Smart Cities: UnderprivilegedCitizens and Ways Towards

Equitable Access to Services andWell-being

Siddharth AgarwalUrban Health Resource Centre, India

May 14, 2015Rotary Club MeerutChamber of Commerce, Bombay Bazaar, Meerut

Find us on facebookwww.uhrc.in

Outline

Urbanization, Health and well-being challenges What Approaches have worked, helped learn practical lessons and the‘How to do’ with relevant stakeholders:

# 1 Spatial city and Neighbourhood maps help better understand living environment # 2 Slum-Community/Women’s Groups increase demand for services [Mahila Arogya Samiti in

NUHM] # 3 Collective Social Needs Savings & Loans [Community Revolving Fund in NUHM] # 4 Gentle Negotiation: Under-served communities address determinants of urban health

across sectors, through community applications for services # 5 Youth-children groups emerging as ‘Force Gen-next’ # 6 Community’s Own Efforts when authorities do not respond # 7 Facilitating Access to Picture ID, Proof of Address and social benefits # 8 Facilitating Access to Food subsidy cards # 9 Multi-dimensional Efforts to Improve Health, Nutrition, Environment, Related Services:Through Coordination & Linkage Building – towards addressing social determinants of health

Urbanization, Health and well-being challenges What Approaches have worked, helped learn practical lessons and the‘How to do’ with relevant stakeholders:

# 1 Spatial city and Neighbourhood maps help better understand living environment # 2 Slum-Community/Women’s Groups increase demand for services [Mahila Arogya Samiti in

NUHM] # 3 Collective Social Needs Savings & Loans [Community Revolving Fund in NUHM] # 4 Gentle Negotiation: Under-served communities address determinants of urban health

across sectors, through community applications for services # 5 Youth-children groups emerging as ‘Force Gen-next’ # 6 Community’s Own Efforts when authorities do not respond # 7 Facilitating Access to Picture ID, Proof of Address and social benefits # 8 Facilitating Access to Food subsidy cards # 9 Multi-dimensional Efforts to Improve Health, Nutrition, Environment, Related Services:Through Coordination & Linkage Building – towards addressing social determinants of health

India’s Urbanizing economy: Affluence andDeprivation Juxtaposed

In India’s glittering cities opulence grows along withdeprivation and poverty 60% of Mumbai’s population lives on 8% of land [Parsuraman, S. 2007]

and contribute to economy in diverse ways, living in severe congestion In Delhi, water-supply for planned colonies is 225 lpcd (liter per capita

daily) and 50 lpcd for listed slums

Urban poor contribute substantially to India’s economicgrowth: Between 60- 90% of urban poor are involved in urban informal sector. Urban sector contributes 60% -70% of GDP

In India’s glittering cities opulence grows along withdeprivation and poverty 60% of Mumbai’s population lives on 8% of land [Parsuraman, S. 2007]

and contribute to economy in diverse ways, living in severe congestion In Delhi, water-supply for planned colonies is 225 lpcd (liter per capita

daily) and 50 lpcd for listed slums

Urban poor contribute substantially to India’s economicgrowth: Between 60- 90% of urban poor are involved in urban informal sector. Urban sector contributes 60% -70% of GDP

Parsuraman, S - http://www.karmayog.org/urbandvlp/upload/21756/Newspaper-essays_Prarsuraman.pdf. This indicateshigh density of living space for 60% living in slums, chawls, informal settlements.Population density of Greater Mumbai (area under Municipal Corporation of Greater Mumbai) estimated at 24,812(Mumbai Suburban district & Mumbai City district) persons per sq. km. as per Census 2011 .Density of Mumbai City – 43,447 per sq. km.

