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Hathras City
Program Implementation Plan
National Urban Health Mission
Prepared by District Health Officials with support from Urban Health Initiative
Page | 2
City Heath Action Plan (2013-14)
National Urban Health Mission
District - HATHRAS
Dr. R.P. Singh Surya Pal Gangwar (IAS) Chief Medical officer District Magistrate Hathras Hathras
Page | 3
TABLE OF CONTENT
Approval of DHS 3
Acknowledgement 4
Acronyms 5
City Profile 6-17
Health Scenario 18
Key Issues 18-19
Strategies, Activities & Work plan under NUHM 19-25
Programme Management Arrangements 26-27
City level targets & indicators 28-29
District Health Society Hathras (Uttar Pradesh)
To, Mission Director National Health Mission 19-A, Vishal Complex, Vidhan Sabha Marg Lucknow (Uttar Pradesh)
Subject:- Submission of City Health Action Plan (under NUHM) for the F.Y. 2013-14.
Respected Sir,
This is to certify that City Health Action Plan for National Urban Health Mission activities proposed in F.Y. 2013-14 prepared by the District Health Authorities with Active involvement of all stakeholders has integrated the health and health facilities improvement
need of the Hathras City.
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 systemat-ically so that we can make the difference in improvement of quality life of urban people specially by reaching the unreached areas.
The plan was discussed in the District Health Society, suggestions were incorpo-
rated and approved.
Date :-................... Surya Pal Gangwar (I.A.S.)
District Magistrate / Chairman
Hathras
It is our pleasure to present the City Health Action Plan for HATHRAS city for the
year 2013-14. The City Health Action Plan seeks to set goals and objectives for the district
health system and delineate implementing processes in the present context of gaps and op-
portunities for the Hathras district health team.
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 of Hathras 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.
We are very glad to share that City Health Action Plan is combined & dedicated efforts
of the team of health professionals, representatives of other development partners and oth-
er NGOs of Hathras. we are also thankful to other developmental heads like ICDS, DUDA, Na-
gar Palika Parishad, & Education for providing us the valuable data & suggestions which were
critical for the document.
The critical efforts of District PMU team are worth mentioning. Without their con-
sistent & regrious efforts collection & compilation of data would not have been possible. We
also would like to thank the Divisional PMU & SPMU officials for providing vital inputs and
support to fill up the relevant annexure, physical & financial sheet along with the entire
preparation of City Health Action Plan development
. We are sure that the plan will set a definite direction and give us an impact to embark
on our mission.
Dr. Ram Pratap Singh Surya Pal Gangwar (IAS) Chief Medical Officer District Magistrate
Hathras Hathras
ACKNOWLEDGEMENT
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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
Page | 7
National Urban Health Mission- Programme Implementation Plan
Hathras 2013-14
1. Hathras Profile
Hathras is a city and a municipal board in Hathras district (formerly Mahamaya Nagar
district) in the Indian state of Uttar Pradesh. It is the headquarters of the district that
was created on 3 May 1997 by incorporating parts of Aligarh, Mathura and Agra dis-
tricts. It forms a part of Aligarh Division. Mahamaya Nagar district was recently re-
named Hathras. Hathras lies within the Braj region in Central or Middle Doab, associ-
ated with the epic Mahabharata and Hindu theology. The principal spoken language is
Hindi. Its dialect Braj Bhasha which is closely related to Khariboli is spoken in this re-
gion. Hathras fall under the Brij region of Northern India and was famous for its Indus-
trial, Literature related, and cultural activities as a part of Aligarh .Historically and ac-
cording to Purans Hathras can be of the age of Mahabharata. Because old folk tales
and archaeological remains prove it. The Freedom struggle started by Raja Dayaram
continued untill India became free in which many people of Hathras participated. On
October 19, 1875, the train between Hathras Road and Mathura Cantonment was
started. Malla vidya (the art of wrestling) is an old hobby of people of Hathras who’s
remains can still be seen today in the form of “Bagichis”(small Gardens) and “Akha-
ras”(the place where people use to exercise and practice wrestling etc.).In the memory
of Swami Vivekanand’s first arrival at Hathras a Shilalekh was established at Hathras
city Railway Station, which reveals that Swami Vivekanand has given the name
Sadanand to his first disciple who was the station master of Hathras city Railway sta-
tion . Kanya Gurukul at Sasni played a great role in spreading the reputation of this dis-
trict. Many girls of different states obtain their graduate and postgraduate education
dependent on Indian culture. Similarly newly established Mangalaytan is developing as
a world famous Jain pilgrimage .This pilgrimage is situated on Hathras – Aligarh road in
the Sasni tehsil of this district.
