Draft PIP of LUCKNOW - NATIONAL URBAN HEALTH …nuhm.upnrhm.gov.in/urban/pip/mirzapurpip.pdfMirzapur...

Mirzapur City

Program Implementation Plan

National Urban Health Mission

Prepared by District Health Officials with support from Urban Health Initiative

Contents 1- District Profi le- ..................................................................................................................................... 7

1.1 LOCATION, BOUNDRIES, AREA AND POPULATION ............................................................. 7

1.2 HISTORY OF THE DISTRICT AS AN ADMINISTRATIVE UNIT- ............................................ 8

1.3 SUBDIVISIONS, TEHSILS AND POLICE STATIONS .............................................................. 8

1.4 Blocks Name – ................................................................................................................................. 8

1.5-Block Position in the District—........................................................................................................ 9

1.6 District Mirzapur at A Glance ( Comparison of 2001 and 2011)................................................ 9

2- SITUATION ANALYSIS OF URBAN AREA MIRZAPUR.............. 10

2.1- Nagar Palika Mirzapur (Mirzapur and Vindhyachal city) ......................................................... 10

2.2-Population, Literacy Rate & Sex Ratio – Mirzapur City ............................................................ 11

2.3-Demographic profile of Mirzapur City .......................................................................................... 11

2.4-Nagar Panchayat Kachhnwa- ....................................................................................................... 11

2.5- Nagar panchayat chunar ............................................................................................................. 12

2.6- Nagar panchayat Ahraura ............................................................................................................ 12

2.7- Urban area Selected Under NUHM Programme-..................................................................... 12

2.8-Urban Poor & Slums of Mirzapur City- ........................................................................................ 13

2.9 -Map and Listing of Slums in Mirzapur as Per DUDA-.............................................................. 14

2.10- List of Slums- ............................................................................................................................... 14

2.11- Muslim populated areas- ............................................................................................................ 15

2.12 -Urban Governance ...................................................................................................................... 16

2.13- Urban Governance and Service delivery institutions............................................................. 16

2.14-Access to Public Facilities........................................................................................................... 17

2.15- Housing ......................................................................................................................................... 17

2.16- Housing Characteristics ............................................................................................................. 17

2.17- Water Resources......................................................................................................................... 18

2.18 Water Supply Indicators ............................................................................................................. 18

2.19 Sewerage and Sanitation Facilities............................................................................................ 18

2.20- Sewage Management (Sewerage and Sanitation) ................................................................ 18

2.21 -Drainage ....................................................................................................................................... 18

2.22-Solid Waste Management ........................................................................................................... 19

District Programme Management Unit, NRHM, Mirzapur

2.23- Solid Waste Management Indicators ....................................................................................... 19

3- Health Infrastructure in Mirzapur City_...................................... 19

3.1-First and Second Tier Health Services........................................................................................ 19

3.2- Health Structure in Mirzapur ........................................................................................................ 20

3.3-Private Health Care providers ...................................................................................................... 20

3.4-.Health Scenario- ............................................................................................................................ 21

3.5- Amenities and Living Conditions ................................................................................................ 26

3.6- Maternal Health............................................................................................................................. 26

3.7- Child Health ................................................................................................................................... 27

3.8- General Health & Health Seeking Behaviour........................................................................... 28

4- Key Issues .................................................................................... 29

4.1-Strategies, Activities and Work plan ............................................................................................ 30

4.2-Listing and Mapping of Households in slums and Key Focus Areas ..................................... 30

4.3-Facility Survey for gaps in infrastructure, HR, equipment, drugs and consumables ........... 31

4.4- -Activity Plan under NUHM for the state and cities .................................................................. 34

4.5-Programme Management Arrangements ................................................................................... 37

4.6-City Level Indicators & Targets .................................................................................................... 39


PREAMBLE

National Urban Health Mission aims to improve the health status of urban population in general and the

poor and other disadvantaged sections in particular. This would be made possible by facilitating equitable

access to quality health care through a revamped primary public health care system, targeted outreach

services and involvement of the community and urban local bodies. Under the scheme, the government

proposes to strengthen and enhance the health care service delivery in urban areas with targeted focus

on urban poor and the disadvantaged.

Mirzapur with a population of 2,496,970 (Census: 2011), is one of the Sixteen districts in Uttar Pradesh

(UP). In 2006 the Ministry of Panchayati Raj named Mirzapur one of the country's 250 most backward

districts (out of a total of 640). It is one of the 34 districts in Uttar Pradesh currently receiving funds from

the Backward Regions Grant Fund Programme (BRGF).

The current sex ratio for the urban areas is 869 females per thousand males which is an area of grave

concern. The AHS-2010-11 reports that institutional deliveries are around 55.8 % in the city and the IMR

is 83 % (AHS 2011-12) with MMR at 308 (AHS 2011-12) which again is a matter of concern. Complete

immunization status of the district is around 45.0% (AHS 2010-11) and if we see the 3+ANC, it is as low

as 25.1% (AHS-10-11) at the district level. Unmet need for family planning services at the district level is

28.5 (AHS-10-11) and if we further examine the data, 10.9 % is for limiting and 17.7 % for spacing

methods.

The health indicators for Mirzapur show are way behind in so many aspects and the launch of National

Urban Health Mission, the efforts for improving the health parameters will complement towards

betterment of urban population and in particular to the urban poor, muslims & slum dwellers.

The NUHM planning for this financial year is based under consideration of direction given by Govt. UP

vide letter.no. 1533/52-3-2013-sa(30) dated 24 August 2013 point No 10 through which 20% of Muslim

community must be benefitted by all activities under NUHM Programme. It is also based on the data,

surveys and available information at city level and hoping that we will initiate the process very

systematically so that we can make the difference in improvement of quality life of urban people specially

by reaching the unreached areas.

District Programme Management Unit, NRHM deserves a very special mention for providing generous

technical support in preparation of City PIP.

Dr. Umesh Singh Yadav Anil Dhingra

Chief Medical Officer/Secretery District Magistrate/Chiarman District Health Society District Health Society

Mirzapur Mirzapur


ACKNOWLEDGEMENT

Considerable efforts have been made by the team in preparing this Project Implementation Plan for Mirzapur under the newly announced National Urban Health Mission. This has been possible through dedication, perseverance and hard work. This exercise of planning would not

have been complete without the help and support of the team.

We do not have hesitation in saying that this work would not have come up without the valuable support and continuous encouragement of Shri Anil Dhingra (IAS), District Magistrate, Mirzapur. His great confidence in team and spurred us into action.

My special gratitude goes to Dr. Umesh Yadav, Chief Medical Officer, Mirzapur, a dynamic and

enthusiastic professional. He has always been a source of great encouragement for us. The initiation and completion of this work has been possible due to his sincere and able guidance, expertise, precious opinion, keen attention, constructive suggestions and constant help. His

critical reading of all the parts of the work has helped shape the NUHM planning in its present form.

I express my gratefulness to Shri. Amit Kumar Ghosh, IAS, Mission Director, National Health Mission & Mr. Shashank Vikram, IFS, Additional Mission Director, NUHM for overarching support and building the thoughts in our mind.

I owe my sincere gratitude to Dr. M. R. Gautam (General Manager), Dr. Usha Gangwar, (Deputy

General Manager-NUHM) and HUP-PFI who have helped us immensely by providing relevant information and valuable suggestions. This planning work got accomplished with their valuable support and eagerness to help.

I am privileged to have such good city level team especially Shri Omkar Singh (DCPM), Shri.

Rupesh Mishra (DDAM) and Shri Kamlesh Kumar Maurya (HMIS Operator) who have supported and helped in contributing their great efforts towards planning and compilation of Data for this city level plan under the NUHM.

I would also like to appreciate the precious help and motivation which I received from

government line department - DUDA, ICDS, Nagar Palika Parishad, Education department, CMS & DTO.

Last but not the least; I would like to thanks all those people who were involved in the planning process directly or indirectly.

Anil Kumar Mishra Dr. D.K. Singh

DPM, NRHM, Add. CMO (RCH), Mirzapur Mirzapur


Acronyms ANM Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AWC Aanganwari Center AWW Aanganwari Worker BSGY Bal Swasthya Guarantee Yojna BSUP Basic services for urban poor BSA Basic Shiksha Adhikari CDPO Child Development Project Officer DH District Hospital DHS District Health Society DUDA District Urban Development Authority ICDS Integrated Child Development Scheme IDSMT Integrated Development of Small & Medium Towns IDSP Integrated Diseases Surveillance Program IHL Individual House level IMR Infant Mortality Rate KFA Key Focus Area LHV Lady Health Visitor LT Lab Technician MAS Mahila Arogya Samiti MMR Maternal Mortality Ratio NHM National Health Mission NPP Nagar Palika Parishad NPSP National Polio Surveillance Program NRHM National Rural Health Mission NUHM National Urban Health Mission OD Open Drainage RSAP Remote Sensing Application Center UA Urban Agglomeration UCHC Urban Community Health Center UFWC Urban Family Welfare Center UHI Urban Health Initiative UHP Urban Health Post UPHC Urban Primary Health Center SAM Severely acute Malnourishment


National Urban Health Mission- Programme Implementation Plan

Mirzapur 2013-14 1- District Profile-

According to the tradition , the name of this town,after which the district itself is named was

GIRZAPUR which in terms derives its name from the goddess Parvati (Girija) who

sacrificed hersel here in a vajna. Mirza, Vindhyavasini and Lakshmi are the other names of the

goddess whose temple exists at Vindhyachal. The present name of the district is derived

from goddess Lakshmi who emerged from the sea .

