine
xii. Dental
xiii. Any other based on epidemiological profile of the City
d. Diagnostic facilities: As per the requirement. Some of it can be:
i. Fully equipped laboratory for biochemistry, microbiology and

hematology
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ii. X- Ray machine with minimum capacity of 60 MA
iii. Ultra-Sonography
iv. Any other based on epidemiological profile of the City
8 - BROAD NORMS FOR NUHM INTERVENTIONS
Activity Norm
1. Mapping of all urban health Norms will have to be developed to classify the
facilities/ poor households poor households. GIS Mapping of all health
care facilities-public and private and slums-
listed and unlisted would be done to study the
population distribution and morbidity pattern
(GIS maps prepared under various urban
schemes would be taken wherever available).
Data base to be generated involving the
Community Workers, CBOs and NGOs. Cost
will vary in mega cities, million plus cities, and
other categories of cities and towns.
2. Preparation of slum/city Based on the detailed GIS mapping and

specific plans household surveys and after intensive
discussion at all levels, Slum/City level plans to
be drawn up. Cost of planning will vary as per
the population.
3. Female Health Worker (FHW) One FHW/ANM will be provided in urban

areas for a population of 10-12 thousand. As
health sub-centres are not proposed under
NUHM, FHWs will be based in U-PHC. They
will be provided mobility support for outreach
services.
4. Community Worker/Link Community Worker/ASHA/ASHA/LW

Worker for every 200-500 preferably a woman should be a local resident
slum/vulnerable households and at least Class 10 pass. To be paid
(1000-2500 slum/vulnerable performance based incentives. Main tasks to be
population) generating awareness in the community,
coordinating with community groups/MAS for
preventive and promotive actions for health
and health determinants, and linking
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households to health facilities (government or

private accredited).
5. Capacity building, performance Basic training modules for Community

based payments, drug kit for Workers to be developed based on the ASHA
Community Worker training modules. 4 weeks induction training
followed by 10-15 days refresher training in
various aspects of public health and community
mobilization. Compensation for training.
6. Community Organization Community Organization in homogeneous

(Mahila Arogya Samiti) for 50- setting with 10-12 members, will receive grant
100 households in slums/other of Rs. 5000 per year. Major responsibility of
vulnerable population (250-500 community mobilization and
slum/vulnerable population). awareness/demand generation addressing
health and health determinants.
7. Training and Capacity Building Through NGOs. To ensure greater role in

of Mahila Arogya Samitis management of savings and community
mobilization. Quarterly orientation
workshops/meetings will be organized for the
MAS members.
8. One Urban Primary Health U-PHC as nodal point. To function under

Centre for every 50,000 government with well defined service
population guarantees and provisions for human
resources, infrastructure, equipment, etc. Indian
Public Health Standards will be developed for
U-PHC as per the recommendations of the Shiv
Lal Committee. U-PHC to operate preferably
from 12 noon to 8 pm.
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9. One Urban Community Health U-CHC to function as in-patient and first

Centre for every 2.5-3 lakhs referral level for the urban population, reducing
population (every 5 –6 U-PHCs) the workload of sub-district/district or medical
in cities above 5 lakh population college hospital in the city (which take the load
of the entire area and only of the city). To
function under government with well defined
service guarantees and provisions for human
resources, infrastructure, equipment, etc. Indian
Public Health Standards will be developed for
U-CHC.
The central assistance would provide only for

one-time grant of Rs.5 crores and the recurrent
cost would be borne by the state.
Establishment of U-CHCs to be decided by the

concerned State Government on the basis of
actual need.
10. Training and Capacity NGOs to be involved in training and capacity
Development of Ward level development of Ward level Standing
Standing Committee on health Committees of health.
under Urban Local Body
11. Untied grants to Rogi Kalyan Each U-PHC to get Rs. 2.5 Lakh and each U-
Samiti CHC to get Rs.5 lakhs as untied grant every
year for local public health action and for its
maintenance and upkeep. The District Health
Society may re-appropriate the overall amount
amongst various health institutions by +25%,
depending on need and utilization levels.
For calculation of resource envelop of a district,

allocation will be done on normative basis for
the health facilities.
12. Resources for outreach services Outreach services at slum level will be
as per fixed schedule in urban provided by the ANM. Buildings (community
slums by ANMs halls etc) constructed under the schemes of the
Department of UD, HUPA and other
government departments may be utilized as
fixed points for providing periodic outreach
services.
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13. Involvement of NGOs in U-PHC NGOs will be utilized for community

area mobilization, capacity building, and other
preventive and promotive activities for health
and health determinants.
14. Hiring of NGOs/Private Services of NGOs and private providers may be

providers for U-PHC services hired to bridge the gaps in health care delivery
as per actual need. For this the accreditation
process and deliverables to be clearly defined.
15. Enhancing planning capacity in Provision for need based additional human
urban local bodies resources in public health, management of
health system, finance, MIS, planning , etc.
16. Referral Transport and Mobile MMUs and Referral Transport System provided
Medical Units in the district under NRHM will also be used to
cover urban areas.
17. Setting up of City Level society In the metropolitan cities and other cities where
the State government decides to hand over the
management of urban health system to
municipal corporations, city level health society
will be set up.
18. Behavior Change IEC and BCC have a very important role
Communication especially in urban areas where the influence of
media and advertizing needs to be countered
effectively, especially against use of junk food,
aerated drinks, tobacco and alchohol
consumption, etc. Provision of Rs. 5 per capita
for IEC/BCC. Interpersonal communication
through LWs/ASHAs to play a major role in
promoting behavior change.
19. MIS for health in urban areas As per need.
20. Management cost for Up to 6 percent of the resource envelope for

programme recurrent cost. A capital grant of Rs.5 lakhs per
Program Management Unit (PMU) would be
provided separately.
21. Interventions for making As per norms of IDSP.
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surveillance system effective
22. Special interventions for As per specific proposals and preferably

vulnerable groups like sex through NGOs.
workers, street children,
migrant labor, etc.
23. Strengthening Secondary and As per need.

tertiary care hospitals
24. Community Monitoring As per need.
25. Urban Areas having less than Urban Areas having less than 50,000 population
50,000 population will be covered by the health care delivery
system supported by the National Rural Health
Mission.
26. Building ownership of Sub In the cities/towns other than State/district

Divisional Officer headquarters, a committee headed by the sub-
divisional officer will be constituted by the
District Magistrate in consultation with the
Chief Medical Officer. This committee will
ensure effective coordination and
implementation of NUHM activities in the
cities/towns in the jurisdiction of the sub-
division. Similar arrangement with Additional
District Magistrate (ADM)/Sub Divisional
Officer may also be put in place for district
headquarter towns/cities.
9 - FINANCIAL RESOURCE NEEDS FOR NUHM
9.1 The National Urban Health Mission would initiate planning activities in 2011-12.
The sharing arrangement for NUHM will be 100% by centre in XI Plan, and 85-15 in the
XII Plan (75-25 for the seven metro cities).
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TABLE 9.1: POPULATION ASSUMPTIONS UNDERLYING FINANCIAL

ESTIMATES FOR NUHM:
Population Numbers
1. Urban Population 2001 ( Census 2001) 28.61 crores
2. Urban population 2011 (Census 2011) 37.71 crores
3. Urban population residing in cities with a 22.13 crores
population of above 50 thousand
4. Projected Urban slum population 2011 (in cities 7.75 crores
above 50 thousand population – estimated 25% of
urban population + 10% additional estimated
vulnerable population)
5. No. of metro cities 7
6. No. of cities with population above 1 million (10 27
lakh) as per projections (taking into account urban
population growth@ 3% p.a)
7. Cities with population between 1 - 10 lakh 353
8. Cities with population between 50,000 - 1 lakh 392
9. Total Number of U-PHCs to be strengthened (@ 1 4,425
U-PHC for 50,000 population)
10. Total Number of U-CHCs (@ 1 U-CHC for 5- 344
UPHCs, i.e. 2.5 lakhs population
11. Total no. of ANMs required in the U-PHCs (@ 4 23,688
ANM per U- PHC)
12. Total Number of ASHAs /LWs required (@ 1 38,720
ASHA for 2000 slum population)
13. Total Number of Mahila Arogya Samitis (@ 1 1,54,882
MAS for 100 HHs in slum areas)
9.2 ESTIMATED FUNDS REQUIRED FOR NATIONAL URBAN HEALTH

