draft pip of lucknow - national urban health … | 4 preamble national urban health mission aims to...

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Jaunpur City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

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Programme Implementation Plan 2013-14 NATIONAL URBAN HEALTH MISSION District Health Society Jaunpur

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TABLE OF CONTENTS

Preamble

Acknowledgement

Acronyms

City Profile

Health Scenario

Key Issues

Strategies, Activities & Work plan under NUHM

Programme Management Arrangements

City level targets & indicators

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PREAMBLE

National Urban Health Mission aims to improve the health status of urban population in general and

the poor and other disadvantaged sections in particular. This would be made possible by facilitating

equitable access to quality health care through a revamped primary public health care system,

targeted outreach services and involvement of the community and urban local bodies. Under the

scheme, the government proposes to strengthen and enhance the health care service delivery in

urban areas with targeted focus on urban poor and the disadvantaged.

The health indicators for Jaunpur show are way behind in so many aspects and the launch of

National Urban Health Mission, the efforts for improving the health parameters will complement

towards betterment of urban population and in particular to the urban poor & slum dwellers.

The NUHM planning for this financial year based on the data, surveys and available information at

city level and hoping that we will initiate the process very systematically so that we can make the

difference in improvement of quality life of urban people specially by reaching the unreached areas.

HUP – PFI deserves a very special mention for providing generous technical support in preparation of

City PIP.

Chief Medical Officer District Magistrate

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ACKNOWLEDGEMENT

Considerable efforts have been made by the team in preparing this Project Implementation Plan for

Lucknow under the newly announced National Urban Health Mission. This has been possible through

dedication, perseverance and hard work. This exercise of planning would not have been complete

without the help and support of the team.

We do not have hesitation in saying that this work would not have come up without the valuable

support and continuous encouragement of Shri - (IAS), District Magistrate, Etah. His great

confidence in team and spurred us into action.

My special gratitude goes to - , Chief Medical Officer, Etah, a dynamic and enthusiastic professional.

He has always been a source of great encouragement for us. The initiation and completion of this

work has been possible due to his sincere and able guidance, expertise, precious opinion, keen

attention, constructive suggestions and constant help. His critical reading of all the parts of the work

has helped shape the NUHM planning in its present form.

I express my gratefulness to Shri. Amit Kumar Ghosh, IAS, Mission Director, National Health Mission

& Mr. Shashank Vikram, IFS, Additional Mission Director, NUHM for overarching support and

building the thoughts in our mind.

I owe my sincere gratitude to Dr. M. R. Gautam (General Manager), Dr. Usha Gangwar, (Deputy

General Manager-NUHM) and HUP-PFI who have helped us immensely by providing relevant

information and valuable suggestions. This planning work got accomplished with their valuable

support and eagerness to help.

I would also like to appreciate the precious help and motivation which I received from government line

department - DUDA, ICDS, Nagar Municipal Corporation, Education department, CMS & DTO.

Last but not the least; I would like to thanks all those people who were involved in the planning

process directly or indirectly.

Add. CMO (RCH), Jaunpur

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Acronyms

ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

AWC Aanganwari Center

AWW Aanganwari Worker

BSGY Bal Swasthya Guarantee Yojna

BSUP Basic services for urban poor

BSA Basic Shiksha Adhikari

CDPO Child Development Project Officer

DH District Hospital

DHS District Health Society

DUDA District Urban Development Authority

ICDS Integrated Child Development Scheme

IDSMT

Integrated Development of Small &

Medium Towns

IDSP Integrated Diseases Surveillance

Program

IHL Individual House level

IMR Infant Mortality Rate

KFA Key Focus Area

LHV Lady Health Visitor

LT Lab Technician

MAS Mahila Arogya Samiti

MMR Maternal Mortality Ratio

NHM National Health Mission

NPP Nagar Palika Parishad

NPSP National Polio Surveillance Program

NRHM National Rural Health Mission

NUHM National Urban Health Mission

OD Open Drainage

RSAP Remote Sensing Application Center

UA Urban Agglomeration

UCHC Urban Community Health Center

UFWC Urban Family Welfare Center

UHI Urban Health Initiative

UHP Urban Health Post

UPHC Urban Primary Health Center

SAM Severely acute Malnourishment

http://urbanindia.nic.in/programme/ud/integrateddevelopment.pdf

http://urbanindia.nic.in/programme/ud/integrateddevelopment.pdf

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National Urban Health Mission- Programme Implementation Plan

Jaunpur 2013-14

The district of Jaunpur is situated in the North-West part of Varanasi Division. Its land area extends

from 24.240N to 26.120N latitude and between 82.70E and 83.50E longitudes. Its attitude varies from

261 ft to 290 ft. above M.S.L. (Mean Sea Level). The topography of the district is mainly a flat plain

with shallow river-balleys. Gomti and Sai are its main parental rivers. Besides these, Varuna, Basuhi,

Pili. Mamur and Gangi are the smaller rivers here. The rivers Gomti and Basuhi divide the district into

nearly four equal landmasses. The soils are mainly sandy, loamy and clayey. Jaunpur district is often

affected by the disaster of floods.

There is a paucity of minerals. Excavations at some places yield to some rocks which are burnt to

make lime. The lime obtained from sand and gravel is used in buildings construction work.

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The temperatures of the district of Jaunpur lie between a minimum of 4.30C and a maximum of

44.60C. Average annual rainfall is 987 mm.

