National Urban Health Mission (NUHM) Scheme in India

The growing expenses of an urban lifestyle make it difficult to afford complicated healthcare treatments. According to Census 2011, the Indian urban population has increased to 37.7 crores, representing 31.16% of the entire population. Therefore, it urged the Indian Government to propose the idea of NUHM, and the Union Cabinet later approved it in 2013.

Are you wondering how to plan your expenses to afford healthcare treatments while residing in an urban household? In this article, you will find the ultimate government scheme that can manage both!

One of the popular healthcare schemes of the Indian Government, NUHM’s full form, is National Urban Health Mission. Its purpose is to enable poor residents in urban households to access healthcare services at an affordable price range. It comes under the National Health Mission, which outlines both National Rural and Urban Health Missions.

As the nursing and healthcare sector is getting more potent with technologies and scientific advancements, costs of services have also been increasing. Therefore, NUHM tries to meet the healthcare needs of the urban poor population. 

World Economic and Social Survey 2013 observed that if the current rate of urbanisation continues, 46% of the Indian population will be in urban areas by the end of 2030. Moreover, NFHS III (2005-06) data shows that 46% of urban children are underweight, and 60% lack total immunisation. It is thus more urgent for the government to take measures for helping the urban population in managing their healthcare expenses. The introduction of NUHM India started with tackling 779 districts having a population of 50,000 and has been expanding to reach more people ever since.

The NUHM scheme aims at solving the overall health concerns and expense issues among the urban population, particularly for poverty-stricken people. However, it can be an extensive and comprehensive process. Some of the immediate objectives of NUHM are as follows.

• Reduction in Infant Mortality Rate in the urban areas to 20 in 1000
• Decrease in Maternal Mortality Rate to 1 in 1000 in the urban areas
• Universal access to healthcare in urban areas, with 100% institutional delivery
• Achieving Total Fertility Rate of 2.1
• Meeting the targets of Disease Control Programmes

The National Urban Health Mission is critical in meeting the urban population's healthcare needs, especially for the vulnerable and poor people. It encompasses the following responsibilities:

Improving Healthcare Access

NUHM cells combat the healthcare deficiencies experienced by the cities. In particular, slum areas and other similar urban barriers are of concern.

Strengthening Urban Health Infrastructure

The mission is to enhance and improve existing urban health centers, develop new ones, and create conditions that fully meet the urban population's requirements for health services.

Promoting Preventive and Primary Healthcare

NUHM prioritises preventive, health education, and primary health care in tackling some diseases and lowering the disease burden in urban areas.

Community Health Workers (CHWs)

Linda describes developing and mobilising Community Health Workers (CHWs) central to the health service provision, community education, and resource mobilisation.

Targeting Urban Poor

NUHM also addresses the areas where most people live: many slum people, daily bread earners, and low-earning people who are not catered for by health services.

Addressing Urban Health Challenges

The mission addresses speciality-oriented problems such as urban development contributing to deficiencies in clean water, most urban issues such as maternal and child health, and the spread of diseases around the crowded city.

Coordination with State and Local Governments

NUHM collaborates with state and local governments to implement health programs effectively and ensure that urban health policies align with local needs and conditions.

NUHM aims to improve overall health outcomes in urban areas by focusing on these roles and ensuring that all urban residents, particularly those from disadvantaged backgrounds, access essential healthcare services.

The development of NUHM aims to make it easier for the urban population to treat their diseases and lead a healthy life without spending a large amount. Based on this, the following features of this scheme ensure that its target audience receives all the facilities.

Convergence for Communicable and Non-Communicable Diseases

NUHM provides convergence for most communicable and non-communicable diseases, including HIV/AIDS. It relies on integrated planning at the city level. The primary healthcare system is in charge of screening, diagnosing and referring cases of chronic diseases through secondary and tertiary levels. It also looks after detailed requirements regarding environmental health, vector control, sanitation, water, housing, and others.

