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  2. 1. INTRODUCTION • In India 377 million people live in urban places, out of which an estimated 97 million people live in urban poverty. • Rapid urbanization and the significant growth of urban poor population in absolute numbers already have new demands on the available infrastructure and service delivery mechanisms.
  3. 2. URBAN HEALTH SERVICES • The urban poor are a mix of people living in slums and the homeless. • Urban poverty is characterized by food insecurity, varied morbidity pattern, poor access to drinking water and sanitation, high costs of living and job insecurity. • All these aspects affect the health seeking behavior of the urban poor and in general the health.
  4. • The Urban Health Initiative (UHI) is part of a five-year, four country initiative supported by the Bill & Melinda Gates Foundation in Nigeria, Kenya, Senegal, and India.
  5. UHI India is a consortium of international, national, nongovernmental, and community-based organizations working together to improve the health of the urban poor
  6. 2.1.URBAN HEALTH INFRA STRUCTURE • The health care infrastructure in urban areas consists of the Community Health Centres and Primary Health Centres. • Population norms for • Community health center- 2,50,000 population • Primary health center- 50,000 population
  7. 2.1.1.URBAN PRIMARY HEALTH CENTER • In order to provide comprehensive primary healthcare services, the National Urban Health Mission aims to establish Urban Primary Healthcare Centres, not as a stand-alone health facility, but as a hub of preventive, promotive and basic curative healthcare for its catchment population. • Within its catchment area, the UPHC is responsible for providing the primary health care and public health needs of the population. The U-PHC is located preferably closer to slum or similar habitations
  8. • The hours of operation may be such so as to enable the urban working population to conveniently access the UPHC sevices. States may opt for any suitable timing, 8 hours of services, which are convenient to the community. It is recommended that the UPHC operates preferably from12 noon to 8 pm or in dual shifts (i.e. 8am to 12pm and 4pm to 8pm); Dual shift timing of UPHC could be flexible with the ability to be modified according to the catchment communities.
  9. • The package of services envisaged at UPHC inclusive of preventive, promotive, curative, rehabilitative and palliative care. Further, in order to strengthen Comprehensive Primary Health Care across the country through “Ayushman Bharat-HWCs”, states are upgrading their Primary Health Care centers as Health and Wellness Centres (HWCs)
  10. FUNCTIONS OF UPHC • Medical care • MCH and family planning • Prevention and control of communicable diseases. • Safe drinking water • Environmental sanitation • Dietary services
  11. 2.1.2. URBAN COMMUNITY HEALTH CENTER • Urban Community Health Centre (U-CHC) is set up as a referral facility for every 4-5 U-PHCs. The U-CHC caters to a population of 250000 to 5 Lakhs. For the metro cities, UCHCs may be established for every 5 lakh population with 100 beds. In addition to primary health care facilities, it provides inpatient services, medical care, surgical facilities and institutional delivery facilities. It is a 30-50 bedded facility.
  12. 3.1.WHAT ARE SLUMS? • A slum is a heavily polluted urban informal settlement characterized by substandard housing and squalor. • OR • Slum is an predominantly a n overcrowded area where dwelling are unfit for human habitation.
  13. • City slums are characterized by poor access to clean water and adequate sanitation, the basic requirements for maintaining good hygiene and robust health.
  14. 3.2.CAUSES OFSLUM Rapid industrialization :The worker employed in the factories generally make their habitation as near possible to the place ofwork. • Hence in a short time the available land or open spaceis occupied without any proper planning. Population growth : • There is a lag between the tremendous growth of population and the construction of house. These shortages main fest themselves in creatingslum.
  15. Poverty:-The main cause of slum formation can be described on one word aspoverty. • For poor people it is difficult to pay heavy rent for decent living. Theymove in slum area. Education:- if they inhabitants are lacking in education ,they may be easily dragged into social evils without any attention to improvement of livingcondition.
  16. Poor housing planning Lack of affordable low cost housing and poor planning encourages the supply side of slums. Insufficient financial resources and lack of coordination in government bureaucracy are two main causes of poor housing planning.
  17. Rural-Urban Migration Rural-urban migration is one of the causes attributed to the formation and expansion of slums. Many people move to urban areas primarily because cities promise more jobs, better schools for poor's children, and diverse income opportunities than subsistence farming in rural area.
  18. 3.3.HEALTHDELIVERYSYSTEMINURBAN SLUMS • The government of India appointed the Krishnan Committee in 1982 to address the problems of urban health. • The health post scheme was devised for urban areas based on the recommendations of the Krishnan Committee. Its report specifically outlines which services have to be provided by the health post .
  19. Cont… • These services have been divided into outreach, preventive, family planning, curative, support (referral) services and reporting and record keeping.
