Jhansi City Program Implementation Plan
National Urban Health Mission
Prepared by District Health Officials with support from Urban Health Initiative
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. In Jhansi, out of the total population for 2011 census, 41.7 percent lives in urban regions of district. In total 83384 people lives in urban areas of which males are 441807 and females are 391677. Sex Ratio in urban region of Jhansi district is 886 as per 2011 census data. Similarly child sex ratio in Jhansi district was 864 in 2011 census. Child population (0-6) in urban region was 96742 of which males and females were 51896 and 44846. This child population figure of Jhansi district is 13.15 % of total urban population. Average literacy rate in Jhansi district as per census 2011 is 65.27 % of which males and females are 74.11 % and 65.61 % literates respectively. In actual number 601520 people are literate in urban region of which males and females are 344504 and 257016 respectively. The health indicators for Jhansi show that they are way behind in so many aspects and with 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 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.
DPM-NHM
Nodal NUHM
Chief Medical Officer
District Magistrate
Jhansi
Jhansi
Jhansi
Jhansi
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Acronyms ANM ASHA AWC AWW BSGY BSUP BSA CDPO DH DHS DUDA ICDS IDSMT IDSP IHL IMR KFA LHV LT MAS MMR NHM NPP NPSP NRHM NUHM OD RSAP UA UCHC UFWC UHI UHP UPHC SAM
Auxiliary Nurse Midwife Accredited Social Health Activist Aanganwari Center Aanganwari Worker Bal Swasthya Guarantee Yojna Basic services for urban poor Basic Shiksha Adhikari Child Development Project Officer District Hospital District Health Society District Urban Development Authority Integrated Child Development Scheme Integrated Development of Small & Medium Towns Integrated Diseases Surveillance Program Individual House level Infant Mortality Rate Key Focus Area Lady Health Visitor Lab Technician Mahila Arogya Samiti Maternal Mortality Ratio National Health Mission Nagar Palika Parishad National Polio Surveillance Program National Rural Health Mission National Urban Health Mission Open Drainage Remote Sensing Application Center Urban Agglomeration Urban Community Health Center Urban Family Welfare Center Urban Health Initiative Urban Health Post Urban Primary Health Center Severely acute Malnourishment
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National Urban Health Mission- Programme Implementation Plan Jhansi 2013-14 1. Jhansi Profile Jhansi is a historic city of northern India, located in the region of Bundelkhand on the banks of the Pahuj or Pushpavati River, in the extreme south of Uttar Pradesh. Jhansi city is the administrative headquarters of Jhansi District and Jhansi Division. istrict is located on the banks of the Betwa River. It is about 415 kilometres from New Delhi and 292 kilometres from Lucknow, and is called the Gateway to Bundelkhand. It is situated between North longitudes 24°11´ and 25°57´and East latitudes 78°10´and 79°25´ and has an average elevation of 284 metres (935 feet).
The history of Jhansi is full of patriotism, treason and valor. The place is widely known for “Jhansi ki Rani” and the hindi poem by noted poetess Subhadra Kumari Chauhan which catapulted her to the highest position of sacrifice in first independence struggle of the nation in 1857.
The area was a stronghold of Chandela kings till eleventh century. The magnificent fort was built by Raja Bir singh deo in five years from 1613 to 1618 and the capital was shifted from Orchha to Balwant Nagar, a city established by him around the fort. For two hundred years it was ruled by Bundelas, Peshwas and local Chandela kings with support and defiance of Mughal and English empires. From 1817 to 1854 Jhansi was the capital of the princely state of Jhansi which was ruled by Maratha rajas. It bore the wraths of English army after the slaughtering of its officials in the hands of mutineers in the fort precincts during the sepoy mutiny. During the English rule it was included in the United Province which became Uttar Pradesh after the Independence.
The district is located at south - western border in the Bundelkhand region of the state. The district consists of the level plain of Bundelkhand, distinguished for its deep black soil, known as mar, and admirably adapted for the cultivation of cotton. The district is intersected or bounded by three principal rivers, the Pahuj, Betwa and Dhasan. Jhansi city, being in the middle of mainland India, is well connected to all major towns in state and nation by road and railway networks. The National Highway Development Project has supported development of Jhansi. The north-south corridor connecting Kashmir to Kanyakumari passes through Jhansi as does the East-West corridor; consequently there has been a sudden rush to infrastructure and real estate development in the city. A green field airport development has also been planned. Jhansi district has the headquarters of the 31st Indian Armoured Division of the Indian Army, stationed at Jhansi-Babina. It is an armoured division which has equipment like the T-72 and T-90 tanks, and the BMP-2 armoured personnel carrier. Jhansi Junction is a major railway junction of Indian Railways: a major intercity hub and a technical stoppage for many superfast trains in India. Jhansi has its own division in the North Central Railway zone of Indian Railways. It lies on the main Delhi-Chennai and Delhi-Mumbai lines.
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The district is bordered on the north by Jalaun District,, to the east by Hamirpur and Mahoba districts, to the south by Tikamgarh District of Madhya Pradesh state, to the southwest by Lalitpur District,, which is joined to Jhansi District by a narrow corridor, and on the east by the Datia and Bhind districts of Madhya Pradesh. Lalitpur District, which extends into the hill country to the south, was added to Jhansi District in 1891, and made a separate district again in 1974. South part of Jhansi district is dominated by the hilly landscapes of Bundelkhand, which slopes down from the Vindhya Range.
1.1. SOCIO CULTURAL PROFILE The district has a one of the largest mining industry in the state. Other towns are Mauranipur, Mauranipur Garautha, Moth, Babina, Chirgaon, Samthar Gursarai,, etc Bundelkhand region is one of the richest areas in terms of natural resources, but the area is grossly undeveloped. Major problems associated with this regio region n are those of drought, development disparities due to industrialization, lack of potable water and declining economic and social status of indigenous population. It is one of the backward areas because of low productivity, lack of awareness and social evi evils ls like cartelism, inequality, child abuse, etc. Lots of male are engaged in stone crushing. Women of the district are engaged in Bidi Making. As a result, they develop respiratory problems and ultimately end up in permanent disability. The rural economy of the district is based on wheat and pulse cultivation, which calls for a lot of migrating population. In view of large proportion of marginalized and sahariya population, the district will be take steps towards improving health, through school health programme, pr routine immunization, swasthya mela’s, Integrated Reproductive and child health camps etc. The same has been proposed in the action plan for every mother and child tracking and insure ANC registration, PNC and child immunization.
DISTRICT HEALTH INFRASTRUCTURE Having the only medical college of the Bundelkhand region, Jhansi is a hub for medical care in the region. The District 1.2.
Hospital has many new facilities to serve patients. There are plenty of private ospitals, especially in the Medical College Coll area.
