Urban Health Resource Centre's practical experiences shared at Urban Thinkers Campus on Health and Wellbeing Convened by United Nations University IIGH, Kuching, Malaysia Ignited slum community groups engage as active citi-zens, negotiate collaboratively for equity and access to contribute to better urban governance . i) Trained, empowered slum women’s groups and cluster-level teams of slum women’s groups gives stronger voice and greater negotiation power. ii) Increase Access to Govt. Address Proof and Picture ID: During Apr 2013 gave legitimacy to urban informal settlement families– Mar 2015: 20,000 persons benefited from Govt. proof of address and Picture ID iii) Empowered women facilitate reduction in alcoholism, domestic violence against women, enhance caring capacity of woman, family, improved social support. With over 125 million women among urban vulnerable in India, women-power has immense potential towards improved health, social justice, wellbeing. iv) Trained slum community groups pull regular outreach health Services by Government providers in Migrant, other Deprived clusters v) With training, mentoring, hand-holding support community groups engage in gentle, tactful negotiation through collective written petitions/requests to officers of Municipal Authorities, Nutrition Dept, Electricity Dept. Disadvantaged communities actively participate in governance, collaborate for equity, justice, access: maintain paper trail, persevere with tact (including tea + biscuits, polite thank you) to achieve “Right to the City”. vi) Slum youth-children groups emerging as ‘Force Gen-next’: With continual mentoring, motivation Youth-children groups in slums improve their own lives; contribute to their communities in tangible ways, bring more vigour and joy to ‘ignite the senses”. It is noteworthy that there are 150 million youth 15-32 yr, 125 million 10-24 yr in urban India vii) Spatial City and Neighborhood Mapping helps make invisible, voiceless poverty clusters and recent migrants, weaker families visible and their social inclusion. viii) Let us Build Human Capability, Expertise, Ignite Action & Engagement, Collaborative efforts and Resilience of Urban Excluded, Deprived Citi-zens, and to bounce forward, prevent their learning to survive in impoverishment Let us translate words into real action towards inclusive, socially just cities.

1. Slum community groups use negotiation
skills, knowledge, to improve access to
services and entitlements:
A demand side approach to better
governance
January 25-27, 2016
www.facebook.com/uhrcindia/
www.uhrc.in
January 25-27, 2016
Urban Thinkers Campus on Health and Wellbeing
Convened by United Nations University IIGH,
Kuching, Malaysia
Agarwal Siddharth, Verma Shabnam, Verma Neeraj,
Agarwal Kabir, Sharma M.R., Sharma C.B
Urban Health Resource Centre, India

2. Presentation Outline
• Glimpses of low access to services, deprivation from our urbanizing
planet
• Demand-side approaches towards more accountable urban
governance and inclusion based on program experience across >
410,000 urban disadvantaged population
1. Trained slum women’s groups and Cluster Teams
2. Increasing Access to Proof of Address and Picture ID
3. Gender empowerment enhances caring capacity of woman and family
4. Pull Outreach health service in migrant and other deprived
neighbourhoods
5. Gentle, tactful Demand-side Negotiation through Collective Community
Petitions
6. Youth-children groups emerging as ‘Force Gen-next’
7. Demonstrate uses of spatial Neighborhood and City Mapping
• Inter-sectoral-Coordination for Bringing Multi-sectoral Efficiencies
for Improved Health and Well-being
• Improvements in Access to Services in Slums, Informal Settlements

3. Glimpses of an Urbanizing World
Competing for water
Washing utensils on
railway track - Kolkata
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 railway track - Kolkata

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

5. Living Conditions of Urban Disadvantaged
The urban disadvantaged, including women
contribute cheap labour towards GDP
Construction site, brick-kiln workers, labourers
Child-bearing migrant-girls faced particular risks.

6. Ignited slum community groups
engage as active citi-zens,
negotiate collaboratively fornegotiate collaboratively for
equity and access to contribute
to better urban governance

7. Trained, empowered slum women’s groups and cluster-level teams of slum
women’s groups gives stronger voice and greater negotiation power
Demand-side Approach to better urban governance # 1
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 services.

8. Demand-side Approach to better urban governance # 2
Increase Access to Govt. Address Proof and Picture ID
During Apr 2013 – Mar 2015: 20,000 persons benefited from Govt. proof of
address and Picture ID

9. Demand-side Approach to better urban governance # 3
Women’s empowerment for enhanced caring
capacity of woman, family, improved social support
• Slum women’s groups gradually contribute to a positive
gender equation at family and society levels, provide
social support to needy families
• Women’s enhanced access to resources and greater
capacity to take timely care of themselves, children, andcapacity to take timely care of themselves, children, and
the family helps the family and community
• Reduce number of alcohol
vending, gambling joints
• Promote savings, girls’ education
There are over 125 million women among
urban vulnerable in India

