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Meerut City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

NATIONAL URBAN

HEALTH MISSION

Programme Implementation Plan

of

Meerut 2013-14

TABLE OF CONTENT

Preamble

Acknowledgement

Acronyms

City Profile

Health Scenario

Key Issues

Strategies, Activities & Work plan under NUHM

Programme Management Arrangements

City level targets & indicators

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.

Meerut with a population of 34,43,689 (Census: 2011), is one of the fourteen districts in Uttar

Pradesh (UP). An estimated 11,22,360 of the said population is living in Urban Slums. The

current sex ratio for the urban areas is 888 females per thousand males which is an area of

grave concern. The DLHS 3-reports that institutional deliveries are around 38.8 % in the city

and the IMR is 56 (AHS 2011-12) with MMR at 256 (AHS 2011-12) which again is a matter of

concern. Complete immunization status of the district is around 63.4 % (AHS 2010-11) and if

we see the 3+ANC, it is as low as 76.2% (AHS-10-11) at the district level. Unmet need for

family planning services at the district level is 26.6 (AHS-10-11) and if we further examine the

data, 17.5 % is for limiting and 9.1% DLHS 3 data for spacing methods.

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

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

complement towards betterment of urban population and in particular to the urban poor &

slum dwellers.

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

information at city level and hoping that we will initiate the process very systematically so that

we can make the difference in improvement of quality life of urban people specially by

reaching the unreached areas.

Dr. Amir Singh Mr. Navdeep Rinwa

MS (IAS)

Chief Medical Officer District Magistrate

MEERUT MEERUT

ACKNOWLEDGEMENT

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

Plan for Meerut under the newly announced National Urban Health Mission. This has been

possible through dedication, perseverance and hard work. This exercise of planning would

not have been complete without the help and support of the team.

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

valuable support and continuous encouragement of Shri Navdeep Rinwa (IAS), District

Magistrate, Meerut. His great confidence in team and spurred us into action.

My special gratitude goes to Dr. Amir Singh, Chief Medical Officer, Meerut, a dynamic and

enthusiastic professional. He has always been a source of great encouragement for us. The

initiation and completion of this work has been possible due to his sincere and able guidance,

expertise, precious opinion, keen attention, constructive suggestions and constant help. His

critical reading of all the parts of the work has helped shape the NUHM planning in its

present form.

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

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

support and building the thoughts in our mind.

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

(Deputy General Manager-NUHM) and HUP-PFI who have helped us immensely by

providing relevant information and valuable suggestions. This planning work got

accomplished with their valuable support and eagerness to help.

I am privileged to have such good city level team especially DR. Vishvas Chaudhary Dy.

C.M.O. NRHM, Mr V.K. Gupta A.R.O. (Stat) , Shri Sachin Srinarain (Div.PMU), Shri. Imran

Khan (DPM NRHM), Shri Harpal Singh, DCPM, NRHM, shri Ajay Singh, DAM, NRHM, who

have supported and helped in contributing their great efforts towards planning of this city

level plan under the NUHM.

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

government line department - DUDA, ICDS, Nagar Municipal Corporation, Education

department, CMS & DTO.

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

planning process directly or indirectly.

Dr. Sanjay Jodha

Add. CMO (RCH), Meerut

October 2013

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

National Urban Health Mission- Programme Implementation Plan

1. Meerut Profile

Meerut City is a priority city for urban health investments. Meerut, the second largest

city of the country in terms of urban poor population, is considered the sports capital of Uttar

Pradesh. Meerut is located at a distance of 70 kms from Delhi. Meerut is famously

associated with the Indianrebellion of 1857 against the British East India Company when

chants of popular Hindi slogan "Dilli Chalo" (lets March to Delhi) were first raised here.

Meerut is an important education centre for western U.P., catering to the city and the

surrounding rural population. Fig 1: Meerut Location Map The district of Meerut spans across

the coordinates 28°98’ North latitude to 77°0 7’ East longitude. Meerut borders the districts of

Ghaziabad in the south, Baghpat in the west, Muzaffar Nagar in the north and Bijnor and

Jyotibaphule Nagar in the east. The city, which is spread over 142 sq km, is a junction of

National Highways. By road and rail, Meerut is well-connected to major cities like Delhi,

Noida, Hapur, Faridabad, Modinagar, Ghaziabad, Saharanpur, Haridwar, Indore and Jaipur.

Meerut has two

railway stations Meerut City and Meerut Cantonment. The city is well connected to Delhi,

Ghaziabad, Agra,

Dehradun and others by train. Some important places of tourist interest in the city include the

Jama Masjid constructed in 1019 AD, the Jain temple, St. John’s Church, Augarnath temple,

Shaheed Smarak and Company Garden.

The climate of Meerut is extreme and tropical. The summers are extremely hot and the

maximum temperature goes as high as 45º C, while the winter is cold with temperatures

dipping to 2º C. Meerut receives an average annual rainfall of 768 mm.

1.1 Meerut District

As per census 2011, the urban population of Meerut district is 1759182. About 51 %

population of Meerut is urban. The urban sex ratio is 888 females per 1000 males. The

average literacy rate in Meerut is 78.29 percent, 83.74% for males and 72.19% for females.

Sex Ratio (Per 1000) 888

Child Sex Ratio (0-6 Age) 847

Average Literacy (%) 78.29

Male Literacy (%) 83.74

Female Literacy (%) 72.19

Table 2: Demographic profile of Meerut City

Total Population of city (in lakhs) 13,05429 Source: Census 2011

Slum Population (in lakhs) 11,50,000 Source: RSAC

Slum Population as percentage of urban

population 88 %

Number of Notified Slums 217 Source: DUDA

Number of slums not notified 85 Source: RSAC

No. of Slum Households 249817 Source: RSAC

No. of slums covered under slum

improvement programme (BSUP,

IDSMT,etc.)

217

Number of slums where households have

individual water connections* 107

Number of slums connected to sewerage

network* NA

Number of slums having a Primary school

65 Source: BSA Deptt.

No. of slums having AWC 187 Source: ICDS Meerut & BSUP

No. of slums having primary health care

facility 7

1.2 Work Participation & Occupation Structure1

Meerut slums are lacking community level processes such as community based

organizations. This results in less voices of community among service providers and decision

makers. 14 DWACUA (Development of Women and Children of Urban Areas) groups,

nurtured by DUDA exist and are mainly engaged in Income Generation Activities (IGA). Apart

from this some women groups (Matri Samittee) are also there with ICDS who are mainly

assisting AWWs in food distribution. In general, those groups promoted by government

agencies have tended not to flourish

Majority of the slum population are daily wage earners, with a few engaged in business

related activities, i.e.,manufacturing of sports goods (cricket bats, wickets,etc.). Most women

who work outside home are domestic maids in the surrounding areas. Living conditions vary

from illegal settlements with kutcha houses, to low rent dwellings, or owned concrete houses.