The word Mirza is formed from two words Mir meaning sea and ja meaning

outcome , with the dditional pur standing for town. It is also locally believed that the town

was founded by raja Nanner and was known as Girijapur,but later on it came to know as

Mirzapur .

The earliest mention of the town is found in the writings of Tieffenthaler, who drew up his

description of the country between 1760 and 1770. He mentioned it, under the name of

Mirzapur specially as a great mart. In the records of Jonathan Duncan, who was resident of

Varanasi, frequent mention is made of the place as Mirzapur.

1.1 LOCATION, BOUNDRIES, AREA AND POPULATION

The District of Mirzapur lies between the aralles of

23.52 & 25.32 North latitude and 82.7 and

83.33 East longitude. It forms a portion of the

Varanasi Division. On the north and north-east it is

bounded by the Varanasi district; on the south bounded

by district Sonbhadra. On the south west by the district of

Allahabad. The shape to the north and west is some what

irregular. In no direction, except for about 13 km. in the

north east where he Ganga separates the Tehsil of

Chunar from the district of Varanasi , has Mirzapur a natural frontier.

According to Central Statistical organisation the district of Mirzapur had an area of 4521

Sq.Km.

An official Census 2011 detail of Mirzapur, a district of Uttar Pradesh has been released by

Directorate of Census Operations in Uttar Pradesh. Enumeration of key persons was also done

by census officials in Mirzapur District of Uttar Pradesh.

In 2011, Mirzapur had population of 2,494,533 of which male and female were 1,312,822 and

1,181,711 respectively. There was change of 17.89 percent in the population compared to

population as per 2001. In the previous census of India 2001, Mirzapur District recorded

increase of 27.44 percent to its population compared to 1991.

The initial provisional data suggest a density of 561 in 2011 compared to 476 of 2001.


1.2 HISTORY OF THE DISTRICT AS AN ADMINISTRATIVE UNIT-

The District of Mirzapur, with the exception of the Villages namely Mowat, Merolatand,

Mahespur, Durjanipur, Mangarahi Deohat, Katra and Bamsaur received from Allahabad in 1861,

falls entirely within the tract of country once known as the province of Benaras. The sovereignty

of this was formally ceded to the East India Company in 1775 year the Nawab-vizir of Avadh;

but the tract itself was included in the zamindari of the raja of Benares and remained

in his actual possession until 1794, when Mahip Narayan Singh surrendered its control of the

Governor General of India by the agreement of 27th october of that year. It is not until

1830 that Mirzapur became a separate revenue jurisdiction of its own, because until that

year it had been included in Varanasi.

Mirzapur was then placed under a local collector of customs, the subdivisions

assigned to new collectorate being tappasChaurasi, Chhiyanve, Upraudh,Kon and

Sakteshgarh of pargana Kantit and other paragnas, Bhagwat Bhuili, Haveli, Chunar,uriat,

Sikhar,Agori, Barhar and Bijaigarh,Bhadohi,Kon and Majhwa were restored to Varanasi on the

protest of raja but were afterwards re-annexed to Mirzapur.At present Agori,Barharand

Bijaigarh are in Sonbhadra District however Bhadohi is in Sant Ravidas Nagar District.

There has been no change in the territorial limits of Mirzapur since 1833, revenue and judicial

administrations were made to coincide throughout the Benares province;but several when the

alternation have been made in the sub-divisional boundries since the tract came in to the

possession of the British.In 1801 every pargana and tappa, with a few exception had a

separate Tehsildar.

In 1804 it was resolved to abolish the office of Tehsildar in the Benares Province. In 1806,

tahsildars were established for tappas Chaurasi, Upraudh, Chhiyanvey Sakteshgarh and

Bhagwat at Chaurasi; and for pargnas Agori-Barhar and Bijaigarh (at present lies in onbhadra

District) at Kusancha.The first of the two tahsils created in 1809 corresponds to a great extent

with the present Mirzapur tahsil.Saketeshgarh and Bhagwat have been taken may from it and

kon and Majhwa added. To the tahsil which had its headquarters in 1809 at Kusancha, Singrauli

and Dudhi were added and the whole was for some time known as the Shahganj tahsil

(Now all these are in Sonbhadra District).

1.3 SUBDIVISIONS, TEHSILS AND POLICE STATIONS

At present the district Mirzapur has four tahsils, Namely Sadar (Mirzapur), Chunar, Marihan and

Lalganj for administrative point of view.

To reached the development at root level the Mirzapur district has 12 blocks and 15

thana which are as under-

1.4 Blocks Name –

Total no of blocks 12 distributed in 04 Tehsils A. Sadar Tehsil

1. Mirzapur (City), 2. Chhanbey,


3. Kon, B. Marihan Tehsil (on way to District Sonebhadra, UP) 1. Marihan, 2. Rajgarh 3. Pahari C. Lalganj Tehsil (on way to District Rewa in MP)

1. Lalganj. 2. Halia, D. Chunar Tehsil (on way to District Varanasi, UP)

1. Sikhar 2. Jamalpur 3. Narayanpur 4. Majhwan ,

1.5-Block Position in the District—

1.6 District Mirzapur at A Glance ( Comparison of 2001 and 2011)

Description 2011 2001

Area 4522 sq. kms

Geographical location Between 24.34 & 25.16 deg. North Latitude (AXANSH) and 82.05 & 83.11

deg East Longitude (DESHANTAR) Surroundings North: Sant Ravidas Nagar (Bhadohi)

West: Allahabad

East: Varanasi

South: Sonebhadra and Rewa District of Madhya Pradesh. Actual Population 2,496,970 2,116,042

Male 1,312,302 1,115,249

Female 1,184,668 1,000,793

Population Growth 18.00% 27.44%

Area Sq. Km 4,405 4,405

Density/km2 567 476

Proportion to Uttar Pradesh 1.25% 1.27%

http://www.mirzapur.in/sant%20ravi%20nagar.htm

http://www.mirzapur.in/sonebhadra.htm

http://www.mirzapur.in/sonebhadra.htm


Population

Sex Ratio (Per 1000) 903 897

Child Sex Ratio (0-6 Age) 902 929

Average Literacy 68.48 55.31

Male Literacy 78.97 69.59

Female Literacy 56.86 39.26

Total Child Population (0-6

Age)

410,621 425,405

Male Population (0-6 Age) 215,841 220,577

Female Population (0-6

Age)

194,780 204,828

Literates 1,428,683 935,101

Male Literates 865,837 622,631

Female Literates 562,846 312,470

Child Proportion (0-6 Age) 16.44% 20.10%

Boys Proportion (0-6 Age) 16.45% 19.78%

Girls Proportion (0-6 Age) 16.44% 20.47%

2- SITUATION ANALYSIS OF URBAN AREA MIRZAPUR

District Mirzapur has covered with Urban areas namely –

1- Nagar Palika Mirzapur

2- Nagar Panchayat Kachhnwa

3- Nagar panchay chunar

4- Nagar panchayat Ahraura

The Urban Population of Mirzapur District is 14 % in

comparison with Rural population as shown in Pie

diagramme.

The detailed demographic information is as follows-

Description Mirzapur District 2011 Mirzapur Urban 2011

Actual Population 2494533 58097 Male 1312822 30571

Female 1181711 27526 Population Decadal Growth rate 27.62 27.62

Density/km2 4522 sq. kms

Sex Ratio (Per 1000) 959

Child Sex Ratio (0-6 Age) 922 Average Literacy (%) 39.68 %

Male Literacy (%) 54.75 %

Female Literacy (%) 22.35 %

2.1- Nagar Palika Mirzapur (Mirzapur and Vindhyachal city)

Mirzapur and Vindhyachal city is governed by Municipal Corporation which comes under Mirzapur and

Vindhyachal Metropolitan Region. As per provisional reports of Census India, population of Mirzapur and

Vindhyachal in 2011 is 233,691; of which male and female are 125,003 and 108,688 respectively.


Although Mirzapur and Vindhyachal city has population of 233,691; its urban / metropolitan population is

245,817 of which 131,534 are males and 114,283 are females.