The geographical area of the district is 4038 sq.km. The economic development of the district is

mainly dependent on agriculture. The chief cause of this is the absence of heavy industry in the

district. Several industries are coming up along the Varanasi Jaunpur highway. A cotton mill is

operational near Karanja Kala. At Satahariya too, about 85 industrial units like M/s Raja Flour Mill,

Pepsico India Holdings, Howkins Cookers Limited, Amit Oil & Vegetablle, Chaudharana Steel Limit,

Saurya Aluminium are running.

The Animal Husbandry, a dairy unit is established. Three fourths of the population of the district of

Jaunpur is dependent on agriculture.

According to the 2001 census, the total population of the district is 39,11,305 in which there are

19,75,729 women and 19,35,516 are men. Thus the male to female ratio is 1:1.02. From the point of

view of the female population, this district can be called a developed district. The number of women is

1020 to every 900 men.

From the administrative point of view, this district has been divided into 6 tehsils (viz. Sadar,

Madiyahun, Machhalishahar, Kerakat, Shahganj and Badlapur) in order to maintain law and order and

speedily implement the developmental works.

Similarly, the district has been divided into 21 Development Blocks, viz: Sondhi (Shahganj),

Suithakala, Khutahan, Karanja Kala, Badlapur, Maharajganj, Sujanganj, Baksha, Mungrabadshahpur,

Machhalishahar, Madiyahun, Barsathi, Rampur, Ramnagar, Jalalpur, Kerakat, Dobhi, Muftiganj,

Dharmapur, Sikrara and Sirkoni. With a view to law enforcement, the district has been divided into 27

thanas, viz. Kotwali, Sadar, Line Bazar, Jafrabad, Khetasarai, Shahganj, Sarpatahan, Kerakat,

Chandwak, Jalalpur, Sarai Khwaja, Gaurabadshahpur, Badlapur, Khutahan, Singramau, Baksha,

Sujanganj, Maharajganj, Mungrabadshahpur, Pawara, Machhalishahar, Mirganj, Sikrara, Madiyahun,

Rampur, Barsathi, Nevadhiya and Sureri.

THE HISTORY OF JAUNPUR

Well-known for its past and the glory of learning Jaunpur holds its own important historical,

social and political status. Studying its past on the basis of panic accounts, rock edicts, archaeological

remains and other available facts, the continuous existence of Jaunpur district is seen, in some form of

the other, till the Late Vedic Period. The glory of the city on the Adi Ganga Gomti and its peaceful

shores was a major pious ground for the meditations and contemplations of sages, Rishis and

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Maharshis from where the sounds of the vedmantras emanated. Even today, the Deva Vanees are

echoing in temples along the banks of the Gomti in Jaunpur city.

In the field of education, this district has held an important position. Students from other

countries have been coming here to learn Arabic and Persian. Sher Shah Suri too was educated here.

Sufism too sprouted and flowered here. During the Sharki period this area showed the way via a

unique Hindu-Muslim communal harmony whose legacy is still present here. Maharshi Yamadagni,

upon some disagreement with Sahastrarjuna, the king of Punjab, the land of seven rivers, headed south

and got captivated by the praiseworthy Nature of Gomti's pristine aims. Maharshi Yamdagni

established his ashram on the right banks of the Gomti between Zafrabad and Jaunpur. To the present

day, there is an ancient temple at this spot. This temple is called the temple of Maharishi Yamdagni.

This place is in Jamaitha village. Yamadagni started to live here alongwith his son Parashuram. This

area was in the domain of the king of Ayodhya at the time and is called Ayodhyapuram. On account of

the old enmity, king Sahastrarjun attacked the ashram and killed Maharishi Yamadagni. Enraged at the

slaying of his father, the valorous Parashuram went to war and slaged his father's assassious in battle.

The first arrival in the district of Jaunpur was of Raghuvanshi Kshattriyas. The king of Benares

got his daughter married to the king of Ayodhya, Devakumar and gave away some part of his

dominion as dowry in which the Raghuvanshis of Dobhi area settled themselves. Right after this

occurred the arrival of Vatyagotri, Durgvanshi and Vyas Kshattriyas in this district. In this district the

Bharas and Soiriyas held away. The Kshattriyas began to have conflicts with them. The Gaharwar

Kshattriyas completely finished the domination of Bharas and Soiriyas. In the eleventh century the

Gaharwar rajputs of Kannauj started making Jafrabad and Yaunapur (Jaunpur) rich and powerful.

Vijaychand came here from Kannauj and got several mansions and forts built. Even today, the ruins of

the fort south of Jafrabad can be seen.

In 1194 A.D., Qutubuddin Aibak attacked Mandev or Mandeya (present day Jafrabad). After

defeating the then king Udaypal, he entrusted power to Dewanjeet Singh and headed towards Banares.

In 1389 A.D., Mahmood Shah, the son of Feroze Shah ascended the throne. He made Sarbar

Khwaja a minister and, later in 1393 A.D. gave him the little of Malik-ul-Sharq and entrusted him with

the area from Kannauj to Bihar. Malik-ul-sharq made Jaunpur his capital and established his reign

from Etawah to Bengal and Vindhyachal to Nepal. The founder of the Sharqi Dynasty, Malik-ul-sharq,

died in 1398 A.D. Whereupon, his foster son Saayed Murakshah ascended the throne of Jaunpur. His

younger brother Ibrahimshah succeeded him to the thorne. Ibrahimshah proved to be an accomplished

and able ruler. He implemented the policy of good will with the Hindus.

