New Delhi: India’s flagship health programme focused on city slums, the National Urban Health Mission (NUHM), has become a casualty of a bureaucratic logjam and inter-ministry turf issues.
The Union ministry of health and family welfare’s policy initiative, which was originally scheduled for an April launch, is now expected to take off by early October after ironing out the overlaps this scheme has with programmes such as the Rashtriya Swasthya Bima Yojana and the Jawaharlal Nehru National Urban Renewal Mission (JNNURM).
Check-up: A view of Asia’s biggest slum Dharavi in Mumbai. Malnutrition levels are the highest among the urban poor and more than 60% children in urban slum communities did not receive all the vaccinations. Photograph: Madhu Kapparath / Mint
“NUHM is scheduled for a late-September or an early October launch as of now,” said a senior health ministry official close to the development, agreeing that there had been a delay in the roll-out over a missing “need for convergence” between various government departments.
The official, who did not want to be identified, added that the Planning Commission, the apex body for economic planning in the government, had approved Rs4,500 crore until 2012 for NUHM.
The programme, which aims to target some 80 million urban poor who are estimated to be growing at 5-7% annually, will be fully funded by the Centre in the first year of launch, but will require participation from state governments and local municipal bodies later.
Siddharth Agarwal, executive director of Urban Health Resource Centre, a New Delhi-based non-government agency and technical consultants to NUHM, said discussions had begun between the health and urban ministries to collaborate on the common ground between their initiatives.
“Despite an increasing purchasing power in the cities, the poorest one-fourth or one-fifth of the population is still deprived either because they don’t have the financial or the social access to the basic health care facilities” around them, he added.
One example of overlaps between the government schemes is the ministry of labour and employment’s Rashtriya Swasthya Bima Yojana, a health insurance scheme for the so-called below poverty line (BPL) sections of the population. The smart card-based scheme aims to provide benefits and cashless medical cover up to Rs30,000 yearly for a BPL family of five.
Under its plan, NUHM, too, provisions for health insurance for urban poor through what it calls “Family Health Suraksha” cards that will cover hospitalization charges, surgical procedures as well as pre-existing diseases for a small, yet-to-be-finalized sum paid as premium.
A second instance is the significant overlap in coverage of cities and services that JNNURM, administered by the ministry of urban employment and poverty alleviation, has with NUHM. The former has identified 63 cities — based on population, historical or tourist importance — to provide or upgrade civic amenities such as sanitation, health, environmental improvement of slums, urban renewal and transportation. Some of the cities identified under NUHM — the health ministry plans to launch the programme in 100 cities in the first year out of the 427 cities it wants to cover — and JNNURM are common.
The health ministry initiative also envisages urban health centres — one for every 50,000 people — and that may now have to be embedded in the health facilities being planned under the urban ministry’s project “in order to avoid duplication of work”, explained the official.
Another factor delaying NUHM is that as much as half of the urban slums in the country, the health ministry found in its surveys, are not notified and, therefore, could fall out of the purview of NUHM. The ministry is using so-called geographical information systems, which use satellite-based technology, to map the slums accurately, the official added.
NUHM is part of a massive hike in the provision for the health sector under the government’s 11th Plan running until 2012. The 11th Plan has projected an allocation of Rs1.24 trillion for health care spending — almost thrice the allocation of Rs45,771 crore spent in the 10th Plan.
According the Urban Health Resource Centre, which based its analysis on government data, mortality of children among the urban poor under the age of 5 is 72.7 deaths for every 1,000 births, and considerably higher than the urban average of 41.8.
Malnutrition levels are the highest among the urban poor at 54.2%—higher than 50.7% in rural areas—and more than 60% children in urban slum communities did not receive all the vaccinations.