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Table.1: Hathras District and Hathras City in Census 20111
Description Hathras District
2011
Hathras City
2011
Actual Population 1564708 137509
Male 836127 73376
Female 728581 64133
Population Decadal Growth
rate
17.12%
Density/km2 850
Sex Ratio (Per 1000) 871 874
Child Sex Ratio (0-6 Age) 865 834
Average Literacy (%) 71.59 79.06
Male Literacy (%) 82.38 83.88
Female Literacy (%) 59.23 73.58
1.1. Hathras City
As per provisional reports of Census India, population of Hathras in 2011 is 137,509; of which male and female
are 73,376 and 64,133 respectively. Although Hathras city has population of 137,509; its urban / metropolitan
population is 161,289 of which 86,028 are males and 75,261 are females.
In education section, total literates in Hathras city are 95,524 of which 53,918 are males while 41,606 are f e-
males. Average literacy rate of Hathras city is 79.06 percent of which male and female literacy was 83.88 and
73.58 percent.
The sex ratio of Hathras city is 874 per 1000 males. Child sex ratio of girls is 834 per 1000 boys.
Total children (0-6) in Hathras city are 16,686 as per figure from Census India report on 2011. There were
9,096 boys while 7,590 are girls. The child forms 12.13 % of total population of Hathras City.
1 2011 census (P)
Page | 9
Table 2: Demographic profile of Hathras City
Total Population of city (in lakhs) 143020 Source: Census 2011
Slum Population (in lakhs) 61000 Source: DUDA
Slum Population as percentage of urban popula-
tion 44.36%
Number of Notified Slums Nil Source: DUDA
Number of slums not notified 34 Source: DUDA
No. of Slum Households 12200 Source: DUDA
No. of slums covered under slum improvement
programme (BSUP, IDSMT,etc.) NIl
Number of slums where households have individ-
ual water connections* NA
Number of slums connected to sewerage net-
work* NA
Number of slums having a Primary school
11 Source: BSA Deptt.
No. of slums having AWC 34 Source: ICDS Hathras
No. of slums having primary health care facility 34
Table 3: Population, Literacy Rate & Sex Ratio – Hathras City2
Description Total Male Female
Population 137509 73,376 64,133
Literates 95,524 53,918 41,606
Children (0-6) 16,686 9,096 7,590
Effective Literacy Rate
(7+Population) %
79.06 83.88 73.58
Sex ratio 874
Child Sex ratio 834
2 Census of India, 2011
Page | 10
1.4 Urban Poor & Slums3
The UP Slum Areas (Improvement and Clearance) Act, 1962, considers an area a slum if the majority of build-
ings 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 o f the in-
habitants in that area, or otherwise in any respect unfit for human habitation. It mentions factors such as re-
pairs, 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; SUDA/UNCHS do not fol-
low this definition but define poverty in terms of vulnerability as does Oxfam.
DUDA’s estimation of slum population is a conservative increase over the Census estimation. However, An au-
thorized slum is one where there is security of tenure with the cluster being either an outcome of a govern-
ment resettlement programme or being located on private/own land. Unauthorized settlements are those
that have emerged on available vacant plots, mainly railway land or on encroached areas. Slum clusters on the
riverbanks or on drains are classified as unauthorized.
