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Wednesday, September 27, 2017

Reflecting Back

“Nothing can bring you peace but yourself.”  Ralph Waldo Emerson

The above quote is the core philosophy of Urban Health Resource Centre, a non-governmental organization. The organization strives to support women living in urban slums to become self-reliant and independent. The Center’s efforts have been consistent and structured in empowering various communities of Indore, Agra and some parts of Delhi. Despite challenges, the outcomes have been positive. The living condition of these communities has improved considerably.

Recently, in January 2017, I had the opportunity to spend some time with the group of slum women and children in Indore. They are called the members of UHRC. I was impressed by their confidence, their will to progress and their overall positive attitude. Their admiration and respect for UHRC team members and constant reference to Dr. Siddharth, the founder and Director UHRC, in his absence was the evidence of their trust and bond between him, other UHRC team members and the community.


The UHRC has been implementing a number of skills-development programs training women and children in various crafts such as tailoring, basket making, and gardening. My task was to train them in Jewellery and Greeting card making.
I arrived on the morning of 8th Feb 2017 and headed to a basti called Pushp Nagar. I was to meet my future students who were at the time of my visit, attending a session on nutrition conducted by Neeraj and Shabnam, experienced coordinators of the UHRC Indore team. When I arrived, the women were being taught through photos the benefits of healthy eating, how to gain the most from local food, how to prepare low-cost sprouts and also how to grow their own vegetables. They recognized that their main challenge was prioritizing nutrition while still making the food tasty. It was a delight to see them identify simple lifestyle changes and to see them so engrossed in nutritional discussions in general. A few members even volunteered to make sprouts for the forthcoming session.

During the training, there was a pause, where I was briefly introduced and was met with fleeting glances. To my joy, those initial curious glances turned into smiles over the course of the next few days. Needless to say, I fell in love with the group. I was excitedly quizzed about my background and the amazement filled reactions to my responses made the attention delightfully memorable!

Day two was my first Jewellery making session in Pushp Nagar. It did not take very long for the group to learn the ways of basic jewelry making.  Soon enough, they were ready to explore their own ideas. They created beautiful pieces and were delighted to adorn them. I was impressed by their improvisations, competitive spirit and most of all their energy level. 

Ms. Deeksha Kushwaha, a local politician, also stopped by to address the group on how the craft could be potentially turned into a livelihood. She shared information on the upcoming craft fair and offered to help the women and children set up their own stall, free of cost.  This was added encouragement for some and it definitely helped the group realize the relevance of the overall exercise.
            Above: Jewellery made displayed on a piece of cloth after the session.

The Jewellery making workshop continued in Jagdish Nagar and Govind Dham bastis for the next three days. Here too, the participants were immensely energetic and curious. Their curiosity however was not confined to jewelry. They wanted to know so much about Egypt (my current home town) and the pyramids in particular. It made me wish I had prepared a slide show to familiarize them with the world beyond. This is something I will remember for my next visit.
                            Above: Children engrossed in learning jewellery making

With regards to card making, I had the understanding that this would be of interest mainly to the children. I thought the women, after a few hours of jewelry making would want to return to their daily chores. To my delight, the children joined and most women stayed as well. This truly spoke to their eager attitudes and their desire to make the most of every opportunity provided to them.
                              Above: One child keenly learning making a greeting card.


 The Centre’s approach has been to learn from the community, find solutions, and adapt those solutions with the community’s inputs. For example, even with card making, we used waste materials such as threads, fabric pieces and paper. I taught them a few basic rules of Warliart and how to do so using just three colors. I left the rest to their imagination. Given their creativity and more importantly their focus during the workshop, I was not the least bit surprised to see so many beautifully designed cards based on the limited materials and just 2 sample designs. 


 Overall, my brief interaction with the community was immensely gratifying and a wonderful learning experience. I was humbled by the diligence and dedication of UHRC team members Neeraj, Shabnam, Amrit and Kailash. After my visit, I promised to always remember the following:


 1)    That one must take pride in whatever one does:


In view of numerous difficulties overcome by the community even to receive basic services, it was not a surprise to see them taking pride in their efforts. For instance, getting a proper road constructed in their slum was not an easy task. These women persevered by making many visits to the Government authorities. They shared the details of their struggle with a glow of victory. Similarly a few girls spoke about their skills and displayed their artistic creations to me with unmatchable confidence.