MISSION
9.2.1 It is estimated that the proposed NUHM would need a total of Rs.22,507 crores
(approximately) from 2012-13 to 2016-17, of which Rs.16,955 crores (approximately) is
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envisaged to be the central government share. Year wise financial requirement, by

central and state share, is shown below.
Year GOI States Total Remarks

2012-13 2,325.61 762.13 3,087.74 GOI 75%, state
2013-14 3,782.74 1,239.42 5,022.17 25% in all states
2014-15 3,957.74 1,296.35 5,254.09 except
northeastern
2015-16 3,949.20 1,293.20 5,242.40
states where the
ratio is
GOI 90%, state
10%
2016-17 2,939.77 961.04 3,900.82

Total 16,955.07 5,552.14 22,507.21
9.2.2 As per the above table, the financial requirement for the central government in
the XII Plan period is estimated to be Rs. 16,955 crores (central share).
9.3 MANAGEMENT COSTS
9.3.1 It is imperative that management capacities be built at each level. To attain the
outcomes, the NUHM would provide management costs up to 6% of the total annual
plan approved for a State/City (similar to NRHM norms of 6% for management costs).
The services of experts and other functionaries may have to be hired on contractual
basis to carry out the activities under the Mission. The Mission would also need to be
vested with authority to strengthen management structures without creating any new
permanent posts.
9.4 NORMS FOR RELEASE OF FUNDS TO THE STATE GOVERNMENTS
9.4.1 In order to ensure that the state specific focus is retained in planning and
management of NUHM the urban population and health infrastructure would be given
appropriate weight-age for release of the funds to the States. However, actual release
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would depend upon the actual State Level PIP based on respective city and district level
PIPs subject to approval by the NPCC at the Central level.
9.5 SUSTAINABILITY
9.5.1 The NUHM would strive to ensure the sustainability of the Mission through
state and ULB contribution, promotion of community structures like the Mahila Arogya
Samitis and facility based Rogi Kalyan Samitis on the lines of NRHM.
9.5.2 The Rogi Kalyan Samiti would also be encouraged to pool funds, on the lines of
NRHM, from other sources like donations/ MP or MLA/ULB etc contributions for
broad-basing the community health fund.
10 - PLANNING PROCESS OF NUHM
10.1 City specific planning is extremely essential as the health structure in cities
varied considerably. However in order to optimize the utilization of central, state,
municipal, and private health assets and manpower, it was essential that a City Health
and Sanitation Planning Committee in the urban areas works under the umbrella of
the District Health Mission and the District Health Society whose primary role would
be to integrate health service delivery to the urban poor in the urban areas.
10.2 The planning process would involve identification, mapping and vulnerability
assessment of slums, assessment and mapping of the existing health care services,
stakeholder consultations, mapping of referrals in each area, rationalization of
manpower, mapping and accrediting the private sector, ensuring private sector
participation and also ensure effective convergence with departments likes ICDS and
JnNURM.
10.3 Household surveys through the Mahila Arogya Samiti and the ASHA/Link
Worker are needed to understand the poverty of households and the challenges of
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public health in urban slums. The Mahila Arogya Samiti will be the basic unit of
planning and community action.
11 - APPRAISAL AND APPROVAL PROCESS OF NUHM
11.1 The NRHM has developed a transparent mechanism for appraisal of state PIPs
and subsequent release of funds. The NUHM will also follow norms as has been
developed under NRHM for programme appraisal and fund release.
11.2 Each City would develop a CPIP, which would be consolidated at the State level
as State Programme Implementation Plan (SPIP) incorporating additonalities at the
State level.
11.3 The CPIP would be a reflection of the comprehensive resources available to the
City under the various ongoing national health/state/ULB programmes and also other
sources of funds including State Health Systems projects, State Partnership Projects,
Finance Commission awards, projects / schemes funded through Global Funds and/or
Global Partnerships in the health sector and projects / schemes being (or proposed to
be) funded outside the State budget as an illustrative but not an exhaustive list. Clear
delineation of funds allocated under RCH, NRHM Flexipool, RNTCP, NVBDCP, IDD,
NLEP, NMHP, NPCB, NACP, UFWC, UHP etc would have to be enunciated in the PIP.
11.4 The National Programme Coordination Committee (NRHM) headed by the

Mission Director would undertake the appraisal of the proposals received and also
recommend for funding.
11.5 With the launching of NUHM, all of these existing programmes/schemes

(supporting the various types of primary healthcare facilities like
UHP/UFWC/Dispensary) will automatically cease to exist. The existing infrastructure
available under these schemes would be rationalized and aligned with the new IPHS.
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11.6 The City /State PIP would also clearly articulate the funds required for the urban
component of the various National programmes and the funds would be released by
the Programme Divisions.
17.7 The NUHM similar to the NRHM would also try to provide a platform for
integrating all the programmes for urban areas as is being done under the NRHM. Till
the time this process is put in place and institutionalized the fund flow mechanism
under the NRHM would be adopted. E-banking systems would be put in place for
facilitating this.
17.8 Given the current absorptive capacities in the States as also the structures for
managing accountability at various levels, it is likely that the demand for resources will
be less in the initial years. The actual need year to year will depend on the pace at which
States push reforms in order to remove the constraints on expenditure and its effective
utilization. Efforts would be made to kick-start the Mission with the desired pace by
capacity building workshops to increase the absorptive capacity of the states. Annual
financial demands would be accordingly made. A flexible pool of resource envelope
would be indicated to the states with provision for inter component variability in
activity heads/costs in view of extant urban situation/city specific conditions.
12 - ROLE OF THE NON-GOVERNMENTAL SECTOR IN NUHM
12.1 Transparent partnerships with non-governmental providers for health care

services
12.1.1 Recognizing that government health facilities do not have adequate reach in
urban slums leading to low demand and poor utilization, involving NGOs in outreach
and referral in the urban poor settings may be a viable option. Many state governments
have also contracted private hospitals to provide outreach activities (using the private
partner’s facilities and staff) in un-served areas and also provide referral support. There
is a considerable existing capacity among private providers (NGOs, medical
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practitioners and other agencies), which should be explored, fruitfully exploited and
operationalised.
12.1.2 Potential private partners should be identified and tapped optimally to improve
the quality and standard of health among the urban poor, by capitalizing on the skills of
potential partners, encouraging pooling of resources, and supplementing the
investment burden on the Government of India’s resources deployed in the health
sector. Appropriate mechanisms for partnering (or entering into agreement) with the
private sector needs to be considered, including accreditation methods (for ensuring
quality), memorandum of understanding, reporting and monitoring systems etc.
12.2 Role of NGOs in strengthening health services for the poor
12.2.1 The presence of active NGOs in several cities presents a unique and powerful
opportunity to extend the reach of health services through various ways of outreach
and enhancing utilization by raising community demand for the existing services. The
support of the NGOs would be encouraged and supported to get suitably involved in
the planning and implementation of the urban health projects. They may support in
undertaking situational analysis, identification and mapping of slums, identification &
capacity building of Link Volunteers and IEC/BCC activities.
13 - ROLE OF REGULATION AND DEFINING STANDARDS
13.1 The IPHS standards for U-PHC and U-CHC will be developed and shared with
the States.
13.2 The Quality Assurance activities would mainly involve formation of an

overarching Quality Assurance Committee (QAC) at state and city levels and one or
more Quality Assurance Teams (QAT), composed of renowned specialists and senior
technicians.
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13.3 The Quality Assurance teams would be responsible for recommending

accreditation of clinics/ hospitals/ nursing homes/ diagnostic centers and pharmacies
for empanelment for outreach services/ U-PHCs/ referral centers.
13.4 These teams would also undertake periodic medical audits of
selected/empanelled health facilities, either by themselves, or through external
auditors, in consultation with the Quality Assurance Committee.
13.5 For this purpose, it is proposed to allocate a lump sum amount of Rs. 50 lacs per
year per metro city, Rs. 20 lacs per city with 10 lac+ population, Rs. 10 lacs per other city
with 1 lac+ population, and Rs. 1 lac for cities less than 1 lac population (but above
50,000 population).
13.6 These funds would also include provision for orientation and training of
QAC/QAT.
13.7 But these provisions do not include funds for certification of government
hospitals.
13.8 In addition a Health Service Charter will be displayed at the facility level. It is
envisaged that such public display of information would empower the community for
demanding services. The different institutional mechanism like Rogi Kalyan Samiti/
Mahila Arogya Samiti would ensure that the service guarantee at each level is met.
13.9 In order to identify discrepancies and take corrective actions the practice of
Concurrent audit may be introduced right from the inception stage. All the funds/
untied grants would be audited on a quarterly basis and report of which would be
made public. This process would also facilitate timely submission of utilization
certificates and Audit Reports to ensure financial health of the Mission.
13.10 A grievance redressal mechanism would be put in place in which a committee,

