Working in the Social Sector

INDIA

Exploring Mumbai’s Urban Health Sector
Sandra Plaza

Collaborate
+ exchange ideas

It started here… of AFH
2004 Rebuild, the San Diego Chapter

© CommunityDesign365

I attended this…

2005 Global Studio, Istanbul Turkey, UIA

2004 Rebuild, The San Diego Chapter of

< 3 months
living in a village
with 7 strangers

I went to AFRICA…

2006, OCA, The Gambia, Jambanjelli Village


Limited shovels, wheelbarrows
resources
+ 5-7

Build a with culture + community
library
Immerse oneself


A library for the community


POINT #1

DESIGN IS A POWERFUL
TOOL THAT CAN ADDRESS
THE WORLD’S GREATEST
MOST PRESSING PROBLEMS

Housing


Health Care


Sanitation


Environment


POINT #2

DESIGN IS MORE
EFFECTIVE WHEN IT IS

MULTIDISCIPLINARY


Meet New People


Learn New Skill Sets


Collaborate & Work Together


POINT #3

DESIGN FOR GOOD &
INSPIRE THE NEXT
GENERATION


1. You know how to dodge your way through objects moving at
high speeds, no problem.

‘25 life lessons you learned from living in India’ - BuzzFeed

newglobalindian.com

2. Crowds don’t phase you at all.


3. Your spice tolerance is uncontestable.

phytophactor.fieldofscience.com

4. And your digestive system is made of steel.

garimakaushal.tumblr.com

5. You can bargain anything down to half its price.

adf.ly

6. “Adjust” isn’t just a word. It’s a way of life.

figandthewasp.wordpress.com

7. You’re good with animals.

dailymail.co.uk

8. After spending a monsoon in Mumbai, rainy days anywhere else
are child’s play.

idyllic.wordpress.com

9. The religious diversity means you know when all major holidays
are, and you know their appropriate greetings..


10. India is pretty awesome and you get to play with colors!


Designing Healthier Urban Environments
for a Healthier Urban World
SNEHA
(Society, Nutrition, Education, Health and Action)
August 2012 – June 2013

SNEHA Program Overview

© Design Impact 2013

SNEHA’S MISSION
•

To work in partnership with communities and health systems building effective and
replicable solutions, empowering women and their families in urban slums to improve their
health

•

Work at the community level to empower women and slum communities to be catalysts of
change in their own right

•

Target four large public health areas - Maternal and Newborn Health, Child Health and
Nutrition, Sexual and Reproductive Health and Prevention of Violence against Women and
Children



Prevention of Violence
Against Women
• Offer counseling services for survivors of
rape, sexual assault and child sexual abuse,
women with disabilities and sex workers, and
women suffering from mental illnesses
•Train staff of police and hospitals on how to
properly address violence

Sexual and
Reproductive Health
• Empower adolescents 11-19 yrs. to make
informed decisions about their health
• Offer education sessions on a skill or
vocation that can make them economically
self-reliant
• Offer family planning through doorstep
awareness, delivery of contraceptives and
referral services


Child Health and
Nutrition
• Provide Day Care Centres for Malnourished
Children 0 – 3 years
• Administer Medical Nutrition Therapy (MNT)
• Offer Home Based Care and Nutrition
Counseling

Maternal and
Newborn Health
• Ensure availability of antenatal clinics at
health posts
• Set up referral links for hospitals and
maternity homes
• Mentally prepare women in any case of
emergency during deliver of their baby through
birth preparedness counseling


Location: Mumbai
India occupies 17.5 percent of the
world's population
Mumbai Population: 20.5 million
(Total Metropolitan Area)
Financial capital
The wealthiest city in India
Over 50% of the population lives in a
slum

Mumbai Overview


Various activities include working at a grassroots level


Rallies in the community


Street campaigns and making the general public awaren of specific issues


Street conditions


Project Summary
•

Our initial proposal was to look at developing a sustainable business model in which new
services would offset the costs to deliver existing SNEHA service

•

We soon realized the costs to deliver SNEHA services was high

•

We decided to alter our focus on the improvement of the delivery of existing services


SRH

CHN
SNEHA
CENTRE
MODEL
CO

MNH

SNEHA Centre Community Trial Project

PVWC


SNEHA Centre Project
•

Total of 20 centres participating in the trial, conducted in three phases in M/East ward

•

M/East ward has the poorest human development ranking and a high proportion of slum
settlements as per the Human Development Index 2009

•

Lowest literacy rate (66%)

•

Highest infant mortality rate (66.4%)

•

Target beneficiaries are women of reproductive age (15-49 yrs) and children < 5

SNEHA Centre Project Overview


UNDERSTAND
CHALLENGES AND
BARRIERS

HOW CAN WE
IMPROVE THE DELIVERY
AND QUALITY
OF HOME BASED
INTERVENTIONS?