 2)    That one must share what one has:


 The UHRC Community Groups help families to send their children to school by collecting uniforms and books. They try and help each other in whatever ways possible. Young children have often come forward on their own to help their friends continue school education by collecting small amounts per children’s group member.


Two women brought my attention to the plants in each household. One of the occupants, a gardener helped each household to grow their plants and saplings. This inspired them to grow their own vegetables and maintain little kitchen garden around on within the walls of their houses.


 3)    To be unafraid to adapt to changes:


 One of the remarkable features of the group that I admired was the openness of women and children to learn. They even make extensive use of technology, be it for communication, searching for new designs online, or to be updated about the developments taking place around them.


The creation of a UHRC WhatsApp group called ‘Team UHRC’ is one more step ahead in that direction. It is proving to be a very effective tool for sharing relevant information about govt. ID, voter card, social schemes for women like Vidhwa (widow) pension, Vriddha (old-age) pensions and more.


The WhatApp group has been instrumental in strengthening social cohesion, spreading innovative ideas like selling homemade products in local fairs and providing timely support whenever needed.


 In the end, I share the same view as Dr. Siddharth, the UHRC Executive Director, that nature has endowed all human beings with similar mental faculties and potential. It is just that some of us are more fortunate to be born in families where we do not have to struggle for shelter, clothing, education, and basic welfare.


I wish all the very best to UHRC team members and a bright future to slum communities!!


Deepti Rana
August, 2017



Friday, August 25, 2017

Miles to go before we sleep

Slum women’s courage in an “illegal” slum in India

Emergence of a new settlement considered “illegal”
The notion of illegality is frequently associated with slums particularly newly established informal settlements. This supposed illegality presents challenges to the residents of such new settlements, adding to their struggle of finding livelihood and trying to settle down in a new city or urban area. 
Out of bounds in the northern eastern peri-urban part of city of Indore a settlement of impoverished migrant population has developed in 2014. A fairly small strip of land and one brick kiln, it  earlier served as a site for open defecation for the residents of the nearby slums. It was only when the land was purchased by a real estate broker who bulldozed it to make it concrete, the place started gaining attention of the new migrants from different parts owing to the possibility of livelihood work in nearby factories and construction sites.
Migrant came from villages of other Districts of Madhya Pradesh mainly Rewa and Khargon including some from Bihar and Uttar Pradesh. Livelihood options as laborers in nearby factories and construction sites and low housing cost (as compared to other slums of Indore) in this area adjacent to Urban Health Resource Centre’s existing programme area contributed  to the migrants settling here.


Living Challenges:  The migrants started settling down amidst challenges of unpaved pathways, lack of electricity and no water supply. Unpaved streets hampered the movement of people and risk the children injuring themselves while playing on pathway, the lack of electricity and water made the lives difficult such as the struggle to fetch water from a distance and living in the challenging situation of no fan and lighting.

Community organising and encouraging requests and petitions
UHRC fosters social cohesion and promotes actionNandan bagh, New Jagdish Nagar and Jairaj Nagar, the neighboring slums had several active and experienced women’s groups. UHRC’s social facilitators, who visit the area to facilitate improvement efforts learnt from the older women’s groups of the newly evolving basti (slum) listened to their challenges. UHRC ‘s women’s group members, who function as volunteers in the slums as part of UHRC’s democracy and governance improvement programme undertook regular visits to the new settlement held discussion to think and determine if forming a group would be helpful for the community.

Sakhi Saheli Mahila Samooh (meaning Friends and Sisters Women’s group) and Nai Kiran Mahila Samooh (meaning New Light women’s group) were formed in the end of 2014. Each group has 12-15 women members. 
                         Above: Interactions with slum women and formation of women's group

Solutions to challenges being tried
The processes that form the core of this AXA Outlook Award supported project attempted in this “illegal” settlement are community organizing and collective action, periodic community assessment, motivation, capacity building, and gentle negotiation with local authorities.  
   Above:Group members participating in AXA Outlook Community Risk Assessment and Action initiative

UHRC attempted the approach of training these newly formed groups of a new settlement in writing collective community petitions for paving of streets and submitting them to the ward councillor. The members of the older women’s groups in the adjacent neighborhood helped these new women’s groups overcome their hesitation in approaching the ward councillor, submit and pursue petitions. The first community petition was submitted in Jan Sunwayi (Public Hearing) on 24th April 2015. The officer remarked that the basti (slum) for which the women are submitting this request for paving the lanes is “illegal”. With the support of leaders of older women’s groups, the newly formed women’s groups gently asserted their rights as citizens and the value of their votes in elections to the ward councillor. This helped overcome the supposed barrier of illegality associated with the slums.      
                        Above: Women's groups members make an in-person representation to Ward Councillor    

