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Mobile Medical Units (MMUs)
Introduction: The National Health Mission encompasses the National Rural Health Mission (NRHM) and the National Urban Health Mission (NUHM) as its two sub-missions. One major initiative under the NRHM was the operationalisation of Mobile Medical Units (MMUs) to provide a range of health care services for population living in remote and inaccessible areas. With the launch of NUHM, the MMUs services are also intended to cater to the urban poor and vulnerable population and provide fixed services in areas where there are no infrastructure.
The NRHM Framework of implementation (2005-2012) envisaged two models of MMUs, one with diagnostics services (for all states other than the N.E states, H.P and J&K). For N.E states, H.P and J&K specialized services such as X-ray, ECG and ultrasound were also envisaged to be provided due to their difficult & hilly terrain and non approachability by public transport etc.
i. To reach populations in remote and inaccessible areas with a set of preventive, promotive and curative services including not limited to RCH services.
ii. Provide access to specialist backup services through telemedicine or referral support to populations in such areas.
In urban areas, MMUs would be deployed where there are habitations of marginalized communities (ragpickers, homeless, migrants) that lives on the fringes of cities and towns, alongside highways & railway tracks or under flyover bridges etc. The MMUs could also be deployed in localities where slum populations live, where there is simply no space for creating fixed infrastructure.
In rural areas MMUs would continue to be deployed in areas with limited or complete lack of access to health care services, such as tribal areas, conflict areas affected by insurgency and extremism, hilly & desert areas, islands, flood affected and snow bound areas.
Nature of Services to be Provided by an MMU
An MMU could be envisaged to provide the following services:-
i. Providing outreach services by ANMs in areas where no such services exist or would suffice, or
ii. the provision of a broader set of clinical services by a medical Officer and his/her team with ANM/ASHA playing a mobilization role (one vehicle outfitted as an outpatient clinic, with examination table, light and sufficient facilities for basic lab. investigations and a second vehicle for team transport, or
iii. provision of specialist services and referral back-up to an existing and functional primary health care system.
Norms for Deployment of MMUs
The approved norm is one MMU per district with normative po[pulation of 10 lakhs, with a cap of five MMUs per district. This has been estimated as follows:-
a) District with population of 10 lakhs - 1 MMU
b) District with population of between 10 & 20 lakhs - 2 MMUs
c) District with population of between 20 & 30 lakhs - 3 MMUs
d) District with population of between 30 & 40 lakhs - 4 MMUs
e) District with population of over 40 lakhs - 5 MMUS
This can be further relaxed for hilly & tribal Areas where the populations are widely dispersed and the geographical terrain is difficult, where the States are expected to address the nature of diversity of their conditions and adopt the most suitable and sustainable model to suit their state's specific needs.
Types of Services Provided
MMUs are envisaged to provide primary care services for common diseases including communicable and non-communicable diseases, RCH services, carry out screening activities and provide referral linkage to appropriate higher faculties., In addition, the MMU would also :-
provide point of care diagnostics, blood glucose, pregnancy testing, urine microscopy, albumin and sugar, Hb, height/weight, vision testing, RDT
collect sputum samples
screen populations over 30 for HT, diabetes and cancers annually and undertake follow-up checks during the monthly visit, including providing patients requiring drugs with a monthly supply
undertake IEC sessions on a range of health topics - improving preventive and promotive behaviors for maternal and child health, communicable diseases, including vector borne diseases, educate the community on lifestyle changes, the need for screening for NCDs, and early recognition and appropriate referral.
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