The union health ministry's ambitious Rs 4495-crore National Urban Health Mission (NUHM) project, aimed to reverse the healthcare fortunes of over 60 million slum dwellers in the urban areas of the country, is stuck in the bureaucratic red-tapism. Even after two years since the Centre sanctioning Rs 4495 crore for the project, the health ministry is yet to launch the project.

According to senior officials in the union health ministry, the ministry's proposal on NUHM, which is to be implemented on the lines of successful National Rural Health Mission (NHRM), was approved by the expenditure finance committee (EFC) of the union finance ministry way back in September, 2008. However, the planning commission suggested for considering many other aspects which influence both access and quality of public health services delivery including good practices that are followed in some countries.

The framework of NUHM has been revisited again to incorporate the concerns of planning commission and the ministry has consulted the ministry of urban development and ministry of housing and urban poverty alleviation.

"In view of above, no specific time frame can be given for launch of NUHM", a senior health ministry official said.

The programme will be implemented on a public-private partnership mode. All cities with population above one lakh and state capitals would be covered under it. As many as 430 cities with a total population of 22 crore with focus on 6.25 crore population in the listed and unlisted slums would get the benefits.

The vulnerable population such as homeless, rag-pickers, street children, rickshaw pullers, construction and brick kiln workers, sex workers and any other temporary migrants would be identified by the Urban Local Body (ULB) concerned or any other State specific mechanism and shall be issued a photo Family Health Card.

Though, no person would be denied service in the public health facilities, marginalized urban families identified under the scheme would receive service on concession terms under NUHM. Synergies are envisioned with Jawaharlal Nehru Urban Renewal Mission (JNNURM), Integrated Child Development Scheme (ICDS) Swarna Jayanti Sharkari Rozgar Yojana (SJSRY), etc. and with the ongoing National Health Programmes for maximizing benefits, sources said.

As per 2001 census, 28.6 crore people live in urban areas, out of which 3.26 crore live in slum areas of the cities/towns having a population of 1 lakh and above. However, as per the latest estimates, it has crossed five-crore mark.

For urban poor, access to urban health facilities are severely restricted due to their being 'crowded out' because of the inadequacy of the public health delivery system. Lack of economic resources restrict their access to private facilities while lack of standards and norms for urban health delivery, illegal status, poor environmental condition, over crowding and environmental pollution make them more vulnerable and worse off than rural counterparts.