The women sustained their courage since they had learnt through training (from UHRC facilitators) that such statements can come anytime from officers. Women’s group members made a representation in person to the elected Ward Councillor and subsequently submitted a reminder petition at the district public hearing in May 2015. 
    Above: Women's group leader requesting officer at Public Hearing after submitting petition for paving street
      
The AXA Outlook Award project “Knowledge and Action Bridge towards Community Risk Assessment and Resilience Building is implementing actionable solutions to slum level challenges by bringing community wisdom to the fore. As part of this initiative, UHRC social facilitators further motivated women of the new settlement to continue preserve through written community applications to city authorities and personal representations to elected ward councillors.        


Initial successes in the new informal settlement and ongoing efforts
Perseverant negotiation by the women led municipal authorities to send workers to begin paving the streets of the new settlement on August 31 2016. About one-third of the lane in one part of the new settlement was paved till October 2016. 
                         

Efforts through community petitions and gentle requests to the elected ward representative are ongoing. A recent reminder for paving the remaining 3/4th part of the street, for a second bore-well and paving streets in the part of the slum that has no government water supply and has unpaved pathways have been submitted to the District Magistrate’s office during Public Hearing in June 2017. 
                     
The second success is of the bore-well being installed on 27th June 2017 which will start functioning soon. As a temporary measure, the community has connected it informally to an electricity source and access water. 


Several visits by women’s group members and UHRC’s social facilitators were made to the elected Ward Councillor, community requests with the signatures of 15-20 persons and gentle reminders were submitted to the authorities. During all these negotiation efforts the protagonists remain gentle, collaborative (willing to and support the functionaries of the Municipal Corporation) and non-confrontational.    


Interim arrangements for services: For addressing the lack of access to water supply, in the interim, the residents were motivated to negotiate with the private bore-well owners in the adjacent older slums had access water at a monthly amount of INR 100. Simultaneously the submission of community petitions requesting water supply were also made. To address the challenge of lack of electricity, UHRC facilitators and women supported the residents to erect long poles and access electric supply from the nearby slum where electricity supply had been installed about 4 years ago.

What is UHRC learning?
This approach has helped UHRC to reinforce the need to “listen” and motivate the less advantaged groups to collectively come together and address their challenges with affirmative action. The approach of listening also helps in producing solutions which arise from the minds of those who lead the lives amidst the challenges 24x7. Soft skills such as tact and the conscious effort to avoid confronting the authorities helped in learning as to how to deal with the notion of illegality.
The experience has also taught that more older and established groups in the neighbouring community are able to motivate and facilitate the formation of collective power in the new informal settlement. Continuous perseverant efforts and action yielding in small victories further nourish the capacity of women as they gradually develop negotiation skills, thereby learning to “pull” services from the Municipal Corporation benefitting the population of 1575.

Siddharth Agarwal, Shabnam Verma, Neeraj Verma, Kanupriya Kothiwal (Team members and volunteer of Urban Health Resource Centre) 

Wednesday, October 5, 2016

Urban Health Resource Centre

(UHRC) is a non-government organization that works towards socio-economic empowerment, improved quality of life, health, nutrition, well-being and empowered social organization among disadvantaged urban communities through – (i) demand-supply improvement, community-provider linkages, and demonstration programs that use a consultative and partnership based approach, (ii) technical support to government and non-government agencies and (iii) research, advocacy and knowledge dissemination. The UHRC’s demonstration programs utilize community organizing to establish women’s community groups consisting of slum-dwelling women who advocate for community-level infrastructure improvements.