During the Sharqi period, many grand buildings, mosques and mausoleums were built.

Ferozeshah had lain the foundations of the Atala Mosque in 1393 A.D. but it was completed by

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Ibrahim shah in 1408 A.D. Ibrahimshah got started the construction of Jama Masjid and Bari Masjid

which were completed by Husainshah. The unique aspect of Hindu-Muslim communal harmony which

had been present during the Sharqi Parishad in Jaunpur district- which has held an important position

in the fields of Education, Culture, Music, Arts and Literature- its fragrance exists even today.

The Lodhy Dynasty held the reins of power on the throne of Jaunpur from 1484 A.D. to 1525

A.D. In 1526 A.D. Babar attached Delhi and defeated and killed Ibrahim Lodhi in the battle of

Panipat. To conquer Jaunpur, Babar sent his son Humayun, who defeated the ruler of Jaunpur. Upon

the death of Humayun in 1556 A.D. his 18 years old son Jalaluddin Akbar ascended to throne. In 1567

A.D. when Ali Kuli Khan rebelled, then Akbar himself attacked and Ali Kuli Khan was killed in the

battle. Akbar stayed for several days at Jaunpur. Thereafter, he went back after appointing Sardar

Muneem Khan as the ruler. It was during the reign of Akbar that the Shahi Pul (Jaunpur) was built.

After the Pranic period, scholars link Jaunpur with the reign of Chandragupta Vikramadigtya

upto Manyeech and the fact that this place had been influenced by Buddhist thoughts also. The Bhars

and Koiree Gujjar, Pratiharas and Gaharwars too have held power here. After the displacement of

Mahmmad Gajnabi from here (11th cent.) the victory of Gauri and the Mohammad Gauri Gyanchand

conflict and the subsequent transfer of the royal treasure to Arabi; the appointment in Jaunpur of Zafar

Khan Tughlaq by his father Gayasuddin Tughlaq- all lead to the building of the present day city. In

1722 A.D. after being a part of the Mughal Sultanat for a century and a half, Jaunpur was entrusted to

the Nawab of Awadh. Later in 1775 A.D. Jaunpur too, alongwith Benares went into the hands of the

English from the king of Benares, Mansaram. From 1775 to 1788 A.D. Jaunpur was under the

dominion of Benares and then it was in the hands of the Regiment Dekana.

For the first time in 1818 A.D. the Deputy Collectorateship was established and later it became

a separate district. In 1820 A.D., Azamgarh district was also brought under Jaunpur but some part of

Azamgarh in 1822 and the whole of Azamgarh in 1830 A.D. was separated from Jaunpur.

Demographic profile of Jaunpur City

Total Population of city (in lakhs) 180362

Slum Population (in lakhs) 15000 (15279)

Slum Population as percentage of urban population 8.31 %

Number of Notified Slums 9

Number of slums not notified Nil

No. of Slum Households 3000 (approax.)

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No. of slums covered under slum improvement programme

(BSUP,IDSMT,etc.) 9

Number of slums where households have individual water connections* 9

Number of slums connected to sewerage network* Nil

Number of slums having a Primary school Not Available

No. of slums having AWC 9

No. of slums having primary health care facility 1

Indicate source of data wherever available (e.g. AHS , NFHS-3 , etc.)

State may also mention if data is unavailable

**e.g. for State slum profile may refer to census 2011 slum household tables

http://www.censusindia.gov.in/2011census/hlo/Slum_table/Slum_table.html

Decadal Population Growth Year 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011

Population 42,771 30,473 32,569 37,675 44,833 52,351 61,851 80,737 1,05,140 1,36,062 1,60,055 1,80,362

Jaunpur City Total Male Female

Population 180362 93718 86644

Literates 128050 70467 57583

Children (0-6) 22710 11877 10833

Average Literacy (%) 71.00 75.19 66.46

Sex ratio 925 -----------

------ -------------

http://www.censusindia.gov.in/2011census/hlo/Slum_table/Slum_table.html

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1.4 Urban Poor & Slums1

The UP Slum Areas (Improvement and Clearance) Act, 1962, considers an area a slum if the majority

of buildings in the area are dilapidated, are over-crowded, have faulty arrangement of buildings or

streets, narrow streets, lack ventilation, light or sanitation facilities, and are detrimental to safety,

health or morals of the inhabitants in that area, or otherwise in any respect unfit for human habitation.

It mentions factors such as repairs, stability, extent of dampness, availability of natural light and air,

water supply; arrangement of drainage and sanitation facilities as considerations. Based on the

definition, estimates of slum population vary, so much so that the Census 2001 originally did not

report any slums and then later revised its findings. DUDA follows the definition as stated in the UP

Slum Areas (Improvement & Clearance) Act 1962

Urban Governance

There are multiple agencies responsible for urban governance and provision and management of

infrastructure and services. While, the Lucknow Nagar Nigam (LNN), Lucknow Jal Sansthan (LJS),

Lucknow Development Authority (LDA) and UP Jal Nigam (UPJN) are the key urban service

providers, other agencies include the Housing Board, Central and State Public Works Departments

(CPWD and PWD), Transport Department, Industries Department and the Department of

Environment. There is significant overlap of roles and responsibilities and fragmentation in service

provision and management of infrastructure, which makes it difficult to hold institutions accountable

and to coordinate.

