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Raibareli City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

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NATIONAL URBAN HEALTH MISSION

Program Implementation Plan

2013-14

Submitted by District Health Society, Raebareli

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PREAMBLE

National Urban Health Mission aims to improve the health status of urban population in general and the poor and other disadvantaged sections in particular, 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, government proposes to set up one Urban Primary Health Centre for every 50,000-60,000 population, an Auxiliary Nursing Midwives (ANM) for 10,000 populations and an Urban Accredited Social Health Activist (ASHA) (community link worker) for

200 to 500 households.

Raebareli District total population 3,40,4004 (Census: 2011), is one of the seventy five districts in Uttar Pradesh having more than 30 Lacs Population (Census: 2011), total urban population in the district is 1,91,056 (Census: 2011) in this population 56063 persons are residing in

the slums. The sex ratio is quite low and it is around 914 per thousand and child sex ratio (0-6 Years) census 2011 is 908 that is also a quite alarming. The AHS-2010-11 reports that institutional deliveries are around 72% and city having the high IMR 55 (AHS 2010-11) with MMR 330 (AHS 2010-11) that is also area of concern. The female sterilization

for family planning at the district level is 99.58% (HMIS 2010-11) and male sterilization is 0.42% (HMIS 2010-11) if we further see the data there are more difference between male and female sterilization.

Looking the situation and available information from various surveys it reveals that Raebareli is behind in so many indicators and planning of National Urban Health Mission will complement for the betterment of urban people particularly to 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.

Dr. A.K. Gupta Shri Amit Gupta (I.A.S.)

Chief Medical Officer District Magistrate

Raebareli Raebareli

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ACKNOWLEDGEMENT

The present work for the planning of National Urban Health Mission came with maintaining hard work, dedication and perseverance. This work of planning would not have been completed without the help and support of a number of people.

We feel really overwhelmed in saying that this work would not have

come up without the valuable support and continuous encouragement of Shri Amit Gupta (IAS), District Magistrate, Raebareli. His great confidence in team had inspired us into action.

My special regard goes to Dr. A.K. Gupta, Chief Medical Officer, Raebareli, a dynamic and enthusiastic personality. He has always been

a source of great encouragement for us. The initiation and completion of this work would be substantiated only in his sincere and able guidance, expertise and precious opinions, 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 owe my sincere gratitude to Dr. M. R. Gautam (General Manager) & Dr. Usha Gangwar, (Deputy General Manager-NUHM) who have helped us immensely by providing relevant information, expert suggestions. This planning work got accomplished with their valuable support and eagerness to help.

I express my gratefulness to Shri. Amit Kumar Ghosh, (I.A.S.), Mission Director, National Health Mission & Dr. Shashank Vikram, (I.F.S.), Additional Mission Director, NUHM for extending support and building the thoughts in our mind.

I am privileged to have such good city level team specially Shri Rajram Yadav, Divisional Programme Manager Dr. Raj Kishor Tripathi

(DPM-NRHM), who have supported, helped, put their great efforts into planning of NUHM at city level.

I am also pleased to appreciate the precious help and motivation which I got from my respective departments DUDA, ICDS, Nagar Palika Parishad, Education department & NGOs.

Last but not the least; I would like to thanks all those people who were involved in the planning process directly or indirectly.

Dr. A.K. Chaudhary Dy. CMO (RCH), Raebareli

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ABBREBIATION

Short forms Abbreviations

MO Medical Officer

ANM Auxiliary Nurse Midwife

DEO Data Entry Operator

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

MMR Maternal Mortality Ratio

KFA Key Focus Area

LHV Lady Health Visitor

LT Lab Technician

MAS Mahila Arogya Samiti

NPP Nagar Palika Parishad

NPSP National Polio Surveillance Program

NHM National Health Mission

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

UPHC Urban Primary Health Center

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UFWC Urban Family Welfare Center