2.2-Population, Literacy Rate & Sex Ratio – Mirzapur City

Mirzapur and Vindhyachal City Total Male Female

Population 233,691 125,003 108,688

Literates 161,128 92,423 68,705

Children (0-6) 27,774 14,779 12,995

Average Literacy (%) 78.25 83.85 71.80

Sex ratio 869

Child Sexratio 879

2.3-Demographic profile of Mirzapur City

Total Population of city (in lakhs) 2.34 Source: Census 2011

Slum Population (in lakhs) 0.58 Source: DUDA

Slum Population as percentage of urban population 20.27

Number of Notified Slums 51 Source: DUDA

Number of slums not notified 0

No. of Slum Households 10334 Source: DUDA

No. of slums covered under slum improvement

programme (BSUP, IDSMT,etc.)

51

Number of slums where households have individual

water connections*

24

Number of slums connected to sewerage network* 3

Number of slums having a Primary school 175 Source: BSA Deptt.

No. of slums having AWC 51 Source: ICDS Mirzapur

No. of slums having primary health care facility 1 UHP

Total AWC in Urban Area 200

2.4-Nagar Panchayat Kachhnwa-

Kachhwa is a town and a nagar panchayat in Mirzapur district. It is located at 25.22°N 82.72°E. It has an

average elevation of 84 metres (275 feet). It is around 35 km. away from Mirzapur district H.Q.

As of 2011 India census Kachhwa had a population of 15,962. Males constitute 52.44% of the population

and females 47.56%. Kachhwa has an average literacy rate of 57%, lower than the national average of

59.5%: male literacy is 66%, and female literacy is 46%. In Kachhwa, 16% of the population is under 6

years of age.

Total Population of city (in lakhs) 0.16 Source: nagar panchay

Slum Population (in lakhs) 0.063 Source: DUDA




No. of Slum Households 1103 Source: DUDA



5

http://en.wikipedia.org/wiki/Nagar_panchayat

http://en.wikipedia.org/wiki/Mirzapur_district


2.5- Nagar panchayat chunar

Chunar located in Mirzapur District of Uttar Pradesh state, India, is an ancient town. The railway tracks

passing through Chunar railway station leads to major destinations of India, including Howrah, Delhi,

Tatanagar and Varanasi. National Highway number 7 also passes through Chunar. It is connected to

Varanasi, the ancient and pilgrimage city also well known as Kashi or Benaras, by roads and rails.

Chunar is well known for its pottery work especially clay toys.

As of 2011 India census Chunar had a population of 40024. Males constitute 53% of the population and

females 47%. Chunar has an average literacy rate of 57%, lower than the national average of 59.5%:

male literacy is 66% and, female literacy is 47%. In Chunar, 16% of the population is under 6 years of

age.

Total Population of city (in lakhs) 0.400 Source: Census 2011

Slum Population (in lakhs) 0.099 Source: Census 2011




No. of Slum Households 1531 Source: Census 2011



15

2.6- Nagar panchayat Ahraura

Ahraura is a city and a municipal board in Mirzapur district in the Indian state of Uttar Pradesh. Aharaura

has many famous places from the point of view holyness as there is a temple situated in rocky mountain

and there is stone letter which is by Emperor Ashok.

As of 2011 India census Ahraura had a population of 27308. Males constitute 52% of the population and

females 48%. Ahraura has an average literacy rate of 52%, lower than the national average of 59.5%;

with 63% of the males and 37% of females literate. 18% of the population is under 6 years of age.

Total Population of city 234871 Source: Census 2011

Slum Population 98000 Source: Census 2011

Slum Population as percentage of urban population 24 %



No. of Slum Households 1549 Source: Census 2011



7

2.7- Urban area Selected Under NUHM Programme-

NUHM will cover the state capitals, district headquarters and all cities and towns having a population

more than 50,000 (as per census 2011) in a phased manner. Since the fund available for 2013-14 is

modest, the state/UT will need to prioritise cities/towns that are more vulnerable in terms of larger

proportion of slums and inadequate provision for primary healthcare services.

http://en.wikipedia.org/wiki/Mirzapur_District

http://en.wikipedia.org/wiki/Uttar_Pradesh

http://en.wikipedia.org/wiki/States_and_territories_of_India

http://en.wikipedia.org/wiki/India

http://en.wikipedia.org/wiki/Chunar_railway_station

http://en.wikipedia.org/wiki/Howrah

http://en.wikipedia.org/wiki/Delhi

http://en.wikipedia.org/wiki/Tatanagar

http://en.wikipedia.org/wiki/Varanasi

http://en.wikipedia.org/wiki/National_Highway_%28India%29

http://en.wikipedia.org/wiki/Municipal_board

http://en.wikipedia.org/wiki/Mirzapur_district

http://en.wikipedia.org/wiki/India

http://en.wikipedia.org/wiki/States_and_territories_of_India

http://en.wikipedia.org/wiki/Uttar_Pradesh


Hence in District Mirzapur only City Mirzapur cum Vindhyachal will cover under NUHM

Programme as it has a total population of 2.34 Lacks, which exceed min population of 0.50 lacks.

2.8-Urban Poor & Slums of Mirzapur City-

The UP Slum Areas (Improvement and Clearance) Act, 1962, considers an area a slum if the

majority of buildings in the area are dilapidated, are over-crowded, have faulty arrangement of

buildings or streets, narrow streets, lack ventilation, light or sanitation facilities, and are

detrimental to safety, health or morals of the inhabitants in that area, or otherwise in any respect

unfit for human habitation. It mentions factors such as repairs, stability, extent of dampness,

availability of natural light and air, water supply; arrangement of drainage and sanitation facilities

as considerations. Based on the definition, estimates of slum population vary, so much so that

the Census 2001 originally did not report any slums and then later revised its findings. DUDA

follows the definition as stated in the UP Slum Areas (Improvement & Clearance) Act 1962;

SUDA/UNCHS do not follow this definition but define poverty in terms of vulnerability as does

Oxfam.

DUDA’s estimation of slum population is a conservative increase over the Census estimation.

that There are 51 poor settlements in the city that can be categorized as slums - authorized and

unauthorized (map overleaf). This classification is on the basis of tenure. An authorized slum is

one where there is security of tenure with the cluster being either an outcome of a government

resettlement programme or being located on private/own land. Unauthorized settlements are

those that have emerged on available vacant plots, mainly railway land or on encroached areas.

Slum clusters on the riverbanks or on drains are classified as unauthorized. The most recent

information on slums available in Mirzapur is from DUDA Mirzapur and this plan has mainly

used this information, partly on the advice of SUDA. Other sources of information have been

cited mainly to point out the range in the available data that will impact the earmarking of

resources for this group. Approximately 58000 people are living in slums with few basic civic

amenities.

Table 5: Selected indicators of slum conditions in Mirzapur

Characteristic Percentage of people/families Water Supply Facilities 42.68%

Individual tap 38.84% Community tap 6.06%

Others Sanitation 47.12%

Individual toilet facility 20.98%

Community toilet facility 28.30% Others

Employment 9.78% Employed 7.97%

Unemployed 81.91% Self employed 41.68%


2.9 -Map and Listing of Slums in Mirzapur as Per DUDA-

2.10- List of Slums-

S. No. Name of Slums Population

1 Angarh Mahabir 936

2 B.D. Pokhara 974

3 Bagh Knjangir 1061

4 Barundha 911

5 Barho Imilia 762

6 Basahi 2037

7 Bathua 924

8 Bhatwa ki Pokhari 3533

9 Bisundarpur 1362

10 Chandradeepa 1918

11 Chota Mirzapur 1337

12 Chhoti Basti 746

13 Chorba Nala 172


14 Danghar 1557

15 Devpurva 2280

16 Dumrauli 552

17 Gaibee Ghat 798

18 Ganeshganj 1799

19 Ghurahoo Patti 1080

20 Gosain Talab 952

21 Imarti Talab 452

22 Imlaha 1269

23 Jalalpur 824

24 Jamunaiya 602

25 Jayarangiri Bagh 1286

26 Jogiyabari 371

27 Kajrahwa 885

28 kantit 426

29 Katwaroo ka Pura 775

30 Mahuaria 546

31 Mallahi Tola 608

32 Natwa 1173

33 Neebi 784

34 Ojhala 340

35 Prasab ka pura 707

36 Pakka Pokhara 1956

37 Packi Saraiya 1567

38 Purani Dasmi 843

39 Ramaipatti 2648

40 Rambagh 1627

41 Ranibagh 817

42 Ratanganj 555

43 Rukhad Ghat 827

44 Sabri 2082

45 Sakhaura 690

46 Mahant Shivala 768

47 Shivpura 567

48 Shukalha 759

49 Tarkapur 4078

50 Tedwa 700

51 Vindhyachal 874

The rapidly growing urban population poses great challenge to the efforts of the state

government towards improving the health of the urban poor.

2.11- Muslim populated areas-

As per Govt of UP guideline 20% Muslim Population must be cover in all developmental program

through which maximum Muslim community benefitted.


