Slum families live amidst dirt leading to contamination of water, spread of flies, rodents, mosquitoes, which carry diseases e.g. diarrhea, typhoid, jaundice, dengue, chikungunya, malaria. U¬5 undernutrition in the poorest urban quartile are 2.5 times higher than the richest urban quartile. Practical approaches: 1.City map: Govt. of India’s NUHM & Housing Policy mandate mapping of all listed/unlisted/hidden slums on city map. UHRC's social facilitators, women's group members with govt. ANMs, Anganwadi workers identified, mapped hidden, unlisted and newly formed slums in Indore. Slum Women’s groups use hand-drawn basti maps to a)prevent exclusion of family from lists for housing, entitlements; b)Track access to health services e.g. vaccination, ANC, c) identify recent migrants, vulnerable slums. 2.Basti women’s groups in Indore & Agra function as slum women’s health groups (Mahila Arogya Samitis or MAS) mandated in Govt. of India’s NUHM to strengthen demand for health, environmental services. With knowledge, confidence & skills, women’s groups increase access to Govt. address proof and Picture ID. 3. MAS members save monthly to build savings pool. This saving helps in time of health emergency, marriage, child's education, rescues poor people from moneylenders. Based on Indore & Agra experience, India’s National Urban Health Mission (NUHM) mandates Mahila Arogya Samiti as a demand side strategy and creation a Revolving Community Fund as two of eight core NUHM strategies (Government of India, 2013). 4. With motivation youth-children groups bring more vigour to community efforts. Youth requests to authorities for streets, garbage cleaning. Basti children’s group members apply & avail govt. scholarship. 5. Outreach Health Services by Govt & Pvt Providers in deprived clusters are facilitated by basti women’s groups. They help ANMs identify vulnerable pockets, improve service access, infection prevention, promote healthy behaviours. With mentoring support from UHRC, they promote nutrition & health with simple recipes e.g. sprouted cooked, garnished black gram. Women take up gardening for nutrition despite space constraints. 6. Women’s groups submit requests to different depts. for paving of basti lanes, water supply, sewage system, electric connections. 7. Ladies & children making jewellery & greeting cards gives creative & psycho-emotional energy despite living in dirt. Creative art stimulates right brain which enhances skills, intellectual responses, learning ability, confidence. These help slum populations gather more strength and hope to better deal with the vagaries of life. 8. Women’s Livelihoods: Tailoring & Stitching training centres for women are run. Women/girls stitch frocks, trousers, girls’ tops, shirts at home on per piece basis. Women also sell vegetables, grocery, run slum convenience store, tiffin service.

1. Siddharth Agarwal
Executive Director
Urban Health Resource Centre, India
Community Model to Improve
Slum Health in Smart Cities,
Wards, Localities
Practical Learning from Programme in Indore and Agra
Find us on facebook
www.uhrc.in
May 6, 2017
National Conference on Opportunities and Challenges to Achieve
SDGs 5 and 6
FWTRC Diamond Jubilee, at GMC Gymkhana, Marine Drive, Mumbai
FWTRC
Mumbai

2. Presentation Outline
• Glimpses of exclusion, deprivation from urbanizing India
• Community approaches towards improved slum health based on program
experience across > 500,000 urban disadvantaged population
1. Spatial City Mapping and hand-drawn spatial neighburhood maps (Prioritising most
vulnerable of NUHM)
2. Slum Women’s Groups (Mahila Arogya Samiti of NUHM)
3. Women’s empowerment enhances caring capacity of woman and family
4. Youth-children groups emerging as ‘Force Gen-next’
5. Improving health, nutrition in migrant and other deprived neighbourhoods
(Outreach service/sessions of NUHM)
6. Gentle Demand-side Negotiation through Collective Community Petitions
(strengthening public health action on NUHM)
7. Stimulating psycho-emotional energy and right brain through creative activities
8. Slum-level Collective Social Needs Savings and Loans (Revolving fund of NUHM)
9. Increasing Access to Proof of Address and Picture ID
10. Encouraging slum women’s livelihood
• Inter‐sectoral‐Coordination for Bringing Multi‐sectoral Efficiencies for
Improved Health and Well‐being (Convergence with other sectors of NUHM)
• Glimpses of improvement