UHP Urban Health Post

PPC Post Partum Centre

PMU Programme Management Unit

UHND Urban Health Nutrition Day

MCTS Mother & Child Tracking System

HMIS Health Management and Information System

MCP Card Mother and Child Protection Card

ED List Essential Drug List

EDD Expected Date of Delivery

ULB Urban Local Bodies

Raebareli an overview

Raebareli, with a population of 3,40,4004, is one of seventy five districts in Uttar Pradesh. Its headquarters, Raebareli city, is located at 82 km. Distance in south from the Lucknow. Raebareli is situated at a distance of about 450 km from New Delhi.

Raebareli has a warm subtropical climate with very cold and dry

winters from December to Mid February and dry, hot summers from April to Mid June. The rainy season is from mid-June to mid-September, when it gets an average rainfall of 1200 mm mostly from the south-west monsoon winds. During extreme winter the maximum temperature is around 12 degrees Celsius and the minimum is in the 3 to 4 degrees Celsius range. Fog is quite common from late December to late January. Summers can be quite hot with temperatures rising to the 40 to 45 degree Celsius range.

Samaspur Bird Sanctuary is situated in Rohaniya Development

block of the district, about 122 km from Lucknow on Lucknow-Varanasi highway. It was established in 1987 on a total area of about 799.371

hectare. Nearest railway station is Unchahar and the nearest airport is Fursatganj, Raebareli. The best period to visit is from November to March. More than 250 varieties of birds can be seen there. Some of the birds come here from a distance of 5000 km which include Greleg Googe, Pin Tail, Common Teel, Vision, Showler, Surkhab etc. Local birds

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include Comb Duck, Whistling Teel, Spot Bill, Spoon Bill, King Fisher, Vulture etc. Twelve varieties of fish are there in the lake at Samaspur.

The city and the district became famous as a political bastion of the

Nehru-Gandhi Nationalist family. After independence, Rae Bareli constituency was won by Jawaharlal Nehru's son-in-law Feroze Gandhi. After Feroze Gandhi's death in 1960, the constituency was won in 1967

by his wife Indira Gandhi (daughter of Jawaharlal Nehru), who went on to become the first woman Prime Minister of India. In 1977, after Indira Gandhi's election from Rae Bareli was revoked by Allahabad High Court for using state machinery in the elections. She held on to the power by having the President of India declare a national emergency.

As per provisional data of 2011 census, Rae Bareli had population

of 3,404,004 of which male and female were 1,753,344 and 1,650,660 respectively. There was change of 18.51 percent in the population compared to census of 2001. As per 2011 census, 90.95% population of Rae Bareli districts lives in rural areas of villages. The total Rae Bareli district population living in rural areas is 3,096,097 of which males and females are 1,593,143 and 1,502,954 respectively. The initial provisional data released by census India 2011, shows that density of Rae Bareli district for 2011 is 739 people per km. The Sex Ratio in Rae Bareli, stood at 941 per 1000 male. The Average literacy rate of Rae Bareli in 2011 was 69.04 with male and female literacy rate being 79.39 and 58.06 respectively.

Religions in raebareli

Religion

Percent

Hindus   68%

Muslims   30%

Jains   1.4%

Others†   0.6%

Distribution of religions Includes Sikhs (0.2%), Buddhists (0.2%).

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Fig 1: Raebareli Location Map

The city is the administrative headquarters of Raebareli district. It shares common boundaries with the district of Lucknow, Unnao, Fatehpur, Barabanki, Amethi and Pratapgarh in the north, Lucknow

and Barabanki in the east Amethi, in the west Unnao and Pratapgarh, Fatehpur in the south. Raebareli pronunciation (help·info) is a city and a municipal board in the Indian state of Uttar Pradesh. It is the administrative headquarters of Raebareli District. The town is situated at the bank of