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1.3. Demographic details The area of District Jhansi is 5024 sq.km. In 2011, Jhansi had population of 1998603 of which male and female were 1957436 and 941167 respectively. Density of Jhansi district is 251 people per sq. Km in 2011. Description Population (%) (Census 2011) Total Population (Census 2011) Male Population Female Population Sex Ratio Child Population (0-6) Male Child(0-6) Female Child(0-6) Child Sex Ratio (0-6) Child Percentage (0-6) Male Child Percentage Female Child Percentage Literates Male Literates Female Literates Average Literacy Male Literacy Female Literacy
Rural 58.30% 1,165,119 615629 549490 892.57 163631 87663 75968 866.59 14% 6.98% 6.04% 1304513 783705 520808 65.27% 74.11% 55.34%
Urban 41.70 833,484 441807 391677 886.53 96742 51896 44846 864.15 12% 6.23% 5.38% 601520 344504 257016 72.17% 77.98% 65.62%
Average literacy rate of Jhansi in 2011 was 65.27%. If things are looked at gender wise, male and female literacy were 74.11% and 55.34% respectively. Total literate in Jhansi District were 1304513 of which male and female were 783705 and 520808 respectively. 1.4. Jhansi City Out of the total Jhansi population for 2011 census, 41.7 percent lives in urban regions of district. Out of these, as per provisional reports of Census 2011, population of Jhansi city in 2011 is 505693. This is 25.30% of total population of the district. 5
Decadal Growth Year Populatio n
1901 55,72 4
1911 70,20 8
1921 66,43 2
1931 64,59 1
1941 88,09 9
1951 106,33 3
1961 140,21 7
1971 173,29 2
1981 246,17 2
1991 313,49 1
2001 426,19 8
2011 505,69 3
Decadal Population Growth 600,000 500,000 400,000 300,000 200,000 100,000 0 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011
Jhansi City Population Literates Children (0-6) Average Literacy (%) Sex ratio Child Sex ratio
Total 505693 373500 55824 73.86% 905 866
Male 265449 209391 29919 78.88% -------------------
Female 240244 164109 25905 68.31% -------------------------
Demographic Profile Jhansi City & Mauranipur City Jhansi City
Mauranipur City
Total Poulation
505693
61449
Slum Population
211550
32000
Slum Population as percentage of urban population
41.83 %
52 %
Number of Slums notified by Nagar Nigam (DUDA)
3
NA
Number of Non- notified Slums
54
NA
42310
NA
NA
NA
3
NA
Number of slums connected to sewerage network*
Nil
NA
Number of slums having a Primary school
NA
NA
116 (Urban)
NA
3
NA
No. of Slum Households No. of slums covered under slum improvement programme (BSUP, IDSMT, etc.) Number of slums where households have individual water connections*
No. of slums having AWC No. of slums having primary health care facility 6
1.5. Mauranipur City Mauranipur is a city in Jhansi district in the Indian state of Uttar Pradesh, India. It is largest Tehsil in Uttar Pradesh and its headquarters is in Jhansi District. It is a textile production centre. Mauranipur was known as Madhupuri in ancient time by its rulers. Geography Mauranipur is located at {25°14'23"N 79°7'47"E}.[1] It has an average elevation of 192 metres (630 ft). Sukhnai river flow around the town. Mauranipur is 60.43 km from the city Jhansi. It is 252 km from Uttar Pradesh's capital city Lucknow. Dam and lakes Saprar Dam at about 3 km from Mauranipur on sukhnai river which looks beautiful specially in rainy season. Siaori Lake Situated at about 8 km north-west of Mauranipur at village Siaori on Lakheri river, this lake was improved in 1906 and opened for irrigation. This also receives water from Kamlasagar, which has increased its irrigation capacity. Pahari dam Situated about 18 km east of Mauranipur in Jhanshi district on Dhasan river this weir was built in the years 1909-12. This serves the purpose of irrigation through the Lachura dam mainly in Hamirpur district. 16.46 m Pahari Weir provides irrigation to Jhanshi dist. Gross capacity of reservoir is 47,800,000 cubic metres and live storage capacity is 46,000,000 cubic metres. Lakheri Dam Lakheri Dam is situated a little upstream of the junction of Chiraya & Tola Nallas near Village Mahewa about 16 km from Mauranipur in Dist Jhansi on Lakheri river. Max. flood discharge of the dam is 1744.07 m³/s. The construction of the dam started in 1981. Lakheri Dam will provide irrigation to 1980 ha of land in doab of Lakheri and Pathari river spread in 13 villages of Tehsil Garautha, through main canal of 9.20 km and distribution system 21 km. The length and the height of the dam are 4 880 m and 10.6 m respectively. Dead dead Storage Capacity of the dam will be 1,700,000 cubic metres and Live Storage Capacity will be 13,900,000 cubic metres. Lahchura Dam was located on Dhasan river, a tributary of river Betwa in Mauranipur Tehsil. The present dam, constructed in 1910.
Kamla Sagar Demographics As of 2011 India census Mauranipur had a population of 61,449. Males constitute 52.4% of the population and females 47.2%. Mauranipur has an average literacy rate of 66%, male literacy is 73%, and female literacy is 60%. In Mauranipur, 12.81% of the population is under 6 years of age. Year
1901
1911
Population 17,231 12,927
1921
1931
1941
1951
1961
1971
1981
1991
2001
2011
12,554
12,797
13,105
15,981
20,224
25,651
33,754
43,714
50,882
61,449
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Decadal Population Growth 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011
Description Population Male Population Female Population Sex Ratio Child Population (0-6) Male Child(0-6) Female Child(0-6) Child Sex Ratio (0-6) Child Percentage (0-6) Male Child Percentage Female Child Percentage Literates Male Literates Female Literates Average Literacy Male Literacy Female Literacy
Mauranipur NPP 61,449 32,221 29,228 90.711 7,875 4,174 3,701 886.68 12.82 6.79 6.02 41,103 23,550 17,553 66.89 73.09 60.06
Culture Faag songs and its rhythmic music could be heard in the whole Bundelkhand region during spring season when the crops are ready for harvesting. The spring season of March–April express the vibrant emotions which are hidden in the tender hearts of the youth, invites each other and to express the mystical attachment between male and female. Finally emotions are transformed into devotion to make devotee divine. Faag was enriched in the early twentieth century by a folk poet Isuri (born 1881, in Mauranipur) who is credited to have composed over a thousand Faags. This festival is celebrated by moving the statue of Hindu God (Ram, Krishna, Ganesh, etc.) on a special type of cart which is carried by the peoples on their shoulders. And in this way they move in the whole town where every home welcomes this Movement. This is done only once in a year.
Before moving to the city this cart is carried to the river Sukhnai , where God take a bath for a while and after that they move to city. In this celebration a fair is arranged called Jal Vihar, in which different types of Programs are celebrated for one month. 8
1.6. Work Participation & Occupation Structure1 The work participation rates as per census 2011 for Jhansi City are: Total Workers Population Total Workers Male Total Workers Female Main Workers Population Main Workers Male Main Workers Female Main Cultivaters Population Main Cultivaters Male Main Cultivaters Female Main Agricultural Labourers Population Main Agricultural Labourers Male Main Agricultural Labourers Female Main Household industries Population Main Household industries Male Main Household industries Female Main Other workers Population Main Other workers Male Main Other workers Female
167,897 133,853 34,044 123,281 103,912 19,369 3302 2572 730 6546 5550 996 8368 6331 2037 105,065 89,459 15,606
1.3. Urban Poor & Slums2 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.
1 2
Sl.