WHICH
STRATEGIES
EMPLOYED
RESULT IN POSITIVE
HUMAN
BEHAVIOR

We began by conducting interviews with Program Staff
To understand the different processes and strategies used to deliver home based interventions

Met with Program Officers, Community Organizers and Program Directors


Shadowed the work of Community Organizers
Community Organizer reviewing sonogram from doctor’s visit

SNEHA Centre Overview: Home Visits


Children very much enjoyed the
Behavior Change Communication
images

Pregnant mother, 22 years old

SNEHA Centre Overview: Individual home visits

Mother, 25 years old, 4 children


We Spoke With the Beneficiaries of SNEHA’s Programs
Organized and designed community workshops, the goal was to understand community values
that impact the health of women and children


© Rebuild Global 2013

Desire to own her own home


Education is a must

Honest doctors


Conducted Workshops With Adolescents
Important to identify dreams and aspirations of community youth members



Conducted Workshops With Adolescents


Reduce child labour

Education helps build a career

Doctors are important, villages
have less doctors


SRH Responses


PROCESS
FLOW

Resist

Home Based
Interventions
Accept

Approach to
home visits

Home Based Intervention: Process Overview

Trust

• Immunizations
• Maternal and Newborn Care
• Child health and nutrition
• Importance of anthropometry
• Immediate care of child
related diseases, awareness,
treatment and symptoms
• Hygiene practices
• Healthy eating habits


Time
Unhealthy
Eating Habits

Migration

Distance

Religion
Health
Information
Not Clear

Home Based Intervention: Challenges and Barriers


Home Based Intervention: Success and success drivers


Conducted Beneficiary Interviews
Discussed their vision for community centres

Community Workshop Overview


WHAT
SNEHA PERCEIVES AS
BARRIERS &
CHALLENGES

Cross Comparative Study of SNEHA Services

WHAT
BENEFICIARIES ACTUALLY
THINK


BARRIERS AND CHALLENGES
1. Beneficiaries do not see value in SNEHA services

False

2. It’s a private matter, women do not feel comfortable talking 50/50
3. Women are not allowed to leave their homes to access centres 50/50
4. Information is not understood False
5. Information is understood, but beneficiaries do not know how to
incorporate/process information in their own lives True
6. Religion and superstition 50/50
7. It’s not the women’s choice to make health decisions 50/50
8. Women do not have time in their daily schedules False
9. Messages do not reach out to wider community

False
10. Misconceptions of the quality of SNEHA services True


Observation: Mothers kept referencing to the importance of their child’s health and well being
and when the SNEHA centre was discussed they kept referring back to the DCC.
Quote: “The most important thing in our life is our children. If they stay healthy we stay healthy,
if they get ill or sick we also get ill or sick.”
Insight: Centering SNEHA Centre activities for children and adolescents will build trust and
knowledge sharing amongst mothers, increasing presence of SNEHA services and information in
the community.

SNEHA Program Interviews
Beneficiary Responses


Observation: Women would like to see income generating activities from the centre and had
mentioned taking courses in stitching or embroidery.
Quote: “Any type of work from which we can earn money. We finish our work in the morning at
10 a.m., after that for the whole day we do not have any work to do, so we let time pass
throughout the whole day.”
Insight: Women are looking for employment opportunities to help sustain their future.

SNEHA Program Interviews


Formed New Conclusions To Improve Delivery Of SNEHA Services
• Activate centre spaces to attract beneficiaries
• Look at different models of teaching to deliver SNEHA services by focusing on a
‘learning by doing’ approach and actively engaging participants
• Provide additional training material for staff so they are up to speed on best
practices for delivering health information and services
• Address social needs and delivery of programs or activities desired by the
community
• Make data transparent to beneficiaries, staff and community



Piloted A Cooking Demonstration
Demonstrated to mothers and young girls how to prepare healthy and nutritious meals

Intervention #1


Staff Demonstrated Cooking Recipes To Beneficiaries
Prepared biryani, a traditional rice based dish made with spices and vegetables and/or meat

Intervention #1


Women And Children Participated In SNEHA Program
More than 25 women and adolescent girls attended the cooking demonstration

Intervention #1


Adolescent girls enjoyed the class
very much

Intervention #1
Cooking Demonstration

Tastings were passed around to
everyone who attended

Mothers and children from the
community participated in the
cooking demonstration


Piloted Puppetry Workshops With SNEHA Staff
Workshop conducted with the Family Planning Association of India

Intervention #2


Women Used Recycled Materials To Make Puppets
Puppets are made using recycled paper, plastic bottles and coconut shells

Intervention #2


Taught Staff How To Effectively Communicate Health Messages
Beneficiaries can participate in creating their own street plays on health and nutrition

Intervention #2


Intervention #2


Dharavi Biennale
Educating communities about health and education through art and action


Dharavi Biennale
Transforming the interiors into an exhibition space


Dharavi Biennale
Surrounding landscape and environment


Thank You
Contact:
Sandra Plaza
splaza@rebuildglobal.org
www.communitydesign365.com
www.rebuildglobal.org

Working in the Social Sector

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