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the Sai river, 82 km, 70 km southeast of Lucknow. It possesses many architectural features, chief of which is a strong and spacious fort erected in 1403A.D. Among other ancient buildings are the magnificent

palace and tomb of nawab Jahan Khan, governor in the time of Shah Jahan, and four fine mosques. The most important town within the district is Lalganj, Uttar Pradesh where is the Rail Coach Factory, Raebareli situated. The factory is already underway with construction

activities in full. Raebareli is located in the heart land of famous Awadh region which was the part ancient Koshala kingdom. Tradition has it that the town was founded by the Bhars and was known as Bharauli or Barauli. Over the course of time, the name was changed to Bareli. The prefix "Rae" represents "Rai" the common title of the

Kayasths and manihar who were masters of the town for a considerable period of time, some famous Kayasths are Rai Saheb Naseerabad, Kali Sahay Saheb, Dr. Shankar Dayal etc. Raja Har Parshad, Kayasth, a native of this town from Naseerabad, was the Nazim or Commissioner of Khairabad Division during the reign of the ex-king. He joined the mutineers and went up to Naipal with Begum Hazrat Mahal of Oudh dynasty and On 31 December 1858 while returning after leaving her safe, he was killed in a battle with British army. The district of Raebareli was created by the British in 1858, and is named after its headquarters town. In the early 20th century, the town was an important center of trade, and Muslin and Cotton weaving. Its population was 15,880 in 1901.

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Raebareli is well connected to the rest of country by rail and road transport. Raebareli Junction, the main station of Raebareli. Several national highways pass through Raebareli; NH-24 connects Raebareli to

Lucknow. Regular buses connect the city to destinations such as Delhi, Lucknow, Allahabad, Sultanpur and Pratapgarh etc. The nearest civilian airport, Amausi (Lucknow), is 80 km from Raebareli.

City institutional structure Raebareli city is divided into 31 municipal wards and chairman is

elected based on votes from each citizen of the city. The Raebareli Development Authority is responsible for the planning and

development of the city. Water Supply and sewerage are being looked after by Raebareli Nagar Palika Parishad. For purposes of law and order, the city is divided into three administrative divisions – City, Infrastructure and Finance & Revenue, each headed by the District Magistrate. The District Magistrate has the overall responsibility for the

district law and order, revenue collection, taxation, the control of planning permission and the handling of natural and manmade emergencies.

NTPC Uchahaar, Raebareli –

NTPC, India’s largest power company, was set up in 1975 to accelerate power development in India. It is emerging with a significant

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presence in the entire value chain of power generation business. NTPC ranked in the ranking of the World’s biggest companies. With a Current generating capacity of 41,184 MW, NTPC plans to become a 128,000

company by 2032. “Develop and provide reliable power, related products and services at competitive prices, integrating multiple energy sources with innovative and eco-friendly technologies and contribute to society.” India’s largest power company, NTPC was set up in 1975 to accelerate power development in India. NTPC is emerging as a

diversified power major with presence in the entire value chain of the power generation business. Apart from power generation, which is the mainstay of the company, NTPC has already ventured into consultancy, power trading, ash utilisation and coal mining. NTPC ranked 337 th in the ‘2012, Forbes Global 2000’ ranking of the World’s biggest companies.

NTPC became a Maharatna company in May, 2010, one of the only four companies to be awarded this status. The total installed capacity of the company is 41,184 MW (including JVs) with 16 coal based and 7 gas based stations, located across the country. In addition under JVs, 7 stations are coal based & another station uses naptha/LNG as fuel and 2 renewable energy projects. The company has set a target to have an installed power generating capacity of 1,28,000 MW by the year 2032. The capacity will have a diversified fuel mix comprising 56% coal, 16% Gas, 11% Nuclear and 17% Renewable Energy Sources(RES) including hydro. By 2032, non fossil fuel based generation capacity shall make up nearly 28% of NTPC’s portfolio.