comprising of members from government and reputed community members would be
constituted which will help resolve the problems and complaints.
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Annexure – II
The list of proposed 779 cities and towns including 7 metros
State City Population State City Population
Andaman Nic Port Blair 99,984 Andhra Pr. Suryapet 94,585
Total (ANC) 1 99,984 Andhra Pr. Chilakaluripet 91,656
Andhra Pr. Hyderabad 57,42,036 Andhra Pr. Miryalaguda 91,359
Andhra Pr. Vishakhapatnam 13,45,938 Andhra Pr. Tadpatri 86,843
Andhra Pr. Vijayawada 10,39,518 Andhra Pr. Kavali 85,616
Andhra Pr. Warangal 5,79,216 Andhra Pr. Jagtial 85,521
Andhra Pr. Guntur 5,14,461 Andhra Pr. Anakapalle 85,486
Andhra Pr. Rajahmundry 4,13,616 Andhra Pr. Yemmiganur 76,411
Andhra Pr. Nellore 4,04,775 Andhra Pr. Palacole 76,308
Andhra Pr. Kakinada 3,76,861 Andhra Pr. Kadiri 76,252
Andhra Pr. Kurnool 3,42,973 Andhra Pr. Nirmal 75,254
Andhra Pr. Tirupati 3,03,521 Andhra Pr. Tanuku 72,970
Andhra Pr. Nizamabad 2,88,722 Andhra Pr. Rayachoti 72,297
Andhra Pr. Cuddapah 2,62,506 Andhra Pr. Bodhan 71,520
Andhra Pr. Anantapur 2,43,143 Andhra Pr. Srikalahasti 70,854
Andhra Pr. Ramagundam 2,37,686 Andhra Pr. Palwancha 69,088
Andhra Pr. Karimanagar 2,18,302 Andhra Pr. Gudur 68,782
Andhra Pr. Eluru 2,15,804 Andhra Pr. Bapatla 68,397
Andhra Pr. Khammam 1,98,620 Andhra Pr. Bellampalle 66,792
Andhra Pr. Vizianagaram 1,95,801 Andhra Pr. Mandamarri 66,596
Andhra Pr. Machilipatnam 1,79,353 Andhra Pr. Sircilla 65,314
Andhra Pr. Chirala 1,66,294 Andhra Pr. Kamareddy 64,496
Andhra Pr. Adoni 1,62,458 Andhra Pr. Siddipet 61,809
Andhra Pr. Nandyal 1,57,120 Andhra Pr. Kagaznagar 59,734
Andhra Pr. Ongole 1,53,829 Andhra Pr. Narasapur 58,604
89
No. L 1907/1/2008-UH
Government of India
Andhra Pr. Tenali 1,53,756 Andhra Pr. Sattenapalle 51,404
Andhra Pr. Chittoor 1,52,654 Andhra Pr. Bhongir 50,407
Andhra Pr. Proddatur 1,50,309 Andhra Pr. Tuni 50,368
Andhra Pr. Bhimavaram 1,42,064 Andhra Pr. Nuzvid 50,354
Andhra Pr. Mahbubnagar 1,39,662 Andhra Pr. Kandukur 50,326
Andhra Pr. Adilabad 1,29,403 Andhra Pr. Wanaparthy 50,114
Andhra Pr. Hindupur 1,25,074 Andhra Pr. Pithapuram 50,103
Andhra Pr. Mancherial 1,18,195 Total (AP) 83 1,86,42,704
Andhra Pr. Srikakulam 1,17,320 Arunachal Pr Itanagar 35,022
Andhra Pr. Guntakal 1,17,103 Total (Ar.P) 1 35,022
Andhra Pr. Gudivada 1,13,054 Assam Guwahati 8,18,809
Andhra Pr. Nalgonda 1,11,380 Assam Silchar 1,84,105
Andhra Pr. Madanapalle 1,07,449 Assam Jorhat 1,37,814
Andhra Pr. Kothagudem 1,05,266 Assam Dibrugarh 1,37,661
Andhra Pr. Dharmavaram 1,03,357 Assam Nagaon 1,23,265
Andhra Pr. Tadepalligudem 1,02,622 Assam Tinsukia 1,08,123
Andhra Pr. Narasaraopet 95,349 Assam Tezpur 1,05,377
Andhra Pr. Bobbili 50,096 Assam Bongaigaon 75,928
Andhra Pr. Markapur 58,462 Assam Dhubri 64,168
Andhra Pr. Tandur 57,941 Assam Lakhimpur North 54,285
Andhra Pr. Ponnur 57,640 Assam Sibsagar 53,854
Andhra Pr. Sangareddy 57,113 Assam Karimganj 52,613
Andhra Pr. Rayadurg 54,125 Assam Diphu 52,310
Andhra Pr. Koratla 54,012 Assam Lumding 50,570
Andhra Pr. Samalkot 53,602 Total (Assam) 14 20,18,882
Andhra Pr. Gadwal 53,560 Bihar Jehanabad 81,503
Andhra Pr. Vinukonda 52,519 Bihar Aurangabad 79,393
90
No. L 1907/1/2008-UH
Government of India
Andhra Pr. Amalapuram 51,444 Bihar Lakhisarai 77,875
Bihar Jamui 66,797 Bihar Mokameh 56,615
Bihar Madhubani 66,340 Bihar Gopalganj 54,449
Bihar Patna 16,97,976 Bihar Supaul 54,085
Bihar Gaya 3,94,945 Total (Bihar) 34 60,98,373
Bihar Bhagalpur 3,50,133 Chandigarh Chandigarh 8,08,515
Bihar Muzzafarpur 3,05,525 Total (Chd) 1 8,08,515
Bihar Darbhanga 2,67,348 Chhattisgarh Durg-Bhilai 9,27,864
Bihar Arrah 2,03,380 Chhattisgarh Raipur 7,00,113
Bihar Purnia 1,97,211 Chhattisgarh Bilaspur 3,35,293
Bihar Katihar 1,90,873 Chhattisgarh Korba 3,15,690
Bihar Munger 1,88,050 Chhattisgarh Rajnandgaon 1,43,770
Bihar Chapra 1,79,190 Chhattisgarh Raigarh 1,15,908
Bihar Sasaram 1,31,172 Chhattisgarh Chirmiri 93,373
Bihar Saharsa 1,25,167 Chhattisgarh Ambikapur 90,967
Bihar Hajipur 1,19,412 Chhattisgarh Dhamtari 82,111
Bihar Dehri 1,19,057 Chhattisgarh Dalli-Rajhara 57,058
Bihar Bettiah 1,16,670 Chhattisgarh Bhatapara 50,118
Bihar Siwan 1,09,919 Total (Chgr) 11 29,12,265
Bihar Motihari 1,08,428 Delhi Delhi 1,28,77,470
Bihar Begusarai 1,07,623 Total (Delhi) 1 1,28,77,470
Bihar Jamalpur 96,983 Goa Mormugao 1,04,758
Bihar Bagaha 91,467 Goa Panaji 99,677
Bihar Sitamarhi 87,279 Goa Margao 94,383
Bihar Kishanganj 85,590 Total (Goa) 3 2,98,818
Bihar Buxar 83,168 Gujarat Ahmadabad 45,25,013
Bihar Nawada 81,891 Gujarat Surat 28,11,614
91
No. L 1907/1/2008-UH
Government of India
Bihar Samastipur 61,998 Gujarat Vadodara 14,91,045
Bihar Araria 60,861 Gujarat Rajkot 10,03,015
Gujarat Jamnagar 5,56,956 Gujarat Dhoraji 80,811
Gujarat Bhavnagar 5,17,708 Gujarat Mahuva 80,726
Gujarat Junagadh 2,52,108 Gujarat Savarkundla 73,774
Gujarat Navsari 2,32,411 Gujarat Visnagar 73,488
Gujarat Wadhwan 2,19,585 Gujarat Vapi 71,406
Gujarat Anand 2,18,486 Gujarat Dhrangadhra 70,663
Gujarat Porbandar 1,97,382 Gujarat Anjar 68,343
Gujarat Nadiad 1,96,793 Gujarat Keshod 63,257
Gujarat Gandhinagar 1,95,985 Gujarat Dholka 61,569
Gujarat Morvi 1,78,055 Gujarat Kadi 60,026
Gujarat Bharuch 1,76,364 Gujarat Sidhpur 58,194
Gujarat Veraval 1,58,032 Gujarat Bilimora 57,564
Gujarat Gandhidham 1,51,693 Gujarat Borsad 56,548
Gujarat Valsad 1,45,592 Gujarat Himatnagar 56,464
Gujarat Mahesana 1,41,453 Gujarat Mangrol 56,320
Gujarat Bhuj 1,36,429 Gujarat Upleta 55,438
Gujarat Godhra 1,31,172 Gujarat Dabhoi 54,952
Gujarat Palanpur 1,22,300 Gujarat Bardoli 51,946
Gujarat Patan 1,13,749 Gujarat Palitana 51,944
Gujarat Anklesvar 1,12,643 Gujarat Una 51,261
Gujarat Dohad 1,12,026 Gujarat Modasa 54,135
Gujarat Kalol 1,12,013 Gujarat Unjha 53,876
Gujarat Jetpur Navagadh 1,04,312 Gujarat Viramgam 53,094
Gujarat Botad 1,00,194 Gujarat Petlad 51,147
Gujarat Gondal 97,506 Total (Guj) 56 1,62,50,463
92
No. L 1907/1/2008-UH
Government of India
Gujarat Amreli 95,307 Haryana Faridabad 10,55,938
Gujarat Khambhat 93,194 Haryana Panipat 3,54,148
Gujarat Deesa 83,382 Haryana Ambala 3,07,595
Haryana Yamunanagar 3,06,740 J&K Baramula 71,896
Haryana Rohtak 2,94,577 J&K Sopore 59,624
Haryana Hisar 2,63,186 J&K Kathua 51,034
Haryana Gurgaon 2,28,820 Total (JK) 7 19,67,122
Haryana Sonipat 2,25,074 Jharkhand Jamshedpur 11,04,713
Haryana Karnal 2,21,236 Jharkhand Dhanbad 10,65,327
Haryana Bhiwani 1,69,531 Jharkhand Ranchi 8,63,495
Haryana Sirsa 1,60,735 Jharkhand Bokaro 4,97,780
Haryana Panchkula 1,40,925 Jharkhand Phusro 1,74,402
Haryana Jind 1,35,855 Jharkhand Hazaribag 1,35,473
Haryana Bahadurgarh 1,31,925 Jharkhand Deoghar 1,12,525
Haryana Thanesar 1,22,319 Jharkhand Ramgarh 1,10,496
Haryana Kaithal 1,17,285 Jharkhand Chirkunda 1,06,227
Haryana Palwal 1,00,722 Jharkhand Giridih 1,05,634
Haryana Rewari 1,00,684 Jharkhand Saunda 85,075
Haryana Hansi 75,747 Jharkhand Sahibganj 80,154
Haryana Narnaul 62,077 Jharkhand Daltonganj 71,422
Haryana Fatehabad 59,917 Jharkhand Jhumri Tilaiya 69,503
Haryana Mandi Dabwali 53,811 Jharkhand Chaibasa 63,648
Haryana Tohana 51,519 Jharkhand Chakradharpur 55,228
Haryana Narwana 50,435 Total (Jhar) 16 47,01,102
Total (Har) 24 47,90,801 Karnataka Bengaluru 57,01,446
Himachal Pr Shimla 1,44,975 Karnataka Mysore 7,99,228
Total (HP) 1 1,44,975 Karnataka Hubli-Dharwad 7,86,195
93
No. L 1907/1/2008-UH
Government of India
J&K Srinagar 9,88,210 Karnataka Mangalore 5,39,387
J&K Jammu 6,12,163 Karnataka Belgaum 5,06,480
J&K Anantnag 97,896 Karnataka Gulbarga 4,30,265
J&K Udhampur 86,299 Karnataka Devangere 3,64,523
Karnataka Bellary 3,16,766 Karnataka Channapatna 63,577
Karnataka Shimoga 2,74,352 Karnataka Sindhnur 61,262
Karnataka Bijapur 2,53,891 Karnataka Chamarajanagar 60,558
