In India’s glittering cities opulence grows along with deprivation and poverty. Health, nutrition, poor living environment, uncertain livelihoods, low access to children's education, poor access to entitlements affect lives of under-privileged city-dwellers. What Approaches have worked, helped learn practical lessons and the ‘How to do’ with relevant stakeholders: 1. Spatial city and Neighbourhood maps help better understand living environment 2. Slum-Community/Women’s Groups increase demand for services [Mahila Arogya Samiti in NUHM] 3. Collective Social Needs Savings & Loans [Community Revolving Fund in NUHM] 4. Gentle Negotiation: Under-served communities address determinants of urban health across sectors, through community applications for services 5. Youth-children groups emerging as ‘Force Gen-next’ 6. Community’s Own Efforts when authorities do not respond 7. Facilitating Access to Picture ID, Proof of Address and social benefits 8. Facilitating Access to Food subsidy cards 9. Multi-dimensional Efforts to Improve Health, Nutrition, Environment, Related Services: Through Coordination & Linkage Building – towards addressing socio-environmental-economic determinants of health

1. Smart Cities: Underprivileged
Citizens and Ways Towards
Equitable Access to Services and
Well-being
Siddharth Agarwal
Urban Health Resource Centre, India
May 14, 2015
Rotary Club Meerut
Chamber of Commerce, Bombay Bazaar, Meerut
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2. Outline
 Urbanization, Health and well-being challenges
 What Approaches have worked, helped learn practical lessons and the
‘How to do’ with relevant stakeholders:
 # 1 Spatial city and Neighbourhood maps help better understand living environment
 # 2 Slum-Community/Women’s Groups increase demand for services [Mahila Arogya Samiti in
NUHM]
 # 3 Collective Social Needs Savings & Loans [Community Revolving Fund in NUHM]
 # 4 Gentle Negotiation: Under-served communities address determinants of urban health
across sectors, through community applications for services
 # 5 Youth-children groups emerging as ‘Force Gen-next’
 # 6 Community’s Own Efforts when authorities do not respond
 # 7 Facilitating Access to Picture ID, Proof of Address and social benefits
 # 8 Facilitating Access to Food subsidy cards
 # 9 Multi-dimensional Efforts to Improve Health, Nutrition, Environment, Related Services:
Through Coordination & Linkage Building – towards addressing social determinants of health
 Urbanization, Health and well-being challenges
 What Approaches have worked, helped learn practical lessons and the
‘How to do’ with relevant stakeholders:
 # 1 Spatial city and Neighbourhood maps help better understand living environment
 # 2 Slum-Community/Women’s Groups increase demand for services [Mahila Arogya Samiti in
NUHM]
 # 3 Collective Social Needs Savings & Loans [Community Revolving Fund in NUHM]
 # 4 Gentle Negotiation: Under-served communities address determinants of urban health
across sectors, through community applications for services
 # 5 Youth-children groups emerging as ‘Force Gen-next’
 # 6 Community’s Own Efforts when authorities do not respond
 # 7 Facilitating Access to Picture ID, Proof of Address and social benefits
 # 8 Facilitating Access to Food subsidy cards
 # 9 Multi-dimensional Efforts to Improve Health, Nutrition, Environment, Related Services:
Through Coordination & Linkage Building – towards addressing social determinants of health

3. India’s Urbanizing economy: Affluence and
Deprivation Juxtaposed
 In India’s glittering cities opulence grows along with
deprivation and poverty
 60% of Mumbai’s population lives on 8% of land [Parsuraman, S. 2007]
and contribute to economy in diverse ways, living in severe congestion
 In Delhi, water-supply for planned colonies is 225 lpcd (liter per capita
daily) and 50 lpcd for listed slums
 Urban poor contribute substantially to India’s economic
growth:
 Between 60- 90% of urban poor are involved in urban informal sector.
 Urban sector contributes 60% -70% of GDP
 In India’s glittering cities opulence grows along with
deprivation and poverty
 60% of Mumbai’s population lives on 8% of land [Parsuraman, S. 2007]
and contribute to economy in diverse ways, living in severe congestion
 In Delhi, water-supply for planned colonies is 225 lpcd (liter per capita
daily) and 50 lpcd for listed slums
 Urban poor contribute substantially to India’s economic
growth:
 Between 60- 90% of urban poor are involved in urban informal sector.
 Urban sector contributes 60% -70% of GDP
Parsuraman, S - http://www.karmayog.org/urbandvlp/upload/21756/Newspaper-essays_Prarsuraman.pdf. This indicates
high density of living space for 60% living in slums, chawls, informal settlements.
Population density of Greater Mumbai (area under Municipal Corporation of Greater Mumbai) estimated at 24,812
(Mumbai Suburban district & Mumbai City district) persons per sq. km. as per Census 2011 .
Density of Mumbai City – 43,447 per sq. km.