In city mirzapur following Major Muslim Slums and General pocket are present-

Sl No Muslim Locality Sl No Muslim Locality

1 BASAHI 9 Imarti Road 2 Bhatwa ki Pokhari 10 Hayat Nagar 3 Natwa 11 Rani Bagh 4 Sabari 12 Kaji Talab 5 Tarka Pur 13 Gosai Talab

6 Immabara 14 Gaurian 7 Ram Bagh 15 Pakki Sarai 8 Ghore Shahid 16 Gajia Tola

2.12 -Urban Governance

There are multiple agencies responsible for urban governance and provision and management

of infrastructure and services. While, the Mirzapur Nagar Panchayat (MNP), MIrzapur Jal Kal

Sansthan (MJKS), Mirzapur Development Authority (MDA) and UP Jal Nigam (UPJN) are the

key urban service providers, other agencies include the Housing Board, Central and State Public

Works Departments (CPWD and PWD), Transport Department, Industries Department and the

Department of Environment. There is significant overlap of roles and responsibilities and

fragmentation in service provision and management of infrastructure, which makes it difficult to

hold institutions accountable and to coordinate.

2.13- Urban Governance and Service delivery institutions

City Level

Mirzapur Nagar Panchayat

(MNP)

Local level governance; Primary Collection of Solid Waste; Maintenance of

Storm Water Drains; Maintenance of municipal roads; Allotment of Trade

Licenses under the Prevention of Food Adulteration Act; O&M of internal

sewers and community toilets; Street lighting; O&M of water supply and

sewerage assets; Collection of water tariff

MIrzapur Development

Authority (MDA)

Preparation of Master Plans for land use; Development of new areas as

well as provision of housing and necessary infrastructure

District Urban Development

Authority (DUDA)

Implementing agency for plans prepared by DUDA.

Responsible for the field work relating to community development –

focusing on the development of slum communities, construction of

community toilets, assistance in construction of individual household

latrines, awareness generation etc.

State Level

UP Jal Nigam (UPJN)

Water supply and sewerage including design of water supply and

sewerage networks. In the last two decades ‘pollution control of rivers’ has

become one of their primary focus areas

UP Awas Vikas Parishad

(UPAVP)

Nodal agency for housing in the state. Involved in planning, designing,

construction and development of almost all types of urban development

projects in the state. Autonomous body generating its own resources

through loans from financial institutions

UP State Transport

Corporation (UPSTC)

Provides intra-city and state wide public transport; maintenance of buses,

bus stands


Public Works Department

(PWD)

Construction of main roads and transport infrastructure including

construction and maintenance of Government houses and Institutions

State Tourism Department

(STC)

Promotion of tourism

Archaeological Survey of

India (ASI)

Maintenance of heritage areas and monuments

UP Pollution Control Board

(UPPCB)

Pollution control and monitoring especially river water quality and

regulating industries

Town and Country Planning

Department (TCPD)

Preparation of Town Plans including infrastructure for the state (rural and

urban)

Office of Commissioner

Vindhayachal Division

Coordination of activities of various institutions

2.14-Access to Public Facilities

Infrastructure development has not been commensurate with the growth of the city and there are

problems confronting the city in terms of access and coverage in key infrastructure sectors –

water supply, sewerage, housing, drainage, and transport. Overall service levels are inadequate

and the situation is worse for the urban poor.

2.15- Housing

Mirzapur has witnessed a radial growth – greater along the Kacchawa Road Majhawa Block,

Bisundarpur and Kantit City Block and Chunar Bajar Narayanpur Block in recent years, The

latter has not been factored into the Master Plan – the formal basis for Government panning.

Estimates of infrastructure requirements and population projections are therefore likely to be

conservative.

The position of the City as the only large urban centre amidst a number of small towns in the

surrounding districts makes it an attractive destination for job seekers and people in need of

education and health facilities. One of the features of the city’s growth has been an increase in

the number of slums but disagreements about the definition of slums and about data hamper

efforts to address service delivery challenges in these areas.

2.16- Housing Characteristics

INDICATOR %

Households living in a Pucca House (%) 88.7

Households living in a Owned House (%) 97.9

Households treating water to make it safer for drinking (%) 1.9

Households having access to toilet facility (%) 84.6

Households sharing toilet facility (%) 27.1

Households having access to electricity (%) 90.1

Households using Electricity (%) 86.1

Households using Firewood/Crop Residues/Cow Dung Cake (%) 42.9

Households using LPG/PNG (%) 54.1

Households having a separate Kitchen (%) 60.6

Households having Computer/laptop with or without Internet Connectivity (%) 10.1

Households having Telephone/Mobile (%) 77.1


2.17- Water Resources

Aside from water resource issues such as pollution of the River GANGA and the declining

quality of groundwater, Mirzapur carries a burden of old infrastructure and the absence of

metering makes it difficult to estimate costs and leakages. Information about assets in physical

and functional terms is also inadequate. Overlapping institutional roles make it difficult to hold

the institutions clearly accountable.

2.18 Water Supply Indicators

Water Supply Indicators

Coverage of water supply

connections (100%)

Per capita supply of water

(1351pcd)

Extent of metering of

water connection

(100%)

Continuity of

water supply (24

Hours)

63 158 0 5

2.19 Sewerage and Sanitation Facilities

Mirzapur has seen no major investment in sewage infrastructure after the proposals in the 1948

Sewage Master Plan. Taking into consideration the service latrines, latrines discharging into

nallas, existing public toilets and open defecation about 40% of the population do not have

access to adequate sanitation. Informal sewers connecting a few households and discharging

into nearby open drains are also seen. The existing main network therefore is for the most part

not able to handle additional load leading to the sullage being discharged directly into the River

GANGA In many places the sewers have been choked by the disposal of solid waste in them as

well as encroachment in sections. This does not allow complete cleaning of the network and

aggravates the problem of discharge.

The lack of current data and information on assets severely impacts planning. While in the newly

developed and developing areas, networks are being provided by developers, coordination with

the state planning process is tenous.

2.20- Sewage Management (Sewerage and Sanitation)

Sewage Management (Sewerage and Sanitation)

Coverage of toilets (100%) Coverage of sewage network

service (100%)

Adequacy of sewage treatment

capacity (100%)

68 57 100

2.21 -Drainage

While in general, the City is good drained, there are local pockets of water logging especially in

areas where the carrying capacity of the drains has been reduced either due to encroachment or

blockage. Such flooding has been observed in Tarka pur ,Kajrahwaha Pokhra and Ghurahu Patti

almost each year during rains. In the newly developed areas, while the developer is responsible

for the provision of internal surface water drainage, the linking of these drains to the larger local

drains and nallahs is neglected, causing waterlogging problems at some places. Maintenance of


drains is ‘reactive’ with the common practice to desilt the drains and dump the sludge near the

edge of the drains to dry out before lifting. In practice, sludge either gets blown away or ends up

in open drains.

Table 10: Storm Water Drainage IndicatorsStorm Water Drainage Indicators

Coverage of storm water drainage network (100%) Incidence of water logging/flooding (0%)

74 583

2.22-Solid Waste Management

The present solid waste management system is not synchronized. There are some pockets

where door-to-door collection has been introduced largely on the initiative of the local residents;

there is no system of collection, transportation and disposal nullifies efforts at the household

level. The numbers of existing waste depots are inadequate for the quantum of waste generated

and are also located far from the city, which encourages indiscriminate dumping. Behavioural

patterns pose health risks and therefore pose health risks for those working in this sector as well

as residents living around waste depots. The indiscriminate dumping results in garbage finding

its way back into sewers and contributing to their choking.

2.23- Solid Waste Management Indicators

Solid Waste Management Indicators

Household level coverage of solid waste management services (100%)

Extent of segregation of municipal solid waste (100%)

Extent of municipal solid waste recovered (80%)

41 53 4

3- Health Infrastructure in Mirzapur City_

Unlike in the rural areas, where the health department has a wide network of primary health care

facilities providing reproductive and child health services, the urban slums lack basic health

infrastructure and outreach services. Thus, they are often bypassed even by national

programmes providing immunization, safe motherhood and family planning services. The sparse

health coverage provided by health facilities like urban family welfare centers, health posts, and

maternity homes in cities is used more for emergencies and curative services. Often these

facilities are far from their service area, poorly staffed, with inadequate space and supply of

medicines and equipment. Urban local bodies like municipal corporations and nagar panchayats

are also expected to provide health care, but resource scarcity restricts them to only providing

sanitation services. NGOs and private trusts are also few and far between.

3.1-First and Second Tier Health Services

The Government of Uttar Pradesh has committed itself to make provisions for health care

services to its population. Though the efforts have been rural centric some efforts have also

been made to improve the delivery of primary health care services to the population living in

urban areas. It has established D Type health centers and dispensaries for providing family


welfare services and OPD facilities. The Urban Local bodies and Department of Health and

Family Welfare are the two main stakeholders for managing these services. In urban areas of

UP, first tier health services are available through D-type health centers, the family welfare

centre, health post and PP centers. Second tier health services are provided in urban areas

through District Male and Female or Combined Hospitals.