3. Glimpses of an Urbanizing India
Rolling incense sticks to
support family income- Indore
An iron-smith’s
daughter on Kolkata
pavement
Children on a temporary
“bridge” across a drain-
Jakarta
Competing for water
Washing utensils on
railway track - Kolkata

4. Physical Living Environment of Urban poor
Slum at the edge of large
drain – risk of floods
Wading through a large drain
for daily transit- Indore
Child filling water -
Delhi
Community toilet- pig;
hard to keep clean
Mosquito breeding in
collected water - Indore
Water enters low-plinth
house after heavy rain:
climate change

5. Living Conditions of Urban Disadvantaged
The urban disadvantaged, including women
contribute cheap labour towards GDP
Construction site workers, labourers
Brick kiln, Traditional Wanderers e.g. potters, iron
smiths, other circular migrants
Difficulties in accessing education, social-
opportunities, and services in city: restrictions on
freedom of movement; weak social-networks; little
awareness of opportunities, services.
Child-bearing migrant-girls faced particular risks.

6. Community Based Approaches
Towards Building Self‐
reliance among the Urban
Deprived based on
programme experience

7. Approach # 1a: Mapping Helps Inclusion of Unlisted
Slums/vulnerable clusters
SLUM NUMBER POPULATION
LISTED 102 455923
UNLISTED 85 216935
TOTAL 187 672858
LOCATION OF SLUMS
Meerut City
7
Spatial city mapping of vulnerable clusters integral strategy of NUHM
This enables inclusion of small pockets, seasonal, recent migrant clusters

8. Approach 1 (a)
Spatial City Mapping
Mapping helps inclusion of unlisted slums/ migrant clusters
Location of Listed, Unlisted Slums in Agra
Slum Number Population
Listed 215 538322
Unlisted 178 303251
Total 393 841573
Agra City
Spatial mapping enables inclusion of small pockets, seasonal, recent migrant clusters

9. 9
Slum Women’s groups in slums use hand‐drawn maps to
a) Ensure that no family is left out from lists used for housing, sewage
system, toilets, entitlements;
b) Track access to health services e.g. Immunization and ANC,
delivery, other health and nutrition services,
c) Help identifying recent migrants for linkage to services,
entitlements
Approach 1(b)
Demonstrate uses of Neighborhood Mapping

10. Cluster-level teams of slum women’s groups gives stronger voice and greater
negotiation power
Slum Community Based Approach 2
Cluster Teams of Women’s Groups, Indore and Agra
Slum women’s health groups (Mahila Arogya Samitis) mandated in Govt. of India’s National
Urban Health Mission to strengthen demand for health, environmental services.

11. • Promote savings, girls education, help repay moneylender debt
• Community women’s groups contribute to a positive gender equation at
family and society levels, provide social support to needy families
• Women’s access to resources and greater capacity to take timely care of
themselves, children, and family helps the family and community
• In a patriarchal society, women's groups help in increasing women’s
autonomy in decisions on healthcare, children’s (including girls’)
education, associated expenditure and promote savings.
• Prevent early marriages of girls in a society where some families
considering girls unsafe and marry them early*
• Reduce number of alcohol vending, gambling joints
*In poorest urban quartile in Maharashtra, 39 % women age
20-24 were mothers/pregnant <18 years age, against 4% in
remaining urban population during 2005-06 (NFHS-3)
Slum Community Based Approach 3
Women’s empowerment enhances caring
capacity of woman, family, lends social support