10. Demand-side Approach to better urban governance # 4
Pull Regular Outreach Health Services by Government
and Private Providers in Migrant, other Deprived clusters
Registration of beneficiaries -
identifying left-outs and drop-outs
Linkage with the Auxiliary Nurse-
Midwife for vaccine administration
Information and community motivation –
women arrive for immunization day
Linkage with Doctor for ailments,
Ante-natal check-up
Urban Health Extension Worker, Community Volunteer in Ethiopia, Urban
Accredited Social Health Activist, ANM in India mandated to identify vulnerable
pockets, improve Service access, infection prevention, promote healthy behaviours

11. Demand-side Approach to better urban governance # 5
Gentle, tractful Negotiation through Collective Petitions
Written requests to officers of Municipal Authorities, Nutrition Dept, Electricity Dept.
Petition
Response of
Civic Authority
Disadvantaged communities actively participate in governance, collaborate
for equity, justice, access: maintain paper trail, persevere with tact
(including tea + biscuits, polite thank you) to achieve “Right to the City”.

12. Demand-side Approach to better urban governance # 6
Youth-children groups emerging as ‘Force Gen-next’
With continual mentoring, motivation Youth-children groups in slums
improve their own lives; also contribute to their communities in
tangible ways. More vigour and joy to ‘ignite the senses”.
Promoting Hygiene,
Hand-washing
Youth requests to civic authorities for streets,
garbage cleaning, family-income certificates
There are 150 million youth 15-32 yr, 125 million 10-24 yr in urban India

13. 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
Demand-side Approach to better urban governance # 7a
Demonstrate uses of Spatial Neighborhood Mapping
1

14. Demand-side Approach to better urban governance # 7b
Spatial City Mapping
Helps make the invisible visible
Location of Listed, Unlisted Slums in Agra
Slum Number Population
Listed 215 538322
Unlisted 178 303251
Total 393 841573
Agra City
Spatial mapping can help socially sensitive planning, inclusion of small pockets, seasonal,
recent migrant clusters

15. Dept. Women Child
Dev.
ICDS, LADLI,
Others
Health Dept
ANC, Immunization
Maternity Benefit Scheme,
Other services
Politicians
Lend support for
Multi-Sectoral Community Groups’ Efforts in
Smart City
Roads, drains,
water., toilet, tenure,
housing
Cluster team of
Women’s Groups
Collector’s Office
Social Assistance Programs
Old Age & Widow Pension
Food Subsidy
Cards: BPL,
APL Cards
Labor Dept
Domestic worker
registration
Lend support for
applications
housing
City Govt/
JNNURM
Picture ID,
proof of
Residence,
Certificate of
residence
UHRC
Indore/
Agra

16. Glimpses of Improved Access
to Services in Slums,
Informal Settlements

17. Group member HH Non Gp member HH Non-Intervention
HH
Availing Healthcare
in Govt. facility
31% 15% 9%
Self-efficacious Slum Women’s Groups Improve Health
care, Knowledge including non-group member families
Knowledge of
FP/birth spacing
method
59% 61% 14%
1. Availing healthcare in Govt. facility was thrice as high among group
member families than non-intervention slums; twice as high as compared
to non group-member families
2. Knowledge of Family Planning methods was four times higher among
program slums than non-intervention slums

18. Self-efficacious Slum Women’s Groups Improve Living
Environment including Non Group Member Families
Group member HH Non Gp member HH Non-Intervention
HH
Toilet in House
60% 58% 30%
Appropriate
Disposal of
Garbage
59% 61% 14%
1. Having toilet in house was twice as high among intervention
slums as compared to non-intervention slums.
2. Appropriate household garbage disposal was four times higher
among intervention slums than non-intervention slum families.

19. Improved access to Toilets, Sewer, Paved Streets
During 2013-2015: 60,000 slum population benefited from sewage system

20. Struggle for
water Water tank
erected
Improved Water Supply
During Apr. 13- Mar. 15: 120,000 slum population in Agra and
Indore slums benefitted from improved water supply

21. During 2013-2015: 40,000 slum population benefited (Agra + Indore) from
electricity connections

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

23. 1. Trust less formally educated to analyse challenges, evolve &
implement solutions with support
2. Appreciation, motivation, sustained mentoring and training builds
collective confidence, negotiation skills among urban vulnerable
communities to work towards overcoming exclusions, vulnerabilities
3. Simple 'indicators' can assess challenges & improvements e.g. i)
proportion of households in neighborhood having toilet, ii)
Lessons for Policy, Action Research, Sustained Efforts
proportion of households in neighborhood having toilet, ii)
proportion of families with money-lender debt, iii) proportion of
families with habitual alcoholics, gamblers, iv) number of community
petitions, reminders per year to civic authorities for services (water
supply, cleaning drains, sewage system, paving of streets)
4. What keeps them motivated: Recognition from the community,
and at public platforms, enhanced self-esteem, opportunity to be co-
opted as Govt. outreach worker through training, outreach work
siddharth@uhrc.in

24. Let us Build Human Capability,
Expertise, Ignite Action & Engagement,
Collaborative efforts and Resilience of
Urban Excluded, Deprived Citi-zens, and
to bounce forward, prevent theirto bounce forward, prevent their
learning to survive in impoverishment
Let us translate words into real action
towards inclusive, socially just cities.
siddharth@uhrc.in