Karnataka Tumkur 2,48,929 Karnataka Yadgir 58,811
Karnataka Raichur 2,07,421 Karnataka Basavakalyan 58,785
Karnataka Bidar 1,74,257 Karnataka Nipani 58,081
Karnataka Hospet 1,64,240 Karnataka Jamkhandi 57,883
Karnataka Bhadravati 1,60,662 Karnataka Koppal 56,160
Karnataka Robertson Pet 1,57,084 Karnataka Haveri 55,913
Karnataka Gadag Betigeri 1,54,982 Karnataka Chik Ballapur 54,968
Karnataka Hassan 1,33,262 Karnataka Dandeli 53,290
Karnataka Mandya 1,31,179 Karnataka Kollegal 52,607
Karnataka Udupi 1,27,124 Karnataka Ilkal 51,920
Karnataka Chitradurga 1,25,170 Karnataka Sagar 50,131
Karnataka Kolar 1,13,907 Karnataka Sira 50,088
Karnataka Gangawati 1,01,392 Total (Ka) 50 1,37,46,611
Karnataka Chikmagalur 1,01,251 Kerala Kochi 13,55,972
Karnataka Bagalkot 90,988 Kerala Thiruvananthapuram 8,89,635
Karnataka Ranibennur 89,618 Kerala Kozhikode 8,80,247
Karnataka Harihar 87,744 Kerala Kannur 4,98,207
Karnataka Ramnagaram 79,394 Kerala Kollam 3,80,091
Karnataka Karwar 75,038 Kerala Thrissur 3,30,122
Karnataka Dod Ballapur 71,606 Kerala Palakkad 1,97,369
94
No. L 1907/1/2008-UH
Government of India
Karnataka Rabkavi-Banhatti 70,248 Kerala Kottayam 1,72,878
Karnataka Gokak 67,170 Kerala Malappuram 1,70,409
Karnataka Shahabad 66,550 Kerala Cherthala 1,41,558
Karnataka Chintamani 65,493 Kerala Guruvayoor 1,38,681
Karnataka Sirsi 65,335 Kerala Kanhangad 1,29,367
Kerala Vadakara 1,24,083 Madhya Pr Bhind 1,53,752
Kerala Kodungallur 94,883 Madhya Pr Chhindwara 1,53,552
Kerala Ponnani 87,495 Madhya Pr Morena 1,50,959
Kerala Kasargod 75,968 Madhya Pr Shivpuri 1,46,892
Kerala Neyyattinkara 69,467 Madhya Pr Guna 1,37,175
Kerala Quilandy 68,982 Madhya Pr Damoh 1,27,967
Kerala Payyannur 68,734 Madhya Pr Vidisha 1,25,453
Kerala Kayamkulam 68,585 Madhya Pr Mandsaur 1,17,555
Kerala Taliparamba 67,507 Madhya Pr Mhow 1,12,887
Kerala Thiruvalla 56,837 Madhya Pr Neemuch 1,12,852
Kerala Nedumangad 56,138 Madhya Pr Chhatarpur 1,09,078
Kerala Tirur 53,654 Madhya Pr Itarsi 1,07,831
Kerala Changanassery 51,967 Madhya Pr Khargone 1,03,448
Kerala Kunnamkulam 51,592 Madhya Pr Hoshangabad 97,424
Total (Keral) 26 62,80,428 Madhya Pr Nagda 96,579
Madhya Pr Indore 15,16,918 Madhya Pr Sarni 95,012
Madhya Pr Bhopal 14,58,416 Madhya Pr Chikhri Parasia 93,037
Madhya Pr Jabalpur 10,98,000 Madhya Pr Sehore 92,518
Madhya Pr Gwalior 8,65,548 Madhya Pr Burhar-Dhanpuri 91,975
Madhya Pr Ujjain 4,31,162 Madhya Pr Seoni 89,801
Madhya Pr Sagar 3,08,922 Madhya Pr Betul 83,722
Madhya Pr Dewas 2,31,672 Madhya Pr Datia 82,755
95
No. L 1907/1/2008-UH
Government of India
Madhya Pr Satna 2,29,307 Madhya Pr Shahdol 78,624
Madhya Pr Burhanpur 1,93,725 Madhya Pr Balaghat 75,997
Madhya Pr Katni 1,87,029 Madhya Pr Dhar 75,374
Madhya Pr Singrauli 1,85,190 Madhya Pr Tikamgarh 68,426
Madhya Pr Rewa 1,83,274 Madhya Pr Pithampur 68,080
Madhya Pr Khandwa 1,72,242 Madhya Pr Basoda 64,937
Madhya Pr Harda 64,497 Maharashtra Ichalkaranji 2,85,860
Madhya Pr Mandla 60,542 Maharashtra Parbhani 2,59,329
Madhya Pr Bina-Etawa 58,401 Maharashtra Jalna 2,35,795
Madhya Pr Sheopur 58,342 Maharashtra Bhusawal 1,87,564
Madhya Pr Shajapur 57,818 Maharashtra Nalasopara 1,84,538
Madhya Pr Ashoknagar 57,705 Maharashtra Vasai 1,74,396
Madhya Pr Dabra 56,672 Maharashtra Yavatmal 1,39,835
Madhya Pr Narsimhapur 56,203 Maharashtra Bid 1,38,196
Madhya Pr Panna 52,057 Maharashtra Kamptee 1,36,491
Total (MP) 50 1,04,97,304 Maharashtra Gondiya 1,20,902
Maharashtra Mumbai 1,64,34,386 Maharashtra Virar 1,18,928
Maharashtra Pune 37,60,636 Maharashtra Wardha 1,11,118
Maharashtra Nagpur 21,29,500 Maharashtra Satara 1,08,048
Maharashtra Nashik 11,52,326 Maharashtra Achalpur 1,07,316
Maharashtra Aurangabad 8,92,483 Maharashtra Barshi 1,04,785
Maharashtra Solapur 8,72,478 Maharashtra Panvel 1,04,058
Maharashtra Bhiwandi 6,21,427 Maharashtra Nandurbar 94,368
Maharashtra Amravati 5,49,510 Maharashtra Hingaghat 92,342
Maharashtra Kolhapur 5,05,541 Maharashtra Udgir 91,933
Maharashtra Sangli 4,47,774 Maharashtra Amalner 91,490
Maharashtra Nanded-Waghala 4,30,733 Maharashtra Pandharpur 91,379
96
No. L 1907/1/2008-UH
Government of India
Maharashtra Malegaon 4,09,403 Maharashtra Chalisgaon 91,110
Maharashtra Akola 4,00,520 Maharashtra Ballarpur 89,995
Maharashtra Jalgaon 3,68,618 Maharashtra Shrirampur 88,761
Maharashtra Ahmadnagar 3,47,549 Maharashtra Khamgaon 88,687
Maharashtra Dhule 3,41,755 Maharashtra Parli 88,537
Maharashtra Latur 2,99,985 Maharashtra Bhandara 85,213
Maharashtra Chandrapur 2,89,450 Maharashtra Navi Mumbai 81,855
Maharashtra Akot 80,726 Manipur Imphal 2,50,234
Maharashtra Osmanabad 80,625 Total (Mani) 1 2,50,234
Maharashtra Malkapur 79,003 Meghalaya Shillong 2,67,662
Maharashtra Manmad 72,401 Meghalaya Tura 58,978
Maharashtra Ratnagiri 70,383 Total (Megha) 2 3,26,640
Maharashtra Ambejogai 69,478 Mizoram Aizwal 2,28,280
Maharashtra Hingoli 69,432 Total (Mizo) 1 2,28,280
Maharashtra Pusad 67,166 Nagaland Dimapur 98,096
Maharashtra Buldana 62,972 Nagaland Kohima 77,030
Maharashtra Washim 62,956 Total (Naga) 2 1,75,126
Maharashtra Sangamner 61,958 Odhisa Bhubaneswar 6,58,220
Maharashtra Shirpur-Warwade 61,694 Odhisa Cuttack 5,87,182
Maharashtra Chopda 60,865 Odhisa Raurkela 4,84,874
Maharashtra Karanja 60,158 Odhisa Brahmapur 3,07,792
Maharashtra Kopargaon 59,970 Odhisa Sambalpur 2,26,469
Maharashtra Khopoli 58,664 Odhisa Puri 1,57,837
Maharashtra Uran Islampur 58,330 Odhisa Baleshwar 1,56,430
Maharashtra Basmath 57,365 Odhisa Baripada 1,00,651
Maharashtra Bhadravati 56,903 Odhisa Bhadrak 92,515
Maharashtra Karad 56,161 Odhisa Balangir 85,261
97
No. L 1907/1/2008-UH
Government of India
Maharashtra Lonavala 55,652 Odhisa Brajarajnagar 76,959
Maharashtra Wani 52,834 Odhisa Jeypur 76,625
Maharashtra Palghar 52,677 Odhisa Jharsuguda 76,100
Maharashtra Shegaon 52,423 Odhisa Paradip 73,625
Maharashtra Baramati 51,334 Odhisa Bargarh 63,678
Maharashtra Anjangaon 51,170 Odhisa Bhawanipatna 60,787
Maharashtra Phaltan 50,800 Odhisa Sunabeda 58,884
Total (Maha) 73 3,55,21,003 Odhisa Jatani 57,957
Odhisa Rayagada 57,759 Punjab Sangrur 77,989
Odhisa Dhenkanal 57,677 Punjab Mansa 72,627
Odhisa Barbil 52,627 Punjab Malout 70,765
Odhisa Kendujhar 51,845 Punjab Gurdaspur 68,441
Total (Odisa) 22 36,21,754 Punjab Fazilka 67,427
Pondicherry Pondicherry 5,05,959 Punjab Nabha 62,000
Pondicherry Karaikal 74,438 Punjab Gobindgarh 60,677
Total (Pondi) 2 5,80,397 Punjab Jagraon 60,080
Punjab Ludhiana 13,98,467 Punjab Sunam 56,251
Punjab Amritsar 10,16,079 Punjab Tarn-Taran 55,787
Punjab Jalandhar 7,54,608 Total (Punjb) 30 61,06,685
Punjab Patiala 3,23,884 Rajasthan Jaipur 23,22,575
Punjab Bathinda 2,17,256 Rajasthan Jodhpur 8,60,818
Punjab Pathankot 1,68,485 Rajasthan Kota 7,03,150
Punjab Firozpur 1,53,153 Rajasthan Bikaner 5,29,690
Punjab Hoshiarpur 1,49,668 Rajasthan Ajmer 4,90,520
Punjab Batala 1,47,872 Rajasthan Udaipur 3,89,438
Punjab Moga 1,35,279 Rajasthan Bhilwara 2,80,128
Punjab Abohar 1,24,339 Rajasthan Alwar 2,66,203
98
No. L 1907/1/2008-UH
Government of India
Punjab Mohali 1,23,484 Rajasthan Ganganagar 2,22,858
Punjab Malerkotla 1,07,009 Rajasthan Bharatpur 2,05,235
Punjab Khanna 1,03,099 Rajasthan Pali 1,87,641
Punjab Phagwara 1,02,253 Rajasthan Sikar 1,85,925
Punjab Barnala 96,624 Rajasthan Tonk 1,35,689
Punjab Kapurthala 85,686 Rajasthan Hanumangarh 1,29,556
Punjab Muktsar 83,655 Rajasthan Beawar 1,25,981
Punjab Rajpura 82,956 Rajasthan Kishangarh 1,25,695
Punjab Kot Kapura 80,785 Rajasthan Gangapur City 1,05,396
Rajasthan Sawai Madhopur 1,01,997 Tamil Nadu Chennai 65,60,242
Rajasthan Churu 1,01,874 Tamil Nadu Coimbatore 14,61,139
Rajasthan Jhunjhunun 1,00,485 Tamil Nadu Madurai 12,03,095
Rajasthan Bundi 88,871 Tamil Nadu Tirichirappalli 8,66,354
