Indian cabinet defers decision on National Urban Health MissionBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1216 (Published 25 February 2013) Cite this as: BMJ 2013;346:f1216
The Indian cabinet seems on Thursday 21 February to have deferred a decision on the proposed National Urban Health Mission, putting on hold the government’s “ambitious” urban healthcare plan, which was meant to herald the first step towards universal health coverage in India.
The new mission would come under a National Health Mission and would cost Rs22 000 crore (£2.7bn; €3.1bn; $4bn). The proposal has been cleared by the finance ministry’s Expenditure Finance Committee and the Planning Commission. President Pranab Mukherjee said, “An overarching National Health Mission, covering both rural and urban areas, is being finalised.”
The new urban health mission is being modelled on the National Rural Health Mission, which is widely credited for improving health indicators such as maternal mortality, infant mortality, total fertility, and life expectancy in the past few years.
It would look to strengthen public health and ensure better quality services and better access to healthcare among people in towns and cities, particularly in slum areas. It would cover 779 cities with populations of more than 50 000.
Figures from the 2011 census show that the urban population grew in absolute terms more than the rural population between 2001and 2011, for the first time since independence in 1947. The proportion living in urban areas rose from 27.8% in 2001 to 31.2% in 2011.1
People living in India’s towns and cities have variable access to healthcare, and services differ widely in quality and affordability. Large numbers of profit making and not for profit private healthcare providers offer a multitude of services that are not subject to any government control or monitoring.
The National Urban Health Mission’s framework of implementation document, produced by the Ministry of Health and Family Welfare, notes that health indicators among the urban poor are similar to and in many cases worse than those of poor people living in rural areas.2
There are also big regional variations in service delivery. For example, the Brihan Mumbai Municipal Corporation has a Rs900 crore health budget (a third of which is earmarked for medical education), many times greater than the health budgets of some smaller states in India.
Tanmay Mahapatra, medical research director at Mission Arogya, a health and information technology research foundation, said that the diversity of the healthcare needs of urban populations, combined with complex patterns of population movement, made public health coverage in towns and cities “very difficult.”
He said that the National Urban Health Mission was an “essential step” towards achieving universal healthcare in India, adding, “NUHM needs to be implemented as soon as possible.”
Cite this as: BMJ 2013;346:f1216