The slum areas are characterized by high population density and extremely poor sanitation

and hygiene conditions

1.3 Urban Poor & Slums2

Most of the slums of Meerut are areas of extreme poverty and severe environmental

degradation. These

conditions place residents at an aggravated risk of disease and mortality. Where legal or

social security is

ensured, one also sees improved housing structures and better access to services. Poverty

is reflected in the

1 http://en.wikipedia.org/wiki/lucknow

2 State of Urban Health in Uttar Pradesh, 2006

http://en.wikipedia.org/wiki/Bhubaneswar

selective access to services and infrastructural facilities. As per NFHS-3, 85.5 % of slum

families in the city have access to toilet facility but within the most vulnerable groups most of

the toilets are open drain toilets. So far as private water tap connection is concerned, 50% of

the slum dwellers have such a facility. Slums vary in several aspects like size, duration of

residence, populationdensity, service facilities, employment status, access to Anganwadi

centres (AWCs), schooling opportunities, infrastructure and social recognition. These factors

impact the quality of life of the residents. From a health perspective, about one-third of the

total number of slums could be considered vulnerable. In poor areas, access to health

facilities is poor and dependence on local healers is found to be very high. Prevalence of

public and private health services (Urban Health Centres, qualified doctors, NGOs and

charitable hospitals) within the poor slum population is negligible.

As per the data available with DUDA and Municipal Corporation out of 102 listed slums

50.9% slums have piped water supply, 6.8% slums have partial water supply, 15.6% slums

have public toilet and most of the slums have tube wells.

Majority of the slum population are daily wage earners, with a few engaged in business

related activities, i.e., manufacturing of sports goods (cricket bats, wickets, etc.). Most

women who work outside home are domestic

maids in the surrounding areas. Living conditions vary from illegal settlements with kutcha

houses, to low rent dwellings, or owned concrete houses. The slum areas are characterized

by high population density and extremely poor sanitation and hygiene conditions

Table 3: Selected indicators of slum conditions in Meerut

Characteristic Percentage of people/families

Water Supply Facilities

Individual tap 48.68%

Community tap 38.84%

Others 6.06%

Sanitation

Individual toilet facility 50.12%

Community toilet facility 20.98%

Others 28.30%

Employment

GIS Map and Listing of Slums in Meerut as Per RSAC

Employed 9.78%

Unemployed 7.97%

Self employed 81.91%

Table 3

MEERUT CITY

Sl.no. Ward no.

Name of the slum Popu lation

Quality of

housing

Quality of sanitation

Status of water supply

(Piped, Hand

pumps,

open wells, none)

Location and

distance of

nearest

AWC

Location

and

distance of neare

st Prima

ry

School

Location and

distance of

nearest

Primary Health

Centre/U

HP/UFWC

(kutcha /pucca/ mixed)

(IHL, community toilets, OD)