3 State of Urban Health in Uttar Pradesh, 2006
S. No. Name of Slums Population
1 Odhpura 1924
2 Nagala Tandula 1386
3 Khoda Hajari 2333
4 Iglas Adda Nai basti 2000
5 Sri nagar 2500
6 madhu Garhi 753
7 Kailash Nagar 244
8 Ramanpur 859
9 Garhi Khandari 3409
10 Naya Nagla Siddharth Nagar 1023
11 Moh. Kharni, Moh. Santoshi 477
12 Moh. Karr 750
13 Ganeshganj, Atal tal 826
14 Bhoorapeer, Baghmoola 1189
15 Nagala Belan Sah 3008
16 Kila Gate 189
17 Nagala Arkenia 545
18 Kila Khai 394
19 Moh. Shiyal 1273
20 Moh. Shiyal Kheda 1068
21 Moh. Chamad Gate 164
22 Moh. Ayea pur Khurd 314
23 Moh. Kanchan Nagar 492
24 Nagla Bhoja 1341
25 Nagala Tika 806
26 Nagala Minya 944
27 Aiyyapur Kalan 5550
28 Nabipur Khurd 2848
29 Moh. Maiyan 655
30 Navipur kalan 3839
31 Moh. Sadabad Gate 594
32 Moh. Nai ka Nagala 7432
33 Lala Ka nagla 6735
34 Bala patti 3139
The rapidly growing urban population poses great challenge to the efforts of the state government
towards improving the health of the urban poor.
Page | 12
1.5 Urban Governance4
There are multiple agencies responsible for urban governance and provision and management of infrastru c-
ture and services. While, ICDS, DUDA, Nagar Palika Parishad Hathras and UP Jal Nigam (UPJN) are the key ur-
ban 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.
Table 6: Urban Governance and Service delivery institutions
City Level
Nagar Palika Parishad,
Hathras
Local level governance; Primary Collection of Solid Waste; Maintenance of
Storm Water Drains; Maintenance of municipal roads; Allotment of Trade Li-
censes under the Prevention of Food Adulteration Act; O&M of internal se w-
ers and community toilets; Street lighting; O&M of water supply and sewerage
assets; Collection of water tariff
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 genera-
tion 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 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 pro-
grammes
UP Awas Vikas Parishad
(UPAVP)
Nodal agency for housing in the state. Involved in planning, designing, con-
struction and development of almost all types of urban development projects
in the state. Autonomous body generating its own resources through loans
from financial institutions
Page | 13
UP State Transport Corpora-
tion (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 In-
dia (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 ur-
ban)
Office of District Magistrate
Hathras
Coordination of activities of various institutions
1.6 Access to Public Facilities5
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.
S.No
.
Name of
Urban
Slums
Slums
Popula-
tion
Water Supply Sanitation Toilets Waste Water Disposal
Sources
of water
in the
slums
Source
use for
drink-
ing
(Y/N)
No. of
house
holds
depend-
ent
Quali-ty Rat-
ing
Individu-al Toilets
Shared Toi-lets
Communi-ty Toilets
With
Sewer-
age net-
work
With
open
drai
n
Wit
h
soak
pit
With
sep-
tic
tank
1 2 4 5 6 7 8 9 10 11 12 13 14 15
1 Odhpura 1924
nagar Pali-ka supply, India Mar-ka 2 hand pump &
submersi-ble
Yes 385
Yes Yes Yes - Yes - Yes
2 Nagala Tandula 1386
Same as above
Yes 277
Yes Yes Yes
- Yes - Yes
3 Khoda Hajari 2333
Same as above
Yes 467 Yes Yes
Yes - Yes - Yes
4 Iglas Adda Nai basti 2000
Same as above
Yes 400 Yes Yes
Yes - Yes - Yes
5 Sri nagar 2500
Same as above
Yes 500 Yes Yes
Yes - Yes - Yes
6 madhu Garhi 753
Same as above
Yes 151 Yes Yes
Yes - Yes - Yes
7 Kailash Na-gar 244
Same as above
Yes 49 Yes Yes
Yes - Yes - Yes
8 Ramanpur 859
Same as above
Yes 172 Yes Yes
Yes - Yes - Yes
9 Garhi Khandari 3409
Same as above
Yes 682 Yes Yes
Yes - Yes - Yes
10 Naya Nagla Siddharth Nagar 1023
Same as above
Yes 205 Yes Yes
Yes - Yes - Yes
11
Moh. Khar-
ni, Moh. Santoshi 477
Same as above
Yes 95 Yes Yes
Yes - Yes - Yes
Page | 15
12 Moh. Karr 750
Same as above
Yes 150 Yes Yes
Yes - Yes - Yes
13
Ganesh-
ganj, Atal tal 826
Same as above
Yes 165 Yes Yes
Yes - Yes - Yes
14 Bhoo-rapeer,
Baghmoola 1189
Same as above
Yes 238 Yes Yes
Yes - Yes - Yes
15 Nagala Belan Sah 3008
Same as above
Yes 602 Yes Yes
Yes - Yes - Yes
16 Kila Gate 189
Same as above
Yes 38 Yes Yes
Yes - Yes - Yes
17 Nagala Arkenia 545
Same as above
Yes 109 Yes Yes
Yes - Yes - Yes
18 Kila Khai 394
Same as above
Yes 79 Yes Yes
Yes - Yes - Yes
19 Moh. Shiyal 1273
Same as above
Yes 255 Yes Yes
Yes - Yes - Yes
20 Moh. Shiyal
Kheda 1068
Same as above
Yes 214 Yes Yes
Yes - Yes - Yes
21
Moh.