Challenging Environment of an UrbanizingWorld

Rolling incense sticks tosupport family income

Unhealthy Living Environment

Approach # 1a: Mapping Helps Inclusionof Unlisted Slums/Clusters

SLUM NUMBER POPULATIONLISTED 102 455923UNLISTED 85 216935TOTAL 187 672858

LOCATION OF SLUMS

Meerut City

6Spatial city mapping of vulnerable clusters integral strategy of NUHM

Community groups in slums prepare maps toa) Ensure that no family is left out from lists used for housing, food subsidy,

entitlements;b) Track access to health services e.g. Immunization and ANC , HIV testing,c) Help identifying and providing services/linkage to recent migrants

Approach:1 (b)Demonstrate uses of Neighborhood Mapping

7

Approach 2: Demand side strategies

Cluster teams of Women’s Groups: Slum-Community/Women’s Groups as agents of change Cluster teams or Congress of slum women’s groups gives stronger voice

and greater negotiation power

Women’s groups are Mahila Arogya Samitis mandated in NUHM 1

1NUHM Framework for Implementation, May 2013

Network of slum-based community groups inIndore and Agra

UHRCIndore/Agra

Training, Monitoring,Supervision &

problem solving

Training, Monitoring,Supervision &

problem solving

• Project coordinator• Field coordinators

Linkage withCivic Authorities

Linkage withCivic Authorities

8 to 23 women groups in a large slum cluster 10-14 members per group 30 to 70,000 slum population per cluster team

5 Cluster teams 7-37members (1 per group)

(has office bearers, bankaccount, registered NGO)

• Grant toclusterteam

• ProgrammeMonitoring

• Grant toclusterteam

• ProgrammeMonitoring

UHRC Delhi

Approach 3: Building skills, self-reliance and confidence Collective Social Needs Savings and Loans: for Health and

related Emergency, Child Education, Starting a smallbusiness, purchasing food grains, Marriage, getting assetsback from money lenders

This approach is a mandated in NUHM as ‘revolving community fund’1

1NUHM Framework for Implementation, May 2013

Utilization of loans from Women’s Groups

Data from collective savings registers of 125 women’s groups in Agra and Indoreduring April‐13 to March‐14 shows that of the 3327 loans given:

925 loans (27.8%) for health needs, of which 550 loans served maternal‐childhealth needs, and 375 loans served other health needs

531 loans (15.96%) helped overcome challenges that interrupt or lead to drop-outin children’s education

524 loans (15.74%) helped start/expand livelihoods 424 loans (12.74%) helped store grains at harvest time, a measure to address food

insecurity during low (or no) wage-earning times 221 loans (6.64%) supported girl marriages 302 loans (9.07%) enabled repaying money‐lender debts 190 loans (5.71%) were used for grocery/kitchen expenses 210 loans (6.31%) enabled houseimprovements, land lease, toilet construction

Data from collective savings registers of 125 women’s groups in Agra and Indoreduring April‐13 to March‐14 shows that of the 3327 loans given:

925 loans (27.8%) for health needs, of which 550 loans served maternal‐childhealth needs, and 375 loans served other health needs

531 loans (15.96%) helped overcome challenges that interrupt or lead to drop-outin children’s education

524 loans (15.74%) helped start/expand livelihoods 424 loans (12.74%) helped store grains at harvest time, a measure to address food

insecurity during low (or no) wage-earning times 221 loans (6.64%) supported girl marriages 302 loans (9.07%) enabled repaying money‐lender debts 190 loans (5.71%) were used for grocery/kitchen expenses 210 loans (6.31%) enabled houseimprovements, land lease, toilet construction

Skill Building, Access toGovernment Schemes

Kamkaji Mahila Card Silai Centre

Approach 4: Gentle Negotiation through CollectivePetitions, reminders (Written requests to officers ofHealth, Nutrition & Environmental Departments)

PetitionResponse of Civic

Authority

Letter in support ofpetition/request by

politician

Letter in support ofpetition/request by

politician

Approach 5: Youth-children groups emergingas ‘Force Gen-next’

With continual mentoring, motivation Youth-children groups inslums are not only improving their own lives but also contributeto their societies in tangible ways.