1 1 SHIV HARI MANDIR COLONY

5883 PUCCA COMMUNITY PIPED YES YES 0.2

2 1 LALLAPURA 6760 MIXED COMMUNITY PIPED YES 0.5 0.3

3 1 CHAUANPURI 1090 PUCCA COMMUNITY PIPED NO 0.5 0.4

4 2 BHAGWATPURA 3960 PUCCA COMMUNITY PIPED YES YES 0

5 2 LAXMANPURI 2670 PUCCA COMMUNITY PIPED YES 0.1 0.4

6 2 ISHWARPURI 2713 PUCCA COMMUNITY PIPED YES 0.1 0.3

7 2 GANESH PURI 3736 MIXED COMMUNITY PIPED YES 0.1 0.5

8 2 GULZAR IBRAHAIM

3050 PUCCA COMMUNITY PIPED YES YES 0.7

9 2 HORAM NAGAR 970 PUCCA COMMUNITY PIPED NO 0.1 0.5

10 3 SUNDRAPUTHA 3540 MIXED COMMUNITY HANDPUMP YES YES 0.6

11 3 KISHANPURA 5575 PUCCA COMMUNITY PIPED YES YES 0.3

12 3 MALIYANA 16950 MIXED IHL PIPED YES YES 0

13 4 PALEHRA 3560 PUCCA COMMUNITY HANDPUMP YES YES 0.8

14 4 SOFIPUR 12790 PUCCA COMMUNITY HANDPUMP YES YES 3

15 5

AMBEDKAR

NAGAR GARH ROAD

2008 PUCCA COMMUNITY HANDPUMP YES 0.2 0.7

16 5 JAI BHEEM NAGAR

11998 MIXED COMMUNITY HANDPUMP YES 0.3 0.6

17 5 SARAI KAJI 3251 MIXED COMMUNITY HANDPUMP YES YES 0.9

18 5 SHIV SHAKTI VIHAR

6570 PUCCA COMMUNITY PIPED YES 0.4 1.2

19 5 AURANG

SDHAHPUR DIGGI 6950

PUCCA IHL PIPED YES YES 0.7

20 5 BHIM NAGAR 3520 MIXED COMMUNITY PIPED YES 0.4 0.5

21 6 DAYAMPUR 5425 PUCCA COMMUNITY HANDPUMP YES YES 4

22 6 SHOBHAPUR 9336 PUCCA COMMUNITY HANDPUMP YES YES 5

23 6 DHABHKA 2614 MIXED COMMUNITY HANDPUMP YES YES 4

24 6 JAWAHAR NAGAR 7785 MIXED COMMUNITY HANDPUMP YES 0.4 3.4

25 6 DHAHAR 2572 MIXED IHL PIPED YES 0.3 4.1

26 6 KUNDA 3785 MIXED COMMUNITY HANDPUMP YES YES 6

27 6 NEW AJANTA

COLONY 242

MIXED COMMUNITY PIPED YES 0.3 1.2

28 7 KANCHNPUR GHOPLA

4834 MIXED COMMUNITY HANDPUMP YES YES 5

29 7 LISARI 5880 MIXED COMMUNITY PIPED YES YES 6

30 7 NOOR NAGAR 7486 MIXED COMMUNITY PIPED YES YES 8

31 7 ASHOKPURI 3677 PUCCA COMMUNITY PIPED YES 0.3 2

32 7 FATHELLAPUR 21255 MIXED COMMUNITY PIPED YES 0,5 44

33 8 CHOWK MOHALLA

3258 PUCCA COMMUNITY PIPED YES O.5 3

34 8 JASSUPURA 1346 PUCCA COMMUNITY PIPED YES 0.4 4

35 8 SHIV LOK PURI 2770 PUCCA COMMUNITY PIPED YES 0.3 1

36 8 SADAN PURI 3720 PUCCA COMMUNITY PIPED YES YES 1

37 8 PARTAPUR BARAL

2540 PUCCA COMMUNITY HANDPUMP YES YES 2

38 9 FAZALPUR 7980 MIXED COMMUNITY PIPED YES YES 5

39 9 PODIWARA 834 PUCCA COMMUNITY PIPED YES YES 0.6

40 10 GOLA BAR 5559 PUCCA COMMUNITY HANDPUMP YES YES 3

41 10 SHAIKHPURA 4374 MIXED COMMUNITY PIPED YES YES 3

42 10 SHIVPURAM 13524 MIXED COMMUNITY PIPED YES 0.5 2

43 10 MOKSHPURI 250 MIXED COMMUNITY HANDPUMP YES 0.2 1

44 10 RATAN NAGAR 930 MIXED COMMUNITY HANDPUMP YES 0.3 2

45 11 RITHANI EAST 2616 MIXED COMMUNITY PIPED YES YES 6

46 11 RITHANI WEST 16650 PUCCA COMMUNITY PIPED YES 0.3 6

47 11 CHAWAHAN

COLONY 2670

PUCCA COMMUNITY PIPED YES 0.4 7

48 11 MOHAKKAMPUR 5954 PUCCA COMMUNITY PIPED YES YES 8

49 11

JHUGGI NEAR

KUSTH ASHRAM DELHI ROAD

6600 KACHHI COMMUNITY HANDPUMP NO 0.3 8

50 12 SHERGARHI 4836 MIXED COMMUNITY PIPED YES YES 5

51 12 JAWAHAR PURI 1043 PUCCA COMMUNITY PIPED YES 0.3 3

52 13 INDRAPURAM 4955 PUCCA COMMUNITY PIPED YES 0.5 7

53 13 INDRA NAGAR COLONY

1572 PUCCA COMMUNITY PIPED YES 0.3 7

54 14 ABDULLAPUR 15795 MIXED COMMUNITY PIPED YES YES 4

55 14 YADGARPUR 12330 MIXED COMMUNITY PIPED YES YES 3

56 14 KHATIKAHAN MOHALLA

1465 MIXED COMMUNITY PIPED YES 0.4 7

57 14 SANJAY NAGAR 6188 PUCCA COMMUNITY PIPED YES 0.1 7

58 14 RAM GARHI 863 PUCCA COMMUNITY PIPED YES 0.4 4

59 14 HANDIYA

MOHALLA 7550

MIXED COMMUNITY PIPED YES YES 3

60 14 FIROZ NAGAR 8100 MIXED COMMUNITY PIPED YES 0.4 3

61 15 KALIYA GARHI 6720 MIXED COMMUNITY PIPED YES 0.4 3

62 15 IQBAL NAGAR 7820 MIXED COMMUNITY PIPED YES 0.3 3

63 16 DANTAL 2689 MIXED COMMUNITY PIPED YES YES 6

64 16 NANDPURI K KHERA

2284 MIXED COMMUNITY PIPED YES 0.4 6

65 16 JATOLI 3708 MIXED COMMUNITY PIPED YES YES 7

66 16 ITIFAQUE NAGAR 8905 MIXED COMMUNITY PIPED YES 0.5 5

67 16 KUMHAR

MOHALLA 385

MIXED COMMUNITY PIPED YES 0.1 3

68 17 SHARDHA PURI 15354 PUCCA COMMUNITY PIPED NO 0.4 5

69 18 BALMIKI NAGAR 968 PUCCA COMMUNITY PIPED YES 0.2 4

70 18 PATELPURI 812 PUCCA IHL PIPED YES 0.4 2

71 18 GOVIND PURI K KHERA

20537 PUCCA IHL PIPED YES YES 3

72 18 AMBEKAR NAGAR KANKER KHERA

2148 MIXED IHL PIPED YES 0.2 4

73 19 MEWALA 1275 MIXED COMMUNITY HANDPUMP YES 0.2 2

74 19 BERIPURA 1080 MIXED COMMUNITY PIPED YES 0.4 1

75 20 MULTAN NAGAR 13028 MIXED IHL PIPED YES YES 2

76 20 ISLAM NAGAR 18960 MIXED COMMUNITY PIPED YES 0.4 5

77 20 DUNGRAWLI 4185 MIXED COMMUNITY HANDPUMP YES YES 3

78 21 DIGGI MOHALLA 14339 MIXED IHL PIPED YES 0.2 4

79 21 ASHA NAGAR 335 MIXED COMMUNITY PIPED YES 0.4 2

