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 (Indore, Agra, 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.
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].
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."
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 Medicine, 88(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:
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/
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]
- 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/