12. Slum Community Based Approach 4
Youth‐children groups emerging as ‘Force Gen‐next’
With continual mentoring, motivation Youth-children groups enhance self-
esteem, improve their own lives; also contribute to their communities in
tangible ways. More vigour and joy to ‘ignite the senses”.
Nukkad natak on clean
environment
Youth requests to civic authorities for
streets, garbage cleaning
There are 150 million youth 15-32 yr, 125 million 10-24 yr in urban India

13. Basti children’s group members apply and avail government
scholarship

14. Slum Community Based Approach 5 a.
Regular Outreach Health Services by Government and
Private Providers in Migrant, other Deprived clusters
Slum Community Based Approach 5 a.
Regular Outreach Health Services by Government and
Private Providers in Migrant, other Deprived clusters
Information and community motivation –
women arrive for immunization day
Registration of beneficiaries -
identifying left-outs and drop-outs
Linkage with the Auxiliary Nurse-
Midwife for vaccine administration
Linkage with Doctor for ailments,
Ante-natal check-up
Urban ASHA, ANM mandated in NUHM to identify vulnerable pockets, improve
service access, infection prevention, promote healthy behaviours

15. Slum Community Based Approach 5 b.
Promoting Nutrition and Health with simple recipes
Sprouted black gram Sprouted cooked peas garnished with
tomatoes, ginger, onion, lemon.
Dry “bhel” of roasted black gram, peas,
peanuts and puffed rice commonly sold.
Women, children eat a nutri-dense snack of sprouted
cooked black gram, peas garnished with ginger, onion,
tomatoes, lemon
Discussing with pictures
nutrition, protein, iron intake,
effect on growing girls, boys,
women in particular. How
anemia, undernutrition can be
detected early

16. Slum Community based Approach 5 c.
Slum Women take up gardening for nutrition despite space constraints
Sowing seeds and nourishing plants in small houses to grow vegetables for their families
350 slum families grew 5250 kg vegetables during Sept 2016 to Feb 2017.UHRC provided seeds,
organic manure and motivation. Vegetables added to family meals, saved scarce resources of
slum families and confidence & zest of making their immediate world more beautiful & natural.
Small “kitchen garden” outside
slum house. Lady plucks
tomatoes from plant for the meal.
Daughter and proudly show
round gourds grown behind their
slum house.
Children
hold a
large bottle
gourd
grown on a
creeper
climbing
slum house
wall. Large brinjals grow on a plant
in slum house.
Daughter-in-law and mother-in-
law harvest beans from a creeper
for a nutritious meal.

17. Slum Community Based Approach 6
Gentle Negotiation through Collective Petitions
Written requests to officers of Municipal Authorities, Nutrition Dept, Electricity Dept.
Petition
Response of
Civic Authority
Inclusive Smart Cities require deprived communities to actively participate in
governance: maintain paper trail, persevere with tact (including tea + biscuits,
polite thank you) towards achieving “Right to the City”, use of Govt. allocation.

18. Slum Community Based Approach 7 a.
Stimulating psycho‐emotional and right brain energy
through creative activities
Ladies and children making jewellery with one’s own hands gives creative and emotional
vigour which adds to other efforts.

19. Ladies, children gleeful with handmade
jewellery
Making jewellery gives psycho-emotional energy despite living amidst dirt

20. Slum Community Based Approach 7 b.
Youth, children learning handmade cards
In addition to giving ideas for school work, creative art stimulate the right brain
which enhances skills, intellectual responses, learning ability, confidence.

21. Handmade Greeting Card session and Outputs
Using hands and creativity to make artistic work causes triggers a form of energy that
emerges from nourishment of the senses, crucial for emotional, mental health, well-being.