80 21 RAJEEV GANDHI

NAGAR 3260

MIXED COMMUNITY PIPED YES 0.3 4

81 22 SUBASH NAGAR 17572 PUCCA IHL PIPED YES YES 1

82 22 POORWA SHEIKH

LAL 2346

PUCCA IHL PIPED YES 0.2 1

83 22 HASHAM PURA 1623 PUCCA IHL PIPED YES 0.3 1.3

84 22 KALWA NAGAR 3840 PUCCA IHL PIPED YES 0.3 2

85 23 GHOSHIPUR 6695 PUCCA IHL PIPED YES YES 3

86 23 KAJIPUR 8033 PUCCA IHL PIPED YES YES 4

87 23 JAHIDPUR

BUDHERA 6963

PUCCA COMMUNITY PIPED YES YES 5

88 23 JHUGGI NEAR HAPUR ROAD

236 KACHHI COMMUNITY HANDPUMP YES 0.3 3

89 24 LALA MOHMADDPUR

10665 MIXED COMMUNITY PIPED YES YES 6

90 24 KASAM PUR 8958 PUCCA COMMUNITY PIPED YES YES 3

91 25 KASERU BAKSAR 7010 MIXED COMMUNITY PIPED YES YES 3

92 26 KAASSHI 8880 MIXED COMMUNITY PIPED YES YES 6

93 26 KATAI MILL 1604 MIXED IHL PIPED YES 0.2 8

94 26 ACHRONDA 3867 MIXED COMMUNITY PIPED YES YES 6

95 26 PURWA ABDUL WALI

5012 PUCCA COMMUNITY PIPED YES 0.3 5

96 27 MANGALPURI 3731 MIXED COMMUNITY PIPED YES 0.3 2

97 27 NANGLA TASHI 9900 MIXED COMMUNITY PIPED YES 0.4 3

98 28 KASERU KHERA 7644 MIXED COMMUNITY PIPED YES YES 4

99 28 UNCHA MOHALLA 2558 MIXED COMMUNITY PIPED YES 0.4 4

100 28 TOPKHANA 16641 MIXED IHL PIPED YES 0.5 2

101 29 KHATKHANA 8474 MIXED IHL PIPED YES 0.4 2

102 30 GAUTAM NAGAR 3070 PUCCA IHL PIPED YES 0.3 2

103 31 JUGHHI OF UNIVERSITY

235 KACHHI COMMUNITY HANDPUMP YES 0.4 12

104 32 SABUN GODAM 4255 MIXED IHL HANDPUMP YES YES 0

105 32 CHANDRALOK 3590 PUCCA IHL PIPED YES 0.5 0.3

106 32 UTTAMNAGAR 1743 PUCCA IHL PIPED YES 0.2 0.3

107 33 KHAROLI 12744 MIXED IHL HANDPUMP YES YES 5

108 33 BAGARIYAN 3025 MIXED COMMUNITY HANDPUMP YES 0.3 0.6

109 33 LAKHWAYA 1486 MIXED COMMUNITY HANDPUMP YES YES 3

110 33 MURLI PUR

GULAB 3778

MIXED COMMUNITY HANDPUMP YES 0.5 4

111 34 AMBEDKAR NAGAR MAWANA STAND

600 MIXED IHL PIPED YES 0.2 3

112 36 MOHANPURI NEW 3340 PUCCA IHL PIPED YES YES 0.4

113 36 MOHANPURI OLD 4148 PUCCA IHL PIPED YES 0.3 0.5

114 37 SHAHPEER GATE 1450 PUCCA IHL PIPED YES 0.4 0.8

115 37 ANSAR PURA 198 PUCCA IHL PIPED YES 0.2 0.9

116 38 INDRA NAGAR 2435 PUCCA IHL PIPED YES 0.3 0.5

117 38 SHIV SHAKTI NAGAR

1631 PUCCA IHL PIPED YES 0.4 0.7

118 38 AMBEDKAR NAGAR

DELHIROAD

1226

PUCCA COMMUNITY PIPED YES 0.5 0.8

119 39 JANTA COLONY 1070 PUCCA COMMUNITY PIPED YES 0.3 2

120 39 ROSHANPUR

DORLI 4336

PUCCA COMMUNITY PIPED YES YES 2.3

121 39 PUSHP VIHAR 670 PUCCA COMMUNITY PIPED YES 0.4 2.6

122 39 PUTLI NAGAR 295 PUCCA IHL PIPED YES 0.2 2

123 39 SADHU NAGAR 1872 PUCCA COMMUNITY PIPED YES 0.3 3.4

124 40 JAI DEVI NAGAR 7597 MIXED IHL PIPED YES 0.5 4

125 40 PURWA TAHIR

HUSSAIN 5630

PUCCA IHL PIPED YES 0.5 5

126 41 PURWA ILAHAI BUX

4068 PUCCA IHL PIPED YES YES 3

127 42 MIYA MOHAMADDNAG

AR

2086

MIXED IHL HANDPUMP YES 0.5 4

128 42 MUMTAZ NAGAR 8320 MIXED IHL HANDPUMP YES 0.6 4

129 42 RAFIQ PURA 2295 MIXED IHL PIPED YES 0.3 2.3

130 43 KUTI 5827 PUCCA IHL PIPED YES 0.6 2.6

131 44 BAGHPAT GATE 2571 PUCCA IHL PIPED YES YES 1.5

132 45 RAM BAGH 1368 PUCCA IHL PIPED YES 0.4 3.2

133 46 RONAKPURA 3939 PUCCA IHL PIPED YES 0.4 2

134 46 POORW DEEN

DAYAL 4780

PUCCA IHL PIPED YES 0.6 2.5

135 46 MAU GARHI 4725 PUCCA COMMUNITY PIPED YES 0.3 2.7

136 47 MADHEENA

COLONY 3025


137 51 SARAY LAL DASS 3940 PUCCA COMMUNITY PIPED YES YES 2.7

138 53 BRAHAMPURI

EAST 10200

PUCCA IHL PIPED YES 0.3 2.9

139 53 BRAHAMPURI WEST

7750 PUCCA IHL PIPED YES 0.5 2.6

140 54 CHAMRA PAITHE 36250 PUCCA COMMUNITY PIPED YES 0.4 4.4

141 56 SARAI BAHLEEM 4560 MIXED IHL PIPED YES 0.5 4.1

142 58 MACHERAN 10356 MIXED IHL PIPED YES 0.4 3.4

143 58 GHOSHI MOHALLA

8652 MIXED IHL PIPED YES 0.6 4.2

144 58 MAKABARRA

DIGGI 3225

MIXED IHL PIPED YES YES 4.1

145 58 MAKABARRA GHOSHIYAN


146 59 AHMAD NAGAR WEST


147 61 KOTHI ATANAS 7440 MIXED IHL PIPED YES YES 1

148 61 BAN BATAN 6750 PUCCA IHL PIPED YES 0.4 0.6

149 62 LUHARPURA 1610 MIXED COMMUNITY PIPED YES 0.5 5.8

150 62 VIKASH NAGAR 1180 MIXED COMMUNITY PIPED YES 0.6 5.9

151 63 JAMUNA NAGAR 1950 MIXED COMMUNITY PIPED YES 0.3 7.4

152 63 RASOOL NAGAR 1428 PUCCA COMMUNITY PIPED YES 0.4 5.9

153 63 JAFERWAL BAGH

JOHAR BAGH 1125


154 63 HUMAYUN NAGAR

16480 MIXED COMMUNITY PIPED YES 0.1 3.4

155 65 UMAR NAGAR 13610 MIXED COMMUNITY PIPED YES 0.1 4.5

156 65 MUSLIM DEVPURI 815 MIXED IHL PIPED YES 0.4 3.5

157 67 SHAUKAT

COLONY 6048


158 67 SHYAM NAGAR 25720 MIXED COMMUNITY PIPED YES 2 2.3

159 69 SAKOOR NAGAR 5820 MIXED COMMUNITY PIPED YES 0.1 3.1

160 69 UNCHA SADIQ NAGAR


161 69 AHMAD NAGAR

POORVI 28910


TABLE MAWANA

Sl.no.

