COURSE: B.

SC NURSING
SUBJECT: COMMUNITY HEALTH NURSING
UNIT-III
TITLE: URBAN-ORGANIZATION ,STAFFING AND
FUNCTION OF URBAN HEALTH SERVICES
PROVIDED BY THE GOVERNMENT
PREPARED BY: NALINI.K.J. M.Sc(N),
ASSISTANT PROFESSOR
 OBJECTIVES

Students are able to

•Introduce about urban welfare services
•Explain about urban slums
•Describe about urban health post
•Explain about dispensary
•Describe about urban family welfare centres
 UNIT CONTENTS
1. Introduction 4.Urban revamping
2. Urban health scheme
services 4.1. Urban health post
2.1. Urban primary 4.1.1. Types
health center 4.1.2. Functions
2.2. Urban community 5. Dispensary
health center 5.1. Staffing pattern
3. Slums 6. Urban Family welfare
3.1. what are slums centres
3.2. Causes of slums 6.1. Staffing pattern
3.3. Health delivery
services in slum 7.Conclusion
area
 1. INTRODUCTION

• In India 377 million people live in urban places,

out of which an estimated 97 million people live in
urban poverty.

• Rapid urbanization and the significant growth of

urban poor population in absolute numbers
already have new demands on the available
infrastructure and service delivery mechanisms.
 2. URBAN HEALTH SERVICES

• The urban poor are a mix of people living in

slums and the homeless.

• Urban poverty is characterized by food

insecurity, varied morbidity pattern, poor
access to drinking water and sanitation, high
costs of living and job insecurity.

• All these aspects affect the health seeking

behavior of the urban poor and in general the
• The Urban Health Initiative (UHI) is part of a
five-year, four country initiative supported by
the Bill & Melinda Gates Foundation in
Nigeria, Kenya, Senegal, and India.
UHI India is a consortium of international, national,
nongovernmental, and community-based
organizations working together to improve the
health of the urban poor
 2.1.URBAN HEALTH INFRA
STRUCTURE

The health care infrastructure in urban areas

consists of the Community Health Centres and
Primary Health Centres.
Population norms for
•Community health center- 2,50,000 population
•Primary health center- 50,000 population
 2.1.1.URBAN PRIMARY HEALTH
CENTER
In order to provide comprehensive primary
healthcare services, the National Urban Health
Mission aims to establish Urban Primary Healthcare
Centers, not as a stand-alone health facility, but as
a hub of preventive, promotive and basic curative
healthcare for its catchment population.
Within its catchment area, the UPHC is responsible
for providing the primary health care and public
health needs of the population. The U-PHC is
located preferably closer to slum or similar
habitations
The hours of operation may be such so as to enable
the urban working population to conveniently
access the UPHC sevices. States may opt for any
suitable timing, 8 hours of services, which are
convenient to the community. It is recommended
that the UPHC operates preferably from12 noon to
8 pm or in dual shifts (i.e. 8am to 12pm and 4pm to
8pm); Dual shift timing of UPHC could be flexible
with the ability to be modified according to the
catchment communities.
The package of services envisaged at UPHC
inclusive of preventive, promotive, curative,
rehabilitative and palliative care. Further, in order to
strengthen Comprehensive Primary Health Care
across the country through “Ayushman Bharat-
HWCs”, states are upgrading their Primary Health
Care centers as Health and Wellness Centres
(HWCs)
 2.1.2. URBAN COMMUNITY HEALTH
CENTER
Urban Community Health Centre (U-CHC) is set up
as a referral facility for every 4-5 U-PHCs. The U-
CHC caters to a population of 250000 to 5 Lakhs.
For the metro cities, UCHCs may be established for
every 5 lakh population with 100 beds. In addition to
primary health care facilities, it provides inpatient
services, medical care, surgical facilities and
institutional delivery facilities. It is a 30-50 bedded
facility.
 3.1.WHAT ARE SLUMS?
A slum is a heavily polluted urban informal
settlement characterized by substandard
housing and squalor.
OR
Slum is an predominantly an overcrowded area
where dwelling are unfit for human habitation.
• City slums are characterized by poor access
to clean water and adequate sanitation, the
basic requirements for maintaining good
hygiene and robust health.
 3.2.CAUSES OF SLUM

Rapid industrialization :The worker employed in the

factories generally make their habitation as near
possible to the place of work.
• Hence in a short time the available land or open
space is occupied without any proper planning.

 Population growth :
• There is a lag between the tremendous growth of
population and the construction of house. These
shortages main fest themselves in creating slum.
Poverty:-The main cause of slum formation can
be described on one word as poverty.

• For poor people it is difficult to pay heavy rent

for decent living. They move in slum area.