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Fig 2: Raebareli City Map -

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Demographic & Social Profile- Demographic data for Raebareli city from the 2011 Census has

been analyzed to understand the demographic patterns. The total population of the district is 3,40,4004, district urban population 307907, total city population 191,056. The city population consists of 52.25% males and 47.75% females. Child Sex Ratio (0-6 Years ) 908, Effective Literacy Rate 83.0%, Effective Literacy Rate of male 87.3%, Effective Literacy Rate of Female 78.3% as per Census 2011. Life births after 36 months 54.8%, Institutional Deliveries 72.2%, IMR 55 per 1000 live births, NNMR 33, U5MR 81, MMR 330, TFR 3.3, Birth to Women Age

15Yrs-19Yrs 100%, Children with birth weight<2.5kg. 29.4%, 3 doses of DPT 49.2%, Measles 84.6%, Fully Immunization 44.6% as per (AHS 2010-11).

Vulnerable Population Raebareli Nagar Palika Parishad has divided the city into the 31

wards based on the status of water and sanitation in the city; these are further categorized into recognized slums; most important colonies and other important colonies. According to the District Urban Development Authority in Raebareli, there are around 53 registered slums. As per Raebareli Nagar Palika Parishad. Over a period of more than a decade

some of the slums have become developed colonies. DUDA has been implementing several schemes for the vulnerable

population and slum improvement. A few examples of DUDA endeavours are: Urban Basic Services Programme (UBSP) Scheme, Nehru Rozgar Yojana, Swarna Jayanti Shahari Rozgar Yojana etc.

Health System and Infrastructure Health services are provided by the Public sector, including the

Department of Medical, Health and Family Welfare, and by the Private sector (hospitals, nursing homes, and clinics).

First Tier Facilities

Primary health care in the city is provided through 2 urban centres, 01 Urban health post and 4 Homeopathic centres, 2 Ayurvadic, 1 Unani clinics are located in various parts of the city. These primary health centres were created to respond for growing health indicator in

the population of the city.

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Table 1: Distribution of Health Facilities

Type of Facilities Number

Government Health Facilities

District Male Hospital

01

District Women Hospital 01

Post Partum Centre 01

Railway 01

Urban Health Post 01 Urban Centre 01

Private Nursing Homes in the city 37

Private Pathology in the city

18

Private X-Ray Centres in the city

12

Private Clinics in the city

181

Source: Office of Chief Medical Officer, 2013

Private (for profit) Health Facilities

A large number of slum residents seek medical care from the private sector, which includes a huge network for profit institutions. As per the list provided by the Chief Medical Officer, Raebareli has total 248 registered private nursing homes/Pathology/X-Ray Centres/Clinics.

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Health Indicators As per the recent District Level Household and Facility Survey

(DLHS-3) 2007-2008, only 22.4% of currently married women are using a

modern method of contraception. Initiation of breast feeding within one hour of birth is 20% (DLHS 2007-08), 32.3% Safe Deliveries conducted in the district (DLHS 2007-08), 3 or more ANC check up is 27.3%(DLHS 2007-08), PNC within one week 73.2%, PNC within 48 hours 73.2% (AHS 2010-11). According to family planning statistics shared by the Chief

Medical Officer, the uptake of family planning methods is very low in Raebareli as compared to other districts in Uttar Pradesh.

Table 1: District level indicators, Raebareli Indicator Achievement Remarks

Total Population* 3404004 Urban population* 191316

Slum population* 60000

Slum population as percentage of urban population *

29.3%

Source :- census 2011*

Slums in Raebareli: - Raebareli city is having a total number of 53 listed slums in DUDA list. The total population of slums, as per government records is 56063 (Source-Nagar Palika Parishad). Population of slums is a matter of debate as different agencies are claiming different population. In the Urban slum populations there is no one NGO is working for health.

