The Rs.4495-crore National Urban Health Mission (NUHM) project, envisioned by the Union health ministry around four years back to reverse the healthcare fortunes of over 60 million slum dwellers in the urban areas of the country, is still stuck in the bureaucratic red-tapism with the government yet not setting any time frame to launch the project.
“Launching of NUHM depends on various approvals including approval by Cabinet. In view of this, it will be difficult to lay down specific time frame for operationalising the NUHM”, minister of state for health and family welfare Sudip Bandyopadhyay said in Parliament.
The minister said that to incorporate the views of different stakeholders in the proposed NUHM, wider consultations with all stakeholders like state governments, ministry of urban development and ministry of housing and urban poverty alleviation etc. have already taken place.
In fact, the expenditure finance committee (EFC) of the union finance ministry way back in September, 2008 had approved the health ministry's proposal on NUHM, which is to be implemented on the lines of successful National Rural Health Mission (NHRM). But, the launch of the project was delayed as 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 was revisited again to incorporate the concerns of planning commission and the health ministry had already consulted the ministry of urban development and ministry of housing and urban poverty alleviation.
The NUHM will address the healthcare needs of urban dwellers including urban poor. It will also include institutional arrangements for its implementation, broad norms, financial resource need, appraisal and approval process, role of community organizations, defining standards for facilities and mechanism for engaging local health providers.
According to the initial proposal, the NUHM 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.