  20. Cont… • Outreach services include population education, motivation for family planning, and health education. In the present context, very few outreach services are being provided to urban slums.
  21. • A municipal corporation covers a population of above three lakh; there are three types of municipal councils – (A) 1 lakh population, (B) 40,000 to 1 lakh and (C) less than 40,000. Primary health services are provided in urban areas through health posts. • There are four types of health posts (A, B, C and D) according to population size (as per GoI guidelines).
  22. Cont…. According to the Krishnan Committee recommendations, the health post was to be located ‘in’ slum areas. The committee had recommended one voluntary health worker (VHW) per 2,000 population with an honorarium of Rs 100.
  23. 4.URBAN REVAMPING SCHEME • Urban revamping scheme was introduced following recommendations by Krishnan committee 1983 . • To provide primary health care, family welfare, service delivery outreach and MCH services in urban areas. • HEALTH POSTS: • There are 871 health posts functioning in 10 States and 2 UTs.
  24. 4.1.URBAN HEALTH POST • The urban health post (HP) scheme was launched in 1983-84. A deputy director and joint director were assigned to urban health, but functioned chiefly to promote family planning goals. • The scheme is centrally funded, and the financial provisions at present continue to be the same as those 15 years before.
  25. 4.2.TYPES OF URBAN HEALTH POST • TYPE A : POPULATION LESS THAN 1000(provide services such as medical services and spacing of births) • TYPE B :POPULATION 5000-10000(covers the area with termination of pregnancy, sterilization) • TYPE C:POPULATION 10000-25000(population with follow up services) • TYPE D:POPULATION 25000-50000(covers the areas with population centres at district and sub divisional levels)
  26. 4.3. FUNCTIONS • Medical care • MCH and family planning. • Prevention and control of communicable diseases. • Safe drinking water. • Environmental sanitation. • Dietary services.
  27. 5. DISPENSARY • A dispensary is an office in a school, hospital or other organization that dispenses medications and medical supplies. • In a traditional dispensary set-up a pharmacist dispenses medication as per prescription or order form.
  28. 5.1.STAFFING PATTERN • Medical Officer • Nurse midwife • Male health assistant • Female health assistant • Male health worker • Female health worker •Pharmacist •Lab technician •Store keeper •Watchman •Driver •Cook
  29. 6.URBAN FAMILY WELFARE CENTRES • Urban Family Welfare Centers are onground since First FiveYearPlanto provide family welfare services in urbanareas • Most of UFWCs are equipped to provide contraceptive supplies. At present 1083 centers are functioning. • There are three types of Urban FamilyWelfare centers basedon the population covered by each centre.
  30. 6.1.STAFFING PATTERN FOR URBAN FAMILY WELFARE CENTERS TYPE POPULA TION COVERED NO. UNITS StaffingPattern TypeI 10000 - 25000 326 ANM -1, FPField Worker -1 TypeII 25000 - 50000 125 FPExtensionEducat or/LHV -1FPField Worker(Male) -1 ANM -1 TypeIII Above50000 632 Medical Officer -1(Pref. Female) ANM - 2, LHV- 1, FPField Worker (Male) - 1 , Storekeeper
  32. SPECIAL CLINICS • Special clinic provides advanced diagnostic or treatment services for specific diseases or part of the body. • They provide outpatient clinics, medical and counselling services for certain specific disorder. • Specialist doctors and nurses are essential for conducting these clinics.
  33. SPECIALTY CLINICS • A sexual health clinic • A fertility clinic • An ambulatory surgery clinic • An abortion clinic
  34. URBAN ADMINISTRATION • Municipal board • Municipal corporation • Town area committee
  35. MUNICIPAL BOARD • Municipal boards are setup in the areas having population between 10000-200000. • The municipal board is headed chairman , president , elected usually by its members. • The term of the members ranges from 3-5 years.
  36. • The municipal board looks after , • Sanitation • Drainage • Water supply • Construction and maintenance of roads • Registration of birth and death • Running of hospitals and dispensaries • Education .
  37. MUNICIPAL CORPORATION • Corporations are setup in the areas having population more than 2,00,000. • The corporation is headed by a mayor • It members are councillors who are elected from various wards of the city. • It carries the similar function or that of municipal board but on a large and wide scale.
  38. TOWN AREA COMMITTEE • The town area committee are set up in areas having population in the range of 5000- 10000. • These are like panchayat and provide sanitary services in area.
  39. 7. CONCLUSION • It envisages to meet health care needs of the urban population focusing on urban poor by making available to them essential primary health care their by reducing out of pocket expenditure for the treatment
  40. EXPECTED QUESTIONS • ESSAY • Explain about delivery of health services in urban area • SHORT NOTES • Slums • SHORT ANSWERS • Population coverage of urban PHC and CHC • Types of urban health post