Urban Governance and Service delivery institutions

City Level

Nagar Palika Parishad Local level governance; Primary Collection of Solid Waste; Maintenance of

Storm Water Drains; Maintenance of municipal roads; Allotment of Trade

Licenses under the Prevention of Food Adulteration Act; O&M of internal

sewers and community toilets; Street lighting; O&M of water supply and

sewerage assets; Collection of water tariff

Development Authority Preparation of Master Plans for land use; Development of new areas as well as

provision of housing and necessary infrastructure

District Urban Development

Authority (DUDA)

Implementing agency for plans prepared by SUDA.

Responsible for the field work relating to community development – focusing on

the development of slum communities, construction of community toilets,

assistance in construction of individual household latrines, awareness

generation etc.

State Level

UP Jal Nigam (UPJN) Water supply and sewerage including design of water supply and sewerage

networks. In the last two decades ‘pollution control of rivers’ has become one of

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their primary focus areas

State Urban Development

Authority (SUDA)

Apex policy-making and monitoring agency for the urban areas of the state.

Responsible for providing overall guidance to the District Urban Development

Authority (DUDA) for implementation of community development programmes

UP Awas Vikas Parishad

(UPAVP)

Nodal agency for housing in the state. Involved in planning, designing,

construction and development of almost all types of urban development

projects in the state. Autonomous body generating its own resources through

loans from financial institutions

UP State Transport

Corporation (UPSTC)

Provides intra-city and state wide public transport; maintenance of buses, bus

stands

Public Works Department

(PWD)

Construction of main roads and transport infrastructure including construction

and maintenance of Government houses and Institutions

State Tourism Department

(STC)

Promotion of tourism

Archaeological Survey of

India (ASI)

Maintenance of heritage areas and monuments

UP Pollution Control Board

(UPPCB)

Pollution control and monitoring especially river water quality and regulating

industries

Town and Country Planning

Department (TCPD)

Preparation of Town Plans including infrastructure for the state (rural and

urban)

Office of Commissioner

Lucknow Division

Coordination of activities of various institutions

Access to Public Facilities

Infrastructure development has not been commensurate with the growth of the city and there are

problems confronting the city in terms of access and coverage in key infrastructure sectors – water

supply, sewerage, housing, drainage, and transport. Overall service levels are inadequate and the

situation is worse for the urban poor.

Health Infrastructure

Unlike in the rural areas, where the health department has a wide network of primary health care

facilities providing reproductive and child health services, the urban slums lack basic health

infrastructure and outreach services. Thus, they are often bypassed even by national programmes

providing immunization, safe motherhood and family planning services. The sparse health coverage

provided by health facilities like urban family welfare centers, health posts, and maternity homes in

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cities is used more for emergencies and curative services. Often these facilities are far from their

service area, poorly staffed, with inadequate space and supply of medicines and equipment. Urban

local bodies like municipal corporations and nagar panchayats are also expected to provide health

care, but resource scarcity restricts them to only providing sanitation services. NGOs and private

trusts are also few and far between.

First and Second Tier Health Services

The Government of Uttar Pradesh has committed itself to make provisions for health care services to

its population. Though the efforts have been rural centric some efforts have also been made to

improve the delivery of primary health care services to the population living in urban areas. It has

established D Type health centers and dispensaries for providing family welfare services and OPD

facilities. The Urban Local bodies and Department of Health and Family Welfare are the two main

stakeholders for managing these services. In urban areas of UP, first tier health services are available

through D-type health centers, the family welfare centre, health post and PP centers2. Second tier

health services are provided in urban areas through District Male and Female or Combined Hospitals.

Health Structure in Etah

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: Overview of existing public health facilities.

The data given in the table above reveals inadequacy of primary health care services. The first tier

health facilities were planned for a population of 50000 but as a result of rapid population growth they

are currently serving a population of more than 75000. The situation gets compounded due to lack of

adequate infrastructure, equipments and medicines. The staff mainly Doctors and ANM is also

inadequate. The high population- staff ratio results in poor service coverage with some areas being

entirely unserved. From the above assessment it becomes evident to consider the poor health

indicators for deciding the norms of staff population ratio. Uttar Pradesh has eight medical colleges

and one post-graduate institute which offer tertiary and super specialty health services.

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15

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Page | 19

21

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Page | 20

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Page | 21

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Health Scenario

AHS Profile of important Indicators of district Jaunpur

Based on the results of AHS the health scenario of Jaunpur city (proxy by the urban part of the

district) is presented as below. The detailed tables are given in the annexure.