Name of Slums
Notified (Yes/ No)
Population
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Puliya No. 9 Tal Pura Nai Basti Mahrajpura TolaBadluram puviatola Biharipura Schoolpura Villashverpura Silvatganj Hirapura Nainagarh Prathappura Kasaipura Mahaveerpura
Yes Yes Yes NO NO NO NO NO NO NO NO NO NO NO NO
10650 10650 12000 750 900 900 900 2400 1050 450 750 2550 750 2250 1800
Census 2011 State of Urban Health in Uttar Pradesh, 2006 9
Sl. 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57
Name of Slums Esaitola Khodan Piriya Summer Nagar MasihaGanj Sangalpura Gwaltoli Gondu Compound Bahar Khanderao Gate Toria Narsinhrao Ander Datia Gate Bahar Datia Gate Sarai Aligol Khidaki Bhera Khidaki Etwariganj Mewati Pura Ander Unnav Gate Bahar Bhandari Gate Ander Unnav Gate Bahar Bhandari Gate Darigaran Rai Ka Tajiya Mukaryana Bisati Khana Purai Najhaye Panna Lal Bahar Saiyer Gate Mohani Baba Madak Khana Suje Kha Khidaki Gudari Bahar Bhandari Gate Darigaran Khusi Pura Chaniapura Bahar Orcha Gate Kushthyana Sagar Gate Lashmi Gate Bangalagh Ander Orcha Gate
10
Notified (Yes/ No)
Population
NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO
1350 600 750 750 6600 750 1350 1500 600 3900 948 1500 1350 2124 1350 6150 6000 3150 1350 1416 2700 2850 1050 3900 1500 3000 900 5850 2550 2100 1735 2286 3300 4758 9600 810 600 2400 3000 600 6000 5400 159127
The rapidly growing urban population poses great challenge to the efforts of the state government towards improving the health of the urban poor. Status of Water Location No Of W Quality Of Quality of Location Supply & Location & Urba ar Housing Sanitation & Sr. Name of Popula (Piped, Distance Distance From n Distance d (Kacha/ (IHL/Comm Slams tion Hand From PHC/UHP/UF Asha No. No Pakka/Mix unity Totail From Pump, Primaery WC Prapo . ed) & OD) AWC wells & School sed other) Lo Dis Lo Dis Loc. Dis. c. . c. . UHP Puliya No. 0 Communit Piped, 1 10650 NA NA NA NA Puliya Mixed 9 Km. y Toilet HP No. 9 UHP 0.5 Communit Piped, 2 Tal Pura 10650 NA NA NA NA Mixed Tahseel Km y Toilet HP UHP 0.5 Communit Piped, 3 Nai Basti 12000 NA NA NA NA Mixed Tahseel Km y Toilet HP UHP 0.5 4 Mahrajpura 750 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km TolaBadlur UHP 0.5 5 900 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km am UHP 0.5 6 puviatola 900 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km UHP 0.5 7 Biharipura 900 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km UHP 0.5 8 Schoolpura 2400 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km Villashverp UHP 1.5 9 1050 IHL & OD HP,wells NA NA NA NA Mixed ura Nagra Km UHP 1.0 10 Silvatganj 450 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km UHP 1.0 11 Hirapura 750 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km UHP 3.0 12 Nainagarh 2550 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km Prathappur UHP 2.0 13 750 IHL & OD HP,wells NA NA NA NA Mixed a Nagra Km UHP 1.0 14 Kasaipura 2250 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km Mahaveerp UHP 1.5 15 1800 IHL & OD HP,wells NA NA NA NA Mixed ura Nagra Km UHP 1.5 16 Esaitola 1350 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km UHP 1.0 17 Khodan 600 IHL & OD HP,wells NA NA NA NA Mixed Nagra Km UHP 18 Piriya 750 IHL & OD HP,wells NA NA NA NA NA Mixed Nagra Summer UHP 19 750 IHL & OD HP,wells NA NA NA NA NA Mixed Nagra Nagar Masiha UHP 1.2 20 6600 IHL & OD HP,wells NA NA NA NA Mixed Ganj Tahseel Km UHP 21 Sangal pura 750 IHL & OD HP,wells NA NA NA NA NA Mixed Tahseel 11
Status of Water Quality Of Quality of Supply Housing Sanitation Popula (Piped, (Kacha/ (IHL/Comm tion Hand Pakka/Mix unity Totail Pump, ed) & OD) wells & other)
Location Location & Location & & Distance Distance From Distance From PHC/UHP/UF From WC Primaery AWC School
W ar Sr. d No. No .
Name of Slams
22
Gwaltoli
1350
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
23
Gondu Compound
1500
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
24
Bahar Khanderao Gate
600
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
25
Toria Narsinhrao
3900
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
26
Ander Datia Gate
948
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
27
Bahar Datia Gate
1500
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
28
Sarai
1350
Mixed
IHL & OD
HP,wells
NA
NA
NA
29
Aligol Khidaki
2124
Mixed
IHL & OD
HP,wells
NA
NA
NA
30
Bhera Khidaki
1350
Mixed
IHL & OD
HP,wells
NA
NA
NA
31
Etwariganj
6150
Mixed
IHL & OD
HP,wells
NA
NA
NA
32
Mewati Pura
6000
Mixed
IHL & OD
HP,wells
NA
NA
NA
3150
Mixed
IHL & OD
HP,wells
NA
NA
NA
1350
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA Etwariganj UHP NA Etwarigan j UHP NA Etwarigan j UHP NA Etwarigan j UHP NA Etwarigan j UHP NA Etwarigan j UHP NA Etwarigan j
1416
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
UHP Tahseel
1.2 km
2700
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
UHP Tahseel
1.5 km
33
34
35
36
Ander Unnav Gate Bahar Bhandari Gate Ander Unnav Gate Bahar Bhandari Gate
UHP
37
Darigaran
2850
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
38
Rai Ka Tajiya
1050
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
12
UHP Sipri Bazar UHP Sipri Bazar UHP Etwarigan j UHP Etwarigan j UHP Etwarigan j UHP Etwarigan j
UHP Tahseel UHP Tahseel
2.0 km 2.0 km 2.0 km 1.0 km 2.5 km 0.5 km 1.5 km 0.7 km 0.6 km 0.7 km 0.1 km 0.5 km 0.5 km
NA 0.2 km
No Of Urba n Asha Prapo sed
W ar Sr. d No. No .
39 40 41 42 43 44 45 46
Name of Slams
Mukaryana Bisati Khana Purai Najhaye Panna Lal Bahar Saiyer Gate Mohani Baba Madak Khana Suje Kha Khidaki
Status of Water Quality Of Quality of Supply Housing Sanitation Popula (Piped, (Kacha/ (IHL/Comm tion Hand Pakka/Mix unity Totail Pump, ed) & OD) wells & other)
Location Location & Location & & Distance Distance From Distance From PHC/UHP/UF From WC Primaery AWC School
3900
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
1500
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
3000
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
900
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
5850
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
2550
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
2100
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
1735
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
47
Gudari
2286
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
48
Bahar Bhandari Gate
3300
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
49
Darigaran
4758
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
50
Khusi Pura
9600
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
51
Chaniapura
810
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
600
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
2400
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
52 53
Bahar Orcha Gate Kushthyan a
54
Sagar Gate
3000
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
55
Lashmi Gate
600
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
56
Bangalagh
6000
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
57
Ander Orcha Gate
5400
Mixed
IHL & OD
HP,wells
NA
NA
NA
NA
159127
13
UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel UHP Tahseel
0.5 km NA NA NA 1.5 km NA NA NA NA 1.0k m NA 0.8 km NA 1.2k m NA NA 0.5 km NA 1.0 km
No Of Urba n Asha Prapo sed
1.4. Urban Governance There are multiple agencies responsible for urban governance and provision and management of infrastructure and services. While, the Jhansi NPP, Jhansi Jal Sansthan, Jhansi Development Authority 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
Jhansi NPP
Jhansi Development Authority District Urban Development Authority (DUDA)
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 Preparation of Master Plans for land use; Development of new areas as well as provision of housing and necessary infrastructure 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)
State Urban Development Authority (SUDA)
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 their primary focus areas 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) UP Pollution Control Board (UPPCB) Town and Country Planning Department (TCPD) Office of Commissioner Jhansi Division
Maintenance of heritage areas and monuments Pollution control and monitoring especially river water quality and regulating industries Preparation of Town Plans including infrastructure for the state (rural and urban) Coordination of activities of various institutions 14
1.5. 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. 1.6. Housing Jhansi has witnessed a radical growth. The position of the city as the only large urban centre amidst a number of small towns in the surrounding districts makes it an attractive destination for job seekers and people in need of education and health facilities. One of the features of the city’s growth has been an increase in the number of slums but disagreements about the definition of slums and about data hamper efforts to address service delivery challenges in these areas.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
HOUSING CHARACTERISTICS Households living in a Pucca House (%) Households living in a Owned House (%) Households having improved source of Drinking Water (%) Households treating water to make it safer for drinking (%) Households having access to toilet facility (%) Households sharing toilet facility (%) Households having access to electricity (%) Households using Electricity (%) Households using Firewood/Crop Residues/Cow Dung Cake (%) Households using LPG/PNG (%) Households having a separate Kitchen (%) Households having Computer/laptop with or without Internet Connectivity (%) Households having Telephone/Mobile (%) HOUSEHOLD CHARACTERISTICS Average Household Size EFFECTIVE LITERACY RATE Person Male Female
83.8 82.1 97.6 11.3 78.3 23.7 94.9 90.5 34.8 61.6 63.3 11 86.5 4.5 86.2 92.1 79.5
2. Health Infrastructure and scenario 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 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. 15
2.1. First and Second Tier Health Services The Government has committed itself to make provisions for health care services to the people. 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 centers3. Second tier health services are provided in urban areas through District Male and Female or Combined Hospitals.
Sl.