3.2- Health Structure in Mirzapur

Sl.

No.

Name & Type of

Facility (DH,

Maternity Home,

CHC, other ref.

hospital UFWC,

UHP,

PHC,Dispensary

etc.)

Managing

Authority

(Municipal

Council,

State Health

Department,

facilities

functioning

on PPP

basis)

Location of

Health

Facility

Population

Covered

by the

Facility

Services

Provided

Human

Resources

available

(List Type

and

Number of

HR

available

i.e. ANM,

LT, SN,

MOs,

Specialists

etc.

No. and

Type of

Equipment

Available

(X-ray

machine,

USG,

autoclave

etc.)

1. PPP NA Rambag,

Mirzapur

100000 RI, ANC,

PNC, NSV

MOs- 1

ANM- 2

NO

2. FWC NA Rambag

Mirzapur

RI, ANC,

PNC, NSV

ANM - 2 NO

3. Urban Helth

Post

NA Tarkapur

Mirzapur.

5078 RI, ANC,

PNC, NSV

MOs – 1

SN – 1

ANM – 1

Other Staff - 1

NO

The data given in the table above reveals inadequacy of primary health care services. The first

tier health facilities were planned for a population of 50000 but as a result of rapid population

growth they are currently serving a population of more than 75000. The situation gets

compounded due to lack of adequate infrastructure, equipments and medicines. The staff mainly

Doctors and ANM is also inadequate. The high population- staff ratio results in poor service

coverage with some areas being entirely unserved. From the above assessment it becomes

evident to consider the poor health indicators for deciding the norms of staff population ratio.

Uttar Pradesh has eight medical colleges and one post-graduate institute which offer tertiary and

superspecialty health services.

3.3-Private Health Care providers

A large network of private providers exists along with a large number of public sector providers.

The total number of private sector doctors is estimated at 500 (Registered and unregistered all

inclusive). The Dai’s (TBAs) are estimated at 450 (Trained and untrained) Commercial outlets

including medical shops, pharmacies etc. number about 150. Unlike the distribution of public

sector providers, the highest concentration of the private providers is in the western region. The


distribution of health providers understandably has strong bearing on the health care in U.P.

Regions with lower concentration of medical providers (in proportion to population) have lower

maternal and child health care coefficient and higher unmet need for family planning services.

3.4-.Health Scenario-

Based on the results of AHS the health scenario of Mirzapur city (proxy by the urban part of the

district) is presented as below. The detailed tables are given in the annexure.

Indicator %

Marrige below legal age (%)

Among females (below 18 Years) 16.7

Among males (below 21 Years) 27.8

CMW age ( 20-24 Years) married before age 18 years 51.2

CMM age ( 20-24 Years) married before age 21 years 52.9

Mean Age at Marriage

Male 22.7

Female 20.2

Morbidity and Health issues

Number of disable persons (1000,000 population)

Person 1607

Male 1692

Female 1519

Number of Injured Persons by type of Treatment received (Per 100,000 Population)

Severe

Person 155

Male 181

Female 127

Major

Person 278

Male 363

Female 190

Minor

Person 1453

Male 2054

Female 823

Persons Suffering from any kind of Acute Illness

(Per 100,000 Population)

Diarrhoea/Dysentery

Person 989

Male 1269

Female 696

Acute Respiratory Infection (ARI)

Person 309

Male 363


Female 253

Fever (All Types)

Person 5966

Male 6344

Female 5570

Any type of Acute Illness

Person 9645

Male 10695

Female 8544

Taking treatment from Any Source (%)

Person 95.5

Male 95.6

Female 95.6

Taking treatment from Government Source (%)

Person 3.0

Male 3.0

Female 3.1

Having Any kind of Symptoms of Chronic Illness

(Per 100,000 Population)

Person 8161

Male 7855

Female 8481

sought Medical Care (%)

Person 88.6

Male 89.2

Female 88.1

Diagnosed for (Per 100,000 Population)

Any kind of Chronic Illness

Person 1020

Male 846

Female 1203

Diabetes

Person 464

Male 725

Female 190

Hypertension

Person 1020

Male 846

Female 1203

Tuberculosis (TB)

Person 213

Male 181

Female 253

Asthma/Chronic Respiratory Disease

Person 711


Male 906

Female 506

Arthritis

Person 989

Male 785

Female 1203

Getting Regular Treatment (%)

Person 66.5

Male 71.6

Female 61.8

Getting Regular Treatment from Government Source (%)

Person 16.4

Male 17.0

Female 15.8

FERTILITY

Total Fertility Rate (TFR) 3.0

Women aged 20-24 reporting birth of order 2 & above (%) 33.3

birth of order 3 & above (%) 34.8

Women with two children wanting no more children (%) 71.3

Median age at first live birth of Women aged 15-49 years 22.7

Median age at first live birth of Women aged 25-49 years 22.3

Women age 15-19 who were already mothers or pregnant at the time of the survey

(%)

47.4

Mean number of children ever born to aged 15-49 3.0

Mean number of children surviving to Women aged 15-49 2.7

Mean number of children ever born to Women aged 45-49 4.1

Live Births taking place after an interval of 36 months (%) 43.5

ABORTION to EMW 15-49 Years (%)

Pregnancy resulting in abortion 6.7

Women who received any ANC before abortion 20.0

Married Women who went for Ultrasound before abortion 30.0

Average Month of pregnancy at the time of abortion 3.3

Abortion performed by skilled health personnel (%) 90.0

Abortion taking place in Institution (%) 70.0

Currently Married Pregnant Women aged 15-49 registered for ANC (%)

Current Usage

Any method (%) 51.0

Any modern method (%) 39.2

Female sterilization (%) 23.9

Male sterilization (%) 1.1

Copper-T/IUD (%) 4.5


Pills (%) 1.2

Condom/Nirodh (%) 8.4

Emergency Contraceptive Pills (%) .0.

Any traditional method (%) 11.8

Periodic abstinence (%) 4.5

Withdrawal (%) 1.8

LAM (%) 1.1

UNMET NEED FOR FAMILY PLANNING

Unmet need for Spacing (%) 11.4

Unmet need for Limiting (%) 11.2

Total Unmet need (%) 22.6

Maternal Health Care

ANTE NATAL CARE

Mothers who received any antenatal check-up (%) 86.7

Mothers who had antenatal check-up in first trimester (%) 55.0

Mothers who received 3 or more antenatal care (%) 40.0

Mothers who received at least one tetanus toxoid (TT) injection (%) 85.8

Mothers who consumed IFA for 100 days or more (%) 5.8

Mothers who had Full Antenatal Check-up (%) 5.8

Mothers who received ANC from Govt. Source (%) 56.7

Mothers whose Blood Pressure (BP) taken (%) 40.8

Mothers whose Blood taken for Hb (%) 26.7

Mothers who underwent Ultrasound (%) 29.2

DELIVERY CARE

Institutional Delivery (%) 55.8

Delivery at Government Institution (%) 25.0

Delivery at Private Institution (%) 30.8

Delivery at Home(%) 44.2

Delivery at home conducted by skilled health personnel (%) 25.5

Safe delivery *(%) 64.2

Caesarean out of total delivery taken place in Government Institutions (%) 13.3

Caesarean out of total delivery taken place in Private Institutions (%) 43.2

Less than 24 hrs. stay in institution after delivery (%) 38.8

Mothers who received Post-natal Check-up within 48 hrs. of delivery (%) 95.0

Mothers who received Post-natal Check-up within 1 week of delivery (%) 95.0

Mothers who did not receive any post-natal Check-up (%) 5.0

New borns who were checked up within 24 hrs. of birth (%) 90.0

JANANI SURAKSHA YOJANA (JSY)

Mothers who availed financial assistance for delivery under JSY (%) 25.3


Mothers who availed financial assistance for institutional delivery under JSY (%) 41.8

Mothers who availed financial assistance for government institutional delivery

under JSY(%)

93.3

IMMUNIZATION (%)

No of Children age 12-23 months 83.3

Children aged 12-23 months who have received BCG 83.3

Children aged 12-23 months who have received 3 doses of Polio vaccine 63.3

Children aged 12-23 months who have received 3 doses of DPT vaccine 63.3

Children aged 12-23 months who have received Measles vaccine 63.3

Children aged 12-23 months Fully Immunized 56.7

Children who have received Polio dose at birth 83.3

Children who did not receive any vaccination 13.3

Children Vitamin A dose during last six months 33.7

Children (aged 6 months) who received IFA tablets/syrup during last 3 months (%) 12.8

Children whose birth weight was taken (%) 63.0

Children with birth weight less than 2.5 Kg. (%) 11.3

CHILDHOOD DISEASES

Children suffering from Diarrhoea (%) 10.2

Children suffering from Diarrhoea

who received HAF/ORS/ORT (%)