Promoting Hygiene,Hand-washing

Youth petitions to civic authoritiesfor streets, garbage cleaning

Cleaner DrainsBefore After

During 2013-2014: 100,000 slum population benefited (Agra + Indore) fromcleaning of drains

Electricity Connection

During 2013-2014: 12000 slum population benefited (Agra + Indore) fromelectricity connections

Before After

Improvement of Slum Pathways, Sewer

During 2013-2014: 50,000 slum population benefited (Agra + Indore) from roads paved

Improvement of Slum Pathways, Lanes

During 2013-2014: 40,000 slum population benefited (Agra + Indore)from roads paved

Water Tanker Installation

During 2013-2014: 37000 slum population benefited (Indore & Agra)from water supply

Approach # 6: Community’s Own EffortsCommunity Contributes to build, re-build vital bridge

in Banganga Area, Indore

BeforeOct’11 Oct’11 Aug’12 Oct’12

Elevating House Plinth to prevent rain-waterentering house

Rain water enters houseRain water enters house

Rain water does not enter elevatedhouseElevating House Plinth

Approach # 7

Perseverant Efforts to enableGovernment Picture ID, Proof ofAddress, Certificate of Birth Date

Perseverant Efforts to enableGovernment Picture ID, Proof ofAddress, Certificate of Birth Date

Women showing their UID-Aadhaar CardsPicture ID & Proof of Address

During Apr 13 – Mar 14: 8000 persons benefited from proof of address and PhotoID

Birth Certificate(Required to applying for child education related benefits)

Approach # 8Efforts towards TranslatingMandate into Reality: FoodSubsidy Cards and Social BenefitSchemes

Approach # 8Efforts towards TranslatingMandate into Reality: FoodSubsidy Cards and Social BenefitSchemes

Food Subsidy Card as per FoodSecurity Act, 2013

Dept. WCDICDS, Girl Child Benefit,

Others

Health DeptANC, Immunization

JSY,Other services

PoliticiansVoice, support for

applications

Municipal Corprn/JNNUR-

Roads, drains,water., toilet, tenure,

housing

Federation ofWomen’s Groups

Approach #9: Multi-dimensional Efforts to ImproveHealth and Related Services Through Coordination &Linkage Building

Dist. Magistrate’s OfficeSocial Assistance ProgramsOld Age & Widow Pension

Food Subsidy BPL,APL Cards

Labour DeptDomestic worker

registration

PoliticiansVoice, support for

applications

Municipal Corprn/JNNUR-

Roads, drains,water., toilet, tenure,

housing

OthersVoter ID, Adhar,

Domicile Certificate,caste Certificate

UHRCIndore/ Agra

Gender empowerment enhancescaring capacity of woman and family

Through women’s groups, gender equationis positively improved at family andsociety level

Women’s enhanced access to resourcesand greater capacity to take timely care ofthemselves, children, and the family helpsthe family and community

Through women’s groups, gender equationis positively improved at family andsociety level

Women’s enhanced access to resourcesand greater capacity to take timely care ofthemselves, children, and the family helpsthe family and community

Empowered Assertive Women TakeAction…….

Women wielding bamboos against alcoholism vending points, gambling joints

….and no boundaries can stopthese empowered women

Women’s group members at the HindustanTimes Social Innovators Conclave, 2014

Vociferous women organise a ‘Jan Jagran’ Rally

“There are ought to be something very specialabout the boundary conditions of the universe,and what can be more special than that thereis no boundary.” – Stephen Hawking

Functioning,AccountableSystem for

Urban Health,Nutrition and

Well-beingLong Lever of :a) Complementary skills, Knowledge,Experiencea) Commitment , Motivationb) Understanding of problemsc) Accountability, responsibility

With Hope and ConfidenceWith Hope and Confidence

33

Functioning,AccountableSystem for

Urban Health,Nutrition and

Well-beingLong Lever of :a) Complementary skills, Knowledge,Experiencea) Commitment , Motivationb) Understanding of problemsc) Accountability, responsibility

“A small body of determined spirits fired by an“A small body of determined spirits fired by anunquenchable faith in their mission, can alter theunquenchable faith in their mission, can alter thecourse of history”course of history” -- MohandasMohandas KaramchandKaramchand GandhiGandhi

www.uhrc.in ; admin@uhrc.in

Social Orgnaisations,Professionals, Govt.Managers, Public &Private

Sectors, slum CBOs,Civil Society