3
Name & Type of health Facility
1
UHP Jhokanbag
2
UHP Tahseel
3
UHP Etwariganj
4
UHP Sipri Bazar
5
UHP Rajghat
6
UHP Puliya No-9
7
UHP Nagra
8
UHP Etwariganj
9
UHP Puliya No-9
10
11
Managing Authority
State Health Deptt State Health Deptt State Health Deptt State Health Deptt State Health Deptt State Health Deptt State Health Deptt
Location
Jhokanbag locality in sadar Tahseel locality in sadar Etwariganj locality in sadar Sipri Bazar locality in sadar Rajghat locality in sadar Puliya No-9 locality in sadar Nagra locality in sadar Etwariganj locality in sadar
Population covered
Services provided
23580
Immunization, FP, OPD
25950
Immunization, FP, OPD
63262
Immunization, FP, OPD
55600
Immunization, FP, OPD
55388
Immunization, FP, OPD
18583
Immunization, FP, OPD
50984
Immunization, FP, OPD
63262
Immunization, FP, OPD
NRHM
Puliya No-9 locality in sadar
18583
Immunization, FP, OPD
UHP Rajgath
NRHM
Nagra locality in sadar
55388
Immunization, FP, OPD
PP Center District Women Hospital
State Health Deptt
District Women Hospital, City
63548
NRHM
Sanctioned MO-1, SN3, & Other -5 MO-1, SN3, & Other -6 MO-1, SN3, & Other -6 MO-1, SN3, & Other -6 MO-1, SN3, & Other -6 MO-1, SN3, & Other -5 MO-1, SN3, & Other -6 MO-1, SN1, ANM-1 & Other -1 1 MO-1, SN-1, ANM-1 & Other -1 MO-1, SN1, ANM-1 & Other -1
In position MO-1, SN-0, & Other -5
No
MO-1, SN-0, & Other -6
No
MO-1, SN-0, & Other -6
No
MO-1, SN-0, & Other -6
No
MO-1, SN-0, & Other -6
No
MO-1, SN-0, & Other -5
No
MO-1, SN-0, & Other -6
No
MO-0, SN-1, ANM-1 & Other -1
No
MO-1, SN-1, ANM-1 & Other -1
No
MO-1, SN-1, ANM-1 & Other -1
No
MCH, Immunization, MO-1, SN- MO-1, SN-2, FP, Pathology, 2, ANM-2 ANM-2 & OPD, IPD & All & Other -4 Other -4 Other Services
Yes
Ministry of Health and Family Welfare. 2005 Annual Report 2003-04. New Delhi : MoHFW.
16
Human resources
No. and type of equipments available
12
PP Center Maharani Laxmi Bai Medical College
State Health Deptt
MLB Medical college
2042569
13
Cantonment Hospital
Armed Forces
CATT.
17070
14
Railway Hospital
Railway
Railway
20619
KochaBawar
62750
15
16
17
State KochaBawar Health Deptt School State Health Health Dispensary Deptt Government State Homeopathy Health Hospital Deptt
Tahseel locality in sadar Near CMO office in sadar
MCH, Immunization, MO-3, SN- MO-3, SN-2, FP, Pathology, 2, ANM-2 ANM-2 & OPD, IPD, & Other -9 Other -5 Other MCH, Immunization, FP, Pathology, NA NA OPD, IPD, Other MCH, Immunization, FP, Pathology, NA NA OPD, IPD, Other MO-1, SNImmunization, MO-1, SN-0, 1, & Other FP, OPD & Other -0 -1
Yes
Yes
Yes
No
25950
Immunization, FP, OPD
MO-1, & Other -2
MO-1, & Other -2
No
63548
OPD
MO-2, SN-1 & Other -2
MO-2, SN-1 & Other -2
No
The data given in the table above reveals inadequacy of primary health care services. 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 underserved. From the above assessment it becomes evident to consider the poor health indicators for deciding the norms of staff population ratio 2.2 Health Scenario Health/Morbidity Profile of the City: Sl. No. Name of Disease/ cause of morbidity (e.g. COPD, trauma, cardiovascular disease etc.) 1. Injuries and Trauma 2. Self inflicted injuries/suicide 3. Cardiovascular Disease 4. Cancer (Breast cancer) 5. Cancer (cervical cancer) 6. Cancer (other types) 7. Mental health and depression 8. Chronic Obstructive Pulmonary Disease (COPD) 9. Malaria 10. Dengue 11. Infectious fever (like H1N1, avian influenza, etc.) 12. TB 13. MDR TB 14. Diarrhoea and gastroenteritis 15. Jaundice/Hepatitis 16. Skin diseases 17. Severely Acute Malnourishment (SAM) 18. Iron deficiency disorder 19. Others (Source: )-District male and Female Hospital and other dispensaries 17
Number of cases admitted in 2012 108494 0 31089 0 0 91 918504 0 40029,PV-1010,PF-11 1 0 1330 49962 1130 0 0 0
The above table reflects the health/ morbidity profile of the Jhansi city. As there are three sources of data, the city planning team has approached all three sources for getting most authenticated as well as updated data. So, data from IDSP, TB clinic and District hospital were taken and mentioned in the above table. Based on the results of AHS the health scenario of Jhansi city (proxy by the urban part of the district) is presented as below. Health Indicators4 1 2 3 4 5 6 7 8 9 10 11 12
13 14 15
16 17 18 19 20 21 22 23 24
25 26 4
Marrige below legal age (%) Among females (below 18 Years) Among males (below 21 Years) CMW age ( 20-24 Years) married before age 18 years CMM age ( 20-24 Years) married before age 21 years Mean Age at Marriage Male Female Children Currently Attending School (Age 6-17 years) Person Male Female Children attended before (Drop out %) Person Male Female Morbidity and Health issues Number of disable persons (1000,000 population) Person Male Female Number of Injured Persons by type of Treatment received (Per 100,000 Population) Severe Person Male Female Major Person Male Female Minor Person Male Female Persons Suffering from any kind of Acute Illness (Per 100,000 Population) Diarrhea/Dysentery Person Male
AHS 2010-11 18
2.2 3.6 27.7 23.5 25.8 22.5 89.3 88.7 89.9 7.7 8.2 7.1
689 719 654
47 69 22 47 57 36 84 120 44
324 303
Health Indicators5 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48
49 50 51 52 53 54 55 56 57 58 59 5
Female Acute Respiratory Infection (ARI) Person Male Female Fever (All Types) Person Male Female Any type of Acute Illness Person Male Female Taking treatment from Any Source (%) Person Male Female Taking treatment from Government Source (%) Person Male Female Having Any kind of Symptoms of Chronic Illness (Per 100,000 Population) Person Male Female sought Medical Care (%) Person Male Female Diagnosed for (Per 100,000 Population) Any kind of Chronic Illness Person Male Female Diabetes Person Male Female Hypertension Person Male Female Tuberculosis (TB) Person Male
AHS 2010-11 19
349 61 69 51 1526 1324 1758 2096 1898 2324 86.5 86.4 86.6 16.9 15.8 18.1 3841 3708 3995 95.3 95.2 95.5
419 221 646 3709 3575 3864 574 662 472 1040 914
Health Indicators6 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90
91 92 93 94 95 96 6
Female Asthma/Chronic Respiratory Disease Person Male Female Arthritis Person Male Female Getting Regular Treatment (%) Person Male Female Getting Regular Treatment from Government Source (%) Person Male Female FERTILITY Total Fertility Rate (TFR) Women aged 20-24 reporting birth of order 2 & above (%) birth of order 3 & above (%) Women with two children wanting no more children (%) Median age at first live birth of Women aged 15-49 years Median age at first live birth of Women aged 25-49 years Women age 15-19 who were already mothers or pregnant at the time of the survey (%) Mean number of children ever born to aged 15-49 Mean number of children surviving to Women aged 15-49 Mean number of children ever born to Women aged 45-49 Live Births taking place after an interval of 36 months (%) ABORTION to EMW 15-49 Years (%) Pregnancy resulting in abortion Women who received any ANC before abortion Married Women who went for Ultrasound before abortion Average Month of pregnancy at the time of abortion Abortion performed by skilled health personnel (%) Abortion taking place in Institution (%) Currently Married Pregnant Women aged 15-49 registered for ANC (%) FAMILY PLANNING PRACTICES (CMW AGED 15-49 YEARS) Current Usage Any method (%) Any modern method (%) Female sterilization (%) Male sterilization (%) Copper-T/IUD (%) Pills (%)
AHS 2010-11 20
1184 101 139 58 219 265 167 72.5 76.7 68 32 35.3 28.5 40.9 27.7 61.1 23.5 22.7 34 2.5 2.4 3.6 51.3 2.7 59.5 27 3.4 73 64.9 78.3
76.4 66.8 40 0.4 0.8 2.6
Health Indicators7 97 98 99 100 101 102 103 104 105
106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 7