Ward no.

Name of the slum

Population

Quality of

housing

Quality of

sanitation

Status of water supply

(Piped, Hand

pumps,

open wells, none)

Locati

on and distance of

nearest A W

C

Location

and distance

of

nearest Primary School

Location and

distance of

nearest

Primary Health

Centre/U

HP/UFWC

(kutcha/pucca/

mixed)

(IHL,community toilets,

OD)

1 1 DHIKOLI 557 MIXED

COMMUNITY

HAND PUMP NO YES 4.0

2 2 TIHAI 930 MIXED

COMMUNITY

HAND PUMP NO YES 1.5

162 69 AHMEDI ,MASJID 25210 MIXED COMMUNITY PIPED YES 0.3 4.6

163 70 ALVI NAGAR 2620 MIXED COMMUNITY HANDPUMP YES 0.3 3.5

164 70 TARAPURI 35620 MIXED IHL HANDPUMP YES 0.4 1.2

165 70 RASEED NAGAR 16800 MIXED IHL HANDPUMP YES 0.3 1.8

166 71 ABRAR NAGAR 1870 MIXED IHL HANDPUMP YES 0.4 4.5

167 71 IDGHA COLONY 7240 MIXED IHL PIPED YES 0.5 4.6

168 71 SAMAR COLONY 7500 MIXED IHL HANDPUMP YES 0.3 4.7

169 72 SHAHJAHAN COLONY

7400 MIXED COMMUNITY HANDPUMP YES 0.4 4.8

170 72 MAJID NAGAR 8130 MIXED COMMUNITY HANDPUMP YES 0.1 5.6

171 74 ASHIYANA COLONY


172 74 KAUSHAL NAGAR 10140 PUCCA COMMUNITY HANDPUMP YES 0.3 5

173 75 LAKHI PURA 19200 MIXED IHL HANDPUMP YES 0.2 3.1

174 76 JAKIR COLONY 25350 MIXED IHL PIPED YES YES 0

175 77 KACHI JAKIAR COLONY


176 78 DHABHI NAGAR 19740 MIXED IHL PIPED YES 0.4 3.1

177 79 ZAIDI FARM 10800 MIXED IHL PIPED YES YES 0.5

178 79 MANJUR NAGAR 10800 PUCCA IHL PIPED YES 0.2 0.8

179 79 KARIM NAGAR 8100 PUCCA COMMUNITY PIPED YES 0.3 0.9

180 80 ISLAMABAD 17200 PUCCA COMMUNITY PIPED YES 0.4 0

181 1C BABAR KI KOTHI 2105 PUCCA COMMUNITY PIPED YES 0.3 1

182 2C CHANDERSHEKH

AR COLONY 2550


183 2C JUBLI GANJ 630 PUCCA COMMUNITY PIPED YES YES 1.9

184 4C KHANNA KI KOTHI 1706 PUCCA COMMUNITY PIPED YES 0.2 3

185 5C RAVINDRA PURI 2040 PUCCA COMMUNITY PIPED YES YES 1.4

3 12 KABLI GATE 563 PUCCA

COMMUNITY PIPED NO YES 0.5

4 13 KABLI GATE 823 PUCCA


5 15 TIHAI 1476 MIXED

COMMUNIT

Y

HAND

PUMP NO YES 2.0

6 16 KALYAN SINGH 1087 PUCCA


7 18 HIRALAL 565 PUCCA



COMMUNIT

Y PIPED NO YES 1.0

9 22 MUNNALAL 1048 MIXED




MAWANA NPP 8941

TABLE SARDHANA

Sl.no.

Ward no.

Name of the slum

Population

Quality of

housin

g

Quality of sanitation

Status of water

supply (Piped, Hand

pumps, open wells,

none)

Location and distan

ce of nearest A W

C

Location and

distance

of nearest Primary

School

Location

and distance

of

nearest Primary Health

Centre/UHP/UFWC

1 5 GARHI KHATIKAN 2544 MIXED

COMMUNITY

HAND PUMP NO 4.0 6.0

2 1 KHEVAN 3275 MIXED COMMUNITY


3 4 BUDA BABU 2450 MIXED

COMMUNIT

Y

HAND

PUMP NO 6.3 4.0

4 6 MANDI CHMARAN 2257 MIXED

COMMUNITY


5 2 BHARTWARA 3019 MIXED COMMUNITY


6 3 KHAKRIBAN 2062 MIXED

COMMUNIT

Y

HAND

PUMP NO 5.8 6.4

7 15 SANSIA COLONY 290 MIXED

COMMUNITY


SARDHANA NPP 15897

The rapidly growing urban population poses great challenge to the efforts of the state

government towards improving the health of the urban poor.

1.4 Urban Governance3

There are multiple agencies responsible for urban governance and provision and

management of infrastructure and services. While, the Lucknow Nagar Nigam (LNN),

Lucknow Jal Sansthan (LJS), Lucknow Development Authority (LDA) and UP Jal Nigam

(UPJN) are the key urban service providers, other agencies include the Housing Board,

Central and State Public Works Departments (CPWD and PWD), Transport Department,

Industries Department and the Department of Environment. There is significant overlap of

roles and responsibilities and fragmentation in service provision and management of

infrastructure, which makes it difficult to hold institutions accountable and to coordinate.

Table : Urban Governance and Service delivery institutions

City Level

Meerut Nagar Nigam 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

Meerut Development

Authority (MDA)

Preparation of Master Plans for land use; Development of new

areas as well as provision of housing and necessary infrastructure

District Urban

Development Authority

(DUDA)

Implementing agency for plans prepared by SUDA.

Responsible for the field work relating to community development

– focusing on the development of slum communities, construction

of community toilets, assistance in construction of individual

household latrines, awareness generation etc.

