A BIG Idea by Shrey Goel

Adapted from one of two winning essays from the UC Berkeley Blum Center for Developing Economies’ 2014 Finding Big Ideas Essay Contest. The original essay can be found here.

This summer I had the privilege of working with the UHRC as a part of my Global Poverty and Practice Minor. This post attempts to outline how the UHRC operates, as I came to understand it, and why I found it’s operational philosophy to be a “big idea”.

The UHRC focuses on urban poverty by entering into slum communities and holding discussions with community members, proposing the idea of forming community women’s groups. These conversations aim to stimulate the women in slums to think about whether or not collective community action can help them confront the challenges they face. In my conversations with Dr. Agarwal, the Executive Director, he explained that an important aspect to this process is not pushing group formation on communities – if community members do not express interest, the UHRC steps back until interest grows because in the absence of an organic investment by the people, the initiative will simply be unsustainable. Once a group has formed, the first step is basic training surrounding health outreach and advocacy. Trainings cover tracking and surveying vulnerable groups (such as pregnant women) in slums as well as reaching out to government, private, and volunteer health providers to run camps in communities.

After groups are well-established, they pursue higher-level activities with the support of UHRC field workers as new needs emerge. For example one need that became evident early on was financial resilience to health exigencies and other similar events. When this need emerged, the UHRC began helping women’s groups establish collective insurance funds by providing trainings on how to collect member contributions, keep records, and administer loans. These collective insurance funds are different from microfinance loans because the seed money comes entirely from group members and loans are granted for home improvement initiatives and health emergencies in addition to microenterprise. Rules[1] are established and enforced by women’s group members who decide on conditions together, rather than following the mandates of an external institution. 

Another need that emerged early on in the UHRC’s operations was infrastructural improvement in communities and knowledge about applying for government schemes and programs. To address this, the UHRC began facilitating trainings on petition writing to local municipal authorities, discussing with groups the best ways to write collective appeals and document all their communications. Groups also began learning to write reminders to local officials when their requests for things like street paving and drain installation were ignored.

What I have outlined thus far is how the UHRC works in the field, but not why the UHRC has elected to approach urban poverty in this fashion. India’s trajectory of urbanization has led many families from poor rural and peri-urban areas into city-centers, but they arrive faster than the planning process can incorporate them. They are relegated to informal and often illegal occupations of whatever free space they can find, where they erect impermanent housing units or occupy existing run down units. The allure and pursuit of better economic prospects pits poor urban families in slums in competition, thus leading to fragmentation as families are not incentivized to work in solidarity towards mutual upliftment. These oppressive factors result in decreased household and community-level social cohesion in slums. Therefore, helping communities build stronger bonds through collective action is the goal that underlies the UHRC’s initiatives.

According to Bandura’s theory of self-efficacy, an individual’s belief in their ability to accomplish a task influences their actual capacity to accomplish it. Applying this concept to groups, Gibson has theorized that just as individuals have self-efficacy, so do groups have group efficacy. In a conversation with Dr. Agarwal, he explained to me that both forms of efficacy depend upon small instances of success early on in order to build confidence for more ambitious endeavors later because they enhance people’s belief in their own ability. This is why the UHRC begins with basic health outreach activity, which lends itself to higher success rates than petitions for infrastructural improvement, which require greater persistence and higher degrees of organizing. However as groups slowly progress, they develop the confidence to interface with municipal authorities and local officials, and this confidence has led to huge improvements in many UHRC program slums, such as paved roads, covered drains, and regular street and garbage cleaning.

What I believe differentiates UHRC from other NGOs is it’s underlying ethos. The UHRC has elected to pursue what Dr. Agarwal calls a “deprojectized” model of development. The organization has no intention of leaving the communities it operates in, and in many cases, other NGOs have come to Agra and Indore to run short-term programs, offering employment to UHRC women’s group members who are able to serve as a high-capacity work force. The women’s groups have become a platform for future development, but the UHRC doesn’t just strap women with responsibility and then leave – it stays and provides continual support through field workers and field offices.