84.6

Children suffering from Acute Respiratory Infection (%) 5.5

Children suffering from Acute Respiratory Infection who sought treatment (%) 100.0

Children suffering from Fever (%) 32.3

Children suffering from Fever who sought treatment (%) 100.0

Child Feeding practices and nutritional staus of children (%)

Children under 3 years breastfed within one hour of birth 40.7

Children (aged 6-35 months) exclusively breastfed for at least six months (%) 9.9

Water 84.9

Animal/Formula Milk 82.6

Semi-Solid mashed food 16.3

Solid (Adult) Food 9.3

Vegetables/Fruits 15.1

Average month of receiving foods other than other than breast milk for children

under 3 years

Water 2.3

Animal/Formula Milk 2.85.8

Semi-Solid mashed food 7.9

Solid (Adult) Food 6.2

Vegetables/Fruits

BIRTH REGISTRATION 59.8


Birth registered (%) 22.0

Children whose birth was registered and received birth certificate (%)

AWARENESS ON HIV/AIDS

Women who are aware of HIV/AIDS (%) 90.4

Women who are aware of RTI/STI (%) 98.00

Women who are aware of HAF/ORS/ORT (%) 99.6

Women who are aware of danger signs of ARI/Pneumonia (%) 97.3

3.5- Amenities and Living Conditions

About 97.9% households were living in their own houses. About 11% were still living in Kutcha

or Semi Pucca houses. Though almost all households had access to improved sources of

drinking water, but 1.9% only were treating water to make it safer.

Whereas 27.1% were sharing toilets, still about 15% were defecating in open. About 87% had

access to electricity. Though 54% were using LPG for cooking, 15% were still using fire

wood/dung cakes/ crop residues for cooking. As high as 90% had telephones/ mobiles and

10.1% even had computers.

3.6- Maternal Health

Fertility

The Total Fertility Rate for Mirzapur city was

estimated at 3.15 which is broadly equals mean

number of children ever born to women age 15-49

years. The births of order 3 and above were reported

by 34.8% only and women with 2 children and

wanting no more child was as high as 71.3%. Further

as high as 44% of births had interval of 36 months or

more. The girls marrying below the legal age of 18

years were only 2.3%. 53% reported using any family

planning method. The most common methods of

family planning were female sterilization - 17% and

condoms as 20%. The use of IUD was just 2.6% and

pills 4%. The traditional method was reported as

being used by 9%. The total unmet need for family

planning was 31%, 14.6% for spacing and 16.6% for limiting.

Ante Natal Care

Though mothers receiving any ante natal check up were 87%, only 40% had full ANC. Around

57% of pregnant women received ANC from Government sources. Of various components of

ANC, at least one TT received by 85.8%, BP taken 41%, blood examination for Hb 28%,

underwent ultrasound 29.2%. Though 40% pregnant women received 3 or more ANCs, those

who consumed IFA for 100 days or more was only 5.8%.


Delivery Care

About 56% of deliveries in Mirzapur were conducted in institutions, of which 25% were in

Government institutions and 43% in private institutions. The home deliveries were only 44% of

which 59% were conducted by skilled health personnel. Caesarian cases were as high as

43.2%, about two-third being conducted in private institutions.

It is important to note that because of high demand on beds for insti tutional deliveries, in about

39% of the cases the stay in the hospital after delivery was less than 24 hours. About 95.0%

mothers received post natal care and new born were also checked.

Importantly, 23.3% of mothers availed financial assistance for deliveries under JSY and 93.3% of mothers availed financial assistance for government institutional delivery.

3.7- Child Health

Child Immunization

About 63.3% of children were fully immunized. Those who received Vitamin A dose were33 %.

Birth Weight

In 63.0% cases birth weight of the child was taken and based on that 11.3% of children were low

birth weight (<2.5Kg). About 74% of births were registered and 68% had birth certificates.

Childhood Diseases

Children with diarrhea, Acute Respiratory Infection and fever were reported as 10%, 5.5% and

32.3% respectively. Those suffering from fever who sought treatment were 94%.

Brest Feeding

Only 10% of children were exclusively breast feed.

Infant & Child Mortality

The IMR was 83 per 1000 live births. The Neo Natal Mortality Rate was high at 60 and Post Neo

Natal at 23. Under 5 Child Mortality Rate was 111.


3.8- General Health & Health Seeking Behaviour

Morbidity

As per the AHS 2010-11, the morbidity rate for acute illness in Mirzapur was estimated at 3.6% it

being higher for females (3.7%) as compared to males (3.4%) as to the specific acute illnesses

the prevalence of fever was estimated at 2.5% (higher for females 2.7% compared to males

2.4%). The prevalence of Diarrhea/ dysentery was estimated at 0.4% for Acute Respiratory

Infection as 0.2%. It is observed that for acute illnesses 99% in Mirzapur took treatment of which

15% from government sources.

The symptoms related to chronic illnesses were reported by 4% in Mirzapur, it being significantly

higher for females (4.5%) as compared to males (3.6%). Of these about 94% were reported as

diagnosed. As to specific chronic illnesses Hypertension was reported by 1.6% and Diabetes by

1%. The prevalence for Hypertension lifestyle disease was higher among females as compared

to males. The problem of Arthritis and Asthma was reported by 0.5% and 0.2% respectively. The

problem of arthritis was much higher among females as compared to males. Tuberculosis was

reported more by males as compared to females, the prevalence being 0.16% in males. For

chronic illnesses 71% reported taking regular treatment of which 27% was from Government

Sources.

Injuries

Little less than 0.9% of the population had injuries due to accidents of which 20% were severe

where individual had to be kept in ICU and another 20% major requiring hospitalization.

Table 12: Disease/Cause of Morbidity Data : Mirzapur

Sl. Name of Disease/ Cause of Morbidity (e.g. COPD,

Trauma, Cardiovascular Disease etc.)

Number of cases

admitted in 2012 Source of Data

1 Injuries and Trauma 1895 IDSP

2 Self inflicted injuries/suicide 00

3 Cardiovascular Disease 1834 IDSP

4 Cancer (Breast cancer) 00

5 Cancer (cervical cancer) 00

6 Cancer (other types) 00

7 Mental health and depression 08 IDSP

8 Chronic Obstructive Pulmonary Disease (COPD) 2604 IDSP

9 Malaria 107 IDSP

10 Dengue 00

11 Infectious fever (like H1N1, avian influenza, etc.) 00

12 TB 478 TB Hospital

13 MDR TB 00

14 Diarrhea and gastroenteritis 11318 IDSP

15 Jaundice/Hepatitis 17 IDSP

16 Skin diseases 00

17 Severely Acute Malnourishment (SAM) 00


18 Iron deficiency disorder 42 IDSP

19 Others 00

(Source: IDSP, TB Hospital)

The above table reflects the health/ morbidity profile of the Mirzapur city. As there are three

sources of data, the city planning team has approached all three sources for getting most

authenticated as well as updated data. So, data from IDSP, TB clinic and District hospital were

taken and mentioned in the above table.

4- Key Issues

The Eleventh Plan had suggested Governance reforms in public health system, such as

Performance linked incentives and Devolution of powers and functions to local health care

institutions and making them responsible for the health of the people living in a defined

geographical area. NRHM’s strategy of decentralization, PRI involvement, integration of vertical

programmes, inter-pectoral convergence and Health Systems Strengthening has been partially

achieved. Despite efforts, lack of capacity and inadequate flexibility in programmes forestall

effective local level Planning and execution based on local disease priorities.

In order to ensure that plans and pronouncements do not remain on paper, NUHM UP would

strive for system of accountability that shall be built at all levels, reporting on service delivery

and system, district health societies reporting to state, facility managers reporting on health

outcomes of those seeking care, and territorial health managers reporting on health outcomes in

their area. Accountability shall be matched with authority and delegation; the NUHM shall frame

model accountability guidelines, which will suggest a framework for accountability to the local

community, requirement for documentation of unit cost of care, transparency in operations and

sharing of information with all stakeholders. The state will incorporate the core principles of The

National Health Mission of Universal Coverage, Achieving Quality Standards, Continuum of

Care and Decentralized Planning.

Following would be the issues for the cities to address: City Health Planning, Public Private

Partnership, Convergence, Capacity Building, Migration, Communitization, Strengthen Data,

Monitoring and Supervision, Health Insurance, Information Dissemination and Focus on NCDs/

Life-Style Diseases.

After considering the available data, city scenario and analysis, the City planning team has

identified issues at both service delivery & demand generation level. Following are the details of

issues which would be addressed through NUHM at the city level:

Need of community volunteers (ASHAs) for taking up the community mobilization activities

Need of Mahila Arogya Samiti (MAS- a group of 10-12 women) for wider spread of

information/ rights and entitlements

Strengthening of ANC, PNC & identification of high risk pregnancies at community level

Home based care of neonates at community level.