3 Lucknow City Development Plan 2006

1.5 Access to Public Facilities4

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 Water Resources

Aside from water resource issues such as pollution of the River Gomti and the declining

quality of groundwater, Lucknow carries a burden of old infrastructure and the absence of

metering makes it difficult to estimate costs and leakages. Information about assets in

physical and functional terms is also inadequate. Overlapping institutional roles make it

difficult to hold the institutions clearly accountable.

Table 8: Water Supply Indicators5

Water Supply Indicators

Coverage of water supply

connections (100%)

Per capita supply of

water (1351pcd)

Extent of metering of

water connection

(100%)

Continuity of

water supply

(24 Hours)

43 128 0

1.7 Sewerage and Sanitation Facilities

Meerut has seen no major investment in sewage infrastructure after the proposals in the

1948

Sewage Master Plan. Taking into consideration the service latrines, latrines discharging into

nallas, existing public toilets and open defecation about 40% of the population do not have

access to adequate sanitation. Informal sewers connecting a few households and

discharging into nearby open drains are also seen. The existing main network therefore is for

the most part not able to handle additional load leading to the sullage being discharged

directly into the River Gomti. In many places the sewers have been choked by the disposal of

solid waste in them as well as encroachment in sections. This does not allow complete

cleaning of the network and aggravates the problem of discharge.

4 Lucknow City Development Plan 2006

5 SUDA

The lack of current data and information on assets severely impacts planning. While in the

newly developed and developing areas, networks are being provided by developers,

coordination with the state planning process is tenous.

Table : Sewage Management (Sewerage and Sanitation)6

Sewage Management (Sewerage and Sanitation)

Coverage of toilets (100%)

Coverage of sewage network

service (100%)

Adequacy of sewage

treatment capacity (100%)

52 47

100

Drainage

While in general, the City is good drained, there are local pockets of water logging especially

in areas where the carrying capacity of the drains has been reduced either due to

encroachment or blockage. Such flooding has been observed in Hazratganj crossing and at

Mawaiya Bridge crossing almost each year during rains. In the newly developed areas, while

the developer is responsible for the provision of internal surface water drainage, the linking of

these drains to the larger local drains and nallahs is neglected, causing waterlogging

problems at some places. Maintenance of drains is ‘reactive’ with the common practice to

desilt the drains and dump the sludge near the edge of the drains to dry out before lifting. In

practice, sludge either gets blown away or ends up in open drains.

Solid Waste Management

The present solid waste management system is not synchronized. There are some pockets

where door-to-door collection has been introduced largely on the initiative of the local

residents; there is no system of collection, transportation and disposal nullifies efforts at the

household level. The numbers of existing waste depots are inadequate for the quantum of

waste generated and are also located far from the city, which encourages indiscriminate

dumping. Behavioural patterns pose health risks and therefore pose health risks for those

working in this sector as well as residents living around waste depots. The indiscriminate

dumping results in garbage finding its way back into sewers and contributing to their choking.

6 SUDA

Table : Solid Waste Management Indicators7

Solid Waste Management Indicators

Household level coverage

of solid waste

management services

(100%)

Extent of segregation of municipal

solid waste (100%)

Extent of municipal solid

waste recovered (80%)

41 53 4

Health Infrastructure

Health System and Infrastructure

Health services in Meerut are provided by the public sector (Department of Health and

Family Welfare) and private sector agencies (hospitals, nursing homes and clinics). For MCH

services communities prefer to go to private facilities.

First Tier facilities

Primary health care in the city is provided through 14 first tier centres located in various parts

of the city, which include Urban Family Welfare Centres (UFWCs) and Urban RCH Health

Posts. Their main job involves OPD Services, ANC registration, ANC check-ups, family

welfare services and routine immunization.

Second Tier Facilities

Medical college hospital, district male and female hospitals play an important role in providing

secondary care facilities to the entire district. PL Sharma and Dufferin hospitals are catering

to the needs of urban as well as rural population. In addition, the defence and railway

hospitals and their network of dispensaries provide services to the city population.

Private Health Service Providers

Meerut has numerous private clinics, maternity centres, nursing homes and hospitals

catering to the health needs of the general population. There are four charitable hospitals,

accessed to a large extent by the poor population.

The population is fast outgrowing the existing health facilities. The heavy workload on the

limited outreach staff (predominantly ANMs) results in insufficient contacts or interactions at

the community level. Some of the health centres cover over 150,000 population with very

minimum staff.

7 SUDA

Type of Facilities Number

Government Health Facilities

First Tier (Primary Health Care Facilities)

Urban Family Welfare Centre / Urban

RCH Health Post

14

Municipal Dispensary 1

Second Tier Facilities

District / Joint Hospital 2

District Women Hospital 1

Postpartum Centre 1

Medical College 1

ESI 1

Railway 1

Defence 2

Other public hospitals (Municipal,

Police etc.)

5

Private Health Facilities

Private for Profit

Health Post Clinics -

Maternity / Nursing Homes -

NGO/ not for profit/ Charitable Clinics

Utilization of Health care by the Urban Poor

Different studies conducted by UHRC (such as qualitative survey, nutrition survey,

vulnerability study etc) showed that, for outpatient care, most of the patients in urban areas

sought treatment from the

private/non-government sector, rather than from public hospitals or Primary Health Centres.

FGDs with slum dwellers revealed that most illnesses are first reported to local healers and

then to private health facilities. Slum residents seek medical care from private practitioners

as a result of easier access, availability of credit/instalment payment, seemingly quick “cures”

and personalized treatments. Though there is a high availability and dependence too on the

private sector for curative services, women usually prefer charitable hospitals and

dispensaries, and they also prefer a female attendant for gynaecological care. Awareness on

health care facilities is negligible among the slum dwellers.

Health Indicators

As per the recent District Level Household and Facility Survey (DLHS-3) 2007 – 2008, only

36.6% of currently

www.uhi-india.org - Meerut City Profile – February 2010 /Page 4 of 4 married women are

using a modern method of contraception. The DLHS 3 estimates unmet family planning need

in Meerut at 26.6%, comprised of 9.0% unmet need for spacing methods and 17.5% unmet

need for limiting methods. The Ministry of Health and Family Welfare, Family Planning

Division has recognized Meerut as a high priority district for family planning program in Uttar

Pradesh.

Reanalysis of NFHS-3 data (UHRC, 2008) shows a 50.5% usage of modern contraceptive

methods among the low SLI (urban poor) group, of which 26.6% utilize permanent

sterilization. This would indicate that there is only a minimal effort in delaying the first

pregnancy or extending the gap between two successive pregnancies.