            The UHRC’s approach aims to tackle poverty at a fundamental level. It is highly resource efficient, and effective, relative to costly multi-national aid initiatives. In bringing community knowledge and expertise to the forefront, this approach challenges the current centers of poverty knowledge generation (such as research institutions and global development banks); it asks poverty experts to recognize community knowledge as legitimate. But this is why the UHRC’s methods have so much potential. I remember one day speaking with some women’s group members in one of the poorest UHRC Agra slums called Indra Nagar. For most of its history, Indra Nagar has been a tent colony, home to nomadic merchants and craftsmen. One of the women explained that before the UHRC, nobody would even come into their slum. Nobody would loan them money and women could barely even leave their homes due to highly conservative gender dynamics. Recently, however, she was able to take out a 10,000 Rupee loan from her Federation[2]. She was able to open up a storefront and is currently paying back her loan at a rate of 1,000 Rupees per month. It is because of this high degree of community member investment that I heard many women this summer talk about going to yet unreached slums to establish women’s groups throughout my stay in Agra.

            I believe it all comes down to something basic – what Dr. Agarwal frequently called trust. What he meant by that is that by putting trust and faith in slum community members, an iterative process of mutual learning is able to take place. It’s a process that allows slum residents to cultivate their faith in their ability to navigate urban institutions and to build a stronger social fabric. It’s also a process that demonstrates the urban poor can and must be given an active role in the upliftment of their communities. And that to me is a big idea.

Shrey Goel
Environmental Science, Pre-Med (Global Poverty and Practice Minor)
4th Year Undergraduate, University of California, Berkeley

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[1] Such as monthly per-member contributions, late fees, and repayment interest rates, which rarely exceed 3%

[2] A Federation is a collective of women’s groups in a particular region that runs a higher level collective savings program and pursues larger-scale initiatives

A Reflection of My Learning and Thoughts While Working in India with UHRC: Danny Tea

When my school offered a rotation experience in India, I was unsure of whether or not I wanted to participate. When I applied and got accepted, I had no idea what to expect. After a month passed in India and it was time to return home, I couldn’t have been more happy and grateful to be a part of such an amazing experience.

This was my first time traveling to India, so I had absolutely no clue as to what to expect nor could I even imagine what to expect.  Arriving in New Delhi, I knew that we would be screening patients for hypertension, diabetes and chronic obstructive pulmonary disease (COPD) in the slums of New Mustafabad but nothing more. The second we stepped off the Seelampur metro stop prior to the rickshaw ride on our first day of work, every single one of us were in complete and utter dismay at the level of poverty this part of town was in, the same part of town just a short distance from the seemingly westernized and urban city our hotel was located.  No words can fully describe how unfathomable it was to me.  I remember during a meeting before we left, one of our professors Dr. Jacobson mentioned that we might be seeing a level of poverty that is going to be unbelievable.  Her words rang truer than ever. Limbless beggars lined the roadside next to small children no older than 5 years of age selling fruits and water. The air smelled of foul odor and flies were everywhere you went, including on the food being sold by the street vendors.

The neighborhood we worked in was equivalent to the environment depicted in the film Slumdog Millionaire. Some children and adults walked around barefoot. Trash was littered everywhere. I could just feel my lungs gasping for air because the air quality was so bad due to the lack of sanitation in the environment.  I got a firsthand look at the community, culture and the lifestyle of the residents here and the challenges they face in healthcare, education, food and everything down to the most basic necessities of life.  It was extremely humbling to be able to experience the reality of these people’s lives and the hardships they face on a daily basis. It not only mentally prepared us for the upcoming month but cultured us in a way that will help us becoming better pharmacists and better people.

We spent our time there split between different parts of the New Mustafabad slum in order to attract as many people as we could. We also took a weekend trip to Agra and held a clinic there as well. It was interesting and eye opening to be able to compare and contrast two different slum communities in differing cities. While the residents of New Delhi and Agra both have similar lifestyles in terms of diet and their quality of life, the medical data we collected from patients painted a different picture.  It was an immensely educational and enlightening process to be able to sit and reason why residents of both Agra and New Delhi both complained of shortness of breath but yet only the people in New Delhi showed very high incidences of hypertension.  I thoroughly enjoyed being able to bridge the gap between those that need help and those that can provide help, while simultaneously furthering my knowledge in medicine, pharmacology and especially public health.  I was never too interested in the idea of public health, mainly because I never fully understood it. This trip to India awarded me the experiences I needed to comprehend the root causes of many widespread health issues and in turn, I developed and acquired a great appreciation and respect for the idea of public health and all health care practitioners that devote their lives to uphold the ideals of public health.  Not only has this influenced the way I think, but this trip to India will forever dictate the way I act and how I carry on my life.

