URBAN -
ORGANIZATION,
STAFFING AND
FUNCTION OF URBAN
HEALTH SERVICES

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.

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.

• 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.

UHI India is a consortium of international, national,
nongovernmental, and community-based
organizations working together to improve the
health of the urban poor

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

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

• 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.

• 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)

FUNCTIONS OF UPHC
• Medical care
• MCH and family planning
• Prevention and control of communicable
diseases.
• Safe drinking water
• Environmental sanitation
• Dietary services

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.

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.

• City slums are characterized by poor access
to clean water and adequate sanitation, the
basic requirements for maintaining good
hygiene and robust health.

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.

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.

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.

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.

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 .

Cont…
• These services have been divided into
outreach, preventive, family planning, curative,
support (referral) services and reporting and
record keeping.

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.

• 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).

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.

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.

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.

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)

4.3. FUNCTIONS
• Medical care
• MCH and family planning.
• Prevention and control of communicable diseases.
• Safe drinking water.
• Environmental sanitation.
• Dietary services.

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.

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

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.

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

Cont.
TYPEOFHEAL
THPOST NO. OFHEAL
THPOSTS
A 65
B 76
C 165
D 565

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.

SPECIALTY CLINICS
• A sexual health clinic
• A fertility clinic
• An ambulatory surgery clinic
• An abortion clinic

URBAN ADMINISTRATION
• Municipal board
• Municipal corporation
• Town area committee

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.

• 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 .

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.

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.

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

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

THANK YOU