Discussions in the slums also revealed a lesser acceptance of any temporary birth spacing

method (pills, condoms, etc.) which is very much associated with their religious beliefs,

especially in the slums of Meerut. It should also be noted that in Muslim communities (who

constitute about 80% of the slum population in Meerut) tubectomy/vasectomy is also not

considered an option due to strong religious beliefs. Slum health programs in Meerut should

therefore consider

Table: Health Structure in Merrut

Sl.

No.

Name & type of facility

(DH, Maternity Home, CHC, other ref. hospital UFWC, UHP

PHC,Dispensary etc.)

Managing Authority

(Municipal Council, State Health

Department, facilities functioning

on PPP basis)

Location of

Health facility

Population covered

by the facility

Services

provided

Human Resources

available – list type

and

number of HR

available

i.e. ANM, LT, SN, MOs,

Specialists etc.

No. and type of

equipment

available: X-ray

machine,

USG, autoclave

etc.

1 LLRM MEDICAL COLLEGE MEERUT

STATE GOVT

MEDICAL COLLEGE

85247 MCH

DELIVERY SNCU

LIST ENCLOSED

XRAY USG ETC

2 DISTRICT WOMEN HOSPITAL MEERUT

STATE GOVT

DISTT. WOMEN HOSPITAL

65879

3 HP D TYPE POLICE LINE

STATE GOVT

POLICE HOSPITAL

45091 OPD MCH LIST

ENCLOSED

NONE

4 HP D TYPE CANTT HOSPITAL

STATE GOVT

CANTT GEN HOSPITAL 53217 OPD MCH NONE

5 HP D TYPE OLD TEHSIL STATE

GOVT

NAGAR NIGAM

DISP. 56013 OPD MCH LIST ENCLOSED

NONE

6 HP D TYPE RAJENDRA NAGAR

STATE GOVT

ZAIDI FARM COLONY 53451 OPD MCH NONE

7 HP D TYPE BRAHAMPURI

STATE GOVT

BHAGWAT PURA 50123 OPD MCH LIST

ENCLOSED

NONE

8 HP C TYPE SABUN

GODAM

STATE

GOVT SABUN GODAM

50567 OPD MCH NONE

9 HP C TYPE RAJBAN STATE GOVT

CANTT GEN HOSPITAL 49874 OPD MCH LIST

ENCLOSED

NONE

10 HP C TYPE SURAJ KUND

NRHM SURAJ KUND 52123 OPD MCH NONE

11 UHP KANKER KHERA NRHM KANKERKHERA 41022 OPD MCH LIST

ENCLOSED

NONE

12 UHP ISLAMABAD NRHM ISLAMABAD 42341 OPD MCH NONE

13 UHP MAQBARA DIGGI

NRHM MAQBARA DIGGI 51234 OPD MCH LIST

ENCLOSED

NONE

14 UHP ZAKIR COLONY/ H NAGAR

NRHM ZAKIR COLONY 52309 OPD MCH NONE

15 UHP NAI BASTI

LALLAPURA NRHM LALLAPURA

49810 OPD MCH LIST ENCLOSED

NONE

16 UHP SANJAY NAGAR NRHM SANJAY NAGAR 51234 OPD MCH NONE

17 UHP TARAPURI

SAKOORNAGAR NRHM TARAPURI

52102 OPD MCH LIST ENCLOSED

NONE

18 UHP LAKHIPURA NRHM LAKHIPURA 53420 OPD MCH NONE

19 UHP JAI BHIM NAGAR

NRHM IJAIBHIM

NAGAR 40192 OPD MCH LIST

ENCLOSED

NONE

20 UHP MALIYANA NRHM MALIYANA 51098 OPD MCH NONE

21 UHP SHALIMAR

GARDEN NRHM

SHALIMAR

GARDEN 41231 OPD MCH NONE

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

first tier health facilities were planned for a population of 50000 but as a result of rapid

population growth they are currently serving a population of more than 75000. The situation

gets compounded due to lack of adequate infrastructure, equipments and medicines. The

staff mainly Doctors and ANM is also inadequate. The high population- staff ratio results in

poor service coverage with some areas being entirely unserved. From the above assessment

it becomes evident to consider the poor health indicators for deciding the norms of staff

population ratio. Uttar Pradesh has eight medical colleges and one post-graduate institute

which offer tertiary and superspecialty health services.

Private Health Care providers8

A large network of private providers exists along with a large number of public sector

providers. The total number of private sector doctors is estimated at 7,259 (Registered and

unregistered all inclusive). The Dai’s (TBAs) are estimated at 12,259 (Trained and untrained)

Commercial outlets including medical shops, pharmacies etc. number about 98,000. Unlike

the distribution of public sector providers, the highest concentration of the private providers is

in the western region. The distribution of health providers understandably has strong bearing

on the health care in U.P. Regions with lower concentration of medical providers (in

proportion to population) have lower maternal and child health care coefficient and higher

unmet need for family planning services.

TABLE 2 HEALTH SENARIO

Sl. No. Name of Disease/ cause of morbidity (e.g. COPD, trauma, cardiovascular disease etc.)

Number of cases admitted in 2012

1 Injuries and Trauma 1274

2 Self inflicted injuries/suicide 34

3 Cardiovascular Disease 75

4 Cancer (Breast cancer) 12

5 Cancer (cervical cancer) 18

6 Cancer (other types) 23

7 Mental health and depression 345

8 Chronic Obstructive Pulmonary Disease (COPD)

6752

9 Malaria 76

10 Dengue 0

11 Infectious fever (like H1N1, avian influenza, etc.)

0

12 TB 543

13 MDR TB 12

14 Diarrhea and gastroenteritis 123

15 Jaundice/Hepatitis 65

16 Skin diseases 453

17 Severely Acute Malnourishment (SAM) 5

18 Iron deficiency disorder 875

19 Others 13

(Source: )

MEDICAL COLLEGE (Govt&Private), DISTRICT HOSPITAL MALE &FEMALE, MAJOR PRIVATE HOSPITALS

The above table reflects the health/ morbidity profile of the Meerut 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.

2. 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, 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 because unmet need for family planning is high in Lucknow

17) Management of communicable & non- communicable diseases

18) Strengthening AYUSH

19) Constitution of BSGY team for urban areas.