Rajasthan Banswara 87,308 Tamil Nadu Salem 7,51,438
Rajasthan Hindaun 84,861 Tamil Nadu Tiruppur 5,50,826
Rajasthan Sujangarh 83,846 Tamil Nadu Tirunelveli 4,33,352
Rajasthan Barmer 83,591 Tamil Nadu Erode 3,89,906
Rajasthan Sardarshahar 81,394 Tamil Nadu Vellore 3,86,746
Rajasthan Baran 78,665 Tamil Nadu Thoothukkudi 2,43,415
Rajasthan Fatehpur 78,462 Tamil Nadu Thanjavur 2,15,314
Rajasthan Karauli 66,239 Tamil Nadu Dindigul 1,96,955
Rajasthan Ratangarh 63,486 Tamil Nadu Kancheepuram 1,88,733
Rajasthan Balotra 61,813 Tamil Nadu Kumbakonam 1,60,767
Rajasthan Dausa 61,601 Tamil Nadu Cuddalore 1,58,634
Rajasthan Suratgarh 58,119 Tamil Nadu Karur 1,53,365
Rajasthan Jaisalmer 57,537 Tamil Nadu Neyveli 1,38,035
Rajasthan Ladnu 57,070 Tamil Nadu Tiruvannamalai 1,30,567
99
No. L 1907/1/2008-UH
Government of India
Rajasthan Nawalgarh 56,491 Tamil Nadu Pollachi 1,28,458
Rajasthan Rajsamand 55,687 Tamil Nadu Pudukkottai 1,26,824
Rajasthan Nimbahera 53,327 Tamil Nadu Karaikkudi 1,25,717
Rajasthan Rajgarh 51,640 Tamil Nadu Rajapalayam 1,22,307
Rajasthan Chomu 50,708 Tamil Nadu Bhavani 1,04,646
Rajasthan Kuchaman City 50,587 Tamil Nadu Vaniyambadi 1,03,950
Rajasthan Bari 50,474 Tamil Nadu Coonoor 1,01,490
Total (Raj) 46 94,12,413 Tamil Nadu Gudiyatham 1,00,115
Sikkim Gangtok 29,354 Tamil Nadu Ambur 99,624
Total (Sikkm) 1 29,354 Tamil Nadu Viluppuram 95,455
Tamil Nadu Valparai 95,107 Tamil Nadu Virudhachalam 60,164
Tamil Nadu Udhagamandalam 93,987 Tamil Nadu Puliyankudi 60,080
Tamil Nadu Nagapattinam 93,148 Tamil Nadu Udumalaipettai 59,668
Tamil Nadu Kovilpatti 87,450 Tamil Nadu Kambam 58,891
Tamil Nadu Tiruchendur 87,101 Tamil Nadu Ambasamudram 58,485
Tamil Nadu Theni Allinagaram 85,498 Tamil Nadu Attur 57,519
Tamil Nadu Hosur 84,934 Tamil Nadu Thiruvarur 56,341
Tamil Nadu Mayiladuthurai 84,505 Tamil Nadu Panruti 55,346
Tamil Nadu Tirupathur 84,435 Tamil Nadu Gobichettipalayam 55,158
Tamil Nadu Aruppukkottai 84,029 Tamil Nadu Mettur 53,633
Tamil Nadu Tiruchengode 80,187 Tamil Nadu Sankarankoil 53,606
Tamil Nadu Arakonam 78,686 Tamil Nadu Namakkal 53,055
Tamil Nadu Mettupalayam 74,145 Total (TN) 68 1,80,76,941
Tamil Nadu Bodinayakanur 73,410 Tripura Agartala 1,89,998
Tamil Nadu Srivilliputhur 73,183 Total (Tripu) 1 1,89,998
Tamil Nadu Chidambaram 67,795 Uttar Pradesh Kanpur 27,15,555
Tamil Nadu Tindivanam 67,737 Uttar Pradesh Lucknow 22,45,509
100
No. L 1907/1/2008-UH
Government of India
Tamil Nadu Palani 67,231 Uttar Pradesh Agra 13,31,339
Tamil Nadu Pattukkottai 65,533 Uttar Pradesh Varanasi 12,03,961
Tamil Nadu Devarshola 65,001 Uttar Pradesh Meerut 11,61,716
Tamil Nadu Dharapuram 64,984 Uttar Pradesh Ghaziabad 9,68,256
Tamil Nadu Krishnagiri 64,587 Uttar Pradesh Bareilly 7,48,353
Tamil Nadu Dharmapuri 64,496 Uttar Pradesh Aligarh 6,69,087
Tamil Nadu Tenkasi 63,432 Uttar Pradesh Moradabad 6,41,583
Tamil Nadu Chengalpattu 62,582 Uttar Pradesh Gorakhpur 6,22,701
Tamil Nadu Ramanathapuram 62,050 Uttar Pradesh Jhansi 4,60,278
Tamil Nadu Mannargudi 61,478 Uttar Pradesh Saharanpur 4,55,754
Tamil Nadu Arani 60,815 Uttar Pradesh Firozabad 4,32,866
Uttar Pradesh Muzaffarnagar 3,31,668 Uttar Pradesh Gonda 1,20,301
Uttar Pradesh Mathura 3,23,315 Uttar Pradesh Mughalsarai 1,16,308
Uttar Pradesh Shahjahanpur 3,21,885 Uttar Pradesh Hardoi 1,12,486
Uttar Pradesh Noida 3,05,058 Uttar Pradesh Lalitpur 1,11,892
Uttar Pradesh Rampur 2,81,494 Uttar Pradesh Basti 1,07,601
Uttar Pradesh Farukha-Fatehgarh 2,42,997 Uttar Pradesh Etah 1,07,110
Uttar Pradesh Maunath Bhanjan 2,12,657 Uttar Pradesh Mainpuri 1,04,851
Uttar Pradesh Hapur 2,11,983 Uttar Pradesh Allahabad 1,04,229
Uttar Pradesh Etawah 2,10,453 Uttar Pradesh Deoria 1,04,227
Uttar Pradesh Faizabad 2,08,162 Uttar Pradesh Chandausi 1,03,749
Uttar Pradesh Mirzapur 2,05,053 Uttar Pradesh Ghazipur 1,03,298
Uttar Pradesh Sambhal 1,82,478 Uttar Pradesh Ballia 1,01,465
Uttar Pradesh Bulandshahar 1,76,425 Uttar Pradesh Sultanpur 1,00,065
Uttar Pradesh Rae Bareli 1,69,333 Uttar Pradesh Khurja 98,610
Uttar Pradesh Bharaich 1,68,323 Uttar Pradesh Behta Hajipur 94,298
Uttar Pradesh Amroha 1,65,129 Uttar Pradesh Azamgarh 93,521
101
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Uttar Pradesh Jaunpur 1,60,055 Uttar Pradesh Barabanki 92,687
Uttar Pradesh Fatehpur 1,52,078 Uttar Pradesh Kasganj 92,541
Uttar Pradesh Sitapur 1,51,908 Uttar Pradesh Bijnor 90,471
Uttar Pradesh Badaun 1,48,029 Uttar Pradesh Shamli 90,055
Uttar Pradesh Unnao 1,44,662 Uttar Pradesh Shikohabad 88,161
Uttar Pradesh Modinagar 1,39,929 Uttar Pradesh Baraut 85,708
Uttar Pradesh Banda 1,39,436 Uttar Pradesh Tanda 83,467
Uttar Pradesh Orai 1,39,318 Uttar Pradesh Deoband 81,641
Uttar Pradesh Hathras 1,26,355 Uttar Pradesh Najibabad 79,025
Uttar Pradesh Pilibhit 1,24,245 Uttar Pradesh Mubarakpur 78,789
Uttar Pradesh Lakhimpur 1,21,486 Uttar Pradesh Mahoba 78,782
Uttar Pradesh Loni 1,20,945 Uttar Pradesh Bhadohi 74,522
Uttar Pradesh Muradnagar 74,151 Uttar Pradesh Obra 51,014
Uttar Pradesh Kairana 73,011 Uttar Pradesh Mauranipur 50,882
Uttar Pradesh Balrampur 72,501 Uttar Pradesh Konch 50,844
Uttar Pradesh Bela Pratapgarh 71,999 Uttar Pradesh Chhibramau 50,268
Uttar Pradesh Kannauj 71,727 Uttar Pradesh Laharpur 50,092
Uttar Pradesh Nagina 71,350 Uttar Pradesh Jalaun 50,057
Uttar Pradesh Gangaghat 70,803 Total (UP) 103 2,37,83,938
Uttar Pradesh Sikandrabad 69,867 Uttarakhand Dehradun 5,30,263
Uttar Pradesh Mawana 69,191 Uttarakhand Hardwar 2,20,767
Uttar Pradesh Chandpur 68,287 Uttarakhand Haldwani 1,58,896
Uttar Pradesh Pilkhuwa 66,907 Uttarakhand Roorkee 1,15,278
Uttar Pradesh Renukoot 66,597 Uttarakhand Kashipur 92,967
Uttar Pradesh Auraiya 64,740 Uttarakhand Rudrapur 88,676
Uttar Pradesh Faridpur 61,139 Total (UK) 6 12,06,847
Uttar Pradesh Khatauli 58,622 West Bengal Kolkata 1,32,05,697
102
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Uttar Pradesh Baheri 58,492 West Bengal Asansol 10,67,369
Uttar Pradesh Dadri 57,416 West Bengal Durgapur 4,93,405
Uttar Pradesh Vrindavan 56,692 West Bengal Siliguri 4,72,374
Uttar Pradesh Rath 55,950 West Bengal Barddhaman 2,85,602
Uttar Pradesh Kiratpur 55,769 West Bengal Kharagpur 2,72,865
Uttar Pradesh Tundla 54,576 West Bengal Habra 2,39,209
Uttar Pradesh Gangoh 53,913 West Bengal English Bazar 2,24,415
Uttar Pradesh Gola Gokarannath 53,842 West Bengal Raiganj 1,75,047
Uttar Pradesh Hasanpur 53,326 West Bengal Haldia 1,70,673
Uttar Pradesh Tilhar 52,911 West Bengal Baharampur 1,70,322
Uttar Pradesh Sherkot 52,880 West Bengal Medinipur 1,49,769
Uttar Pradesh Jahangirabad 51,394 West Bengal Krishnanagar 1,48,709
Uttar Pradesh Ujhani 51,051 West Bengal Ranaghat 1,45,285
West Bengal Balurghat 1,43,321 Total (WB) 42 1,95,79,529
West Bengal Santipur 1,38,235
West Bengal Bankura 1,28,781
West Bengal Birnagar 1,15,127
West Bengal Alipurduar 1,14,035
West Bengal Puruliya 1,13,806
West Bengal Basirhat 1,13,159
West Bengal Darjiling 1,08,830
West Bengal Koch Bihar 1,03,008
West Bengal Bangaon 1,02,163
West Bengal Chakdaha 1,01,320
West Bengal Jalpaiguri 1,00,348
West Bengal Contai 77,513
West Bengal Katwa 77,255
103
No. L 1907/1/2008-UH
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West Bengal Jangipur 74,458
West Bengal Dhulian 72,850
West Bengal Bolpur 65,693
West Bengal Bishnupur 61,947
West Bengal Suri 61,806
West Bengal Kalna 59,155
West Bengal Gobardanga 57,878
West Bengal Arambag 56,140
West Bengal Gangarampur 53,533
West Bengal Jhargram 53,145
West Bengal Islampur 52,738
West Bengal Ghatal 51,582
West Bengal Rampurhat 50,613
West Bengal Kandi 50,349
104
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Annexure –II
Assumptions and justification for physical norms and costs
A. Capital (non-Recurrent) Costs:
Components Units No. of Justification of Rates Justification of costs