History and outline of UHRC operations
UHRC was established in 2005 as a registered non-profit company under India’s Companies Act, 1956 with the aim of working towards socio-economic empowerment, improved quality of life, health, nutrition, and general well-being for urban disadvantaged families. Its startup was supported by USAID between 2004 and 2005, but as of 2009, the UHRC no longer receives USAID financial support.
UHRC implements demonstration programs among slum-dwelling populations in cities (IndoreAgra, and more recently North-East Delhi) with the intention that they be adapted, replicated and up-scaled by other government and non-government agencies. These demonstration programs focus simultaneously on community empowerment to enhance demand for services and on working with the service providers to improve supply side responsiveness to meet the increased demand. Since slum-dwellers are usually not connected to the mainstream population, part of the UHRC’s ground work involves proactive community mobilization, encouragement and outreach to identify vulnerable populations and facilitate their connection to social and economic sector service providers such as healthcare, living environment services, house improvement services and employment programs.
UHRC programs facilitate the formation of women's and children's groups to strengthen the social cohesion in slums and to address gender inequity. The program works toward building their capacity to take charge of processes that affect family economics, health, education, nutrition, housing improvement and overall social well-being. UHRC provides targeted trainings and workshops to community groups on topics such as a) acquiring knowledge, b) building negotiations skills (such as sending collective application to civic authorities) and, c) interfacing with diverse government agencies to improve slum living environments and access to health, nutrition and social entitlements. Slum communities in UHRC program cities participate in health education and promotion sessions facilitated by UHRC field workers on topics such as maternal and child health, nutrition, hygiene, and environmental health.
As the number of community groups in a local region reaches a critical mass, they are networked into a larger congress or cluster-team of women's groups, consisting of democratically agreed-upon representatives from each group. Cluster-level teams of women's groups and slum-level groups receive regular supervision, mentoring support and materials (such as steel containers to store registers, charts, behaviour promotion materials, floor mats to sit during meetings) from UHRC teams to carry out meetings and activities working towards improved health and well-being. UHRC partners with participating community groups and federations to help them access available services, schemes and resources. Groups and cluster-team members are also coached on negotiation skills and provided trainings on how to effectively negotiate with healthcare providers and other civic authorities through dialogue and formal applications to obtain health services and environmental services such as road paving, drain installation, sanitation/water infrastructure, garbage removal, and other entitlements.
Along with running the demonstration programs, UHRC also provides technical support to the government (at national, provincial, and city levels) and non-government agencies in the form of research, advocacy, and knowledge dissemination. Additionally, the UHRC central and field offices provides trainings, internships, and volunteer options for students from different universities in India and abroad. All interns and volunteers, who in the past eight years have included Masters and PhD students, have learnt from field based participatory action research in UHRC's program sites.


UHRC programs

Health outreach, service access, and behavior promotion

Some of the first activities the UHRC encourages slum women to discuss and analyze health, well-being challenges faced by their families and the community as a whole. UHRC helps a new slum women’s group with are health activism training and advocacy of healthy household practices. Through workshops and training sessions, women’s groups are encouraged to begin promoting healthy practices and health seeking behaviors in their communities, such as going to the hospital when a woman goes into labor. This process involves training women’s group members to become social health activists so they can conduct preventive and promotive health workshops and sessions for their peers. An aspect of this training is encouraging women’s group members to promote cultural and religious traditions that are relevant to their communities, while incorporating educational curriculums surrounding proper hygiene and healthy behaviors for new mothers. One example is that UHRC women’s groups often hold group Annaprashan ceremonies (a ceremony wherein a child is first fed food other than milk), incorporating curriculums surrounding ante-natal child care.
UHRC also trains group members on reaching out to private and public healthcare providers such as Auxiliary Nurse Midwives (ANMs) and Anganwadi centers to run health camps in their communities. At the 13th World Congress on Public Health, the UHRC reported improvements in slum residents’ access to health services and information and adoption of healthy behaviors in intervention areas. Furthermore, they noted that as of 2009, 70% of children in intervention areas were completely immunized as opposed to 28% in areas that had not yet developed UHRC programs [https://wfpha.confex.com/wfpha/2012/webprogram/Paper10702.html]
In addition to advocacy and education, UHRC women's groups also play a direct role in linking women in urban slums to health services. Women's group members frequently escort married adolescent migrant girls to hospitals for safer deliveries when they go into labor, and to ante-natal services which they may not otherwise be familiar with [Ministry of Health and Family Welfare. Government of India. Guidelines for developing city level urban health projects, New Delhi: Government of India: 2005].