Education:- if they inhabitants are lacking in

education ,they may be easily dragged into
social evils without any attention to
improvement of living condition.
Poor housing planning

 Lack of affordable low cost housing and

poor planning encourages the supply side
of slums.
 Insufficient financial resources and lack of
coordination in government bureaucracy are
two main causes of poor housing planning.
 Rural-Urban Migration
 Rural-urban migration is one of the causes
attributed to the formation and expansion of
slums.
 Many people move to urban areas primarily
because cities promise more jobs, better
schools for poor's children, and diverse
income opportunities than subsistence
farming in rural area.
 3.3.HEALTH DELIVERY SYSTEM IN URBAN
SLUMS

• The government of India appointed the Krishnan

Committee in 1982 to address the problems of
urban health.

• The health post scheme was devised for urban

areas based on the recommendations of the
Krishnan Committee. Its report specifically outlines
which services have to be provided by the health
post .
 Cont
…
• These services have been divided into
outreach, preventive, family planning, curative,
support (referral) services and reporting and
record keeping.
 Cont…
• Outreach services include population
education, motivation for family planning, and
health education. In the present context, very
few outreach services are being provided to
urban slums.
• A municipal corporation covers a population of
above three lakh; there are three types of municipal
councils – (A) 1 lakh population, (B) 40,000 to 1
lakh and
(C) less than 40,000. Primary health services
are provided in urban areas through health
posts.

• There are four types of health posts (A, B, C and D)

according to population size (as per GoI guidelines).
 Cont….

According to the Krishnan Committee

recommendations, the health post was to be located
‘in’ slum areas.

 The committee had recommended one voluntary

health worker (VHW) per 2,000 population with

an honorarium of Rs 100.
 4.URBAN REVAMPING SCHEME
• Urban revamping scheme was introduced following
recommendations by Krishnan committee 1983 .

• To provide primary health care, family welfare,

service delivery outreach and MCH services in
urban areas.

• HEALTH POSTS:

• There are 871 health posts functioning in 10 States

and 2 UTs.
 4.1.URBAN HEALTH POST

• The urban health post (HP) scheme was launched in

1983-84. A deputy director and joint director were
assigned to urban health, but functioned chiefly to
promote family planning goals.

• The scheme is centrally funded, and the financial

provisions at present continue to be the same as those
15 years before.
 4.2.TYPES OF URBAN HEALTH POST
TYPE A : POPULATION LESS THAN 1000(provide
services such as medical services and spacing of births)
TYPE B :POPULATION 5000-10000(covers the area
with termination of pregnancy, sterilization)
TYPE C:POPULATION 10000-25000(population with
follow up services)
TYPE D:POPULATION 25000-50000(covers the areas
with population centres at district and sub divisional
levels)
 4.3. FUNCTIONS

• Medical care

• MCH and family planning.

• Prevention and control of communicable diseases.

• Safe drinking water.

• Environmental sanitation.

• Dietary services.
 5. DISPENSARY

• A dispensary is an office in a school,

hospital or other organization that
dispenses medications and medical
supplies.

• In a traditional dispensary set-up a pharmacist

dispenses medication as per prescription or
order form.
 5.1.STAFFING PATTERN
• Medical Officer
• Nurse midwife • Pharmacist
• Lab technician
• Male health
• Store keeper
assistant
• Watchman
• Female health • Driver
assistant • Cook
• Male health
worker
• Female health
worker
 6.URBAN FAMILY WELFARE CENTRES
• Urban Family Welfare Centers are on ground since
First Five Year Plan to provide family welfare
services in urban areas
• Most of UFWCs are equipped to provide
contraceptive supplies. At present 1083
centers are functioning.
• There are three types of Urban Family Welfare
centers based on the population covered by each
centre.
 6.1.STAFFING PATTERN FOR URBAN FAMILY
WELFARE CENTERS
POPULATIO
TYP NO. UNITS Staffing
N
E Pattern
COVERED ANM -1, FP
Type 10000 - 326
Field Worker -1
I 25000
FPExtensionEducat
or/LHV -1FP Field
Type 25000 - 125
Worker(Male) -1
II 50000
ANM -1
Medical Officer
-1(Pref. Female)
ANM - 2, LHV -
Type Above 632 1,
III 50000 FP Field Worker
(Male) - 1 ,
 Cont
TYPE OF HEALTH POST . NO. OF HEALTH POSTS
A 65
B 76
C 165
D 565
 7. CONCLUSION

It envisages to meet health care needs of the urban

population focusing on urban poor by making

available to them essential primary health care

their by reducing out of pocket expenditure for the

treatment
 EXPECTED QUESTIONS

ESSAY
•Explain about delivery of health services in urban
area
SHORT NOTES
•Slums
SHORT ANSWERS
•Population coverage of urban PHC and CHC
•Types of urban health post
THANK YOU