A one day workshop on

• NUHM would enhance efficiency of health services by strengthening the extant systems, rationalizing available manpower/resources and filling gaps in services through private & public partnerships.
• Since cities are different and have diverse needs and capacities, the NUHM proposes city specific planning based on spatial mapping of slums as well as existing health facilities to ensure that all urban poor clusters are covered.
• Proposed Community Level Activities: a) An Urban Social Health Activist (USHA) for a slum population of 1000-2500. b) Mahila Arogya Samiti (MAS) – a community based group representing about 100 households for promoting health and facilitating community risk pooling mechanism. c) Regular outreach health services in slums. d) USHA and MAS to facilitate improved access to health services, and to ensure public action for improved health care.
• Proposed Community Risk Pooling and Health Insurance Mechanism: a) The members of MAS will pool Rs.10-20/ month. The collected amount could be used to disperse loans to meet health related emergencies. NUHM would provide for seed money for such groups. b) A Government funded community health insurance model to enable identified families to access quality medical care for hospitalization/surgery. Smart Cards would serve as the proof of eligibility.
• Partnership with private providers for expanding reach and improving quality.
• NUHM would build capacity of all stakeholders to ensure effective implementation.
• 7-10% of NUHM budget would be allocated for the most vulnerable including construction site workers, homeless persons, street children, invisible habitations such as lime and brick kiln workers.

Release of Wall Planners and Annual report

The Urban Health Wall Chart which illustrates health of the urban poor in India compared to other population groups based on an analysis of the recently released NFHS-3 conducted in 2005-06. It was released by Mr. Pravir Krishn and Ms. P Bolina. The results highlight the health status of urban poor and reiterate the sharp disparities which exist within urban areas. Along with this, annual report of UHRC was also released.

Poster Session
A poster session was also organized at the event. 14 organizations participated in the session and demonstrated their program experience on strengthening community level processes in ensuring health to the urban poor in India. The posters were judged by Dr. MK Agarwal (Govt. of Delhi), Dr. GP Singh (MCD), Ms. Reema Nanda (American India Foundation) and Ms. Mrinalini Gupta (Michael and Susan Dell Foundation). Six appreciation awards were given for the poster presentation. The posters emphasized the need for community participation and empowerment and depicted the community level processes adopted for improving health care among the urban poor.

Urban Health Literature Exhibition
The urban health literature stall was displayed at the venue. It included a series of compendia, Urban Health Library CD, workshop reports, State of Urban Health Reports and many other research articles, newsletters etc for distribution. There was an overwhelming demand from the participants for the displayed materials.

Session 2 – Community Participation and Primary Health Care in Urban India
This session was chaired by Ms. Archana Varma, Deputy Secretary, Ministry of Health and Family Welfare. This session had three presentations from speakers with vast variation in their background and experience.

Sunita Kochle (Tulsi Smooh) and Naval Singh (Jatan Sanstha), CBO Members from Indore shared their experiences: From partnership to Leadership- Facilitating Community Ownership of Health Programs. They shared their journey from common slum dwellers to empowered community representatives. They highlighted two key points, a) Empowering women and the community can improve the demand for and the utilization of healthcare services, b) Individual to collective – c`ombined effort in form of Community groups can better negotiate with health care providers to extend more timely services.

Gerry Pinto, Advisor, Butterflies spoke on Challenges of providing Healthcare to Unorganized Communities such as Street and working Children, homeless destitutes. He talked about the project run by Butterflies to improve the health and education status of homeless street children, who constantly ‘struggle for survival’. He suggested a non institutional approach to the issue by using night shelters and mobile health clinics. This program also initiated night schools, child cooperative and spread health awareness through child health educators.

Dr. Siddharth Agarwal, Executive Director, UHRC, discussed about Improving Access to Quality Health Care Services through Community Risk Pooling. He emphasized on the heavy burden imposed by health expenses on the poor. Inspite of government’s subsidized hospital treatment, 78% curative care goes to the richest 3 quintiles. Poor not only suffer from economic burden of hospitalization but also bear indirect cost of opportunity loss. Generating ‘community health funds’ can reduce the health care burden of the poor by saving households from financial crisis during health emergencies and improving access to health services.

While making chairperson’s remarks Ms. Archana Varma started with two quotes:(1) “Poverty magnifies the need for health care and shrinks the capacity to finance it” and (2) “Poverty impinges on behavior change”. She added that health is often not the priority of the urban poor because of their constant struggle for survival. Slums are unstable communities, often under constant threat of demolition. Therefore, she suggested a need based, situation specific design for urban slum programs. It is crucial to facilitate slum communities in evolving whatever approach they determine would serve their needs best. Lastly, she acknowledged the value of experiences shared by Indore CBO leaders related to community empowerment processes and said these could serve as important leanings for other city programs.

Session 3 – Panel Discussion on Community Participation: Program learnings, Challenges and Suggested Future Action
The panel discussion was held with the panelist Ms. Razia (Rehbar Mahila Mandal, Indore), Ms. Nandita Kapadia (Additional Director, Institute of Health Management, Pachod), Ms. Karuna Singh (Project Director, IPP VIII, MCD, Delhi), Ms. Neena Shah More (Project Coordinator, SNEHA, Mumbai), Ms. Sunita Rai (Mahila Sandesh Vikas Samiti, Indore), Ms. Rashmi Singh (Joint Director, Department of Women and Child Development) and Ms. Monica Rana (State Health Mission, Delhi). Dr. Siddharth Agarwal moderated the session. Issues pertinent to community participation were discussed. Following suggestions emerged from the discussion.

1. How people come together? Much effort is required in the beginning of the program to win the trust of people before starting their collective effort. This may take 2-3 months or even more, and requires endurance. ‘A strong community group should have a firm base of trust, respect and commitment.
2. Significance of a structured community group: Formation of community groups is essential to combat vulnerability, ignorance and low negotiating capacity of slum residents. Groups can provide an effective platform to residents to share their problems, thoughts as well as solutions since ‘Local problems can be best solved by local solutions’. The zeal and energy towards working in a group can be an effective tool to involve them as strategic partners in development programs.
3. Patient, sustained efforts required: Any community based program is time taking in terms of showing measurable results at the slum level. Program starts showing results after 2-3 years of sustained inputs and interaction.
4. Flexible programs: Diversity among slums even within the same city implies that a program which is successful in one area may not be so in another area. Slum based programs, therefore, should be flexible to accommodate diverse local needs.
5. How can government foster community empowerment: Three Government officers on the panel suggested that the Government should promote community involvement and act as a catalyst in community programs, entrusting and empowering them to take charge. Only then will the community take up the responsibility.
6. Community participation could be ensured in ways like :
   • Identifying community representatives: Asha, Usha, Sakhi, Basti Sevika are all synonyms to active, trusted community women with sense of social responsibility and leadership qualities who can open the doors to the community.
   • Community Basti Organizations are structured groups which can act as change agents with some essential capacity building on community health.

In the concluding remarks Dr Siddharth Agarwal said that it is crucial to acknowledge urban poor communities as potentially capable citizens who can acquire knowledge and skills and develop the collective strength to influence their well-being rather than consider them as passive recipients of services.

Photographs of the Event