Planning & Mapping- Distt. Raebareli has population of 191056 & it has 53 slums having

population about 56063. For better planning & exact mapping of these slums a external agency needed to be hired. GIS mapping is required for

exact localization of slums, Rs. 5 lakhs have been proposed for this purpose/activity.

Programme management-

For better implementation of NUHM activities, it is planned to strengthen District Programme management unit for monitoring &

evaluation activities. 01 Urban Health Coordinator, 01 Accountant & 01

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Data Entry Operator (DEO) is proposed to create NUHM cell at DPMU. One vehicle will be hired for Urban Health Coordinator @ 25000 per month. Rs.25000 per month for office expenses including internet and

one time Rs. 70000 for one computer, printer, table and chairs for UPHC used by HMIS/MCTS operator. Strengthening of district nodal officer (NUHM) urban health, furniture, AC, desktop, minor renovation etc. Rs. 2.5 Lakhs for DPMU Office NUHM Office Strengthening and Rs. 50000 for DPM laptop along with data card.

Urban local bodies-

NUHM would promote active participation of ULBs in the planning & management of urban health programme. Funds will flow to the District Health Society Intrasectorial convergence is envisaged to be established through integrated planning for implementation of various

health programmes like RCH, RNTCP, NVBDCP, NPCB etc. Intrasectorial convergence with department of urban development, housing &urban poverty alleviation, women & child development, school education, minority affairs, labour will be established through city urban health committees headed by the executive officer Nagar

Palika Parishad/DM. In 1st phase 0f 13-14 orientation of ULBs is proposed for 6 months (Oct- March14). Rs. 1 Lakhs proposed for orientation of urban local bodies (ULB).

Trainning of ANM & Paramedical Staff/MO-

ANMs may be engaged as per the norm of one ANM for 10,000 urban population. As there is no provision for Sub Centres under

NUHM, they will be co-located within existing health facilities (like urban health posts, Urban Centres etc.) till the urban PHCs become functional. They would have a clearly defined area of operation where they will be conducting outreach sessions, as per the norms under NUHM. Creation of Sub Centres has not been proposed under NUHM.

Outreach services will be provided through Female Health Workers (FHWs)/Auxiliary Nursing Midwives (ANMs) headquartered at the UPHCs. Additional ANMs would be engaged as per the norm of one ANM for about 10,000 urban populations. Raebareli Urban has population of 191056 so that 20 ANMs will be required but there is 07

regular ANMs already existing in urban area so there is only 13 ANMs is required. Maximum Rs. 5000 per ANM for entire training package (5 ANMs and 2 Staff Nurses from UPHC will be trained). Maximum Rs. 10000 per MO for entire training package.

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Orientation of MAS

Process could be initiated for formation of Mahila Arogya Samitis (MAS) as per the norm of one MAS for 50-100 households in the KFAs (as per the processes suggested in the NUHM “Framework for Implementation”; sections 7.14.2.1 through to 7.14.2 .4). Mahila Arogya Samitis will act as community based groups in KFAs, involved in community mobilization, monitoring and referral. Existing community based institutions (CBO) could be utilized for the purpose. NUHM would provide untied grants and capacity building support to MAS/ CBOs. Total MAS to be done is 186 and for the first six months we are

expecting 30% of the MAS to be formed and oriented. Maximum 10000 per MAS for entire Orientation package, In the city 56 MAS will be formed in the Six moths.

Selection & Training of Urban ASHA

ASHAs may be engaged as per the norm of one ASHA for 200-500 households in slums. ASHA would serve as an effective and demand–generating link between the health facility and the urban slum population. However, the state has the flexibility to either engage ASHA or entrust the responsibilities to MAS/any other community based

organisation (CBO). Link Workers engaged presently under Urban RCH or any other programme (either supported by central government or by local government) may be continue to work under the same terms and conditions, but designated as ASHA and no additional ASHA may be deployed in such areas.We expect around 100% of the ASHAs (Total is 28) to be trained in the first 6 Months. Maximum Rs. 10000 per ASHA for entire training package. In the district total 28 urban ASHAs will be trained under NUHM.