23. • Creative & artistically fulfilling activities give a sense of
freedom, purposefulness of action, stimulate psycho‐
emotional & right brain energies.
• These help slum populations gather more strength,
resilience, motivation and hope to better deal with the
vagaries of life.
• This is related to neuro‐physiology we learn during our
medical training and emotional energy as a component of
healing we learn while trying to help people stay or
become healthy.
How do creative energies help
"Creativity is a great motivator because it makes people interested in what they are doing. Creativity gives
hope that there can be a worthwhile idea. Creativity gives the possibility of some sort of achievement to
everyone. Creativity makes life more fun and more interesting. Creativity provides a framework for working
with others as a team.“ – Edward De Bono

24. Slum Community Based Approach 8
Collective Social Needs Savings and Loans:
Building skills, self‐reliance, confidence
(for Health and related Emergency, Child Education, starting small business, purchasing food
grains, marriage, repaying money lender loan)
Realizing the importance of ready source of
money, slum women save in a collective fund
Women’s group’s money box with lock. Key kept with
one member; box with another group member.
The rules regulations and all financial
transactions are documented at group level
Each member of women’s groups is given a “pass-
book” recording her contribution, loan,
repayment of loan
This approach has been mandated in Govt. of India’s National Urban Health Mission (Gazette
Notified Jun 26, 2013) as ‘revolving community fund’

25. 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, including toilet construction

26. Slum Community Based Approach 9
Increasing Access to Govt. Address Proof and Picture ID
During Apr 15 – Mar 16: 18,000 persons obtained Govt. proof of address and
Picture ID who previously did not have these

27. Slum Community Based Approach 10
Encouraging Women’s Livelihoods
Vocational Training - Tailoring and Stitching and women’s group loan

28. Slum Community Based Approach 10
Encouraging Women’s Livelihoods
Live example based training; women’s group loans
Slum convenience store
Vegetable
seller
Food joint; Tiffin service Making clay dolls,
pottery in festival
seasonal

29. Ward/Zone/U-PHC
Committee
facilitated by
Govt./NGO/CBO
Municipal Corporation
(Zonal Office/City Office)
Local Resources
(Local clubs, Schools, CBOs)
Private Providers
Elected
Representatives
Urban DevelopmentICDS, Food Security
Charitable
Organizations, NGOs
Health Dept
Prabhag Kalyan Samiti in Maharashtra, Urban PHC Committee in Uttrakhand; Health
and Family Welfare Committee at Municipal level in West Bengal/Kolkata;
Inter‐sectoral‐Coordination for Multi‐sectoral Efficiencies
Towards Health, Nutrition and Well‐being

30. Dept. Women Child
Dev.
ICDS, LADLI,
SABLA
Health Dept
ANC, Immunization
Maternity Benefit Scheme,
Other services
District/Sub-divisional
Office
Social Assistance
Programs
Old Age & Widow PensionFood Subsidy
access
Labour Dept.
Domestic worker card,
Mazdoor Diary
Politicians
Lend support for
applications
Roads, drains,
water., toilet, tenure,
housing
City Govt/
Picture ID,
proof of
Residence,
birth certificate
UHRC
Indore/
Agra
Cluster team of
Women’s Groups
Multi‐Dimensional Inclusiveness and Health
Improvement Efforts in Smart Cities

31. Glimpses of Improved Access to
services in slums, informal
settlements: utilization of
Government allocated
resources

32. Improved access to Toilets, Sewer, Paved Streets
During 2015-2016: 80,000 slum population benefited from sewage system

33. Struggle for
water Water tank
erected
During Apr. 15- Mar. 16: 100,000 slum population in Agra and
Indore slums benefitted from improved water supply
Improved Water Supply

34. During 2014-2016: 85,000 slum population benefited (Agra + Indore) from electricity
connections

35. Slum Women’s, Children-Youth Groups community requests to
civic authorities over 5 years bring bridge over large drain, Indore
2015
2013-2015:Determined women’s, children-youth group
members continued to submit written applications to civic
authorities and represented in person.
More permanent,
taller bridge is built
Women’s group members at
Dist. Public hearing
August
2012
20112010
October
2012
Bridge over Large Drain Benefits 1,20,000 population

36. Let us Build Human Capability, Self‐
reliance of Migrants, other Deprived
Citi‐zens, prevent their learning to
survive in impoverishment.
Let us translate words into real action
towards Inclusive Smart Cities.
siddharth@uhrc.in

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