20) Identification & management of SAM children

3. 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

operationalized rapidly over the years.

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

behaviours 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.

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 wi ll be

outsourced to a research agency. Development Partners like Health of the Urban Poor

project will technically support this effort.

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 optimised.

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 organisations 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 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.

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. 15,000/- 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.

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.

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.

ASHA-

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

effective and demand–generating link between the health facility and the urban slum

population. Each link worker/ASHA would have a well-defined service area of about 1000-

2,500 beneficiaries/ between 200-500 households based on spatial consideration.

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 counselling. 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

Innovations –

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.

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.

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 city level Urban Health Committees headed by the

Municipal Commissioner/ Deputy Commissioner/ District Collector.

Activity Plan under NUHM for the state and cities

Act

. No.

Activity

Responsibili

ty

Months : October'13 -

March'14

Remar

ks

State

level

City

level Oc

t.

No

v.

De

c

Ja

n

Fe

b

Ma

r

1

Establishment of Platform for

Convergence at state level

Circular

to be isued from

state level to all their

district level

nodal officers

2

Preparation & Finalization of

Guidelines for City Coord. Committee/ City Program Management Committee

These

will be one time

activities and

will apply across

the state

3 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 Descriptions 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 under NUHM

14

Establishment & orientation of City Program Management

Committee (UH)

15

Identification of groups, collectives formed under

various govt. programs (like NHG under SJSRY, self help groups etc.) for MAS

16

Organize meetings with women in slums where no groups could be identified

17

Formation and restructuring

of groups as per MAS guidelines

18 Orientation of MAS members

18 Selection of ASHAs

18

a

- Selection of local NGOs for

ASHA selection 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. Stakeholders

20

Mapping & listing exercise (for health facilities and

slums)

20

a

- Mapping of all urban health facilities (public & pvt.) for

services

To continu

e 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 continu

e in 2014-15

22 Baseline survey of urban

poor/ slums (KFAs)

(to determine vulnerability, morbidity pattern & health status)

23

Meetings of RKS for all the

public health facilites under NUHM

24 Identification of alternate/ suitable locations for UPHCs

To continu

under various urban devp. Programs

e in 2014-15

25 Strengthening of public

health facilities

- Selection, training and deployment of HR in pub. health facilities

To continue in

2014-15

26 IEC activities

27 Outreach camps & UHNDs

(from existing UHPs)

28

Empanelment of Private

Health Facilities for health care provisioning

To

continue in

2014-15

29 Involvement of CSR activities

4. Programme Management Arrangements

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

the District Magistrate. District Program Management Units have been further strengthened

to provide appropriate managerial and operational support for the implementation of the

NUHM program at the district level.

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:

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

following norms:

District total Urban

population

Additional Staff Proposed

10lakh to 20lakhs 2 Urban Health Coordinator,2 Accountants and 2 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.

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/ 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

Members – School Education - BSA & DIOS

Members – Dev. Partners - Partners working in urban health sector

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 workers and MAS

representatives

Once a month UPHC All ANMs, PHN, LMO,

Community Organizer, Social

Mobilization officer

Meeting of UPHC

Coordination

Committee

Once a month UPHC LMO, PHN/Community

Organizer, Social Mobilization

officer, representative from

2nd tier facility, and reps.

From other departments

Meeting with CMO &

UH Program

Coordinator

Once a month CMO

Office

CMO, Program Coord., Asst.

Program Coordinator, LMO/

PHN/ Community Organizer,

Social Mobilization officer

City Task Force

Meeting

Once in two

months

DM’s

office

CMO, Program Coord. UH,

Various departments’ reps. ,

private partners, NGOs

5. City Level Indicators & Targets

City Level Indicators and Targets Meerut City

Processes & Inputs

Indicators Baseline

(as

applicable)

Number Proposed

(2013-14)

Number

Achieved

(2013-14)

Community Processes

1. Number of Mahila Arogya Samiti (MAS) formed * 1150

2. Number of MAS members trained * 11500

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

575

Health Systems

4. Number of ANMs recruited * 122

5. No. of Special Outreach health camps organized in

the slum/HFAs * 130

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

1150

7. Number of UPHCs made operational * 26

8. Number of UCHCs made operational * 0

9. No. of RKS created at UPHC and UCHC * 26

10. OPD attendance in the UPHCs 336000

11. No. of deliveries conducted in public health facilities 7596

RCH Services

12. ANC early registration in first trimester 29206

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

29206

14. TT (2nd dose) coverage among pregnant women 26166

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

26098

16. No. of Severely Acute Malnourished (SAM) children

identified and referred for treatment 2921

Communicable Diseases

17. No. of malaria cases detected through blood

examination 73

18. No. of TB cases identified through chest symptomatic 3229

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

7192

20. No. of MDR-TB cases put under DOTS-plus 14

Non Communicable Diseases

21. No. of Diabetes cases screened in the city 7326

22. No. of Cancer cases screened in the city 67

23. No. of Hypertesion cases screened in the city

8719

Table 2: Demographic profile of Mawana City

Total Population of city (in lakhs) 81443

Slum Population (in lakhs) 9000


population 11 %

Number of Notified Slums -

Number of slums not notified -

No. of Slum Households 1800



IDSMT,etc.)

-


individual water connections* -


network* -


-

No. of slums having AWC -


facility -

City Level Indicators of – MAWANA CITY

Processes & Inputs

Indicators Baseline

(as applicable)

Number Proposed (2013-14)

Number

Achieved

(2013-14)

Community Processes




5

Health Systems


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

8

6. No. of UHNDs organized in the slums and vulnerable

areas * 69




Table 2: Demographic profile of Sardhana City

Total Population of city (in lakhs) 58252 Source: Census 2011

Slum Population (in lakhs) 16000 Source: RSAC


population 27 %

Number of Notified Slums - Source: DUDA

Number of slums not notified - Source: RSAC

No. of Slum Households Source: RSAC



IDSMT,etc.)


individual water connections*


network*


Source: BSA Deptt.

No. of slums having AWC Source: ICDS Meerut & BSUP


facility

City Level Indicators of – Sardhana City

Processes & Inputs

Indicators Baseline

(as

applicable)

Number Proposed

(2013-14)

Number

Achieved

(2013-14)

Community Processes




8

Health Systems


5. No. of Special Outreach health camps organized in

the slum/HFAs * 6

6. No. of UHNDs organized in the slums and vulnerable

areas * 16




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