Urban Social Health Activist (USHA)

The NUHM scheme requires all the slums and communities to have USHA community workers. These people are expected to deliver the required services at their doorsteps. Usually, a USHA worker resides in a slum, around 25-45 years of age. One worker looks after about 250-500 households, having around 1000-2500 beneficiaries. A USHA worker is a link between the facilities of an Urban Primary Health Centre and the slum population.

Auxiliary Nurse Midwife (ANM)

NUHM posts about 4-5 ANMs in each primary healthcare centre. They are responsible for conducting outreach sessions staying at a community level. These sessions include free check-ups, counselling and drug dispensing to the eligible population. The outreach sessions are specifically designed for the vulnerable urban population.

Urban Primary Health Centre (U-PHC)

A U-PHC should be located in a slum or at least within a 1km radius of one. At this level, few services include primary lab diagnosis, outpatient department (OPD) consultation, health education and counselling for communicable and non-communicable diseases, drug dispensing etc.

Urban Community Health Centre (U-CHC)

Every 4-5 U-PHCs come under the roof of a U-CHC. These come as satellite hospitals to provide 30-40 bedded patient services. Typically, cities with five lakhs or more residents have such centres. The government ensures at least one U-CHC for every 250,000 urban people.

Community-Based Groups

NUHM has several groups for serving different healthcare requirements in eligible communities. For instance, Mahila Arogya Samiti (MAS) promotes the necessity for health and hygiene behaviour change among the eligible population. It also looks after the risk pooling mechanism within the community. Instances are not rare when poor urban people become victims of debts and poverty only to afford healthcare expenses. Keeping this in mind, NUHM has developed Mahila Arogya Samitisto to pool monetary resources for sudden expenses of the community members in terms of their healthcare treatments.

Member of Parliament Local Area Development Scheme (MPLADS)

All members of the Legislative Council (MLAs) and Parliament (MPs), and Municipal Councillors (MCs) receive area development funds under NUHM. They can mobilise this fund, particularly for creating health facilities in urban areas they deem necessary. The underserved urban neighbourhoods should be equipped with advanced healthcare technologies, ambulances, Mobile Medical Units, etc.

The significance of NUHM is therefore undeniable in the Indian urban context. Urban people eligible for this mission can therefore avail following benefits while handling their healthcare expenses.

• Marginalised sections of this population can avail of cost-effective healthcare services.
• It helps prevent the spread of diseases with health thrust on social determinants, including vector control, sanitation and clean drinking water.
• It has increased disease awareness among the target audience and influenced them to visit government health centres for regular check-ups.
• The community groups maintain effective communication with the population to inform them about the services, availability of beds, procedures, etc.
• Existing institutional structures and arrangements are designed to suit city-specific needs under NUHM.

ICT usage in NUHM makes the services more efficient in registration, personal health records, supply chain of drugs, vaccines and logistics, etc.

While India's urban areas and people constitute its target audience, NUHM mainly focuses on the listed and unlisted slums residents. Professions such as rag-pickers, rickshaw pullers, workers in construction and brick and lime kiln, sex workers, etc., are considered eligible to receive National Urban Health Mission India benefits. This scheme also recognises street children, homeless people and temporary migrants of the urban areas. It covers all cities and districts with a population of over 50,000.

When individuals are eligible for NUHM, they can visit their municipality office to locate the closest U-PHC. In another case, if they are permanent residents of slums, they are more likely to find USHA workers who can guide them regarding their needs and steps to utilise healthcare benefits. Other than this, they can also visit the official website of the National Health Mission and find the workers' contact details at various levels after selecting their State/UTs.

Thus, a conclusion for the National Urban Health Mission can be that it has been a vital government initiative towards addressing healthcare expenses for the urban population. It helps control the rising costs of healthcare services and the inconveniences of accessing them for the vulnerable population. As a result, balancing a city life and expenses can become more manageable when handling healthcare treatments.