Dr. Siddarth Agarwal, founder and president of the UHRC, lends a helping hand in our clinic.

One of the greatest lessons I took away from this global health experience in India is not related to medicine or pharmacy whatsoever.  Living in a foreign environment where values and ideals differ from the ones you hold personally can really help to expand your thinking and understanding of the world. Cultural competence is something that can be taught, but not necessarily fully understood. Seeing a different part of the world and watching how people behave, react and carry on their normal lives really taught me the meaning of being culturally competent.  I can’t emphasize how humbling this past month has been for me.  Realizing that I was a guest in someone else’s country, I found myself taking a step back to observe mannerisms and also respecting the people’s beliefs.  It wasn’t until I understood them did I fully respect them. And it wasn’t until I respected them was I able to accept them. Cultural acceptance is something I learned during my stay and is something I find to be different than just culturally competent.  Working in close conjunction with the population and interacting with them really touched my heart. Despite our backgrounds or where in the world we are, we must not forget that at the end of the day, we are all people of the same kind.

Initially, interviewing patients and attempting to counsel them proved an arduous task.  However, despite our language barrier and cultural differences, we were able to develop a rapport with the community population without speaking a single word to each other.  Body language and unique gestures provided not only a mutual understanding but also a mutual respect for each other once we both saw the beneficial outcomes of our screening process.  It’s hard enough as it is to trust and accept someone without fully understanding their words and motives.  We were able to overcome all this and found a way to eventually have the people embrace us, and us them. Providing help to those that need it is something that anyone can understand.  Thus, it is not about where you live or how much you have that defines who you are as a person.  It is character that resonates the loudest and it is character that will always continue to stand as the universal language of people everywhere.

Danny Tea
Doctor of Pharmacy Candidate, Class of 2014
Touro College of Pharmacy
New York, NY

Uplifting One Neighborhood at a Time Through Children's Groups

“Bahu, zara meri chai toh leke aa!!” (“Where the hell is my tea!!”) No, this is not a dialogue from your typical saas-bahu daily soaps but a scene from one of the plays performed by the children as a part of Children’s Day celebrations organized by UHRC in Banganga area, Indore. In the Nukkad Natak competition based on the theme, ‘Neighbourhood Upliftment through Children's Groups’, the children put up plays on issues ranging from neighbourhood sanitation, vaccination, child labour and importance of education. The children came in colourful costumes and delivered their dialogues confidently. The plays were entertaining and made the audience laugh but at the same time they also conveyed a relevant social message.

Before the competition, chief guest Mr. Praveen Joshi, Senior Journalist ‘Chautha Sansar’ had a very candid conversation with the children. He explained how childhood is the best phase of ones life and that everything we learn in childhood remains with us forever. He advised the children to enjoy their childhood as much as they can. He also stressed on the importance of a healthy routine and good habits like waking up early and maintaining cleanliness in daily life. Through examples like Eklavya, he also explained to the children, the value of hard work. He told them how hard work will help them to become a successful person in life. Hopefully, the children will keep their promise given to him about following whatever he taught them. 

‘All work no play makes Jack a dull boy’. Keeping this proverb in mind, a chair race was also organized for the children. Shrieks of joy and laughter rang in the air as the game started. The enthusiasm of the children could be seen in the way they were running and those who got out were very sporting about it. Even after the game ended, the children were very excited and not at all exhausted.

The prize distribution ceremony was also a delightful affair as the children clapped and cheered for the winners who were given prizes like carom board, badminton rackets and many more.

Hence, all the people present including guests, volunteers, federation members and of course, the children, made the evening very special. The children went home happy and hoping that more such events take place soon!

