National Urban Health Mission draft.

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National Urban Health Mission draft

Posted by: "Abhay" abhayseema

Sun Mar 23, 2008 5:51 am (PDT)

Dear friends,The draft document of the National Urban Health Mission is now available on the NRHM website and can be downloaded at -http://mohfw. nic.in/NRHM/ NUHM%20%20March% 2009-08.docSome key issues that are evident are:- While it talks of strengthening existing public health facilities in urban areas, there is no plan to expand the presently very weak urban public health services. Since existing public health services are quite sparse in most urban areas, this means that the delivery of services in NUHM would depend to a large extent on 'partnership' with private providers.- The major emphasis on PPPs (euphemistically called 'partnership with non government sector') is evident in the document, this includes possibility of transferring public health facilities to private

providers. The following points are given in an 'indicative list of partnerships' based on the task force report on urban health:"§ In cities or parts of a city where no public sector first tier facility is available, the entire first tier service delivery component may be transferred to a non government provider with requisite capacity. § Private medical practitioners may also be engaged on part-time basis for first as well as second tier facilities (based on the experience in IPP VIII in Kolkata and neighboring cities). § The FRU level services and diagnostic services may be outsourced to private medical facility on reimbursement basis. A uniform rate list needs to be developed in mutual consultations. The NCMH costing as provided in the Appendix IV may be a good source to begin with. Wherever worthwhile and feasible, second tier services can also be contracted out to private/ charitable hospitals, with proven

credentials.§ Government may transfer an existing health care facility to non government agency with some infrastructure (including drugs/ equipment) support and the non government provider may take responsibility of management including staff and supplies." - Another key basis of NUHM appears to be community risk pooling by 'Mahila Arogya Samitis' where urban poor women would be expected to regularly contribute money to meet their families health care needs. Further, for health insurance, NUHM would provide subsidy upto Rs. 600 per year in case of persons from urban slums and vulnerable groups, yet "Additional cost of the subsidy (if premium quoted by insurance company is higher than Rs.600 per family) may be paid by the state/district/ ULB and/or the beneficiaries themselves". The proposed insurance plan needs careful analysis, especially given the poor track record of previous official 'targetted' insurance shemes, the likely

required contribution from poor families themselves, and the implications for those not recieving the subsidy, and for those who happen to not be insured such as migrant workers. It is not clear as to whether primarily BPL families will recieve the subsidy, or this will be available to all needy families in urban areas (those not recieving subsidy would be expected to pay full premiums at commercial rates).I have attached the executive summary of the NUHM draft and the indicative list of partnerships given in this document. It is definitely high time that the approach of NUHM is discussed in JSA and we formulate a response, to be definitely communicated to decision makers before this major programme is finalised and implemented on a national scale.With regards,Abhay

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