Condom/Nirodh (%) Emergency Contraceptive Pills (%) Any traditional method (%) Periodic abstinence (%) Withdrawal (%) LAM (%) UNMET NEED Unmet need for Spacing (%) Unmet need for Limiting (%) Total Unmet need (%) Maternal Health Care ANTE NATAL CARE Mothers who received any antenatal check-up (%) Mothers who had antenatal check-up in first trimester (%) Mothers who received 3 or more antenatal care (%) Mothers who received at least one tetanus toxoid (TT) injection (%) Mothers who consumed IFA for 100 days or more (%) Mothers who had Full Antenatal Check-up (%) Mothers who received ANC from Govt. Source (%) Mothers whose Blood Pressure (BP) taken (%) Mothers whose Blood taken for Hb (%) Mothers who underwent Ultrasound (%) DELIVERY CARE Institutional Delivery (%) Delivery at Government Institution (%) Delivery at Private Institution (%) Delivery at Home(%) Delivery at home conducted by skilled health personnel (%) Safe delivery *(%) Caesarean out of total delivery taken place in Government Institutions (%) Caesarean out of total delivery taken place in Private Institutions (%) Less than 24 hrs. stay in institution after delivery (%) Mothers who received Post-natal Check-up within 48 hrs. of delivery (%) Mothers who received Post-natal Check-up within 1 week of delivery (%) Mothers who did not receive any post-natal Check-up (%) New borns who were checked up within 24 hrs. of birth (%) JANANI SURAKSHA YOJANA (JSY) Mothers who availed financial assistance for delivery under JSY (%) Mothers who availed financial assistance for institutional delivery under JSY (%) Mothers who availed financial assistance for government institutional delivery under JSY(%) IMMUNIZATION (%) No of Children age 12-23 months Children aged 12-23 months who have received BCG Children aged 12-23 months who have received 3 doses of Polio vaccine
AHS 2010-11 21
22.8 0 9.6 8.7 0.7 0.1 10.1 3.7 13.8
95.7 70.5 60 95.4 17.1 12.4 61.4 73.6 63.9 46.9 80.3 45.4 34.8 19.6 68.8 93.8 9.6 38.4 70 79.5 82.8 15.1 80.1 40.1 49.5 84.6 96.2 97.3 88.5
135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157
158 159 160 161 162 163 164 165 166 167 168
8
Health Indicators8 Children aged 12-23 months who have received 3 doses of DPT vaccine Children aged 12-23 months who have received Measles vaccine Children aged 12-23 months Fully Immunized Children who have received Polio dose at birth Children who did not receive any vaccination Children Vitamin A dose during last six months Children (aged 6 months) who received IFA tablets/syrup during last 3 months (%) Children whose birth weight was taken (%) Children with birth weight less than 2.5 Kg. (%) CHILDHOOD DISEASES Children suffering from Diarrhoea (%) Children suffering from Diarrhoea who received HAF/ORS/ORT (%) Children suffering from Acute Respiratory Infection (%) Children suffering from Acute Respiratory Infection who sought treatment (%) Children suffering from Fever (%) Children suffering from Fever who sought treatment (%) Child Feeding practices and nutritional staus of children (%) Children under 3 years breastfed within one hour of birth Children (aged 6-35 months) exclusively breastfed for at least six months (%) Water Animal/Formula Milk Semi-Solid mashed food Solid (Adult) Food Vegetables/Fruits Average month of receiving foods other than other than breast milk for children under 3 years Water Animal/Formula Milk Semi-Solid mashed food Solid (Adult) Food Vegetables/Fruits BIRTH REGISTRATION Birth registered (%) Children whose birth was registered and received birth certificate (%) AWARENESS ON HIV/AIDS Women who are aware of HIV/AIDS (%) Women who are aware of RTI/STI (%) Women who are aware of HAF/ORS/ORT (%) Women who are aware of danger signs of ARI/Pneumonia (%)
AHS 2010-11 22
87.2 85 80.6 93.7 2.2 63.4 6 65.6 14.3 3.8 77.6 2.5 100 3.5 95.6 77.3 34 57.1 52.2 7.8 3.7 2.9
3.6 4 6.9 8.3 9.5 28 23.9 74.8 88 88.2 72.2
3. 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 strive 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, Commoditization, 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 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 23
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 Jhansi 17) Management of communicable & non- communicable diseases 18) Strengthening AYUSH 19) Constitution of BSGY team for urban areas. 20) Identification & management of SAM children
4. 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 size 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. 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. 24
4.3. 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.
4.4. 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.
Monitoring & Evaluation The M&E systems would also capture qualitative data to understand the complexities in health interventions, undertake 4.5.
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.
4.6. Strengthening of health facilities Urban - Primary Health Centre (U-PHC) – 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.
4.7. 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. 4.8. 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. 25
4.9. ASHAFor 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 welldefined service area of about 1000-2,500 beneficiaries/ between 200-500 households based on spatial consideration.
4.10. 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. 4.11.
Innovations –
4.11.1. PPP & CSR – For Jhansi 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 with the technical support of Health of the Urban Poor program of PFI. 4.11.2. An urban specific IEC strategy Covering urban contexts would be developed, field tested and then applied to cover RCH. The IEC plans should especially focus on interpersonal or group communication which would include a description of expected behaviour change in different community segments. For effective tracking of its implementation, benchmarks and milestones would be developed. 4.11.3. 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. 4.12. 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. 26
5. Activity Plan under NUHM
1
2 3 4 5 6
7 8 9 10 11 12 13 14
15
16
Establishment of Platform Convergence at state level
Remarks
Mar
Feb
Jan
City level
Dec
Activity
Oct.
Act. No.
Nov.
Months : October'13 - March'14
Circular to be isued from state level to all their district level nodal officers
for
Preparation & Finalization of Guidelines for City Coord. Committee/ City Program Management Committee Preparation & Finalization of Guidelines for Urban ASHAs Preparation & Finalization of Guidelines for Mahila Arogya Samiti Preparation & Finalization of Guidelines for UHND Preparation & Finalization of Guidelines for Outreach sessions/ School Health Programs Preparation & Finalization of Job Descriptions for all district level NUHM positions Preparation & Finalization of Guidelines for PPP Induction of state level staff for Urban Health Cell Induction of city level staff for Urban Health program Meeting of DHS for establishment of City Program Management Committee (UH) Sensitization of new probable members on NUHM Identification of NGOs for their role under NUHM Establishment & orientation of City Program Management Committee (UH) Identification of groups, collectives formed under various govt. programs (like NHG under SJSRY, self help groups etc.) for MAS Organize meetings with women in slums where no groups could be identified
These will be one time activities and will apply across the state
27
17 18 18 18a 18b 18c 19 20 20a 20b 20c 21
22
23 24 25
26 27 28 29
Formation and restructuring of groups as per MAS guidelines Orientation of MAS members Selection of ASHAs - Selection of local NGOs for ASHA selection facilitation - Listing of local community members as facilitators by NGOs - Listing of probable ASHA candidates and finalize selection Convergence meeting with govt. Stakeholders Mapping & listing exercise (for health facilities and slums) - Mapping of all urban health facilities (public & pvt.) for services - Mapping of slums (listed and unlisted) - House listing of slums/ poor settlements Planning for strengthening of health facilities/ services - Health Facility Assessment (of public facilities including listing of public facility wise infra & HR requirement) Baseline survey of urban poor/ slums (KFAs) (to determine vulnerability, morbidity pattern & health status) Meetings of RKS for all the public health facilities under NUHM Identification of alternate/ suitable locations for UPHCs under various urban devp. Programs Strengthening of public health facilities - Selection, training and deployment of HR in pub. health facilities IEC activities Outreach camps & UHNDs (from existing UHPs) Empanelment of Private Health Facilities for health care provisioning Involvement of CSR activities 28
Remarks
Mar
Feb
Jan
City level
Dec
Activity
Oct.