INDICATOR Jaunpur

HOUSING CHARACTERISTICS

Households living in a Pucca House (%) 94.5

Households living in a Owned House (%) 91.6

Households having improved source of Drinking Water (%) 98

Households treating water to make it safer for drinking (%) 1.8

Households having access to toilet facility (%) 62

Households sharing toilet facility (%) 15.5

Households having access to electricity (%) 88.3

Households using Electricity (%) 78.8

Households using Firewood/Crop Residues/Cow Dung Cake (%) 55.6

Households using LPG/PNG (%) 42.2

Households having a separate Kitchen (%) 48.6

Households having Computer/laptop with or without Internet Connectivity (%) 10.6

Households having Telephone/Mobile (%) 83.7

HOUSEHOLD CHARACTERISTICS

Average Household Size 6.1

EFFECTIVE LITERACY RATE

Person 81.8

Male 90.8

Female 72.3

Page | 22

Slum Profile of Jaunpur

efyu cLrh ,oa vjcu vk'kk ds p;u laca/kh tkudkjh izi=

'kgjh LokLF; dk;ZØe

ftys dk uke%&tkSuiqj

Ø- ftys esa 50 gtkj ls vf/kd 'kgjh vkcknh okyss 'kgj dk uke

'kgj esa efyu cfLr;ksa dh la[;k

'kgj esa efyu cfLr;ksa dh dqy

tula[;k

'kgj esa vjcu vk'kk ds p;u

dk y{;

iksf"kr viksf"kr dqy 1 tkSuiqj 9 0 9 15000 9

Name of Districts:

Jaunpur

S.

N

o.

Name

of

Urban

Slums

No

.

of

W

ar

d

Slum

s

Popu

latio

n

Name

of

Allop

athic

Dispe

nsarie

s

Name

of

Ayur

vedic

Dispe

nsarie

s

Name

of

Home

opathi

c

Dispe

nsarie

s

Name of Nearest Health

Facility taken by Slum

population

Name

of

Gover

nment

Hospit

als

Na

me

of

Priv

ate

Hos

pital

s

Name

of

Anga

nwadi

s

Centr

e

under

ICDS

Na

me

of

Oth

ers

Urb

an

Hea

lth

faci

litie

s

State Bu

dgut

NRH

M

Others/NGO/Privat

e

Tota

l

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1

Naiganj Faqirana Kumhar Basti 1 2115

NIL NIL NIL

District

Hospital

Male,Distric

NIL 200 NIL

Page | 23

2

Naiganj Harijan Basti 2 1009

t Hospi

tal Femal

e

3

Matapur Harijan Basti 3 2835

UHP

4

Vajitpur Harijan Basti 4 2127

5

Jahangirabad Harijan Basti 5 1523

6

Kurchanpur Harijan Basti 6 1062

7

Sukhipur Sonkar Basti 7 901

8

Jiyanipur Harijan Basti 8 2165

9

Premrajpur Harijan Basti 9 1542

Page | 24

Summary of Urban Area in Water supply, Sanitation Toilets,

Waste Water Disposal Jaunpur

S.

No

.

Name

of

Urban

Slums

No

. of

W

ar

d

Slum

s

Popul

ation

Water Supply Sanitation Toilets Waste Water

Disposal

Sou

rces

of

wat

er

in

the

slu

ms

Sou

rce

use

for

drin

king

(Y/

N)

No.

of

house

holds

depe

ndent

Quality

Rating

Individual Toile

ts

Shared Toilets

Communit

y Toilet

s

With

Sewe

rage

netw

ork

Wi

th

op

en

dr

ai

n

W

ith

so

ak

pit

Wi

th

se

pti

c

ta

nk

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

1

Naiganj Faqirana Kumhar Basti 1 2115

Jal Nigam

yes - - - 0 yes - yes - -

2

Naiganj Harijan Basti 2 1009

Jal Nigam

yes - - - 0 yes - yes - -

3

Matapur Harijan Basti 3 2835

Jal Nigam

yes - - - 0 yes - yes - -

4

Vajitpur Harijan Basti 4 2127

Jal Nigam

yes - - - 0 yes - yes - -

5

Jahangirabad Harijan Basti 5 1523

Jal Nigam

yes - - - 0 yes - yes - -

6 Kurchanpur Harijan 6 1062

Jal Nigam

yes - - - 0 yes - yes - -

Page | 25

Basti

7

Sukhipur Sonkar Basti 7 901

Jal Nigam

yes - - - 0 yes - yes - -

8

Jiyanipur Harijan Basti 8 2165

Jal Nigam

yes - - - 0 yes - yes - -

9

Premrajpur Harijan Basti 9 1542

Jal Nigam

yes - - - 0 yes - yes - -

1. Key Issues

The Eleventh Plan had suggested Governance reforms in public health system, such as Performance

linked incentives and Devolution of powers and functions to local health care institutions and making

them responsible for the health of the people living in a defined geographical area. NRHM’s strategy

of decentralization, PRI involvement, integration of vertical programmes, inter-sectoral convergence

and Health Systems Strengthening has been partially achieved. Despite efforts, lack of capacity and

inadequate flexibility in programmes forestall effective local level Planning and execution based on

local disease priorities.

In order to ensure that plans and pronouncements do not remain on paper, NUHM UP would s trive

for system of accountability that shall be built at all levels, reporting on service delivery and system,

district health societies reporting to state, facility managers reporting on health outcomes of those

seeking care, and territorial health managers reporting on health outcomes in their area.

Accountability shall be matched with authority and delegation; the NUHM shall frame model

accountability guidelines, which will suggest a framework for accountability to the local community,

requirement for documentation of unit cost of care, transparency in operations and sharing of

information with all stakeholders. The state will incorporate the core principles of The National Health

Mission of Universal Coverage, Achieving Quality Standards, Continuum of Care and Decentralized

Planning.

Following would be the issues for the cities to address: City Health Planning, Public Private

Partnership, Convergence, Capacity Building, Migration, Communitization, Strengthen Data,

Monitoring and Supervision, Health Insurance, Information Dissemination and Focus on NCDs/ Life-

Style Diseases.