Collective savings/social resilience funds

Once groups have developed a regular meeting schedule and have undertaken some basic health outreach activities, the UHRC proposes to groups that they could form a collective savings fund. These collective savings funds are essentially a method of risk pooling. Groups decide upon a certain monthly or weekly contribution that each member needs to make to grow their fund. All contributions to the pool are recorded by a treasurer who is elected by the group. The women are facilitated to establish standards for mutual accountability. The UHRC aids in establishing a record keeping system and in training the women to keep these records up to date – trainings cover how to track and record collective savings, loans given from the savings pool, interest received along with the principal amount, and essential elements of managing savings and loans. When a member or even a non-member family is in need of a loan, women’s groups can provide low to zero interest loans (for example one group in Agra, Saraswati Mahila Swasth Samiti, has adopted a 2% interest rate). Collecting payments, managing the fund, and administering all loans is facilitated by women’s group members with support from UHRC's team members. These funds play a crucial role in reducing the burden of health care costs on poor families, particularly during health emergencies. Loans are given for a variety of needs: a) Maternal and Child Health, b) Health emergencies, c) Prevention of school drop-outs, d) House improvements, e) Food insecurity, f) starting or strengthening women's small enterprise from home or nearby market, g) starting or expansion of men's small enterprises, h) Repaying debts from money-lender, and i) Social and family expenditures.


Petition writing and infrastructure improvement

Based on its initial experience with the program in Indore, and Agra, beginning November 2009, UHRC program strategies have evolved towards a broader development of the urban slums/vulnerable populations goal. UHRC has found educating communities about government resources and services to be particularly effective. As groups bring municipal problems forward, the UHRC will suggest that communities begin writing applications and letters to service providers, and holds trainings and workshops where group members can practice writing applications and learn about the importance of making and filing copies of all applications and letters that submitted. Field workers encourage groups to write highly specific, concrete requests that focus on a single issue rather than multiple issues to increase chances of success. They are also encouraged to have all members sign each request or petition to show consensus.

Usually the first few petitions or letters written are followed by a period of struggle or stagnancy. Municipal service providers and government officials tend to be initially unresponsive and uncooperative. Group members are therefore trained to write reminders following up on requests and to seek formal receipts from civic authorities for any communications sent. For example, group members are trained to send reminders through the government postal system, which automatically provides receipts to senders.
Women’s groups also learn to recruit the support of democratically elected ward representatives who can help in interfacing with municipal corporations. UHRC social facilitators guide women's group members to start by pursuing simple tasks, such as getting a street drain cleaned, before moving on to more ambitious projects such as road paving and water supply installation.


Social awareness and advocacy

UHRC women’s groups have also begun organizing rallies around community needs, such as ousting alcohol vendors to disincentivize alcoholism, demonstrating against gambling to protect household finances, advocating against domestic violence, or organizing public health advocacy campaigns. Groups have also orchestrated sit ins at government offices to urge them to be responsive to community needs and requests by providing services, such as slum street paving, drain installation, water supply and sewage system installation, health and nutrition services, food security services, and access to government's social welfare schemes such as education scholarship, widows' pension scheme, old-age pension scheme.


Government scheme awareness and application support

Through engagement with its target populations in Indore, Agra, and Delhi, the UHRC began focusing its efforts on helping slum residents attain proper identification documentation. Slum residents, and particularly migrant adolescents living within urban slums, who do not have proper documentation face barriers such as ineligibility for government welfare programs and education scholarships as well as housing insecurity. The UHRC assists women's group members to learn about and apply for various forms of picture ID, voter ID, proof-of-address, and other documentation.

Source: Montgomery, Mark R.; Balk, Deborah; Liu, Zhen; Agarwal, Siddharth; Jones, Eleri; Adamo, Susana (2016-01-01). White, Michael J., ed. International Handbook of Migration and Population Distribution. International Handbooks of Population. Springer Netherlands. pp. 573–604. doi:10.1007/978-94-017-7282-2_26ISBN 9789401772815.


Policy advocacy & technical support to government/NGOs

In 2004, prior to its renaming from USAID-EHP to the Urban Health Resource Centre, the Ministry of Health and Family Welfare designated UHRC as “the nodal technical agency for ‘Urban Health Programme’”. UHRC continued to be designated as “the nodal technical agency for ‘Urban Health Programme’” in the Ministry's communications and in this capacity, the UHRC’s role has been to “provide further assistance to State Governments in formulating urban health proposals and to provide concrete examples for planning of health care delivery to the urban poor in different categories of cities” Source:Draft final report of the task force to advise the National Rural Health Mission on “Strategies for Urban Health Care. This technical assistance included recommendations for goals and objectives of the Urban Health Program, coverage criteria, and a workflow for the development of urban health proposals by cities eligible for support from the Ministry of Health. UHRC along with the Area Projects Division of Ministry of Health and Family Welfare, Government of India steered the series of meetings and consultations of the Task Force for Advising NRHM for Urban Health Strategies. These consultations contributed to the preparation of the first comprehensive report on Urban Health Strategies with a focus on the urban vulnerable, published formally by the Government of India as the Draft final report of the task force to advise the National Rural Health Mission on “Strategies for Urban Health Care. The UHRC also played a key role in shaping the National Urban Health Mission (NUHM), now a sub-mission to the National Health Mission (NHM) and launched in 2013, intended to consolidate, focus, and expand the Government of India’s initiatives for addressing the needs of the urban poor which were formerly operated under the NHRM (Corburn and Cohen 2012). Since its renaming to the UHRC, the organization has continued in its capacity of providing technical assistance to State Governments within India as they propose and execute urban health projects.