Chamad Gate 164
Same as above
Yes 33 Yes Yes
Yes - Yes - Yes
22 Moh. Ayea
pur Khurd 314
Same as above
Yes 63 Yes Yes
Yes - Yes - Yes
23 Moh. Kan-chan Nagar
492
Same as above
Yes 98 Yes Yes
Yes - Yes - Yes
24 Nagla Bhoja 1341
Same as above
Yes 268 Yes Yes
Yes - Yes - Yes
25 Nagala Tika 806
Same as above
Yes 161
Yes Yes Yes
- Yes - Yes
26 Nagala Minya 944
Same as above
Yes 189 Yes Yes
Yes - Yes - Yes
27 Aiyyapur Kalan 5550
Same as above
Yes 1110 Yes Yes
Yes - Yes - Yes
28 Nabipur Khurd 2848
Same as above
Yes 570 Yes Yes
Yes - Yes - Yes
Page | 16
29 Moh. Mai-yan 655
Same as above
Yes 131 Yes Yes
Yes - Yes - Yes
30 Navipur kalan 3839
Same as above
Yes 768 Yes Yes
Yes - Yes - Yes
31 Moh. Sa-dabad Gate 594
Same as above
Yes 119 Yes Yes
Yes - Yes - Yes
32 Moh. Nai ka Nagala 7432
Same as above
Yes 1486 Yes Yes
Yes - Yes - Yes
33 Lala Ka nagla 6735
Same as above
Yes 1347 Yes Yes
Yes - Yes - Yes
34 Bala patti 3139
Same as above
Yes 628 Yes Yes
Yes - Yes - Yes
1.7 Health Infrastructure
Government Facilities: 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- District Level Hospitals, MD TB Hospital, urban
Health Post 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.
Table 8: Government Health Facilities in Hathras
Sl. No.
Name & type of facility (DH, Maternity Home, CHC, other ref. hospital UFWC, UHP PHC,Dispensary etc.)
Managing Au-thority (Munici-pal Council, State Health Department, facilities func-tioning on PPP basis)
Location of Health facility
Popula-tion covered by the facility
Services pro-vided
Human Re-sources availa-ble – list type
and number of HR available i.e. ANM, LT,
SN, MOs, Spe-cialists etc.
No. and type of
equipment available: X-ray ma-
chine, USG, autoclave
etc.
1. District Male Hospital
State Health De-
partment
Hathras City
1564708 Emegency & General sur-gery etc.
List Annexed X-ray ma-chine, USG
2. District Fe-male Hospital
State Health De-
partment
Hathras City
728581 Deliv-ery,ANC, PNC,Immunization,FP,MTP Etc.
List Annexed X-ray ma-chine, USG
3 MDTB Hospital State Health De-
partment
Hathras City
_ Overall Traetmet of TB patient
List Annexed X-ray ma-chine,
4 Urban Health Post
NRHM Hathras City
143020 Immuniza-tion, Deliv-ery,ANC, PNC, Etc.
List Annexed _
The data given in the table above reveals inadequacy of primary health care services. The first tier health facil i-
ties were planned for a population of 50000 but as a result of rapid population growth they are currently serv-
ing a population much more than that. 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
Page | 18
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.