After considering the available data, city scenario and analysis, the City planning team has identified issues at

both service delivery & demand generation level. Following are the details of issues which would be addressed

through NUHM at the city level:

1) Need of community volunteers (ASHAs) for taking up the community mobilization activities

2) Need of Mahila Arogya Samiti (MAS- a group of 10-12 women) for wider spread of information/ rights

and entitlements

Page | 26

3) Strengthening of ANC, PNC & identification of high risk pregnancies at community level

4) Home based care of neonates at community level

5) Promotion of institutional deliveries

6) Health education for all, especially for adolescent group

7) Complete immunization of pregnant women & children

8) Needs to strengthen the existing health care facilities by recruiting human resources

9) Need assessment of community in health scenario

10) Need a better convergence with other programs and wider determinants

11) Need of training & capacity building of human resources

12) Need of Strengthened program management structure at district level

13) Need of intensive baseline survey to start the community processes and identifying local needs

14) Involvement of local bodies in decision making and managing the program locally

15) Gap analysis of HR & recruitment

16) Promotion of family planning methods through basket of choice approach & counselling because unmet

need for family planning is high in Lucknow

17) Management of communicable & non- communicable diseases

18) Strengthening AYUSH

19) Constitution of BSGY team for urban areas.

20) Identification & management of SAM children

2. Strategies, Activities and Work plan

The key overarching strategies under NUHM for 2013-14 include data based planning, strengthening

of management and monitoring systems at the state and district level, improving the primary health

care delivery system and community outreach through ASHAs, MAS and Urban Health and Nutrition

Days(UHNDs).

The key activities at the district level will include convergence with key urban stakeholders,

sensitization of ULBs on their role in urban health, strengthening UPHCs for provision of primary

health care to urban poor, community outreach through selection, training and support to ASHAs and

MAS, conducting UHNDs and outreach camps to get services closer to the community and reach

complete coverage of slum and vulnerable populations.

With the aim to improve the health parameters of urban population in the city, structures and

strategies as recommended for the NUHM in its framework will be adopted and operationalised

rapidly over the years.

4.1. Listing and Mapping of Households in slums and Key Focus Areas

Listing and mapping of households will provide accurate numbers for population their family s ize and

composition residing in slums. Currently, estimates of population residing in slums are available from

District Urban Development Agency (DUDA) and National Polio Surveillance Project as the

immunization micro plans (under NPSP) provide updated estimates of slum and vulnerable

populations and are expected to be fairly complete. The current plan for covering slums is based on

the currently available data of urban population of each city.

Page | 27

Once the ASHA are deployed they will list all households and fill the Slum Health Index Registers

(SHIR) including the number and details of family members in each household. This data will be

compiled for city and will provide the population composition of slums and key focus areas. This will

also help the urban ASHA know her community better and build a rapport with the families that will go

a long way in helping her advocate for better health behaviors and link communities to health facilities

under the NUHM. It is expected that once the household mapping is completed in cities, the number

of ASHAs will be reviewed and adjusted upwards or downwards and the geographical boundaries of

the coverage area for each ASHA would be realigned. This is due to the reason that the actual

population may be higher or lower than the original estimate used for planning.

4.2. Facility Survey for gaps in infrastructure, HR, equipment, drugs and consumables

Facility survey will be carried out in the public facilities to assess the gaps in infrastructure, human

resource, equipment, drugs and consumables availability as against expected patient load. Further

planning, particularly for UCHCs, will be based on these gaps. This work will be outsourced to a

research agency. Development Partners like Health of the Urban Poor project will technically support

this effort.

a. Baseline Survey

The state envisions monitoring progress in health indicators in urban areas and among urban poor

over the period of implementation of NUHM. This proposed Baseline survey will generate data on the

health and related indicators which will be reviewed during the course of implementation of the

program to assess the impact of implementation and necessary course corrections can accordingly

be made and use of resources can be optimized.

b. Training and Capacity Building

ULB, Medical and Paramedical staff, Urban ASHAs and MAS will be trained. The trainings will have

to be followed by periodic refresher trainings to keep these frontline health workers motivated. NUHM

will engage with development organizations to develop the training modules and facilitate the

trainings.

c. Monitoring & Evaluation

The M&E systems would also capture qualitative data to understand the complexities in health

interventions, undertake periodic process documentation and self evaluation cross learning among

the Planning Units to be made more systematic.

The Monitoring and Evaluation framework would be based on triangulation of information. The three

components would be Community Based Monitoring, HMIS for reporting and feedback and external

evaluations.

d. Strengthening of health facilities

Urban - Primary Health Centre (U-PHC) –

Page | 28

During the first year of implementation of the program, the existing urban health posts will be

attempted to be strengthened. Towards this, the UHPs existing in rented accommodations will be

shifted to adequately larger premises which would help in rendering the mandated services. A

provision of Rs. 10,000/- per month per UPHC is being proposed for immediate service provision

capacity enhancement, but over the period of time the said rented accommodations will be shifted to

owned premises for sustained services. Accommodations belonging to other stakeholder government

line departments will be explored and then adopted after entering into necessary agreements/

arrangements with the said department.