Promotion of institutional deliveries

Health education for all, especially for adolescent group

Complete immunization of pregnant women & children

Needs to strengthen the existing health care facilities by recruiting human resources


Need assessment of community in health scenario

Need a better convergence with other programs and wider determinants

Need of training & capacity building of human resources

Need of Strengthened program management structure at district level

Need of intensive baseline survey to start the community processes and identifying local

needs

Involvement of local bodies in decision making and managing the program locally

Gap analysis of HR & recruitment

Promotion of family planning methods through basket of choice approach & counselling

because unmet need for family planning is high in Mirzapur

Management of communicable & non- communicable diseases

Strengthening AYUSH

Constitution of BSGY team for urban areas.

Identification & management of SAM children

4.1-Strategies, Activities and Work plan

The key overarching strategies under NUHM for 2013-14 include data based planning,

strengthening of management and monitoring systems at the state and district level, improving

the primary health care delivery system and community outreach through ASHAs, MAS and

Urban Health and Nutrition Days(UHNDs).

The key activities at the district level will include convergence with key urban stakeholders,

sensitization of ULBs on their role in urban health, strengthening UPHCs for provision of primary

health care to urban poor, community outreach through selection, training and support to ASHAs

and MAS, conducting UHNDs and outreach camps to get services closer to the community and

reach complete coverage of slum and vulnerable populations.

With the aim to improve the health parameters of urban population in the city, structures and

strategies as recommended for the NUHM in its framework will be adopted and operationalized

rapidly over the years.

4.2-Listing and Mapping of Households in slums and Key Focus Areas

Listing and mapping of households will provide accurate numbers for population their family size

and composition residing in slums. Currently, estimates of population residing in slums are

available from District Urban Development Agency (DUDA) and National Polio Surveillance

Project as the immunization micro plans (under NPSP) provide updated estimates of slum and

vulnerable populations and are expected to be fairly complete. The current plan for covering

slums is based on the currently available data of urban population of each city.

Once the ASHA are deployed they will list all households and fill the Slum Health Index

Registers (SHIR) including the number and details of family members in each household. This

data will be compiled for city and will provide the population composition of slums and key focus

areas. This will also help the urban ASHA know her community better and build a rapport with

the families that will go a long way in helping her advocate for better health behaviours and link


communities to health facilities under the NUHM. It is expected that once the household

mapping is completed in cities, the number of ASHAs will be reviewed and adjusted upwards or

downwards and the geographical boundaries of the coverage area for each ASHA would be

realigned. This is due to the reason that the actual population may be higher or lower than the

original estimate used for planning.

4.3-Facility Survey for gaps in infrastructure, HR, equipment, drugs and consumables

Facility survey will be carried out in the public facilities to assess the gaps in infrastructure,

human resource, equipment, drugs and consumables availability as against expected patient

load. Further planning, particularly for UCHCs, will be based on these gaps. This work will be

outsourced to a research agency. Development Partners like Health of the Urban Poor project

will technically support this effort.

Baseline Survey

The state envisions monitoring progress in health indicators in urban areas and among urban

poor over the period of implementation of NUHM. This proposed Baseline survey will generate

data on the health and related indicators which will be reviewed during the course of

implementation of the program to assess the impact of implementation and necessary course

corrections can accordingly be made and use of resources can be optimised.

Training and Capacity Building

ULB, Medical and Paramedical staff, Urban ASHAs and MAS will be trained. The trainings will

have to be followed by periodic refresher trainings to keep these frontline health workers

motivated. NUHM will engage with development organisations to develop the training modules

and facilitate the trainings.

Monitoring & Evaluation

The M&E systems would also capture qualitative data to understand the complexities in health

interventions, undertake periodic process documentation and self evaluation cross learning

among the Planning Units to be made more systematic.

The Monitoring and Evaluation framework would be based on triangulation of information. The

three components would be Community Based Monitoring, HMIS for reporting and feedback and

external evaluations.

Strengthening of health facilities

Urban - Primary Health Centre (U-PHC) –

During the first year of implementation of the program, the existing 1 urban health posts situated

at Tarka Pur Slum area will be attempted to be strengthened. Towards this, the UHPs existing


in rented accommodations will be shifted to adequately larger premises which would help in

rendering the mandated services.

There is a total population 2.34 lack out which 51 Slums as well as 16 Major Muslim

Pockets in City Mirzapur.As per NUHM guideline it will cover the state capitals, district

headquarters and all cities and towns having a population more than 50,000 (as per census

2011) in a phased manner. In the Year 2013-14 a Total No of 4 urban PHC’s will established at

Mirzapur City preferably in following places where maximum Muslim community and Slums are

Located-

Sl NO UPHC No Proposed Location

1 UPHC 1 Bhatwa ki Pokari 2 UPHC 2 Sabri

3 UPHC 3 Pakka Pokhra 4 UPHC 4 Natwa

A provision of Rs. 10,000/- per month per UPHC is being proposed for immediate service

provision capacity enhancement, but over the period of time the said rented accommodations

will be shifted to owned premises for sustained services. Accommodations belonging to other

stakeholder government line departments will be explored and then adopted after entering into

necessary agreements/ arrangements with the said department.

Targeted intervention for urban poor –

The process of listing of households in the KFAs, mapping of KFAs and health facilities and

baseline survey of the KFA households will help determine the scope and extent of services

required for targeting of the urban poor. A deliberate effort will be made to identify the vulnerable

poor on the basis of their residence status, occupational status and social status, besides other

micro-level indicators, which will further help focusing the health care services to the most

deserving.

Mahila Arogya Samiti (MAS)-

MAS will act as community based peer education group in slums, involved in community

mobilization, monitoring and referral with focus on preventive and promotive care, facilitating

access to identified facilities and management of grants received. Existing community based

institutions could be utilized for this purpose. City planning team is proposing formation of only

one MAS under each ASHA in the first year and the identification of the remaining planned MAS

will be undertaken in the subsequent years.

ASHA-

For reaching out to the households ASHAs (frontline community worker) would serve as an

effective and demand–generating link between the health facility and the urban slum population.


Each link worker/ASHA would have a well-defined service area of about 1000-2,500

beneficiaries/ between 200-500 households based on spatial consideration.

Outreach services –

Outreach services will be provided to the slum areas and KFAs through ANMs who would be

responsible for providing preventive and promotive healthcare services at the household level

through regular visits and outreach sessions. Each ANM will organize a minimum of one routine

outreach session in her area every month.

Special outreach sessions (for slum and vulnerable population) will be organized once in a week

in partnership with other health professionals (doctors/ pharmacist/ technicians/ nurses –

government or private). It will include screening and follow-up, basic lab investigations (using

portable /disposable kits), drug dispensing, and counselling. The outreach sessions (both routine

and special outreach) could be organized at designated locations mentioned in the aforesaid

paras in coordination with ASHA and MAS members

Innovations –

An urban specific IEC strategy covering urban contexts would be developed, field tested and

then applied to cover RCH. The IEC plans should especially focus on interpersonal or group

communication which would include a description of expected behaviour change in different

community segments. For effective tracking of its implementation, benchmarks and milestones

would be developed.

School Health Services

School health program under NUHM has been an important component to provide not only the

preventive and curative services to children but also to ensure their contribution in overall health

development of the urban communities. It is envisaged that the active involvement of children in

the program will enable them to be a change agent for themselves as well as communities by

taking home good knowledge and practices in terms of preventive health care activities. It is

planned that children will be engaged through innovative and creative actions to make the

learning entertaining and educational.

Objective: To evolve innovative ways to involve children in preventive health care activities to

make them a change agent for them and their families.

Innovation: An activity called SEEKH (Systematic Effort to Ensure Knowledge on Health) will be

implemented in each urban government school for active involvement of children based on two

way education and learning package.

Process: To ensure the participation of each and every children in proposed activity, the

following process and flow is planned and will be implemented:


A small booklet on primary health information will be developed (or leveraged from SALONI

program) for school going children.

The school health team will distribute the booklet to students during their visit to schools and

children will have to read the booklet in 45 minutes (we can call it SWASTHYA CLASS).

The reading will be followed by filling up a small questionnaire in 15 minutes

All the students participating in the activity will receive a batch with tagline “Member-Baal

Swasthya Sena”.

The three top scorer children will be rewarded as “Nayak-Baal Swasthya Sena” and will be

known as class monitor till the next round

These three will be responsible to ensure that all students are aware about mentioned good

health practices

They will also follow up with students that they are talking these points at their households and

practicing good practices (such as Hand wash, Personal hygiene etc)

PPP & CSR –

For Mirzapur city a few innovative interventions have been planned. Interventions performed

under Public Private Partnership (PPP) arrangements and Corporate Social Responsibiltoy

(CSR) will be undertaken with the intent to evolve successful models for health care delivery to

the urban poor.