Private Health Facilities:
Private Facilities: Table 9: Private health facilities in Hathras:
S.No. Name of City / Nagra Palika
Name of heath facility with address
1. Hathras Suchitra Hospital Jalesar Road, hathras
2. Hathras Saraswati Hosapital & Research center, Beniganj
3. Hathras Vashneya Nursing Home, Near Ram Darwar Temple, Talab x-ing, Hathras
4. Hathras Agra Hospital, Near Bus Stand, Hathras
5. Hathras Gavar Hospital & research Center, PO Lane Hathras
6. Hathras Sri ram Hospital, Aligarh Road Hathras
7. Hathras Bansal Surgical & Maternity Home opp. Chintaharan Mandir, Hathras
8. Hathras Jha Nursing Home Madhu garhi, hathras
9. Hathras Krishna Nurshing Home opp. Chinta Haran mandir, hathras 10. Hathras Prem raghu Hospital & Maternity Home Gijrauli, Hathras
11. Hathras Gulati Nursing Home, PO Lane hathras
12. Hathras Sujata Hospital, Mathura Road, madhu garhi, hathras
13. Hathras Aman Children Hosital, Purana Mill compound, hathras
14. Hathras Khetan Netra Chikitsalaya, City station road, hathras
15. Hathras Sahni Nursing home Kila gate hathras
16. Hathras Shanti Nursing Home , palika bazar hathras
17. Hathras RDGD, Lifecare Hospital, Purana Mill Compound, hathras
24 Hathras Deep hospital, Mathura Road, Madhugarhi, hathras
First and Second Tier Health Services
The Government of Uttar Pradesh has committed itself to make provisions for health care services to its pop u-
lation. Though the efforts have been rural centric some efforts have also been made to i mprove 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 Depart-
ment 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 centers6. Second tier health services are provided in urban areas through District Male and Female
or Combined Hospitals.
6 Ministry of Health and Family Welf are. 2005 Annual Report 2003-04. New Delhi : MoHFW.
Page | 19
2 .Health Scenario
Table 10: Disease/Cause of Morbidity Data : Hathras
Sl. Name of Disease/ Cause of Morbidity (e.g. COPD, Trau-
ma, Cardiovascular Disease etc.)
Number of cases admit-
ted in 2012 Source of Data
1 Injuries and Trauma Not Available IDSP
2 Self inflicted injuries/suicide Not Available
3 Cardiovascular Disease 174 IDSP
4 Cancer (Breast cancer) Not Available
5 Cancer (cervical cancer) Not Available
6 Cancer (other types) Not Available
7 Mental health and depression 0 IDSP
8 Chronic Obstructive Pulmonary Disease (COPD) 722 IDSP
9 Malaria 236 IDSP
10 Dengue Not Available
11 Infectious fever (like H1N1, avian influenza, etc.) Not Available
12 TB
13 MDR TB Not Available
14 Diarrhea and gastroenteritis 2611 IDSP
15 Jaundice/Hepatitis 0 IDSP
16 Skin diseases Not Available
17 Severely Acute Malnourishment (SAM) Not Available
18 Iron deficiency disorder Not Available
19 Others Not Available
(Source: IDSP, TB & District Hospital)
The above table reflects the health/ morbidity profile of the Hathras 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.
3. Key Issues
The Eleventh Plan had suggested Governance reforms in public health system, such as Performance linked i n-
centives 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 i n-
volvement, 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.
Page | 20
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 soci e-
ties reporting to state, facility managers reporting on health outcomes of those seeking care, and territorial
health managers reporting on health outcomes in their area. Accountabi lity 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 De-
centralized Planning.
Following would be the issues for the cities to address: City Health Planning, Public Private Partnership, Con-
vergence, 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
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.
17) Management of communicable & non- communicable diseases
18) Strengthening AYUSH
19) Constitution of BSGY team for urban areas.