Mrs. Shabnam Verma 

UHRC Indore Staff Member

        &

Meenal Namjoshi 

Symbiosis Institute of Media & Communication, Pune, India

Studying Bachelor of Media Studies   

Intern at UHRC, Indore - Nov 19 to Dec. 29, 2012.

Reflection On My Visit to Agra and the UHRC Women’s Groups: Saswathi Natta

Hello everyone,

I am currently a 4^th year undergrad student at Princeton University and this past summer, I was in Delhi at a Human Rights internship. In addition to my internship, I had the good fortune of being connected to Siddharth Agarwala and being able to see some of the work that he and the UHRC has done. I want to share some of my thoughts and later reflections on my visit to the Women’s groups in Agra.

My visit to Agra started with a quick trip to the Taj Mahal very early in the morning. It was beautiful, surrounded by a light mist from the early morning dew and sun beams. I walked around it in awe and appreciated it’s beauty along with all the other tourists snapping pictures and trying to capture an image of it’s magnificence to take home.

Leaving the Taj, I continued my visit to a very different part of Agra. A part that few see, or even know of when they visit the Agra that revolves around the Taj Mahal. Our driver, who had worked with UHRC before, knew his way into what I would call a slum area where there was a group of children waiting for us. They were like any other group of kids, bright eyed and curious about the newcomers. They were of all ages, from toddlers that were barely walking to college age students.  They showed us what they had been learning from UHRC about personal hygiene and displayed a map of their little neighborhood. I doubt that there exists any other map of the twists and turns and small one room homes of their neighborhood. It contained dots that represented households where a child had been vaccinated, visually displaying the progress that UHRC has made in the area. Then all the kids gathered around and told us what they wanted to be when they grew up. 

                  

Some wanted to be Teachers and Police officers to help other kids learn and catch thieves, others wanted to be Doctors and Engineers, get graduate degrees and make a difference in the world. Then there were those who were a bit shy about sharing and some had dropped out of school to help around the house. Some of the smallest kids stood up and recited the alphabets and poems. Some sang songs, and some brought out a little box that they called the DJ. It was a homemade wooden box with colorful lights that one of the littlest girls stood on and danced for us, like a Disco Dance floor.  Another boy had made a cardboard doll house and put in his own electric wiring that allowed for a fan and a little light bulb within the house to light up images of Ganesh. They were such smart kids and so friendly! One of us went out on the spot and got a bunch of samosas and little things like pencils to hand out before we left. Just as I was leaving, one of the older girls came to me and said that she was an engineering college student and asked for my email address. We’ve emailed a bit since and I sent her the pictures we took there.  Hopefully I can meet those kids again and see how they have grown and I hope that they reach their goals.

From there we went to one of the local Women’s groups. There were 7 women and an UHRC representative who talked about the main tasks that they perform for the community. The women were very organized and had a fund that they collected to loan out to women who needed medical help during pregnancies or to fulfill various other needs in the community, very similar to microfinance. The group also had a map of their neighborhood marking which homes had pregnant women and who was getting health care. These women were empowered, and organized and knew that they were making a positive impact in their neighborhood as leaders of the community. What struck me most about this gathering was that one of the women’s husbands was present at home, but he took a back seat. He just watched the women at work and didn’t interfere more than to place a fan in front of the group for their comfort. As we left this group we shook hands with all the women and just as we were about to get back in the car, the husband that had been present came and also shook my hand before sending us off to the next group.

If the first two groups were heartwarming and full of potential, this next group of women was even more inspirational. They were the women’s federation for the area, with representatives from each of the smaller women’s groups. They welcomed us with a song and a drum beat and showed us some of the main issues that they focus on. These included Health care, environmental awareness, microfinance in the community, and children’s education in addition to other issues. This was the group that would go and give police complaints, or argue against unfair treatment toward the community. This was the group that once ganged up on a medical professional who was taking advantage of women in the community under the cover of being a doctor. This was a group of women who used to be simple housewives, but who had learned to be independent and strong. Some even talk of how they defied their husbands and in-laws to attend these meetings because they wanted to have a real impact on the community. They also shared some of the failures, of how they raised funds for a child’s medical bills but ended up losing the child, but they learned from each experience. I have never seen such a sense of purpose and determination in a group. They were determined to better themselves and their community with little to no outside help. As a goodbye, the women sang us a song about their determination and of how they would break any lock that would hold them back from coming to these meetings and creating an impact. They danced and laughed and sang with a sense of freedom that I have not seen in many people living in such poverty. They really convinced me that with women empowered like this, they can face anything as a community and fight for their rights and make the right choices for their community.