UHNDs-

ANMs would provide preventive promotive health care services to households through routine immunization. Total 474 UHND sessions will be held in 66 AWC in 6 months at the city (Only in the area of Slums).

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Special outreach camps in slums/ vulnerable areas:-

Expansion of services through outreach camps to children by covering at least all govt. schools & AWW centres. Schools located in the slums would also be covered. During such sessions screening for birth defects, disease, disability &deficiency would be carried out &follow up actions would be initiated. Total 120 outreach camps other than UHND session have been planned in 6 months.

Urban PHC (UPHC)

1) One urban primary health centre (UPHC) may be planned for

every 50-60 thousand population. In case there is existing

infrastructure of UHC, UHP, etc., it may be upgraded and

strengthened as UPHC. Where none exists, new UPHCs will

have to be established. The new UPHCs will be located as close

to KFAs as possible and the catchment population needs to be

clearly defined. This will facilitate the provision of primary care

services in measurable terms.

2) Land for establishment of new UPHCs has to be identified and

provided by state Government/ULB. The cost of land shall not

be included in the total project cost for the purpose of

calculating the State share. NUHM would provide both capital

and recurrent cost for building, upgradation and maintenance

the UPHCs, as per the norms in the Framework for

Implementation. The land for such buildings has to be provided

free of cost. The OPD timings of the UPHC should cover the

evening hours (upto 8 pm). It may be covered in one afternoon-

evening shift. But UPHCs with higher case load (of more than

150 OPD per day) may run two shifts. The provision for second

doctor in the UPHC can be used innovatively like contracting

services of specialists in rotation (on fixed days in a week).

Similarly, the provision for 2 Staff Nurses can also be used

innovatively like one for general and RCH services, the second

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for non-communicable diseases and third only in case the UPHC

runs two shifts in a day. The same provision can also be used to

hire services of other paramedical staffs (like ophthalmologist,

dental technician, as may be needed). 01 HMIS/MCTS Operator

will be hired for each UPHC. 01 Computer system with Printer,

Computer table, Computer Chair.

3) INSTITUTIONAL STRENGTHENING

The existing institutional mechanism and management

structures created and functioning under NRHM would be

strengthened to meet the needs of NUHM. Minister(s) in charge

of Urban Development and Housing will be member(s) of the

State Health Mission. The State Health Society would co-opt

Secretaries of the Urban Development and Housing

departments as members. MD, NRHM will also function as MD,

NUHM. Urban Local Bodies/District Health Societies will be

responsible for implementation of NUHM in the cities and

towns. The state may decide to hand over implementation of

NUHM to the urban local bodies where sufficient capacity exists

for the same. Rs. 3 Lackhs per UPHC one time activity for rented

UPHCs purpose of equipments. Operating cost support for

running UPHC (other than untied grants and medicines,

consumables). Office expenses @ 10000 per month per UPHC.

Medicine and consumables @ 12.5 lacs per UPHC per year,

Untied grants @ 2.5 lakhs per year per UPHC. One medical team

(01 MBBS Doctor @ 36000 pm, 01 ANM @ 10000 pm, 01

Ophthalmic assistant @ 11880 pm). One vehicle will be hired @

25000 pm for school health team, Drug and consumables @ 8000

pm per team.

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1. City Level Indicators & Targets- Raebareli 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 * 0 56 0

2. Number of MAS members trained * 0 560 0

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

0 28 0

Health Systems

4. Number of ANMs recruited * 0 13 0

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

0 20 0

6. No. of UHNDs organized in the slums and vulnerable areas * 0 66 0

7. Number of UPHCs made operational * 0 4 0

8. Number of UCHCs made operational * 0 0 0

9. No. of RKS created at UPHC and UCHC * 0 4 0

Chief Medical Officer,

Raebareli.