e. Targeted intervention for urban poor –

The process of listing of households in the KFAs, mapping of KFAs and health facilities and baseline

survey of the KFA households will help determine the scope and extent of services required for

targeting of the urban poor. A deliberate effort will be made to identify the vulnerable poor on the

basis of their residence status, occupational status and social status, besides other micro-level

indicators, which will further help focusing the health care services to the most deserving.

f. Mahila Arogya Samiti (MAS)-

MAS will act as community based peer education group in slums, involved in community mobilization,

monitoring and referral with focus on preventive and promotive care, facilitating access to identified

facilities and management of grants received. Existing community based institutions could be utilized

for this purpose. City planning team is proposing formation of only one MAS under each ASHA in the

first year and the identification of the remaining planned MAS will be undertaken in the subsequent

years.

g. ASHA-

For reaching out to the households ASHAs (frontline community worker) would serve as an effective

and demand–generating link between the health facility and the urban slum population. Each link

worker/ASHA would have a well-defined service area of about 1000-2,500 beneficiaries/ between

200-500 households based on spatial consideration.

h. Outreach services –

Outreach services will be provided to the slum areas and KFAs through ANMs who would be

responsible for providing preventive and promotive healthcare services at the household level through

regular visits and outreach sessions. Each ANM will organize a minimum of one routine outreach

session in her area every month.

Special outreach sessions (for slum and vulnerable population) will be organized once in a week 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. 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

i. Innovations –

i. PPP & CSR –

Page | 29

For Chitrakoot city a few innovative interventions would be planned. Interventions performed under

Public Private Partnership (PPP) arrangements and Corporate Social Responsibiltoy (CSR) will be

undertaken with the intent to evolve successful models for health care delivery to the urban poor.

ii. School Health Services

School health program under NUHM has been an important component to provide not only the

preventive and curative services to children but also to ensure their contribution in overall health

development of the urban communities. It is envisaged that the active involvement of children in the

program will enable them to be a change agent for themselves as well as communities by taking

home good knowledge and practices in terms of preventive health care activities. It is planned that

children will be engaged through innovative and creative actions to make the learning entertaining

and educational.

j. Convergence –

Intra-sectoral convergence is envisaged to be established through integrated planning for

implementation of various health programmes like RCH, RNTCP, NVBDCP, NPCB, National Mental

Health Programme, National Programme for Health Care of the Elderly, etc. at the city level. Inter-

sectoral convergence with Departments of Urban Development, Housing and Urban Poverty

Alleviation, Women & Child Development, School Education, Minority Affairs, Labour will be

established through DHS headed by the District Magistrate.

3. Activity Plan under NUHM

Act

.

No.

Activity

Months : October'13 - March'14 Remarks

City

level

Oct.

No

v.

Dec

Jan

Feb

Mar

1

Establishment of Platform for

Convergence at state level

Circular to be

isued from state

level to all their

district level

nodal officers

2

Preparation & Finalization of

Guidelines for City Coord.

Committee/ City Program

Management Committee

These will be

one time

activities and will

apply across the

state 3


Guidelines for Urban ASHAs

4 Preparation & Finalization of

Page | 30

Guidelines for Mahila Arogya

Samiti


Guidelines for UHND

6


Guidelines for Outreach

sessions/ School Health

Programs

7


Job Descriptions for all district

level NUHM positions


Guidelines for PPP

9 Induction of state level staff for

Urban Health Cell

10 Induction of city level staff for

Urban Health program

11

Meeting of DHS for

establishment of City Program

Management Committee (UH)

12 Sensitization of new probable

members on NUHM

13 Identification of NGOs for their

role under NUHM

14

Establishment & orientation of

City Program Management

Committee (UH)

15

Identification of groups,

collectives formed under

various govt. programs (like

NHG under SJSRY, self help

groups etc.) for MAS

16

Organize meetings with women

in slums where no groups

could be identified

17 Formation and restructuring of

groups as per MAS guidelines

18 Orientation of MAS members

18 Selection of ASHAs

18a - Selection of local NGOs for

ASHA selection facilitation

18b - Listing of local community

members as facilitators by NGOs

Page | 31

18c - Listing of probable ASHA

candidates and finalize selection

19 Convergence meeting with

govt. Stakeholders

20 Mapping & listing exercise (for

health facilities and slums)

20a

- Mapping of all urban health

facilities (public & pvt.) for

services

To continue in

2014-15

20b - Mapping of slums (listed and

unlisted)

To continue in

2014-15

20c - Houselisting of slums/ poor

settlements

To continue in

2014-15

21 Planning for strengthening of

health facilites/ services

- Health Facility Assessment (of

public facilities including listing of

public facility wise infra & HR

requirement)

To continue in

2014-15

22 Baseline survey of urban poor/

slums (KFAs)

(to determine vulnerability,

morbidity pattern & health status)

23

Meetings of RKS for all the

public health facilites under

NUHM

24

Identification of alternate/

suitable locations for UPHCs

under various urban devp.

Programs

To continue in

2014-15

25 Strengthening of public health

facilities

- Selection, training and

deployment of HR in pub. health

facilities

To continue in

2014-15

26 IEC activities

27 Outreach camps & UHNDs (from

existing UHPs)

28

Empanelment of Private Health

Facilities for health care

provisioning

To continue in

2014-15

29 Involvement of CSR activities

Page | 32

4. Programme Management Arrangements

Districts Heath Society will be the implementing authority for NUHM under the leadership of the

District Magistrate. District Program Management Units have been further strengthened to provide

appropriate managerial and operational support for the implementation of the NUHM program at the

district level.