Act. No.
Nov.
Months : October'13 - March'14
To continue 2014-15 To continue 2014-15 To continue 2014-15
in
To continue 2014-15
in
To continue 2014-15
in
To continue 2014-15
in
To continue 2014-15
in
in in
6. 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 district 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: Jhansi Urban population 1 lakh to 10 lakh
Additional Staff Proposed 1 Urban Health Coordinator,1 Accountant and 1 Data Entry Operator
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
Member DUDA & UD
-
Project Officer
Members – School Education
-
BSA & DIOS
Members – Dev. Partners
-
Partners working in urban NGO's 29
Review Meetings at UPHC and City Level
Nature of Meeting
Periodicity
Meeting Venue
Participants
Mahila Aarogya Samiti Meeting Review meeting with Link workers and MAS representatives
Once a month for each MAS
Slum
ANM, HV, Community Organizer, Social Mobilization officer
Once a month
UPHC
All ANMs, PHN, LMO, Community Organizer, Social Mobilization officer
Meeting of UPHC Coordination Committee
Once a month
UPHC
Meeting with CMO & UH Program Coordinator
Once a month
CMO Office
City Task Force Meeting
Once in two months
DM’s office
LMO, PHN/Community Organizer, Social Mobilization officer, representative from 2nd tier facility, and reps. From other departments CMO, Program Coord., Asst. Program Coordinator, LMO/ PHN/ Community Organizer, Social Mobilization officer CMO, Program Coord. UH, Various departments’ reps. , private partners, NGOs
7. City Level Indicators & Targets 7.1. Jhansi City Processes & Inputs Baseline (as applicable)
Number Proposed (2013-14)
Number Achieved (2013-14)
1. Number of Mahila Arogya Samiti (MAS) to be formed *
0
210
0
2. Number of MAS members to be trained *
0
2100
0
3. Number of Accredited Social Health Activists (ASHAs) to be selected and trained *
0
105
0
Indicators Community Processes
0
Health Systems 0
32
0
0
51
0
0
212
0
7. Number of UPHCs to be made operational *
0
12
0
8. Number of UCHCs to be made operational *
0
0
0
9. No. of RKS to be created at UPHC and UCHC *
0
12
0
4. Number of ANMs to be recruited * 5. No. of Special Outreach health camps to be organized in the slum/HFAs * 6. No. of UHNDs to be organized in the slums and vulnerable areas *
30
7.2. Mauranipur City Indicators
Processes & Inputs Baseline (as Number Proposed applicable) (2013-14)
Community Processes 10. Number of Mahila Arogya Samiti (MAS) to be formed * 11. Number of MAS members to be trained * 12. Number of Accredited Social Health Activists (ASHAs) to be selected and trained * Health Systems 13. Number of ANMs to be recruited * 14. No. of Special Outreach health camps to be organized in the slum/HFAs * 15. No. of UHNDs to be organized in the slums and vulnerable areas * 16. Number of UPHCs to be made operational * 17. Number of UCHCs to be made operational * 18. No. of RKS to be created at UPHC and UCHC *
Number Achieved (2013-14)
0 0
22 220
0 0
0
11
0
0
5
0 0
0
6
0
0
32
0
0 0 0
1 0 1
0 0 0
8. SUMMARY OF CITY NUHM BUDGET (2013-14) 8.1 Budget Summary Jhansi City FMR Code Budget Head 1 Planning & Mapping 2 Programme Management 3 Training & Capacity Building 4 Strengthening of Health Services 4.a Human Resource 4.b Infrastructure 4.c Untied grants 4.d Procurement (drugs and consumable) 4.e Other services 5 Regulation & Quality Assurance 6 Community Processes 7 Innovative Actions & PPP 8 Monitoring & Evaluation TOTAL
Budget (Rs. Lakhs) 0 13.16 41.3 481.2602 150.9792 64.4 30 150.96 84.921 0 16.8 0 0 552.5202
8.2 Budget Summary Mauranipur City FMR Code Budget Head 1 Planning & Mapping 2 Programme Management 3 Training & Capacity Building 4 Strengthening of Health Services 4.a Human Resource 4.b Infrastructure 4.c Untied grants 4.d Procurement (drugs and consumable) 4.e Other services 5 Regulation & Quality Assurance 6 Community Processes 7 Innovative Actions & PPP 8 Monitoring & Evaluation TOTAL
Budget (Rs. Lakhs) 2 0 4.55 41.5478 0.6 0.7 0 0 0.3 0 0 0 0 49.8578
31
% total budget 0% 2.38% 7.47% 87.1%
0% 3.04% 0.0% 0% 100%
% total budget 4.01 9.13 83.33 1.20 1.40 0.60 100.00
9. Detailed City NUHM Budget ( 2013-14) Jhansi Detailed City NUHM Budget ( 2013-14) Jhansi Unit FMR Budget Head cost* (Rs. Code In lakhs)
1
Planning & Mapping
1.1 1.1.1
Metro cities Mapping Data gathering (secondary/primary) Any Other Million+ cities Mapping Data gathering (secondary/primary) Any Other Cities (1 lakh to 10 lakh population) Mapping Data gathering (secondary/primary) Any Other Towns (50,000 to 1 lakh population) Mapping Data gathering (secondary/primary) Any Other Programme Management State PMU Human Resources Mobility support Office Expenses District PMU
1.1.2 1.1.3 1.2 1.2.1 1.2.2 1.2.3 1.3 1.3.1 1.3.2 1.3.3 1.4 1.4.1 1.4.2 1.4.3 2 2.1 2.1.1 2.1.2 2.1.3 2.2
2.2.1
Human Resources
Physical Budget Target Months (Rs. Lakhs) (No.)
0
15
Remarks Mapping has been done by Urban Development department and under NRHM , so no budget has been proposed
0 0 0 0 0 0
10
0 0 5
1
0 0 0 0
2
0 0 0 0 13.16
13.16
0.66
1
6
32
3.96
District total Urban Population 1-10 lakhs so 1 Urban Health Co-ordinator (UHC) , 1 Accountant and 1 Data Entry Operator (DEO), UHC Salary Rs. 30,000 pm, Accountant Rs. 18,000 PM. and DEO Salary Rs. 10,000 pm. Rs 8000 pm for Incentive to DPM for preparatory activity of NUHM.
FMR Code
Budget Head
Unit cost* (Rs. In lakhs)
Physical Budget Target Months (Rs. Lakhs) (No.)
2.2.2
Mobility support
0.25
1
6
1.5
2.2.3
Office Expenses, for Rent
0.25
1
6
2.2
2.2.4
Strengthening Urban Health cell at District level
5.5
1
1
5.5
2.3
City PMU
As per ne
2.3.1 2.3.2 2.3.3
Human Resources Mobility support Office Expenses Training & Capacity Building
3
41.3
Orientation of Urban Local Bodies (ULB)
1
1
1
1
3.2
Training of ANM/paramedical staff
0.05
84
1
4.2
3.3
Training of Medical Officers
0.10
24
1
2.4
3.4
Orientation of Specialists
3.5
Orientation of MAS
0.10
210
1
21
0.10
105
1
10.5
3.7
Selection & Training of ASHA Other Trainings/Orientations
One vehicle will be hired Rs. Rs 25,000 per month per Urban Health Co-ordinator Rs.25,000 pm for office expenses including internet and one time Rs.70,000 for one computer,data card, storage device, printer, table and chairs for each DEO of DPMU Rs.2.5 lakhs for Furniture, ACs, desktops, minor renovations etc. for the District level Nodal Officer & 2.5 lakhs for DPMU office NUHM office strengthe ning, & Rs 50,000 for DPM laptop along with data card.