Technical Support to Government of Uttrakhand's Urban Health Programme

An example of the UHRC’s role in supporting state governments is its role in helping the Uttrakhand Health & Family Welfare Society to develop its Program Implementation Plan (PIP) under the National Rural Health Mission. Program Implementation Plan 2011-12 of UttarakhandHealth & Family Welfare Society mentions on pages 4-67 to 4-82 that the "Urban Health Resource Centre (UHRC) New Delhi have been involved for imparting training to NGO functionaries for the smooth functioning of the UHCs. Prior to this selection process the UHRC have done GIS mapping of these intervention cities which include the no. of slum, coverage and identification of location of UHCs. The UHRC New Delhi also developed BCC strategy for urban slums & guidelines for Mahila Arogya Samities (MAS) & convergence with other stakeholder. UHC staff has been trained on BCC strategy and on other modules by UHRC at state level. Besides this UHRC is providing technical support for implementation and monitoring of Urban RCH programme in the state". The UHRC provided technical support to run Urban Health Centres (UHCs) aimed at providing health care and support in slum communities and regularized outreach camps to vulnerable urban populations. The UHRC’s functions included coordinating NGO functionaries and collaborators and providing training to their staffs to help run UHCs, conducting GIS mapping of cities and slums to determine the most effective locations to place UHCs, and developing and piloting guidelines for women’s group programs through its experience in its other program cities such as Indore and Agra. Key activities of UHCs include providing maternal and child healthcare, providing antenatal and postnatal care, providing immunizations for newborns and children, care coordination through collaboration with other NGOs, behavior change education with regards to health and sanitation, resource awareness education for slum-dwelling families, and community capacity building through collective action initiatives.
One of the UHRC's key roles in influencing policy is in catalyzing local urban governments to recognize yet unlisted slums. Censuses often exclude the homeless and informal urban settlements as such settlements are often built on land that is not legally owned by the residents [Elsey et all 2016]. An analysis of five Indian cities conducted by the UHRC through field work and review of local records kept by UHRC community groups showed that 40% of slums were unlisted and thus not recognized by local governments. Further analysis revealed that unlisted slum residents made up about 36% of all slum residents in these cities. "Slum enumeration" techniques used by the UHRC rely on slum community members to draw upon their knowledge of their communities and to reach out to other households in their slum to collect information for the enumeration. Such activities and relationship building allow UHRC community groups to document additional information such as income flows, and make decisions about which slum-improvement initiatives to prioritize[Vlahov, Agarwal et al 2011].

Datasets and analyses of existing data generated by the UHRC have been used by UN organizations including the WHO and UN-Habitat.[9] The UHRC's disaggregation and analysis of Demographic and Health Surveys (DHS) was highlighted in the WHO's "Hidden Cities" report page 84. Using India's National Family Health Survey (NFHS) dataset (an adaptation of DHS), the UHRC conducted an analysis of the poorest quartile of urban residents as compared to the rest of the urban population in Indian cities. The analysis revealed that the under-five mortality rate among the poorest quartile of urban residents in many provinces in India was nearly three times higher than for the rest of the urban population. Inter-provincial disparities also exist with Uttar Pradesh's under-five mortality more than twice as high as that of Maharashtra. The analysis also showed that among the poorest quartile: 60% of children had not completed immunization regiments and around 50% suffered from undernutrition, about half of all births were not assisted by health workers, less than 20% had a direct water supply, and more than half did not use a flush or pit toilet to dispose of waste [Satterthwaite, 2011]. This work has been referenced in numerous publications including UNICEF's State of the World's Children 2012 reportDraft final report of the task force to advise the National Rural Health Mission on “Strategies for Urban Health Care