4. Challenging Environment of an Urbanizing
World
Rolling incense sticks to
support family income

5. Unhealthy Living Environment

6. Approach # 1a: Mapping Helps Inclusion
of Unlisted Slums/Clusters
SLUM NUMBER POPULATION
LISTED 102 455923
UNLISTED 85 216935
TOTAL 187 672858
LOCATION OF SLUMS
Meerut City
6Spatial city mapping of vulnerable clusters integral strategy of NUHM

7. Community groups in slums prepare maps to
a) Ensure that no family is left out from lists used for housing, food subsidy,
entitlements;
b) Track access to health services e.g. Immunization and ANC , HIV testing,
c) Help identifying and providing services/linkage to recent migrants
Approach:1 (b)
Demonstrate uses of Neighborhood Mapping
7

8. Approach 2: Demand side strategies
 Cluster teams of Women’s Groups:
 Slum-Community/Women’s Groups as agents of change
 Cluster teams or Congress of slum women’s groups gives stronger voice
and greater negotiation power
Women’s groups are Mahila Arogya Samitis mandated in NUHM 1
1NUHM Framework for Implementation, May 2013

9. Network of slum-based community groups in
Indore and Agra
UHRC
Indore/Agra
Training, Monitoring,
Supervision &
problem solving
Training, Monitoring,
Supervision &
problem solving
• Project coordinator
• Field coordinators
Linkage with
Civic Authorities
Linkage with
Civic Authorities
 8 to 23 women groups in a large slum cluster
 10-14 members per group
 30 to 70,000 slum population per cluster team
5 Cluster teams 7-37
members (1 per group)
(has office bearers, bank
account, registered NGO)
• Grant to
cluster
team
• Programme
Monitoring
• Grant to
cluster
team
• Programme
Monitoring
UHRC Delhi

10. Approach 3: Building skills, self-
reliance and confidence
 Collective Social Needs Savings and Loans: for Health and
related Emergency, Child Education, Starting a small
business, purchasing food grains, Marriage, getting assets
back from money lenders
This approach is a mandated in NUHM as ‘revolving community fund’1
1NUHM Framework for Implementation, May 2013

11. Utilization of loans from Women’s Groups
Data from collective savings registers of 125 women’s groups in Agra and Indore
during April‐13 to March‐14 shows that of the 3327 loans given:
 925 loans (27.8%) for health needs, of which 550 loans served maternal‐child
health needs, and 375 loans served other health needs
 531 loans (15.96%) helped overcome challenges that interrupt or lead to drop-out
in children’s education
 524 loans (15.74%) helped start/expand livelihoods
 424 loans (12.74%) helped store grains at harvest time, a measure to address food
insecurity during low (or no) wage-earning times
 221 loans (6.64%) supported girl marriages
 302 loans (9.07%) enabled repaying money‐lender debts
 190 loans (5.71%) were used for grocery/
kitchen expenses
 210 loans (6.31%) enabled house
improvements, land lease, toilet construction
Data from collective savings registers of 125 women’s groups in Agra and Indore
during April‐13 to March‐14 shows that of the 3327 loans given:
 925 loans (27.8%) for health needs, of which 550 loans served maternal‐child
health needs, and 375 loans served other health needs
 531 loans (15.96%) helped overcome challenges that interrupt or lead to drop-out
in children’s education
 524 loans (15.74%) helped start/expand livelihoods
 424 loans (12.74%) helped store grains at harvest time, a measure to address food
insecurity during low (or no) wage-earning times
 221 loans (6.64%) supported girl marriages
 302 loans (9.07%) enabled repaying money‐lender debts
 190 loans (5.71%) were used for grocery/
kitchen expenses
 210 loans (6.31%) enabled house
improvements, land lease, toilet construction

12. Skill Building, Access to
Government Schemes
Kamkaji Mahila Card Silai Centre

13. Approach 4: Gentle Negotiation through Collective
Petitions, reminders (Written requests to officers of
Health, Nutrition & Environmental Departments)
Petition
Response of Civic
Authority