After extensive deliberations the state plans to designate the District Health Society under the chairmanship

of the District Magistrate as the implementing authority for NUHM

Fund flow mechanisms have been set up and separate accounts will be opened at in the distric t for

receiving the NUHM funds.

Urban Health will be included as a key agenda item for review by the District Health Society with

participation of city level urban stakeholders.

An Additional / Deputy CMO has been designated as the nodal officer for NUHM at the district level. The

District Program Management Unit will co-opt implementation of NUHM program in the district and the

District Program Manager will be overall responsible for the implementation of NUHM. To support this the

following additional staff and funds are proposed for strengthening the District Program Management Units

for implementing NUHM:

a. Urban Health Coordinator, Accountant and Data Entry Operators according to the following norms:

b. District Programme Manager will be nodal for all NUHM activities so extra incentive and budget for

1 laptop to each DPM has been proposed for DPM for undertaking NUHM activities.

c. A onetime expense for computers, printer and furniture for the above staff has been budgeted along

with the recurring operations expenses.

d. Onetime expenses have been budgeted for up-gradation of the office of Additional/ Deputy CMO

and District Programme management Unit.

The City Program Management Committee will function as an Apex Body for management of the City

Health Plan, which will lead to delivery of Maternal, Newborn, Child Health and Nutrition (MNCHN)

and water, sanitation and hygiene (WASH) services to the urban poor and will work towards the

following objectives:

1. Establish a forum for convergence of city level stakeholders for the delivery of MNCHN

and WASH services to the urban poor.

2. Serve as the nodal body for the planning and monitoring of MNCHN and WASH service

delivery to the urban poor.

3. Provide a forum for exploring, reviewing and approving PPP initiatives and innovations

to address the gaps in MNCHN and WASH service delivery to the urban poor.

The structure proposed for the City Coordination Committee :

Chairperson - DM

Convener - CMO

Members – Health - ACMO-Urban

Member – ICDS - CDPO

Member – Nagar Nigam - Sum Improvement Officer

Member – Water & Sanitation- Sup. En. / Ex.En. JalKal Vibhag, Nagar Nigam

Page | 33

Member DUDA & UD - Project Officer

Members – School Education - BSA & DIOS

Members – Dev. Partners - Partners working in urban NGO's

Review Meetings at UPHC and City Level

Nature of Meeting Periodicity Meeting

Venue

Participants

Mahila Aarogya

Samiti Meeting

Once a month

for each MAS

Slum ANM, HV, Community Organizer,

Social Mobilization officer

Review meeting with

Link workers and

MAS representatives

Once a month UPHC All ANMs, PHN, LMO, Community

Organizer, Social Mobilization officer

Meeting of UPHC

Coordination

Committee

Once a month UPHC LMO, PHN/Community Organizer,

Social Mobilization officer,

representative from 2nd tier facility, and

reps. From other departments

Meeting with CMO &

UH Program

Coordinator

Once a month CMO Office CMO, Program Coord., Asst. Program

Coordinator, LMO/ PHN/ Community

Organizer, Social Mobilization officer

City Task Force

Meeting

Once in two

months

DM’s office CMO, Program Coord. UH, Various

departments’ reps. , private partners,

NGOs

Page | 34

CITY LEVEL INDICATORS AND TARGETS

Name of the City: Jaunpur

Processes & Inputs

Indicators Baseline (as

applicable)

Number

Proposed

(2013-14)

Number

Achieved

(2013-14)

Community Processes

1. Number of Mahila Arogya Samiti (MAS) to be formed * 0 18 0

2. Number of MAS members to be trained * 180 0

3. Number of Accredited Social Health Activists (ASHAs) to be selected and trained *

0 9 0

Health Systems

4. Number of ANMs to be recruited * 0 15 0

5. No. of Special Outreach health camps to be organized in the slum/HFAs *

0 8 0

6. No. of UHNDs to be organized in the slums and vulnerable areas *

0 200 0

7. Number of UPHCs to be made operational * 0 3 0

8. Number of UCHCs to be made operational * 0 0 0

9. No. of RKS to be created at UPHC and UCHC * 0 3

10. OPD attendance in the UPHCs 6000

11. No. of deliveries conducted in public health facilities 0

RCH Services

12. ANC early registration in first trimester 720

13. Number of women who had ANC check-up in their first trimester of pregnancy

720

14. TT (2nd dose) coverage among pregnant women 720

15. No. of children fully immunised (through public health facilities)

448

16. No. of Severely Acute Malnourished (SAM) children identified and referred for treatment

10

Communicable Diseases

Page | 35

Processes & Inputs

Indicators Baseline (as

applicable)

Number

Proposed

(2013-14)

Number

Achieved

(2013-14)

17. No. of malaria cases detected through blood examination

18. No. of TB cases identified through chest symptomatic

19. No. of suspected TB cases referred for sputum examination

20. No. of MDR-TB cases put under DOTS-plus

Non Communicable Diseases

21. No. of Diabetes cases screened in the city

22. No. of Cancer cases screened in the city

23. No. of Hypertension cases screened in the city

* Year 2013-14 being the baseline year, the indicators for these NUHM components would be zero. For other

indicators, the figure for 2012-13 will be the base line

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