Research and knowledge sharing
Secondary and primary research conducted by UHRC has been instrumental in shaping National and global documents and policy directions.
1. Health Disparities within urban areas unmasked:
a) David Satterthwaite in his editorial in Environment and Urbanization 2011 (http://eau.sagepub.com/content/23/1/5.full.pdf)  highlights the significance of UHRC's research. He states that UHRC's research provides "evidence of the lack of attention to the health of the urban poor. For instance, in 2004–2005, the under-five mortality rate of the poorest urban quartile in many states in India was two to three times that of the rest of the urban population. The evidence also points to considerable differences between states in this regard. The poorest urban quartile in Uttar Pradesh, for instance, had an under-five mortality rate more than double that of the poorest urban quartile in Maharashtra. For the poorest quartile of India’s urban population:
• 60 per cent of children were not completely immunized;
• 54 per cent of children were stunted and 47 per cent were underweight;
• only half of births were assisted by health personnel;
• less than one-fifth have water piped into their homes; and
• less than half use a flush or pit toilet to dispose of their excreta. One aspect of this lack of attention to urban health has been the use of inappropriate definitions regarding provision for water"
Sattherthwaite goes on to stress that UHRC's research exposes the "scale of health disadvantages experienced by the poorest quartile of India’s urban population and the large disparities in provision of health care, water and sanitation and in housing conditions in the urban population of seven states, between the poorest quartile and the rest of the population."
Source: Satterthwaite, David. "Editorial: Why is urban health so poor even in many successful cities?." Environment and Urbanization 23.1 (2011): 5-11. accessed on 23-9-2016 at http://eau.sagepub.com/content/23/1/5.full.pdf
" A study of the National Family Health Survey (NFHS-3) in India from 2005 to 2006 found that levels of undernutrition in urban areas continue to be very high. At least a quarter of urban children under 5 were stunted, indicating that they had been undernourished for some time. Income was a significant factor. Among the poorest fourth of urban residents, 54 per cent of children were stunted and 47 per cent were underweight, compared with 33 per cent and 26 per cent, respectively, among the rest of the urban population".
Source: Unicef. The state of the world's children 2012: children in an urban world. eSocialSciences, 2012. Accessed23-9-16 at http://www.unicef.org/sowc/files/SOWC_2012-Main_Report_EN_21Dec2011.pdf
c). Hidden Cities has used UHRC's example of using analysis of available data (Demographic Health Survey data which is available for several countries), called national family Health Survey in India. On page 84 of the WHO and UN-Habitat report using UHRC's research emphasizes how existing data can help better understand disparities within urban areas and better understand that all of urban is not necessarily benefiting from what is often taken as "urban advantage".

2. Under counting of urban vulnerable populations:

A report entitled "Roundtable on Urban Living Environment Research (RULER)" that evolved over a Rockefeller Foundation supported research conducted through working group of twenty-one researchers over one year highlights Urban Health Resource Centre's stellar research stressing that urban vulnerable (often called slum) populations are under-counted through administrative data sources.

The report states “ 'Slum' enumerations are also a means of mobilizing the population as the enumerators (who are residents, not outsiders) explain to every household why they are collecting the information. They help residents to better understand their settlement and capabilities. For example, they may encourage the formation of savings groups. Often they provide a household with the first written evidence that it lives there, as each house structure is numbered and each household receives a document showing the information collected about it during the enumeration. These are often useful for residents of informal settlements in seeking government entitlements. Enumerations can also document local income flows, giving residents an indication of what they can afford to invest in themselves and often leading to community-identified initiatives.
The example of community enumerations and assessments coordinated by Urban Health Resource Centre in India: Table 1 shows data from five Indian cities—the proportion of slums that are unlisted and therefore without recognition is staggering, representing about 40% of all slums and 36% of all slum residents."
Table 1
Number of listed and unlisted slums in five Indian cities
Source: Vlahov, D., Agarwal, S. R., Buckley, R. M., Caiaffa, W. T., Corvalan, C. F., Ezeh, A. C., … Watson, V. J. (2011). Roundtable on Urban Living Environment Research (RULER). Journal of Urban Health : Bulletin of the New York Academy of Medicine88(5), 793–857. http://doi.org/10.1007/s11524-011-9613-2 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191208/
3. Collaborative research on maternal and newborn health in slums:

a) Collaborative research of Urban Health Resource Centre with Johns Hopkins School of Public Health on Birth preparedness and complication readiness among slum women in Indore city, India