14. Letter in support of
petition/request by
politician
Letter in support of
petition/request by
politician

15. Approach 5: Youth-children groups emerging
as ‘Force Gen-next’
With continual mentoring, motivation Youth-children groups in
slums are not only improving their own lives but also contribute
to their societies in tangible ways.
Promoting Hygiene,
Hand-washing
Youth petitions to civic authorities
for streets, garbage cleaning

16. Cleaner Drains
Before After
During 2013-2014: 100,000 slum population benefited (Agra + Indore) from
cleaning of drains

17. Electricity Connection
During 2013-2014: 12000 slum population benefited (Agra + Indore) from
electricity connections
Before After

18. Improvement of Slum Pathways, Sewer
During 2013-2014: 50,000 slum population benefited (Agra + Indore) from roads paved

19. Improvement of Slum Pathways, Lanes
During 2013-2014: 40,000 slum population benefited (Agra + Indore)
from roads paved

20. Water Tanker Installation
During 2013-2014: 37000 slum population benefited (Indore & Agra)
from water supply

21. Approach # 6: Community’s Own Efforts
Community Contributes to build, re-build vital bridge
in Banganga Area, Indore
Before
Oct’11 Oct’11 Aug’12 Oct’12

22. Elevating House Plinth to prevent rain-water
entering house
Rain water enters houseRain water enters house
Rain water does not enter elevated
houseElevating House Plinth

23. Approach # 7
 Perseverant Efforts to enable
Government Picture ID, Proof of
Address, Certificate of Birth Date
 Perseverant Efforts to enable
Government Picture ID, Proof of
Address, Certificate of Birth Date

24. Women showing their UID-Aadhaar Cards
Picture ID & Proof of Address
During Apr 13 – Mar 14: 8000 persons benefited from proof of address and Photo
ID

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

26. Approach # 8
Efforts towards Translating
Mandate into Reality: Food
Subsidy Cards and Social Benefit
Schemes
Approach # 8
Efforts towards Translating
Mandate into Reality: Food
Subsidy Cards and Social Benefit
Schemes

27. Food Subsidy Card as per Food
Security Act, 2013

28. Dept. WCD
ICDS, Girl Child Benefit,
Others
Health Dept
ANC, Immunization
JSY,
Other services
Politicians
Voice, support for
applications
Municipal Corprn/
JNNUR-
Roads, drains,
water., toilet, tenure,
housing
Federation of
Women’s Groups
Approach #9: Multi-dimensional Efforts to Improve
Health and Related Services Through Coordination &
Linkage Building
Dist. Magistrate’s Office
Social Assistance Programs
Old Age & Widow Pension
Food Subsidy BPL,
APL Cards
Labour Dept
Domestic worker
registration
Politicians
Voice, support for
applications
Municipal Corprn/
JNNUR-
Roads, drains,
water., toilet, tenure,
housing
Others
Voter ID, Adhar,
Domicile Certificate,
caste Certificate
UHRC
Indore/ Agra

29. Gender empowerment enhances
caring capacity of woman and family
 Through women’s groups, gender equation
is positively improved at family and
society level
 Women’s enhanced access to resources
and greater capacity to take timely care of
themselves, children, and the family helps
the family and community
 Through women’s groups, gender equation
is positively improved at family and
society level
 Women’s enhanced access to resources
and greater capacity to take timely care of
themselves, children, and the family helps
the family and community

30. Empowered Assertive Women Take
Action…….
Women wielding bamboos against alcoholism vending points, gambling joints

31. ….and no boundaries can stop
these empowered women
Women’s group members at the Hindustan
Times Social Innovators Conclave, 2014
Vociferous women organise a ‘Jan Jagran’ Rally

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

33. Functioning,
Accountable
System for
Urban Health,
Nutrition and
Well-being
Long Lever of :
a) Complementary skills, Knowledge,
Experience
a) Commitment , Motivation
b) Understanding of problems
c) Accountability, responsibility
With Hope and ConfidenceWith Hope and Confidence
33
Functioning,
Accountable
System for
Urban Health,
Nutrition and
Well-being
Long Lever of :
a) Complementary skills, Knowledge,
Experience
a) Commitment , Motivation
b) Understanding of problems
c) Accountability, responsibility
“A small body of determined spirits fired by an“A small body of determined spirits fired by an
unquenchable faith in their mission, can alter theunquenchable faith in their mission, can alter the
course of history”course of history” -- MohandasMohandas KaramchandKaramchand GandhiGandhi
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Social Orgnaisations,
Professionals, Govt.
Managers, Public &
Private
Sectors, slum CBOs,
Civil Society