1.3
3.1
3.6
Remarks
0
Rs.5 lakhs for metros, Rs.3 lakhs for million+ cities, Rs.1 lakh for other cities above 1 lakh and Rs.0.5 lakhs for smaller towns below 1 lakh, One time activity, Maximum Rs.5000 per ANM (for entire training package), 5 ANMs and 2 Staff nurses from each UPHC will be trained. Maximum Rs.10,000 per MO (for entire training package), All MOs for UPHCs will be trained. 02 Mos Not planned this year Maximum Rs.10,000 per MAS (for entire training package) Maximum Rs.10,000 per ASHA (for entire training package)
2.2
3.7.1
Stakeholders Workshop for NUHM
1
1
1
1
3.7.2
Quarterly Multi-sectoral convergence Meeting
0.1
1
2
0.2
3.7.3
Launch of NUHM
1
1
1
1
33
Rs1,00,000 for district headquarters and Rs.10,000 for towns. Rs10,000 for district headquarters and Rs.5,000 for towns. Rs1,00,000 for district headquarters.
FMR Code 4 4.a 4.b 4.c 4.d 4.e 4.1
Budget Head
Unit cost* (Rs. In lakhs)
Physical Target Months (No.)
Strengthening of Health Services Human Resource Infrastructure Untied grants Procurement (drugs and consumable) Other services Outreach services/camps/UHNDs
Budget (Rs. Lakhs) 481.2602 150.9792 64.4 30 150.96 84.921 49.68
4.1.1
UHNDs
0.015
212
6
19.08
4.1.2
Special outreach camps in slums/ vulnerable areas
0.1
51
6
30.6
4.2
ANM/LHV Salary support for ANM/LHV
0.1
32
6
19.2
4.2.2
Mobility support for ANM/LHV
0.005
60
6
1.8
4.3.1 4.3.1.1
4.3.1.2
Urban PHC (UPHC) Renovation/up-gradation of existing facility to UPHC For Government owned buildings
For equipments
Rs. 1500 per UHND. 01 UHND per AWC per month ,if AWC is not there than ANM will conduct 01 session per month per 1000 Urban Slum Population One outreach camp per 10,000 population per month Rs.10,000 per outreach camp.
21
4.2.1
4.3
Remarks
Maximum Rs.10,000 pm for ANM as per approved norms in NRHM; (5 ANMs per UPHC) Only for contractual ANMs. Rs.500 pm for all ANMs contractual as well as on government payroll.
378.2336 64.4 10
2
1
20
3.7
12
1
44.4
4.3.2
Building of new UPHC Operating cost support for running UPHC (other than 4.3.3 untied grants and medicines & consumables) 4.3.3.1 Human Resource 4.3.3.1.1 MO salary 0.36
Rs.10 lakhs per UPHC, one time activity for building renovation Rs.3 lakhs per UPHC, one time activity for UPHCs for purchase of equipment's , Rs 70000/- for One Computer System with printer, data card , storage device,Computer table, Computer chair, one for each UPHCs for HMIS / MCTS data entry operator.
0 133.8336
24
6
34
Rs.20 lakhs per year per UPHC ( For 1 UPHC)
124.8336 2 MOs per UPHC Rs.36,000 pm 51.84
FMR Code
Budget Head
Unit cost* (Rs. In lakhs)
Salary of paramedical & nursing staff (Staff Nurse/ 4.3.3.1.2 Lab Technician/ Pharmacist/ Other)
Physical Target Months (No.)
Budget (Rs. Lakhs)
12
6
44.1936
0.05
36
6
10.8
4.3.3.1.4 HMIS / MCTS operator
0.1
12
6
7.2
4.3.3.1.5 Office Expenses Others (e.g. hiring of 4.3.3.2 premises/mobile PHC)
0.15
12
6
10.8
0.15
10
6
9
2.5
12
1
30
12
1
150
4.3.3.1.3
4.3.4 4.3.5 4.3.5.1 4.3.6 4.4 4.4.1 4.4.2 4.4.2.1 4.4.2.2 4.4.3 4.4.4 4.5 4.5.1
4.5.2 4.5.3 4.6 4.6.1
4.6.2
4.6.3
Salary of support staff (non clinical staff)
Untied grants to UPHC
Medicines & Consumables 12.5 for UPHC Emergency drugs Other Urban CHC (UCHC) Capital cost support for new UCHC Human Resource
Untied grants for UCHC Medicines & Consumables for UCHC School Health Program Human Resource Other School Health services Drugs,consumable & Operational expenses IEC/BCC ASHA Kit Flip Book, Slum HIR, Bag, ID, Pen, handouts for community UPHC Citizen's charter, ED List, Immunization Schedule, Signage
Safe Motherhood, Booklet, MCP Card and IEC material for U-PHC
Remarks 2 Staff Nurses per UPHC Rs.16,500 pm, 1 Pharmacist per UPHC Rs.16500 pm; 1 Lab Technician Rs.11,880 pm 3 Support staff(1 Ayah , 1 Ward Boy and 1 Sweeper cum Chowk -idar) for 1 UPHC Rs.5,000 pm HMIS / MCTS operators, one for 1 UPHC. Salary 10,000 pm Rs. 15,000 pm per UPHC Rent for UPHCs running in rented buildings Rs.15,000pm Rs.2.50 lakhs per year per UPHC Rs.12.50 lakhs per year per UPHC
0 0 0 0
0
0 0 0
0 0 0 0
0
0 10.9056
0.5788
2
6
6.9456
0.25
2
6
3
0.08
2
6
0.96
One team consisting of 1 doctor Rs.36,000 pm; 1 ANM Rs.10,000 pm and 1 Ophthalmic Assistant Rs.11,880 pm Hired vehicle Rs.25,000pm, per School Health team Rs. 8000 pm per team for 6 Month
21.441 0.02
105
1
2.1
one time Rs. 2,000 per ASHA
0.2
12
1
2.4
One time Rs.20,000 per UPHC
10.26
1500 sets of MCP Card and Safe Motherhood booklet to be printed per UPHC @ Rs.37/- per booklet and MCP card Rs 30,000/ for per U-PHC for printing of other IEC material @ Rs 3/- per household on communicable and non communicable diseases
0.00057
12
1500
35
FMR Code
Budget Head
Unit cost* (Rs. In lakhs)
Physical Target Months (No.)
Budget (Rs. Lakhs)
Remarks
4.6.4
Family Health Card
0.0001
42,310
1
4.231
Family Health Card to be printed for all slum households Rs 10 per card per house hold
4.6.5
Communcation material and wall painting at AWCs
0.01
145
1
1.45
One time, Rs.1,000 per AWC
4.6.6
NUHM Hording
0.2
5
1
1
Rs 20000/- Including printing & installation.
Regulation & Quality Assurance Community Processes MAS/community groups ASHA (urban) NGO support for community processes Innovative Actions & PPP Monitoring & Evaluation Baseline/end line surveys Research Studies in Urban Public Health IT based monitoring initiatives TOTAL
5 6 6.1 6.2 6.3 7 8 8.1 8.2 8.3
0 0.05 0.02
0
210 105
1 3
16.8 10.5 6.3 0
As per need As per need
Rs.5000 per year per MAS Approx. Rs.2000 pm per ASHA Quarterly community processes meeting
0
552.5202
9.2. Detailed Budget Mauranipur City Detailed City NUHM Budget ( 2013-14) JhanMauranipur Unit cost* Physical FMR Budget Head (Rs. In Target Months Code lakhs) (No.) 1
Planning & Mapping
1.1 1.1.1
Metro cities Mapping Data gathering (secondary/primary) Any Other Million+ cities Mapping Data gathering (secondary/primary) Any Other Cities (1 lakh to 10 lakh population) Mapping
1.1.2 1.1.3 1.2 1.2.1 1.2.2 1.2.3 1.3 1.3.1
Budget (Rs. Lakhs) 2 0 0
15
0 0 0 0
10
0 0 5
0 0 36
Remarks Rs 2.00 Lakhs has been proposed for GIS mapping, Listing of slum and facility mapping
FMR Code 1.3.2 1.3.3 1.4 1.4.1 1.4.2 1.4.3 2 2.1 2.1.1 2.1.2 2.1.3 2.2 2.2.1 2.2.2 2.2.3 2.2.4 2.3 2.3.1 2.3.2 2.3.3 3
Budget Head Data gathering (secondary/primary) Any Other Towns (50,000 to 1 lakh population) Mapping Data gathering (secondary/primary) Any Other Programme Management State PMU Human Resources Mobility support Office Expenses District PMU Human Resources Mobility support Office Expenses Strengthening Urban Health cell in District lebel City PMU
Unit cost* Physical (Rs. In Target Months lakhs) (No.)