20) Identification & management of SAM children
Page | 21
4. Strategies, Activities and Work plan
This section describes detailed strategies, activities and work plan of Urban areas of Hamirpur district. 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 strengthening UPHCs for provision of primary health care to
urban poor, deploying trained human resource at urban health centres, convergence with key urban stake-
holders, sensitization of ULBs on their role in urban health, , community outreach through selection, training
and support to ASHAs and MAS, conducting UHNDs and outreach camps to get services closer to the commu-
nity 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 operationalized rapidly over the years.
4.1 Planning and Mapping exercise :
4.1.1 Listing and Mapping of Households in slums and Key Focus Areas
One of the most important component of plan will be listing and mapListing and mapping of households will
provide accurate numbers for population, their family size and composition residing in slums. Currently, esti-
mates of population residing in slums are available from District Urban Development Agency (DUDA) and N a-
tional 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 Urban ASHAs 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 behaviours and link communities to health facil ities under the NUHM. It is expected that once
the household mapping is completed in cities, the number of Urban ASHAs will be reviewed and adjusted up-
wards or downwards and the geographical boundaries of the coverage area for each Urban ASHA would be
realigned. This is due to the reason that the actual population may be higher or lower than the original esti-
mate used for planning.
4.1.2 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 Part-
ners like Health of the Urban Poor project will technically support this effort.
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4.1.3 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 relat-
ed indicators which will be reviewed during the course of implementation of the program to assess the i mpact
of implementation and necessary course corrections can accordingly be made and use of resources can be
optimised.
4.2 Program Management:
4.2.1 City level establishments and HR : One urban health Cell (UHC) will be established at district level with
adequate infrastructural and HR arrangements. A total of Rs 5.5 Lakhs will be required for the setup of the cell.
This cost includes basic furniture, ACs, computer peripherals, minor renovation work and laptop support to
DPMU. One Urban Health Coordinator (UHC) and one data operator will be appointed and to be based in dis-
trict headquarter. Apart from this some provisions have been made in budge for UHC to initiate the process.
Provision of an accountant has also been made in budget. Running cost for the cell has also been provisioned
in the budget
4.3 Training and Capacity Building:
Various training program will be organized for ULB, Medical and Paramedical staff, Urban ASHAs and MAS of
the city to capacitate them on the issue. One time orientation program will be organized for Municipal officials
in the beginning. 21 ANM will be trained in which 5 ANMs and 2 staff nurses will be taken from each of the
three UPHCs. For entire training package for ANM, Rs 5000 is provisioned for each of the ANMs. Likewise 6
medical officers will be given training on the expenses of Rs 10000 per medical officer . There are 60 MAS
groups in the cities. These MAS groups will be trained by the experts. To work in the 34 sums of the Hathras
city, 30 Urban ASHAs will be selected and oriented on the program and work responsibilities. The trainings
will have to be followed by periodic refresher trainings to keep these frontline health workers motivated.
NUHM will engage with development organisations to develop the training modules and facilitate the trai n-
ings
4.3.1 Stakeholders Sensitization and Orientation:
One city level workshop will organized by DPMU covering all stakeholders of government, private facilities,
NGOs and other to orient them on urban health intervention and expected support. This workshop will be o r-
ganized at district headquarter level.
4.3.2 Quarterly multi-sectoral convergence meeting:
Strong convergence with programs and departments is an important aspect of the program. Meeting with these departments and program officials will be organized at district level to facilitate and strengthen coordi-nation and convergence in urban health mission program. Such programs are RCH, RNTCP, NVBDCP, NPCB, National Mental Health Programme, National Programme for Health Care of the Elderly, etc. at the city level.
Page | 23
Similarly various Departments like Urban Development, Housing and Urban Poverty Alleviation, Women & Child Development, School Education, Minority Affairs, Labour will be called for the convergence meeting.
4.4. Strengthening of health facilities
4.4.1 Setting up Urban Primary Health Centre (U-PHC) –
During the first year of implementation of the program, the one existing urban health posts and two new will
be attempted to be strengthened. One existing UPHC is running in government building which will require
renovation. One time renovation cost of Rs 10 Lakhs has been proposed in the budget. Two new Urban PHCs
will be opened in rented premise on the rent of Rs 15000 per month.