Units physical units (Rs.)
1. Planning &
Mapping No capital cost for GIS mapping etc.
2. Program State PMU 35 No. of states and Rs. 5 lacs Lump-sum for rent,
Management UTs furniture, computers,
stationery, etc.
City PMU 779 Cities with Rs. 5 lacs Lump-sum for rent,
population furniture, computers,
above 50 stationery, etc.
thousand
(projected for
2011)
3. Training & No capital cost
Capacity
Building
4. Strengthening
Health Services
(a) Outreach ANM (bike) 23,689 @ 1 ANM per Rs. 30,000 Cost of Scooty/moped,
10,000 urban based on approximate
population, and market cost [Dropped].
10% additional This amount to be used
for non-metro for mobility support for
cities outreach
(b) U-PHC upgradation 746 33% of required Rs. 10 lacs NRHM norm for PHC
of existing PHCs in metros upgradation
(assumed) and
10% of required
PHCs in other
cities (assumed)
new U-PHC 3,679 Remaining 67% Rs. 75 lacs NRHM norm for new
of required PHC (based on IPHS
PHCs in metros defined constructed
105
No. L 1907/1/2008-UH
Government of India

Units physical units (Rs.)
and 90% of area)
required PHCs
in other cities
Total U-PHC 4,425 @ 1 U-PHC per --- ---
50,000 pop
(c) Referral U-CHC 344 @ 1 U-CHC per Rs. 5 As per NRHM norms
2.5 lakh crores
population in 66
cities with more
than 5 lakhs
population; and
in 7 metros it is
taken per 5 lakh
population
Strengthening No capital cost on one-time grants to District Hospitals, is that is
DH covered under a separate program.
(d) Assistance to Govt. Med 150 Approximate no. Rs. 5 lakhs Lump-sum for training
Med Coll Coll of govt. med. or research support to
Colleges (as per the city where the
MCI website) medical college is
located
(e) IEC/BCC No capital cost
The assumption of 746 U-PHCs takes into account 632 Type-III UFWC covering 50,000 population
each and some of 565 Type-D UHPs that might be covering 50,000 population (Type-D UHPs cover
25,000 to 50,000 population). Other types of health facilities cover less than 50,000 population and
hence have not been accounted for.
5. Regulation &
Quality
Assurance
6. Community
Processes No capital cost
7. Innovative
Actions & PPP
8. Monitoring &
Evaluation
B. Recurrent Costs:
106
No. L 1907/1/2008-UH
Government of India