Budget (Rs. Lakhs) 0 0
2
1
1
2 0 0 0 0
0 0 0 0 0 As per need
Human Resources Mobility support Office Expenses Training & Capacity Building
1.3 4.55
3.1
Orientation of Urban Local Bodies (ULB)
0.5
1
1
0.5
3.2
Training of ANM/paramedical staff
0.05
7
1
0.35
3.3
Training of Medical Officers
0.10
2
1
0.2
3.4
Orientation of Specialists
3.5
Orientation of MAS
0.10
22
1
2.2
0.10
11
1
1.1
3.6 3.7
Selection & Training of ASHA Other Trainings/Orientations
Remarks
0
37
0.2
Rs.5 lakhs for metros, Rs.3 lakhs for million+ cities, Rs.1 lakh for other cities above 1 lakh and Rs.0.5 lakhs for smaller towns below 1 lakh, One time activity, Maximum Rs.5000 per ANM (for entire training package), 5 ANMs and 2 Staff nurses from each UPHC will be trained. Maximum Rs.10,000 per MO (for entire training package), All MOs for UPHCs will be trained. 02 Mos per U-PHCs Not planned this year Maximum Rs.10,000 per MAS (for entire training package) Maximum Rs.10,000 per ASHA (for entire training package)
Unit cost* Physical (Rs. In Target Months lakhs) (No.)
Budget (Rs. Lakhs)
FMR Code
Budget Head
3.7.1
Stakeholders Workshop for NUHM
0.1
1
1
0.1
3.7.2
Quarterly Multi-sectoral convergence Meeting
0.05
1
2
0.1
3.7.3
Launch of NUHM
4
0
Strengthening of Health Services Human Resource
0.1
1
6
0.6
4.b
Infrastructure
0.7
1
1
0.7
4.c
Untied grants Procurement (drugs and consumable)
4.e
Other services
4.1
Outreach services/camps/UHNDs
4.1.1
UHNDs
4.1.2
Special outreach camps in slums/ vulnerable areas
4.2 4.2.1
4.2.2
Mobility support for ANM/LHV
4.3 4.3.1 4.3.1.1 4.3.1.2 4.3.2
0.05
1
6
0.015
32
6
2.88
0.1
6
6
3.6
Operating cost for HMIS / MCTS data entry Rs.5000 per month for 1 UPHC
Rs. 1500 per UHND. 01 UHND per AWC per month ,if AWC is not there than ANM will conduct 01 session per month per 1000 Urban Slum Population One outreach camp per 10,000 population per month Rs.10,000 per outreach camp.
3.15 0.1
5
6
3
0.005
5
6
0.15
Urban PHC (UPHC) Renovation/up-gradation of existing facility to UPHC For Government owned buildings For Equipments
0.3
HMIS / MCTS operators, one for 1 UPHC. Salary 10,000 pm One Computer System with printer, Computer table, Computer chair, one for each UPHCs for HMIS / MCTS data entry operator.
6.48
ANM/LHV Salary support for ANM/LHV
Rs1,00,000 for district head quarters & Rs.10,000 for towns. Rs10,000 for district headquarters and Rs.5,000 for towns. Rs1,00,000 for district headquarters.
41.5478
4.a
4.d
Remarks
Maximum Rs.10,000 pm for ANM as per approved norms in NRHM; (5 ANMs per UPHC) Only for contractual ANMs. Rs.500 pm for all ANMs contractual as well as on government payroll.
28.4028 3 0 3
1
Building of new UPHC
1 0
38
3
Rs.10 lakhs per UPHC, one time activity for building renovation Rs.3 lakhs per UPHC, one time activity for UPHCs for purchase of equipments
FMR Code
4.3.3 4.3.3.1
Budget Head
Unit cost* Physical (Rs. In Target Months lakhs) (No.)
Operating cost support for running UPHC (other than untied grants and medicines & consumables) Human Resource
4.3.3.1.1 MO salary
Salary of support staff (non clinical staff)
0.36
4.3.4 4.3.5 4.3.5.1 4.3.6 4.4 4.4.1 4.4.2 4.4.2.1 4.4.2.2 4.4.3 4.4.4 4.5
Untied grants to UPHC Medicines & Consumables for UPHC Emergency drugs Other Urban CHC (UCHC) Capital cost support for new UCHC Human Resource
10.4028
Rs.20 lakhs per year per UPHC ( For 1 UPHC)
0.05
2
6
4.32
1
6
3.6828
3
6
0.9
6
0
4.3.3.1.4 4.3.3.1.5 Office Expenses Others (e.g. hiring of 4.3.3.2 premises/mobile PHC)
Remarks
9.5028
Salary of paramedical & nursing staff (Staff Nurse/ 4.3.3.1.2 Lab Technician/ Pharmacist/ Other) 4.3.3.1.3
Budget (Rs. Lakhs)
0.1
1
6
0.6
0.15
1
6
0.9
2.5
1
1
2.5
12.5
1
1
12.5
0 0 0 0 0
Untied grants for UCHC Medicines & Consumables for UCHC School Health Program
0 0
Human Resource
0
4.5.2
Other School Health services
0
4.5.3
Drugs & consumable
0
4.6.1 4.6.2
IEC/BCC ASHA Kit Flip Book, Slum HIR, Bag, ID, Pen UPHC Citizen's charter, ED List, Immunization Schedule, Signage
Rs. 10,000 pm per UPHC Rent for UPHCs running in rented buildings Rs.15,000pm Rs.2.50 lakhs per year per UPHC Rs.12.50 lakhs per year per UPHC
0 0 0
4.5.1
4.6
2 MO IC per UPHC Rs.36,000 pm 2 Staff Nurses per UPHC Rs.16,500 pm, 1 Pharmacist per UPHC Rs.16500 pm; 1 Lab Technician Rs.11,880 pm 3 Support staff(1 Ayah , 1 Ward Boy and 01 Sweeper cum Chowk -idar) for 1 UPHC Rs.5,000 pm
One team consisting of 1 doctor Rs.36,000 pm; 1 ANM Rs.10,000 pm and 1 Ophthalmic Assistant Rs.11,880 pm Hired vehicle Rs.25,000pm, per School Health team Rs. 8000 pm per team for 6 Month
1.915 0.02
11
1
0.22
one time Rs. 2,000 per ASHA
0.2
1
1
0.2
One time Rs.20,000 per UPHC
39
FMR Code
Budget Head
Unit cost* Physical (Rs. In Target Months lakhs) (No.)
Budget (Rs. Lakhs)
4.6.3
Safe Motherhood Booklet, MCP Card etc.
0.00057
1
1500
0.855
4.6.4
Family Health Card
0.0001
4,400
1
0.44
4.6.5
Communcation material and wall painting at AWCs
0.01
1
0
4.6.6
NUHM Hording
0.2
1
0.2
5 6 6.1 6.2 6.3
Regulation & Quality Assurance Community Processes MAS/community groups ASHA (urban) NGO support for community processes
7
Innovative Actions & PPP
8
Monitoring & Evaluation
8.1
Baseline/end line surveys Research Studies in Urban Public Health IT based monitoring initiatives TOTAL
8.2 8.3
0.05 0.02
1 0
0
22 11
1.76 1.1 0.66
1 3
0 As per need As per need
Remarks 1500 to be printed per UPHC area covering 50,000 population Rs. 57.00 for the set of MCP Card and Safe Motherhood booklet Family Health Card to be printed for all slum households Rs 10 per card per house hold One time, Rs.1,000 per AWC Rs 20000/- Including printing & installation.
Rs.5000 per year per MAS Approx. Rs.2000 pm per ASHA Quarterly community processes meeting
0
49.8578
Chief Medical Officer Jhansi
40