4.4.2. Data entry operator for UPHC:
One HMIS/MCTS operator will be appointed/ deputed at UPHC level on each of the centres. All basic
infrastructures like computer, printer and table chair will be made available on each of the UPHCs. Operating
cost is also mentioned in the budget
4.4.3 Urban Health and Nutrition Day (UHND):
Health and nutrition day will be organized at every slum level every month. A provision of Rs 1500 has been
made for each of the UHND for six months.
4.4.3. Special Outreach health camps for vulnerable population:
One health camp will be organized every month in identified vulnerable communities on per 10000
population. These special outreach camps will reach to the most vulnerable communities of the slums and
provide them door step health services.
4.4.4 Provision of ANMs/LHV on contractual basis:
5 ANMS will be selected for each of the Urban PHCs. Total 15 ANMs will be selected. Salary of the ANMs will
be as per the NRHM guideline. Monthly travel support to these ANMs/LHVs will be provided as per NRHM
norms.
4.5. Medical officers, paramedical and nonclinical staffs provisioning:
Two MOICs will be deputed as MO at UPHCs to provide their expert services to slum population. Two staff
nurses, one pharmacist and one Lab Technician will also be posted at each of the PHCs. Three support staff
will be appointed to help in functioning of the Urban Primary Health Centres. Budgetary provisions for the
same have been made in budget.
4.6. IEC materials support:
4.6.1. ASHA Kit Flip Book, Slum HIR, Bag, ID, Pen-
Each of the ASHAs will be given IEC support and for this a provision of Rs 2000 per ASHA has provisioned.
Under IEC support as a package consisting of kit, flip book. Slum HIR, Bag, ID and pen will be given to every
Urban ASHAs.
4.6.2. UPHC Citizen's charter, ED List, Immunization Schedule, Signage
For one time expenses on UPHC citizens charter, ED list, Immunization schedule and signage related work, a
provision of Rs 20000 has been made in budget.
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4.6.3. Safe Motherhood Booklet, MCP Card etc.
1500 set of safe motherhood booklet and MCP cards will be printed per UPHC area covering 50,000city slum
population.
4.6.4.Family health card, Wall painting and NUHM Hording:
Family card for every household of the slum will be printed and used for health services. This card will be
printed for 12200 families residing in the cities. One wall painting will also done at e ach of the 225
Anganwari Centres. One big hording of NUHM will be printed and installed which will cost Rs 20000.
4.7. Community Processes:
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.
4.7.1 Mahila Arogya Samiti (MAS)-
60 Mahila Arogya Samitis will be strengthened in Hathras city. For this purpose orientation cum traning pro-
gram will be organized with these groups to make them aware of the NUHM and become the active player in
mobilization and communication. 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.
4.7.2 ASHA
On the basis of ASHA working in rural areas, ASHA for urban areas will be selected and trained on community
health issues. It is proposed that 30 ASHA at urban level will be selected to work in 34 slums of Hathras cove r-
ing average 1500-2000 population. 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 popu-
lation. An honorarium of Rs 2000 per month has been proposed in budget.
4.7.3 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 ou t-
reach sessions. Each ANM will organize a minimum of one routine outreach session .
To cover vulnerable population of urban slums, Special outreach sessions (for slum and vulnerable population)
will be organized on every 10000 population every month in partnership with other health professionals (doc-
tors/ pharmacist/ technicians/ nurses – government or private). Total 10 special outreach health sessions will
be organized at slum level in Hathras city in 6 months of intervention. It will include screening and follow-up,
basic lab investigations (using portable /disposable kits), drug dispensing, and counselling. The outreach ses-
sions (both routine and special outreach) could be organized at designated locations mentioned in the afore-
said in coordination with ASHA and MAS members
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4.8. Convergence with programs and departments:
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 Educa-
tion, Minority Affairs, Labour will be established through city level Urban Health Committees headed by the
Municipal Commissioner/ Deputy Commissioner/ District Collector.
Six monthly Activity plan of Hathras City is given below:
Activity Plan under NUHM for the state and cities
Act. No.
Activity
Responsibility Months : October'13 - March'14 Remarks
State level
City level O
ct.
No
v.
