Eleventh Five Year Plan

Health and Family Welfare and AYUSH 733.1.55 NUHM would cover all cities with a populationof more than 100000. It would cover slum dwellers;other marginalized urban dwellers like rickshawpullers, street vendors, railway and bus station coolies,homeless people, street children, construction siteworkers, who may be in slums or on sites.3.1.56 The existing Urban Health Posts and UrbanFamily Welfare Centres would continue underNUHM. They will be marked on a map and classifiedas the Urban Health Centres on the basis of theircurrent population coverage. All the existing humanresources will then be suitably reorganized and rationalized.These centres will also be considered forupgradation.3.1.57 Intersectoral coordination mechanism andconvergence will be planned between the JawaharlalNehru National Urban Renewal Mission (JNNURM)and the NUHM.Strengthening Existing Health System3.1.58 There is need to shift to decentralization offunctions to hospital units/health centres and localbodies. The States need to move away from the narrowfocus on the implementation of budgeted programmesand vertical schemes. They need to develop systemsthat comprehensively address the health needs of allcitizens. Thus, in order to improve the health careservices in the country, the Eleventh Five Year Plan willinsist on Integrated District Health Plans and BlockSpecific Health Plans. It will mandate involvement ofall health related sectors and emphasize partnershipwith PRIs, local bodies, communities, NGOs, Voluntaryand Civil Society Organizations.PRIMARY HEALTH CARE3.1.59 During the Eleventh Five Year Plan, majorfocus will be on NRHM initiatives. Efforts will be madefor restructuring and reorganizing all health facilitiesbelow district level into the Three Tier Rural PrimaryHealth Care System. These will serve the populationsin a well-defined area and have referral linkages witheach other. Population-centric norms, which continueto drive the provisioning of health infrastructure, willbe modified. These will be replaced with flexible normscomprising habitation-based needs, community-basedneeds, and disease pattern-based needs. Steps will alsobe taken to reorganize Urban Primary Health CareInstitutions and make them responsible for the healthcare of people living in a defined geographic area,particularly slum dwellers.3.1.60 The Approach Paper on Eleventh Five Year Planstated accessibility as a major issue, especially in ruralareas, where habitations are scattered and women andchildren continue to die en route to hospital. Policyinterventions, therefore, have to be evidence based andresponsive to area specific differences as shown inAssam (Box 3.1.5). Concerted action will be takensuch as enabling pregnant women to have skilledattendance at birth and receive nutritional supplements.PHCs and CHCs will be connected by allweather roads so that they can be reached quicklyin emergencies (accessibility to hospital would bemeasured in travel time, not just distance from nearestPHC). Home-based neonatal care will be provided,including emergency life saving measures. Achievementof health objectives will, therefore, involve muchmore than curative or even preventive health care, anintegrated approach will be adopted.3.1.61 The Eleventh Five Year Plan will ensure availabilityof essential drugs and supplies, vaccines, medicalequipment, along with the basic infrastructure likeelectricity, water supply, toilets, telecommunications,and computers for maintaining records. All Stateswill be encouraged to implement the Tamil Nadumodel in which close to 58% of the health centresare functioning round the clock. Success models ofvarious States such as higher salary to health workersposted in tribal regions of Himachal Pradesh andKBK districts of Orissa can be considered and replicated.3.1.62 Tribal population in India is considered tobe the most socio-economically disadvantaged group.The National Population Policy (2000) has made specialmention of tribal areas in terms of improvingbasic health and Reproductive and Child Health(RCH) services. In order to ensure adequate access tohealth care services for the tribal population, apartfrom dispensaries and mobile health clinics, 20284SCs, 3230 PHCs, and 750 CHCs have been established.