My final view of the Taj came from the other side of the river and its beauty was just as magnificent as it had been that morning, but this time, for me, it was overshadowed by everything else I had see in Agra. Those women and children that I had met, who had so much strength and compassion and hope.  If the Taj is one of humanity’s greatest works, then these small grass roots organizations like the women’s federation that the UHRC helped create are yet another symbol of humanity’s achievement. If this model could be replicated around the world, it has the potential to empower many people and allow them to provide for themselves and their communities. Issues of education and poverty and sanitation could be addressed from the bottom up.

The work that the UHRC is doing is absolutely amazing. I hope to see more of it and contribute my part to spreading this kind of community empowerment as I go through my career.

Saswathi Natta

4th Year Undergraduate Student at Princeton University, 

Visited UHRC Agra Program in July 2012

Student Highlight: Mihir Chaudhary

This summer I spent about two months between Delhi, Agra and Indore with the Urban Health Resource Centre (UHRC). My goal was to research their health programming, specifically in relation to family planning. The UHRC, a non-governmental organization, has been operating in slums for over a decade. Through my partnership with the UHRC I had the opportunity to interview families and self-help groups of women[1] in UHRC sites throughout these three cities. What follows is an overview of my key findings from this summer.

Before describing the community-building strategies of the Urban Health Resource Centre it is appropriate to describe the context of the slums I worked in. Delhi, Agra and Indore are sprawling metropolises. Each city has a population of over one million. Additionally, these cities contain significant numbers of un-enumerated slums. This means that several slums do not fall under the purview of municipal authorities – they are essentially invisible with regard to health, education, and infrastructure services. Much of UHRC’s work develops in these slums. UHRC leadership aims to create grassroots self-help groups to build community resilience in the absence of state-provided services. My first point of insight is centered on the self-help group strategy.

Self-help groups are not a new strategy and they are especially common in India. Many lower-income women in both villages and urban slums coalesce into savings unions. This happens both naturally and through external action. The Urban Health Resource Center typically sends a field officer into a vulnerable, isolated slum to educate community leaders on the benefits of the self-help group. The groups I witnessed were already fairly mature. Indeed in some of the UHRC field sites new groups were organically emerging from the action of self-help group members previously seeded by UHRC. In any case, UHRC officers arriving in new slums face entrenched patriarchy. Women are spatially confined to their domiciles. Only through persistent effort does UHRC win household favor in forming self-help groups. The time required to bring women into the self-help group varies depending on the slum. By the time the women are regularly saving and meeting in the slum, UHRC officers will try to instrumentalize the group further. This involves using the self-help group as an educational vehicle. I interviewed many women on their knowledge of contraceptive methods and maternal health services. The most mature self-help groups had high rates of knowledge on these topics. And this knowledge was greater relative to non-group members. This is evidence of, on some level, an effective knowledge dissemination role of the group. It is important to note that information, like family planning knowledge, is often spread through the group by other non-governmental organizations. In Agra, Avaad, a peer-to-peer family planning network, used UHRC self-help groups to recruit capable peer leaders and to disseminate information and contraceptives. In an important sense, UHRC uses the financial incentive of savings and loans to facilitate group formation. Once the group is formed it can be effectively used as a platform for other activities.

One such activity that the group is often used for is activism. The most mature self-help groups in Urban Health Resource Center catchment areas were linked to the nearest municipal government representative. Formerly invisible slums developed direct ties to their government. Of course this process is initially facilitated by exogenous forces. In the case of the most politically active Agra groups, women had extensive training at the hands of UHRC representatives. But once a certain threshold of knowledge and confidence is reached, self-help groups become regular political bodies. Many groups had organized petition drives, marches, and direct meetings with municipal governors. One group, through extensive petitions and meetings with the local municipal commissioner, had convinced the government to pave the roads. Again, the central factor in allowing this activism was the creation of a unified group platform. It is important to explore here the limits to the group-based approach to information dissemination and activism. I share two here: network limitations and gender role reification.