De
c
Ja
n
Fe
b
Ma
r
1
Establishment of Platform for Conver-gence at state level
Circular to be issued from state level to all their dis-trict level nodal officers
2 Preparation & Finalization of Guidelines for City Coord. Committee/ City Pro-gram Management Committee
These will be one time activities and will apply across the state
3 Preparation & Finalization of Guidelines for Urban ASHAs
4 Preparation & Finalization of Guidelines for Mahila Arogya Samiti
5 Preparation & Finalization of Guidelines for UHND
6 Preparation & Finalization of Guidelines for Outreach sessions/ School Health Programs
7 Preparation & Finalization of Job De-scriptions for all district level NUHM positions
8 Preparation & Finalization of 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 un-der NUHM
14 Establishment & orientation of City Program Management Committee (UH)
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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 identi-fied
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 selec-tion facilitation
18b - Listing of local community members as facilitators by NGOs
18c - Listing of probable ASHA candidates and finalize selection
19 Convergence meeting with govt. Stake-holders
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 pat-tern & health status)
23 Meetings of RKS for all the public health facilites under NUHM
24 Identification of alternate/ suitable loca-tions 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 Facili-ties for health care provisioning
To continue in 2014-15
29 Involvement of CSR activities
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5. Programme Management Arrangements:
Districts Heath Society will be the implementing authority for NUHM under the leadership of the District Mag-
istrate. District Program Management Units have been further strengthened to provide appropriate manage-
rial 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 chairman-
ship 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 recei v-
ing the NUHM funds.
Urban Health will be included as a key agenda item for review by the District Health Society with particip a-
tion 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 fol lowing
norms:
District total Urban
population
Additional Staff Proposed
Less than 1 lakh 1 Data Entry Operator
1lakh to 10lakhs 1 Urban Health Coordinator,1 Accountant and 1 Data Entry Operator
10lakh to 20lakhs 2 Urban Health Coordinator,2 Accountants and 2 Data Entry Operators
20lakh to 30lakhs 3 Urban Health Coordinator , 3 Accountants and 3 Data Entry Operators
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.
Page | 28
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 fo llowing 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/ Municipal Commissioner
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
Member – ESIC - ESIC Hosp. Supdt.
Member – SPM - SPM Deptt, KGMU, Hathras
Members – School Education - BSA & DIOS
Members – Dev. Partners - Partners working in urban health sector ( HUP)
Coordinator - Lead Dev. Partner
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 work-
ers and MAS representatives
Once a month UPHC All ANMs, PHN, LMO, Community Organiz-
er, 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 de-
partments
Meeting with CMO & UH Pro-
gram Coordinator
Once a month CMO Office CMO, Program Coord., Asst. Program Co-
ordinator, LMO/ PHN/ Community Organ-
Page | 29
izer, Social Mobilization officer
City Task Force Meeting Once in two
months
DM’s office CMO, Program Coord. UH, Various de-
partments’ reps. , private partners, NGOs
6. City Level Indicators & Targets
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 60
2. Number of MAS members to be trained * 0 600
3. Number of Accredited Social Health Activists (ASHAs) to be selected and trained *
0 30
Health Systems
4. Number of ANMs to be recruited * 0 15
5. No. of Special Outreach health camps to be organized in the slum/HFAs *
0 10
6. No. of UHNDs to be organized in the slums and vulnera-ble areas *
0 217
7. Number of UPHCs to be made operational * 0 03
8. Number of UCHCs to be made operational * 0 00
9. No. of RKS to be created at UPHC and UCHC * 0 03
10. OPD attendance in the UPHCs 0 9000
11. No. of deliveries conducted in public health facilities 0 150
RCH Services
12. ANC early registration in first trimester 1695
13. Number of women who had ANC check-up in their first trimester of pregnancy
1695
14. TT (2nd dose) coverage among pregnant women 620
15. No. of children fully immunised (through public health facilities)
540
16. No. of Severely Acute Malnourished (SAM) children identified and referred for treatment
180
Page | 30
Processes & Inputs
Indicators Baseline (as
applicable)
Number
Proposed
(2013-14)
Number
Achieved
(2013-14)
Communicable Diseases
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 examina-tion
-
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 -