National Health Programmes in Urban India: NUHM and Key Initiatives

India’s urban population has grown rapidly over the past few decades, creating unique healthcare challenges for millions living in cities. With projections suggesting that nearly 46% of India’s population will reside in urban areas by 2030, the strain on healthcare infrastructure has become increasingly evident. Slum dwellers, migrant workers, and economically disadvantaged urban residents often face significant barriers in accessing quality healthcare. To address these challenges, the Government of India has implemented several national health programmes specifically designed to improve healthcare delivery in urban settings.

National Urban Health Mission: bridging healthcare gaps in cities 🔗

The National Urban Health Mission (NUHM) was approved by the Cabinet on 1st May 2013 as a sub-mission of the National Health Mission (NHM). This landmark initiative aims to meet the healthcare needs of urban populations, with a primary focus on the urban poor. The mission covers all state capitals, district headquarters, and cities with populations exceeding 50,000, targeting slum dwellers, homeless individuals, street children, construction workers, and other vulnerable urban communities.

Key objectives and structure 🔗

NUHM works toward several critical goals: reducing infant mortality rates to 20 per 1,000 live births in urban areas, decreasing maternal mortality, and ensuring universal access to healthcare with 100% institutional deliveries. The programme delivers comprehensive primary healthcare through Urban Primary Health Centres (U-PHCs) and Urban Community Health Centres (U-CHCs), supported by strong outreach services.

A distinctive feature of NUHM is the deployment of Urban Social Health Activists (USHAs), who serve as vital links between slum communities and health facilities. Each USHA worker, typically aged 25-45 years and residing within the slum area, is responsible for 200-500 households, delivering doorstep health services to approximately 1,000-2,500 beneficiaries. The programme also promotes Mahila Arogya Samitis (MAS), which are women’s health committees that receive annual grants of Rs. 5,000 to conduct health awareness meetings and address community health needs.

Funding and implementation 🔗

NUHM follows a cost-sharing model between central and state governments. For most states, the funding ratio is 75:25 (centre to state), while northeastern and special category states receive a more favourable 90:10 ratio. This financial structure enables flexible, city-specific implementation models led by urban local bodies, acknowledging the diverse healthcare needs across different urban settings.

Reproductive and child health initiatives 🔗

Maternal and child health remains a priority within urban health programming. The Janani Shishu Suraksha Karyakram (JSSK), launched on 1st June 2011, directly addresses the financial barriers that prevent many women from accessing institutional care during pregnancy and childbirth.

Zero-expense deliveries through JSSK 🔗

JSSK entitles all pregnant women delivering in public health institutions to completely free services, including caesarean sections. The programme eliminates out-of-pocket expenses by providing free drugs and consumables, diagnostic services, blood transfusion when required, diet during hospital stay, and transport from home to health facility and back. In 2014, the programme was expanded to cover all antenatal and postnatal complications, along with treatment for sick infants up to one year of age.

This initiative has demonstrated significant impact. Research from public health studies indicates that free diagnostics and drugs were provided to 96% and 86% of surveyed mothers respectively, showing substantial reach of these entitlements in public sector facilities.

Controlling communicable diseases in urban environments 🔗

Urban areas face particular challenges with communicable diseases due to population density, sanitation issues, and mobility patterns. India’s Revised National Tuberculosis Control Programme (RNTCP) has been instrumental in addressing tuberculosis across both rural and urban settings. The programme emphasizes early case detection, standardized treatment protocols, and community-based directly observed treatment.

NUHM provides a convergent platform for integrating various disease control programmes, including those addressing vector-borne diseases, HIV/AIDS, and other communicable conditions. This integrated approach ensures that urban primary health centres can offer comprehensive services addressing multiple health concerns at a single point of care.

Tackling non-communicable diseases 🔗

India is experiencing a rapid epidemiological transition, with non-communicable diseases (NCDs) now accounting for approximately 60% of all deaths. The burden is particularly acute in urban areas, where lifestyle factors and environmental conditions contribute to higher prevalence rates.

NPCDCS: a comprehensive response 🔗

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010 to address this growing burden. The programme focuses on health promotion through behaviour change, early screening and diagnosis, and capacity building at various levels of healthcare delivery. According to government data, coronary artery disease affects 3-4% of Indians in rural areas and 8-10% in urban areas, highlighting the urban-specific nature of this health challenge.