highlights that "Factors associated with well-preparedness were maternal literacy [odds ratio (OR) = 1.9, (95%) confidence interval (CI) 1.1-3.4] and availing of antenatal services (OR = 1.7, CI 1.05-2.8). Deliveries in the slum-home were high (56.4%). Among these, skilled attendance was low (7.4%); 77.3% of them were assisted by traditional birth attendants. Skilled attendance during delivery was three times higher in well-prepared mothers compared to less-prepared mothers (OR: 3.0, CI 1.6-5.4) Antenatal outreach sessions can be used for promoting BPACR. It will be important to increase the competency of slum-based traditional birth attendants, along with promoting institutional deliveries.
Source: Agarwal, S., Sethi, V., Srivastava, K., Jha, P. K., & Baqui, A. H. (2010). Birth preparedness and complication readiness among slum women in Indore city, India. Journal of Health, Population and Nutrition, 383-391. accessed on 23-9-2016 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965330/


b) Another example of collaborative research of Urban Health Resource Centre with Johns Hopkins School of Public Health demonstrates the significance of simple Human touch method to detect hypothermia in neonates in Indian slum dwellings.

This research shows that Hypothermia prevalence (axillary temperature <36.5 degrees C) was 30.9%. Prevalence varied by season but insignificantly. Hypothermia was insignificantly associated with poor suckle (31% vs 19.7%, p=0.21) and undernutrition (33.3% vs 25.3%, p=0.4). HT had moderate diagnostic accuracy when compared with ADT (kappa: 0.38, sensitivity: 74.5%, specificity: 68.5%).Human touch (HT) emerged simpler and programmatically feasible method of early assessment of newborn sickness. The research calls for the need to examine whether trained and supervised community-based health workers and mothers can use HT accurately to identify and manage hypothermia and other simple signs.  of newborn illness using minimal algorithm at home and more confidently refer such newborns to proximal facilities linked to the program to ensure prompt management of illness.
Source: Agarwal, S., Sethi, V., Srivastava, K., Jha, P., & Baqui, A. H. (2010). Human touch to detect hypothermia in neonates in Indian slum dwellings. The Indian Journal of Pediatrics, 77(7), 759-762. Accessed23-09-2016 at http://medind.nic.in/icb/t10/i7/icbt10i7p759.pdf

c) Technology Review: MIT's Magazine on Innovation: India Edition, July 2010 discussing issues for Maternal Health care describes Urban Health Resource Centre's collaboration research with JHSPH and CSMM University, India. The magazine  reports: "A household survey by Urban Health Resource Center (UHRC) in collaboration with the Johns Hopkins Bloomberg School of Public Health, USA and Chhatrapati Shahu Ji Maharaj Medical University, Lucknow, conducted between October 2007 and March 2008 in Meerut, found that only 60 percent pregnancies were registered with a health facility. The survey covered 15,025 women who had a live or still birth in the three years preceding the survey— referred to as recently delivered women (RDW). The women were drawn from 44,888 households across 45 slums within the city. Of the 60 percent registered pregnancies, 59.4 percent pregnancies were registered within first three months, 21.7 percent between 4-6 months and 18.9 percent after six months of gestation. Among those who registered, private facility was the preferred place of registration for more than 40 percent pregnant mothers. Around one-fourth of the mothers approached a government facility and another one-fourth of mothers registered with a NGO run health facility.
Early registration of pregnancy with a healthcare provider facilitates assessment of health and nutritional status of the mother and to obtain their baseline information on blood pressure, weight, and more. An early contact with a health provider also helps to screen for complications early and manage appropriately by referral as and where required. An important reason for not availing health services from government facilities was absence/poor functioning of public facilities in the vicinity. Service usage of public facilities by pregnant women was also low because of shortage of staff especially lady doctors; shortage of medicines including IFA tablets; lack of diagnostic services; poor referral system; unfavorable timings of the facility that does not suit the working slum women; long queues in the higher level facilities; impolite attitude of health center staff towards slum women; and lack of privacy.
Source: Technology Review: MIT's Magazine on Innovation: India Edition, July 2010 https://s3.amazonaws.com/files.technologyreview.com/p/pub/legacy/tr_07_10_01_low_res.pdf

Recognition and Awards[edit]


  1. UHRC's initiative, Resolve-Flight-Zest (Sankalp-Umang-Udaan) for Education, was recognized in Aug 2017 by South Asia Education Summit with an award in the category "Innovative Strategy for Equitable access to Children's Education in Cities". http://ictpost.com/3rd- edition-of-south-asia- education-summit-award-2017/