Student Dissertation

Agency : ASHA; AWW; ANM; UHC

Objective : NUHM would endeavor to achieve its goal through: - • Need-based city specific urban health care system to meet the diverse health care needs of the urban poor and other vulnerable sections. • Institutional mechanism and management systems to meet the health-related challenges of a rapidly growing urban population. • Partnership with the community and local bodies for more proactive involvement in planning, implementation, and monitoring of health activities. • Availability of resources for providing essential primary health care to urban poor. • Partnerships with NGOs, for profit and not for profit health service providers and other stakeholders.

Background : The Government of India has launched the National Urban Health Mission (NUHM) as a submission under the National Health Mission (NHM), the National Health Mission (NHM) being the other submission. NUHM envisages meeting health care needs of the urban population with the focus on urban poor, by making available to them essential primary health care services and reducing them out of pocket expenses for treatment. This will be achieved by strengthening the existing health care service delivery system, targeting the people living in slums and converging with various schemes relating to wider determinants of health like drinking water, sanitation, school education, etc. implemented by the Ministries of Urban Development, Housing & Urban Poverty Alleviation, Human Resource Development and Women & Child Development.

Methodology : Study Design: Cross-sectional Study Source of Data: It was a mixed method study. It needed both quantitative and qualitative data. For the objective 1 Quantitative data was collected by past records of e Mamta For objective 2 Qualitative data was collected by an in-depth interview from MO and beneficiaries, Setting: All the (five) urban health centers of District Bharuch, Gujarat Duration of Study: 3 months (1-Feb-2018 to 30-Apr-2018) Sample Selection: Objective 1: Health record on all the selected indicators, Objective 2: Total sample size was150 out of those 30 beneficiaries (ANC, Immunization, and Medication) from each center. Inclusion criteria: Beneficiaries data available on e-mamta and beneficiaries available on centre, Exclusion criteria: beneficiaries refuse to provide information. DATA COLLECTION PROCEDURE: the data available on e-Mamta and in-depth interview with MO and beneficiaries.

Findings : Objective 1 A study was conducted on Analysis of gaps and perception of beneficiaries regarding infrastructure and services at UHC at Bharuch district, Gujarat 2017 -18. Study found that urban health centre at Dholikui and lalbazzar are comparatively better than other three urban health centres. Around 91 percent of human resource is available at all the UHC of the districts but the key post like the medical officer is 50 percent filled. OPD coverage is lacking behind in Lalbaazar UHC as compare to other UHC’s due to unavailability of the full-time medical officer. Moreover, around 43 percent of diabetes screening is done at Ankleshwar-1 UHC that is quite less as expected but Ankleshwar- 1 is performing better in this indicator than other UHC’s. This shows that field services provided by the urban health centers are not up to the expected level. Moreover, data related to other services provided shows that four ANC visits decreased from 1st to 4th ANC except for Ankleshwar UHC as migration population is more in Ankleshwar due to GIDC area. However, around 22 percent and 23 percent of the ANC are at high risk in Ankleshwar-1 and Ankleshwar-2 respectively as compare to the other three UHC’s. Out of those high-risk mothers at Ankleshwar-1 and Ankleshwar -2 around 64 percent and 65 percent ANC are anemic. Further data shows that PNC services are quite well at all the UHC’s but Ankleshwar-1 and Ankleshwar-2 UHC shows 126 percent and 153 percent due to migrated population. Furthermore, around 87 percent coverage of routine immunization is achieved at three i.e. Dholikui, lalbaazar and Vejalpur UHC’s except both UHC’s at Ankleshwar is achieving more than 100percent due to migrated population. Around 19 percent average LBW babies are present in urban areas of the district. Further data shows that average screening for SAM children is 99 percent at all UHC’s of the district, but total SAM children identified are less than 1 percent that shows underreporting of the data. Further data shows that children refer to CMTC is 100 percent. The further table shows that SRB of the urban sector is 828. Objective 2 A study related to the perception of beneficiaries regarding services provided at the UHC of Bharuch district shows that information provided by ASHA for ANC visit is 100 percent at Lalbaazar UHC as compare to other UHC which is 70 percent, 40 percent, and 10 percent at Ankleshwar-1, Dholikui, Ankleshwar-2 UHC respectively. This graph shows that 100 percent e mamta session planned at the same place at Vejalpur UHC and 70 percent at Dholikui UHC which is least among all which is one of the reasons for reducing 4th Anc visit. Around 20 percent of respondents respond to the side effects due to earlier vaccination. Further data shows that less than 30 min takes by the health provider to provide medication for the side effects. Further data shows that ANM of Ankleshwar-2 provides information about side effects of vaccination to only 89 percent respondents. The above data shows that around 80 percent of deliveries occur at a private institute in Dholikui and Ankleshwar-1 UHC. Around 10 percent of parents missed the Immunization of their child due to personal issues. Respond related to medication shows that more than 90 percent of centers are providing services within 30 min. Vejalpur is lagging behind in comparison to other centers. Further data suggest that 11 percent of respondents of the Lalbaazar do not satisfy with the behavior of the doctor. Moreover, 22 percent of respondents from the Lalbaazar do not prefer to buy medicine from the Government pharmacy.

Recommendations : There is no doubt to the fact that UHCs can play a vital role in the health of the urban population that too in urban slum population which is the ignorant part of the society. For this to happen, it becomes important to provide infrastructure and human resource to perform adequate functions. it becomes important to strengthen our screening procedures, both at the community and facility level. This study makes us realize the importance of infrastructure and human resource available in the Centre and engagement of the field staff for providing ANC, immunization and field services like sample collection. The field level staff should be periodically sensitized regarding the program and its associated benefits. Once the screening and referral procedures are taken care of, it becomes necessary to develop effective strategies for supportive supervision and monitoring The authorities that have the power to bring transformation, as well as the key policymakers, should take a keen interest in developing innovative approaches to address various barriers and challenges affecting the successful implementation of the program under NUHM. At the same time, they should be actively involved in solving the various managerial issues related to finance and Human Resources that often go unnoticed and neglected. Thus, in conclusion, we can say that, with consolidated efforts from all the key stakeholders at various levels of the healthcare system, Urban Health Centres be established as an effective intervention to tackle the need of urban population and also leads to change in their perception regarding services provided by the staff of UHC. That render good health and well-being to all its beneficiaries.

NUHM would cover all State capitals, district headquarters and cities/towns with a population of more than 50000. It would primarily focus on slum dwellers and other marginalized groups like rickshaw pullers, street vendors, railway and bus station coolies, homeless people, street children, construction site workers. [1] The urban center of Bharuch district established in 2013. There are five Urban Health Centers in Bharuch district. Their names and population coverage according to the Census 2011 is as follows. S No. Urban Health Centre name Population coverage 1 UHC, Dholikui 43490 2 UHC, lalbazaar 46514 3 UHC, Vejalpur 45725 4 UHC, Ankleshwar-1 47075 5 UHC, Ankleshwar-2 42031 The study was conducted to find out the gaps on infrastructure and various service indicators which are as follows: I. Infrastructure • Building • Human resource II. Service provided Indicators • OPD services • A sample was taken (blood sample, sputum, diabetes screening) • Maternal death • Infant death • ANC registration • PNC check up • HBNC • Immunization • ANC corticosteroids • LBW babies • SAM • CMTC admission. • Sex ratio at birth • High-risk mother