Key interventions under NPCDCS include population-based screening for diabetes, hypertension, and common cancers (oral, breast, and cervical) through trained frontline workers. The programme has established NCD clinics at district and community health centre levels, along with cardiac care units and day care centres. An innovative aspect is the integration of AYUSH methodologies with NPCDCS services, where yoga practice forms an integral part of NCD prevention and management.

Ayushman Bharat: transforming healthcare delivery 🔗

Ayushman Bharat, launched in 2018, represents a fundamental shift from fragmented healthcare approaches toward comprehensive, needs-based service delivery. The programme has two complementary components that together aim to achieve universal health coverage.

Pradhan Mantri Jan Arogya Yojana (PM-JAY) 🔗

PM-JAY is recognized as the world’s largest health assurance scheme, providing coverage of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization. The scheme targets approximately 55 crore beneficiaries from the bottom 40% of India’s population, identified through deprivation and occupational criteria from census data. Benefits are portable across the country, allowing beneficiaries to access cashless treatment at any empanelled public or private hospital nationwide.

Health and Wellness Centres 🔗

The first component involves transforming 1,50,000 Sub-Centres and Primary Health Centres into Ayushman Arogya Mandirs (Health and Wellness Centres). These centres deliver expanded services beyond traditional maternal and child health, including care for non-communicable diseases, mental health services, oral and eye care, and first-level emergency response. In urban areas, 11,024 Urban Health and Wellness Centres are being established under PM-ABHIM to ensure decentralized primary healthcare delivery closer to vulnerable populations.

Digital transformation through ABDM 🔗

The Ayushman Bharat Digital Mission (ABDM), previously known as the National Digital Health Mission, was launched in September 2021 to create a national digital health ecosystem. This initiative aims to bridge gaps among healthcare stakeholders through integrated digital infrastructure.

Building blocks of digital health 🔗

ABDM establishes unique Ayushman Bharat Health Account (ABHA) numbers for citizens, creating standardized health identification across all healthcare providers. As of recent data, nearly 380 million ABHA numbers have been generated, with over 262 million health records digitized and linked. The mission includes the Health Facility Registry and Healthcare Professionals Registry, enabling verification and coordination across the health ecosystem.

For patients, ABDM enables secure storage and sharing of medical records including prescriptions, diagnostic reports, and discharge summaries. The platform facilitates teleconsultations and e-pharmacy services, particularly valuable for urban populations facing time and accessibility constraints. Healthcare providers benefit from better access to patient medical histories, supporting more informed clinical decisions.

Strengthening tertiary care through PMSSY 🔗

The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was announced in 2003 with two primary objectives: correcting regional imbalances in tertiary healthcare availability and augmenting medical education facilities. The scheme has two components: establishing new All India Institutes of Medical Sciences (AIIMS) and upgrading existing government medical colleges.

Under PMSSY, 22 new AIIMS have been approved across various states, with six already fully functional at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, and Rishikesh. Additionally, 75 projects for upgrading existing government medical colleges have been sanctioned, creating super-specialty blocks and enhancing diagnostic and treatment capabilities. These investments directly benefit urban populations by expanding access to advanced medical care and increasing the availability of trained healthcare professionals.

Integration and convergence for better outcomes 🔗

A distinctive strength of India’s urban health approach lies in the convergence of various programmes. NUHM explicitly emphasizes partnerships with initiatives addressing broader determinants of health, including drinking water supply, sanitation, and nutrition programmes. The integration of communicable and non-communicable disease programmes through common platforms at Urban Primary Health Centres ensures comprehensive care delivery.

This convergent approach is particularly important in urban settings where health challenges are multidimensional. Slum populations often face simultaneous burdens of infectious diseases, malnutrition, and emerging chronic conditions. By creating robust referral mechanisms and integrating services at the primary care level, these programmes work to address the complete spectrum of urban health needs.

What do you think? As India’s urban population continues to grow, how can these national health programmes better adapt to the changing needs of city dwellers? What role can technology and community participation play in making urban healthcare more accessible and responsive to those who need it most?

References

1. https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=970&lid=137
2. https://nhsrcindia.org/practice-areas/kmd/urban-health-nuhm
3. https://nhm.gov.in/index1.php?lang=1&level=3&sublinkid=842&lid=308
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC4746958/
5. https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1048&lid=604
6. https://nha.gov.in/PM-JAY
7. https://nhsrcindia.org/ayushman-bharat
8. https://nha.gov.in/NDHM
9. https://pmssy-mohfw.nic.in/index1.php?lang=1&level=1&sublinkid=81&lid=127