Convergence –

Intra-sectoral convergence is envisaged to be established through integrated planning for

implementation of various health programmes like RCH, RNTCP, NVBDCP, NPCB, National

Mental Health Programme, National Programme for Health Care of the Elderly, etc. at the city

level. Inter-sectoral convergence with Departments of Urban Development, Housing and Urban

Poverty Alleviation, Women & Child Development, School Education, Minority Affairs, Labour

will be established through city level Urban Health Committees headed by the Municipal

Commissioner/ Deputy Commissioner/ District Collector.

4.4- -Activity Plan under NUHM for the state and cities

Act.

No. Activity

Responsibility Months : October'13 - March'14 Remark

s

State

level

City

level Oct.

Nov.

Dec

Jan

Feb

Mar

1

Establishment of Platform for

Convergence at state level

Circular

to be

isued

from

state

level to


Act.

No. Activity


s

State

level

City

level Oct.

Nov.

Dec

Jan

Feb

Mar

all their

district

level

nodal

officers

2

Preparation & Finalization of

Guidelines for City Coord.

Committee/ City Program

Management Committee

These

will be

one time

activities

and will

apply

across

the state

3 Preparation & Finalization of

Guidelines for Urban ASHAs


Guidelines for Mahila Arogya Samiti


Guidelines for UHND

6

Preparation & Finalization of

Guidelines for Outreach sessions/

School Health Programs

7

Preparation & Finalization of Job

Descriptions for all district level

NUHM positions


Guidelines for PPP

9 Induction of state level staff for

Urban Health Cell

10 Induction of city level staff for Urban

Health program

11

Meeting of DHS for establishment

of City Program Management

Committee (UH)

12 Sensitization of new probable

members on NUHM

13 Identification of NGOs for their role

under NUHM

14

Establishment & orientation of City

Program Management Committee

(UH)

15

Identification of groups, collectives

formed under various govt.

programs (like NHG under SJSRY,

self help groups etc.) for MAS


Act.

No. Activity


s

State

level

City

level Oct.

Nov.

Dec

Jan

Feb

Mar

16

Organize meetings with women in

slums where no groups could be

identified

17 Formation and restructuring of

groups as per MAS guidelines

18 Orientation of MAS members

18 Selection of ASHAs

18a - Selection of local NGOs for

ASHA selection facilitation

18b - Listing of local community

members as facilitators by NGOs

18c - Listing of probable ASHA

candidates and finalize selection

19 Convergence meeting with govt.

Stakeholders

20 Mapping & listing exercise (for

health facilities and slums)

20a

- Mapping of all urban health

facilities (public & pvt.) for services

To

continue

in 2014-

15

20b

- Mapping of slums (listed and

unlisted)

To

continue

in 2014-

15

20c

- Houselisting of slums/ poor

settlements

To

continue

in 2014-

15

21 Planning for strengthening of health

facilites/ services

- Health Facility Assessment (of

public facilities including listing of

public facility wise infra & HR

requirement)

To

continue

in 2014-

15

22 Baseline survey of urban poor/


Act.

No. Activity


s

State

level

City

level Oct.

Nov.

Dec

Jan

Feb

Mar

slums (KFAs)

(to determine vulnerability,

morbidity pattern & health status)

23 Meetings of RKS for all the public

health facilites under NUHM

24

Identification of alternate/ suitable

locations for UPHCs under various

urban devp. Programs

To

continue

in 2014-

15

25 Strengthening of public health

facilities

- Selection, training and

deployment of HR in pub. health

facilities

To

continue

in 2014-

15

26 IEC activities

27 Outreach camps & UHNDs (from

existing UHPs)

28

Empanelment of Private Health

Facilities for health care

provisioning

To

continue

in 2014-

15

29 Involvement of CSR activities

4.5-Programme Management Arrangements

Districts Heath Society will be the implementing authority for NUHM under the leadership of the

District Magistrate. District Program Management Units have been further strengthened to

provide appropriate managerial and operational support for the implementation of the NUHM

program at the district level.

After extensive deliberations the state plans to designate the District Health Society under the

chairmanship of the District Magistrate as the implementing authority for NUHM


Fund flow mechanisms have been set up and separate accounts will be opened at in the district

for receiving the NUHM funds.

Urban Health will be included as a key agenda item for review by the District Health Society with

participation of city level urban stakeholders.

An Additional / Deputy CMO has been designated as the nodal officer for NUHM at the district

level. The District Program Management Unit will co-opt implementation of NUHM program in

the district and the District Program Manager will be overall responsible for the implementation

of NUHM. To support this the following additional staff and funds are proposed for strengthening

the District Program Management Units for implementing NUHM:

Urban Health Coordinator, Accountant and Data Entry Operators according to the following norms:

District total Urban population Additional Staff Proposed

1lakh to 10lakhs

1 Urban Health Coordinator,

1 Accountant

1 Data Entry Operator

District Programme Manager will be nodal for all NUHM activities so extra incentive and budget

for 1 laptop to each DPM has been proposed for DPM for undertaking NUHM activities.

A onetime expense for computers, printer and furniture for the above staff has been budgeted

along with the recurring operations expenses.

Onetime expenses have been budgeted for up-gradation of the office of Additional/ Deputy CMO

and District Programme management Unit.

The City Program Management Committee will function as an Apex Body for management of the

City

Health Plan, which will lead to delivery of Maternal, Newborn, Child Health and Nutrition

(MNCHN) and water, sanitation and hygiene (WASH) services to the urban poor and will work

towards the following objectives:

Establish a forum for convergence of city level stakeholders for the delivery of MNCHN and

WASH services to the urban poor.

Serve as the nodal body for the planning and monitoring of MNCHN and WASH service delivery

to the urban poor.

Provide a forum for exploring, reviewing and approving PPP initiatives and innovations to

address the gaps in MNCHN and WASH service delivery to the urban poor.

The structure proposed for the City Coordination Committee :

Chairperson - DM/ Municipal Commissioner

Convener - CMO

Members – Health - ACMO-Urban

Member- NRHM - DPM, NRHM

Member – ICDS - CDPO

Member – Nagar Nigam - Sum Improvement Officer

Member – Water & Sanitation- Sup. En. / Ex.En. JalKal Vibhag, Nagar Nigam

Member DUDA & UD - Project Officer


Members – School Education - BSA & DIOS

Members – Dev. Partners - Partners working in urban health sector ( HUP)

Coordinator - Lead Dev. Partner

Review Meetings at UPHC and City Level

Nature of Meeting Periodicity Meeting

Venue

Participants

Mahila Aarogya Samiti

Meeting

Once a month for

each MAS

Slum ANM, HV, Community Organizer,

Social Mobilization officer

Review meeting with Link

workers and MAS

representatives

Once a month UPHC All ANMs, PHN, LMO, Community

Organizer, Social Mobilization officer

Meeting of UPHC

Coordination Committee

Once a month UPHC LMO, PHN/Community Organizer,

Social Mobilization officer,

representative from 2nd tier facility,

and reps. From other departments

Meeting with CMO & UH

Program Coordinator

Once a month CMO

Office

CMO, Program Coord., Asst.

Program Coordinator, LMO/ PHN/

Community Organizer, Social

Mobilization officer

City Task Force Meeting Once in two

months

DM’s

office

CMO, Program Coord. UH, Various

departments’ reps. , private partners,

NGOs

4.6-City Level Indicators & Targets

Indicators Baseline (as

applicable)

Number

Proposed

(2013-14)

Community Processes

1. Number of Mahila Arogya Samiti (MAS) formed * 0 60

2. Number of MAS members trained * 0 600


3. Number of Accredited Social Health Activists (ASHAs) selected

and trained * 0 30

Health Systems

4. Number of ANMs recruited * 0 18

5. No. of Special Outreach health camps organized in the slum/HFAs

* 0 8

6. No. of UHNDs organized in the slums and vulnerable areas * 0 58

7. Number of UPHCs made operational * 0 4

8. Number of UCHCs made operational * 0 00

9. No. of RKS created at UPHC and UCHC * 0 4

10. OPD attendance in the UPHCs 0 3000

11. No. of deliveries conducted in public health facilities 0 500

RCH Services

12. ANC early registration in first trimester 1500

13. Number of women who had ANC check-up in their first trimester of

pregnancy 1500

14. TT (2nd dose) coverage among pregnant women 1500

15. No. of children fully immunised (through public health facilities) 00

16. No. of Severely Acute Malnourished (SAM) children identified and

referred for treatment 00

Communicable Diseases


17. No. of malaria cases detected through blood examination 00

18. No. of TB cases identified through chest symptomatic 00

19. No. of suspected TB cases referred for sputum examination 00

20. No. of MDR-TB cases put under DOTS-plus 00

Non Communicable Diseases

21. No. of Diabetes cases screened in the city 00

22. No. of Cancer cases screened in the city 00

23. No. of Hypertension cases screened in the city 00

Draft PIP of LUCKNOW - NATIONAL URBAN HEALTH …nuhm.upnrhm.gov.in/urban/pip/mirzapurpip.pdfMirzapur...

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