Despite the many benefits of the self-help group strategy it raises important issues. The first is regarding group identity. Most of the groups I interviewed were formed of one caste[2] or, at most, two castes. These individuals lived in the same spatial zone in the slum, communicated with each other and supported each other even before the formation of the self-help group. In one sense, then, these groups merely formalize social networks that already existed. The groups did seem to further turn some families inward and limit the formation of diverse social networks. To take one example, a higher caste family in one slum in Agra, was completely unaware of the existence of self-help groups amongst families that existed a few meters away. These self-help groups consisted of lower castes. Instead of attempting to extend social networks, UHRC groups form a self-limited source of support. To be sure it is likely impossible for any organization to purposively create cohesive mixed-caste groups in Indian slums. But if we are to recognize these social limitations to self-help groups it may be wiser to categorize them as coping social capital rather than getting-ahead social capital. Indeed even years after the creation of many of these self-help groups the female members had not advanced significantly socially or economically. This is partly due to the continued rigidity of caste in urban slums and partly because of the limited inherent power of homogenous self-help groups.

Malcolm Gladwell, in his novel Tipping Point, describes Connectors as people who “link us up with the world…people with a special gift for bringing the world together”. Malcolm’s research reveals that the ability to build relationships, sometimes across rigid class and social lines, is a rather innate (or at least arbitrarily socialized) ability. Social capital based strategies that employ groups, and particularly specific individuals within these groups, to disseminate health information implicitly rely on Connectors. That these Connectors exist, and that a few of them seem to emerge within slums, is evidenced by our research. 

Within health groups the chosen leader is also very often a Connector. Other women recognize this and push this Connector to be the leader. For example, one of the leaders, Lakshmi[3] in response to a question inquiring about her health group’s leaders said:

“Yes [I am the leader]. I don’t want to keep doing it but they [the group] keep convincing me.”

The other benefit of group-based strategies is that they facilitate the emergence of latent Connectors. Often times structured meeting opportunities can allow Connectors to operationalize their inherent tendency to make relationships and link people. A health group cluster leader (i.e. woman who administers all health groups in a certain geographical unit called a cluster) said:

“[Before the group] we would meet informally in the basti. But we were not very close before.”

Thus the imposition of a structure to meetings could actually facilitate building close relationships – something that Connectors are known for. The same cluster leader also mentioned that health group meetings are a time for talking and exchanging information. She emphasized her role in sharing different information at different times of the year, “We talk about the weather and what illnesses spread in what weather.” Indeed Gladwell characterized another type of individual, a Maven, as someone who is “pathologically helpful”. This particular cluster leader, bent on spreading temporally relevant information related to illness, was afforded a captive audience through health group formation to do so. Thus, as a tool for information dissemination, the formation of groups can very organically attract people – Connectors and Mavens – most naturally inclined to spread health information for the sake of spreading health information.

Mihir Chaudhary 
Undergraduate Sociology Student 

Harvard University, Boston, United States

Intern with UHRC, June-July, 2011

Sources

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[1] A self-help group is a limited circle of women that save and loan money collectively on a monthly basis. These groups, called health groups by UHRC, were significant as mediums for information dissemination and activism.

[2] Caste refers to a social hierarchy based throughout Hindu India. There are four major varnas which are ranked based on their ritual purity. Certain castes (called scheduled castes) are associated with a low socio-economic status.

[3] All names used throughout are pseudonyms to protect the privacy of interview participants.

Premise of Blog

Interns from The UCLA School of Public Health engaged in community activities 

Over the years, Urban Health Resource Centre (UHRC) has been home to many interns, student volunteers and short-term visitors from across the world. Students from diverse backgrounds and interests have come to UHRC to learn, experience urban health and well-being programming among disadvantaged communities in India. This blog will display stories and experiences of interns, volunteers shared with UHRC over time.  Additionally, this  blog will serve as a forum where UHRC staff members will share photos and experiences of events and news. We look forward to share the deep and meaningful experiences with you. Enjoy!