Units physical units (per year)
(per
year)
1. Planning & Metros 7 As per projection for Rs. 15 Lump-sum estimate

Mapping 2011, based on 2001 lacs (two-thirds of NRHM
census norm for district
planning)
10lac+ 27 Rs. 10 Lump-sum estimate

cities lacs (half of NRHM norm
for district planning)
other 353 Rs. 5 lacs Half of large cities

cities (10lac+ population)
cities 392 Rs. 2 lacs One-fifth of large cities

<1lac
2. Program Lump- --- --- 6% of Similar to NRHM

Management sum NUHM norm for program
budget management costs
3. Training &
Capacity
Building
(a) ULBs Metros 7 As per projection for Rs. 5 lacs Approximate workshop
2011, based on 2001 cost in metros (based
census on experience under
NRHM)
10lac+ 27 Rs. 3 lacs Approximate workshop

cities cost in large cities
(based on experience
under NRHM)
other 353 Rs. 1 lac Approximate workshop

cities cost at district
headquarter level
under NRHM)
cities 392 Rs. 50,000 Approximate workshop

<1lac cost at block level
under NRHM)
107
No. L 1907/1/2008-UH
Government of India

(per
year)
(b) Govt. Health ANM/ 55,960 @ 500 per metro, Rs. 5,000 Approximate training
staff8 Nurse/ 200 per 10lac+ city, costs under NRHM (as
Paramed 100 per 1-10lac city, reflected by state PIPs)
ic and 30 per city with
1lac-50 thousand
population)
MO 27,980 Half of the estimated Rs. 10,000 Twice that of

no. of ANMs approximate training
costs under NRHM (as
Speciali 5,596 One-tenth of the Rs. 10,000 reflected by state PIPs)
sts estimated no. of
ANMs
(c) ASHA & MAS 1,54,882 Per 100 slum Rs. 10,000 Similar to training
CBOs households (per 500 norm for ASHA under
slum population) NRHM
ASHA 38,720 Per 400 slum Rs. 10,000 Similar to training

households (per norm for ASHA under
2000 slum NRHM
population)
The training load of government health staff is almost 2½ times the number of new ANMs, 3 times the
number of doctors in the proposed UPHCs and 2 times the number of specialists in the proposed new
UCHCs. The higher training load accommodates existing staff in various urban health facilities and
hospitals and also for re-training/orientation (2-3 times during the 12th Plan period)
4. Strengthening
Health Services
(a) Outreach Outreach 8,291 As slum/vulnerable Rs. 10,000 Similar to norm for
(25% Slum sessions population is Village Health &
population + 10% per ANM assumed as 35% of Nutrition Day (VHND)
vulnerable in slums9 total urban under NRHM
population) population, the
number of ANMs
serving
slum/vulnerable
population is taken
as 35% of total
9
These are special outreach sessions in slums, where the ANMs can rope in services of govt or private doctors,
pharmacists, lab technicians to organize a more comprehensive health camp in the slums.
108
No. L 1907/1/2008-UH
Government of India

(per
year)
ANMs.
ANM10 23,689 One per 10,000 Rs. 6,800 Rs. 500 per month in
(rec. urban population, first 2 years and Rs.
cost) with 10% additional 600 per month
numbers for non- thereafter
metro cities.
ANM 23,689 Rs.1.5 Rs.12,500 per month
(salary lakhs
cost)
LHV 4,425 One LHV per U- Rs.1.8 Rs.15,000 per month

PHC lakhs
(b) U-PHC U-PHC 4,425 One per 50,000 Rs. 20 Operating and
population lacs maintenance cost,
exclusive of
ANM/LHV salary and
medicines cost.
(Details in Annex IV)
untied 4,425 One per 50,000 Rs. 2.5 50% more than current
grants to population lacs untied grants norm for
U-PHC PHCs under NRHM
Drugs & 4,425 One per 50,000 Rs.12.5 Rs.25 per capita per
Consuma population lakhs per year. As, states are
bles per year spending around Rs.20
U-PHC per capita on medicines
(as per state budgets),
this is short by Rs.25
per capita to meet the
WHO norm of Rs.45
per capita (US$ 1 per
capita norm).
(c) Referral U-CHC 344 One U-CHC per 2.5 Rs. 5 lacs Equal to current untied
(untied lakhs urban grants to hospitals
grants) population for cities (district/sub-division
above 5 lakhs level) under NRHM
population. In metro
cities, one U-CHC
10
This is for routine outreach that ANMs would undertake (for the entire population and not only for slum
population) for ANC/PNC, immunization, etc.
109
No. L 1907/1/2008-UH
Government of India

(per
year)
per 5 lakh population
(d) Med College No recurrent costs

support
(e) IEC/BCC Urban 22.13 Projected population Rs.5 per Half of NRHM norm
Populati crores for 2011 for cities capita of Rs.10 per capita for
on with population IEC/BCC (based on
more than 50,000 NCMH estimates)
(based on 2001
census)
5. Regulation & Metros 7 As per projection for Rs.50 lacs Lump-sum grants for
Quality 2011, based on 2001 constituting, training
Assurance 10lac+ 27 census Rs.20 lacs and operationalising a
cities Quality Assurance
Committee and
1 lac+ 353 Rs.10 lacs conducting medical
cities audits at city level
cities <1 392 Rs.1 lac
lac
6. Community MAS 1,54,882 Per 100 slum Rs.5,000 Matching grants – half
Processes households (per 500 of untied grants to
slum population) Village Health &
Sanitation Committee
(VHSC) under NRHM
(other half to be
contributed by MAS
members)
ASHA 38,720 Per 400 slum Rs.24,000 Maximum Rs.2000 per

households (per month per ASHA
2000 slum (similar to estimates for
population) remuneration of ASHA
under NRHM)
NGO 7.74 Slum population Rs.20 per Estimate for

support crores estimated as 30% of capita community level
per slum urban population + activities, converted to
pop additional 10% per capita from norms
vulnerable for FNGOs under
population MNGO scheme (under
RCH-II)
7. Innovative Populati 22.13 Projected population Rs.10 per Similar to norm for
110
No. L 1907/1/2008-UH
Government of India

(per
year)
actions/PPP on crores for 2011 for cities capita M&E and research
with population studies under NRHM
more than 50,000
(based on 2001
census)
8. Monitoring &
Evaluation
(a) Health metros 7 Rs.20 lacs

Survey/Con. Eval
Other 772 Non-metro cities Rs.10 lacs
cities above 50,000
population
(b) Research High 11 Rs.30 lacs

Grant Focus
states11
Metro 7 Rs.30 lacs

cities
NE12 & 14 Rs.10 lacs Lump-sum grants

UTs
Other 12 Rs.20 lacs

states
(d) Community metros 7 Rs.10 lacs

Audits
Other 772 Non-metro cities Rs.1 lac
cities above 50,000
population
(e) CRM/3rd- States/ 35 Rs.5 lacs

party Evaluation UTs
11
8 EAG states and J&K, HP, Assam
12
7 smaller NE states (minus Assam)
111
No. L 1907/1/2008-UH
Government of India
Annexure –III
Financing pattern of U-PHCs

The broad financing pattern of U-PHCs at present and as per revised norms would be as follows:
Annual funds requirement for Urban Primary Health Centers
Sl. Item AS PER EXISTING AS PER REVISED Difference

No. NORMS NORMS
between
current &
suggested
norms (Rs.) for
one SC
Norms Cost (Rs.) Norms Costs (Rs)
A Capital/Non-
recurring
1 PHC building 4000 sft @ 24,00,000 3000 sft @ 30,00,000

Rs.600/ sft. Rs.1000/ sft.
2
2 Staff Quarters 1 for MO @ 7,20,000 1200 sft for MO 42,00,000
1200 sft and 800 sq ft for
nurses X 3 , and
600 sq ft for
class IV staff @
Rs.1000/sft
3 Equipment (As 1 kit each 41,500 1,00,000 lumpsum
per IPHS per district
Standards)
4 Furniture 2,00,000 lumpsum
(As per IPHS
Standards)
Sub-total 31,61,500 75,00,000
B Recurring
1 Staff
Medical Officer 1 3,15,225 1+1(AYUSH) 5,40,000 25,000, 20,000
Pharmacist 1 1,53,720 (on contract) 1 1,92,000 16,000
Staff Nurse 1 1,53,720 3 5,76,000 16,000
112
No. L 1907/1/2008-UH
Government of India
Health Worker 1 1,36,260

(F)/ANM
Health Educator 1 1,53,720 0 -
Health Assistant 1 1,71,180 0

(Male)
Health Assistant 1 1,71,180

(F)/LHV
Public Health 0 - (on contract) -
Nurse
practitioner
UDC/Computer 1 1,18,800 1 -
clerk
LDC 1 91,330 1 1,08,000 9,000
Laboratory 1 1,18,800 1 1,20,000 10,000

Technician
Driver 1 79,806 0 -
Class IV 4 2,77,320 (on contract) -
Sub-total for 15 19,41,061 9 15,36,000

salaries
2 Drugs ( As per Under RCH 9,025 3,00,000

IPHS norms and
standards)
3 Travel Allowance Rs.75/ visit 12 visits/mth X 2 28,800
persons
4 For contractual None - Rs.3500 + 60,000
Class IV.
Pharmacist Rs.1500/mth.
5 Telephone None - Rs.1000/ mth 12,000
6 For hiring None - Rs.300/case X 24,000

transport in 80 cases
emergency.
7 Other expenses no norms - Rs.2000/mth 24,000
Sub-total 19,50,086 19,84,800
113
No. L 1907/1/2008-UH
Government of India
Apart from this, additional contractual staff in the form of Public Health Manager (@
Rs.25,000 pm) and IEC/BCC (@ Rs. 20,000 pm) coordinator, will be required. This will
cost additional Rs.5,40,000 per year, taking the total Recurrent Cost projected for U-PHC
to Rs.17,66,470. This is rounded off to Rs.20 lakhs per U-PHC per year.
Note: The provision of ANM (@ approx. 3 ANMs per U-PHC + 1 LHV per U-PHC), and
that for medicines, consumables and blood products (@ Rs.25 per capita per year) has
been shown separately as a different budget head, and therefore not included in the U-
PHC cost estimates.
114

Urban Health Mission1

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No.

MINISTRY OF HEALTH AND FAMILY WELFARE

S.No. Chapter Page No.

2 The Urban Health Context – A Situation Analysis 12

3 Key Public Health Challenges in Urban Areas 31

4 Defining the Poor in Urban Areas 37

5 NUHM- Goals, Objectives, Strategies and Outcomes 38

6 Convergent Action in Urban Areas 45

7 Institutional Arrangements for Implementation 57

8 Broad Norms for NUHM Interventions 79

9 Financial Resource Needs for NUHM 83

10 Planning Process of NUHM 86

11 Appraisal and Approval Process of NUHM 87

12 Role of the Non Governmental Sector in NUHM 89

13 Role of Regulation and Defining Standards 90

1.10 The NUHM would have high focus on:

1.10.1 Urban Poor Population living in listed and unlisted slums

1.15 Empowerment of community through awareness generation, whereby they are

Diagram: Urban Health Care Delivery Model

Urban Social Health Activist(200-500 HH)

Urban Health Care Facilities

200- 500 HHs

50-100 HHs Mahila Arogya Samiti

States/ UTs wise Urban and Slum Population in India 2001

2 - THE URBAN HEALTH CONTEXT – A SITUATION ANALYSIS

Table 2.2: ANNUAL POPULATION GROWTH RATE

Table 2.3: URBAN AREAS COVERED UNDER N.U.H.M

Table 2.4: CITIES COVERED UNDER N.U.H.M

MEGA CITIES 7 – GREATER MUMBAI, KOLKATA,

CITIES WITH POPULATION BETWEEN 1- 552

Box 2.1: HEALTH CONDITION OF THE URBAN POOR

◙ U5MR of 72.7 against urban average of 51.9

Table 2.5: Cause of Death in Rural & Urban Areas

Table 2.6: Age-wise causes of Death (%), Urban India

0-4 5-14 15-24 25-69 70+

HIGHEST RATES OF URBAN POVERTY LOWEST RATES OF URBAN POVERTY

*Source; Expert group – Planning Commission- 2009.

Box 2.2: Findings of some studies regarding urban areas

 Prevalence of diabetes in adults estimated to be 3.8% in rural areas and 11.8% in

 Prevalence of hypertension has been reported to range between 20-40% in urban

 Dental caries more prevalent in urban areas;

 Higher rates of traffic accidents in urban areas;

 Higher rates of domestic violence in cities;

 Drugs, Tobacco and alcohol abuse in urban areas

Box 2.3: Current status of the private sector in India

1. A highly skewed distribution of resources — 88% of towns have a facility compared

An overview of the private sector:

1. Serious supply gaps and distributional inequities;

2. Need for uniform standards and treatment protocols;

3. Need for cost controls and quality assurance mechanisms;

4. Regulations to protect consumer interests and enforcement systems;

2.1 Expenditure on Health Care

2.2 The Urban Poor and the Private Health Sector

2.2.2.1 the fully-organized-and-fully qualified;

2.2.2.3 the ‘less-than-fully-qualified’ practitioners in the slum.

2.4 City wise description of health care system

Group Cities Type of Health Gaps and Constraints

A IPP CITIES Three tier Inequitable spatial distribution of

Presence of vast shortage of medicines, drugs,

Group Cities Type of Health Gaps and Constraints

Limited community linkages and

Limited identification of the urban

In many instances the first