STAFF APPRAISAL REPORT FAMILY WELFARE (URBAN SLUMS) PROJECT
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STAFF APPRAISAL REPORT
FAMILY WELFARE (URBAN SLUMS) PROJECT - extracted text
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Report No. 10548 —IN
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STAFF APPRAISAL REPORT
INDIA
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FAMILY WELFARE (URBAN SLUMS) PROJECT
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MAY 26, 1992
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TASK FORCE ON HEALTH ANd'FAMILY
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India Country Operations Department
Population and Human Resources Division
WELFARE
Governmsnt of Karnataka
PHI Build; g Annex, Ground Floor,
Sas.iadri Roud, BANGAs.0 w 5 J? oT
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CURRENCY EQUIVALENTS
(as of May 26, 1992)
Currency Unit = Rupee
Rupee 26.2 = US$1.00
Rupee 1.00 = US$ 0.038
METRIC EQUIVALENTS
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1 Meter (m) = 3.28 Feet (ft)
1 Kilometer (km) = 0.62 Miles
FISCAL YEAR
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April 1 - March 31
ABBREVIATIONS AND ACRONYMS
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ANM
AP
BCC
CMDA
CMOH
CSIP
CUDP III
ESIP
ECCR
ESOPD
FP
GOI
GOWB
HAU
HHW
IEC\^
MIS
MCD
MCH
MOHFW
MCH V"
NGO x.
PVO v—
PMP vRTC
RMC
SHE v—
UBSP y
UFWC <
UHC rUNFPA UNICEFr
UIP
URS '
WHO /
Auxiliary Nurse Midwife
Andhra Pradesh
Bangalore City Corporation
Calcutta Metropolitan Development Authority
Chief Medical Officer of Health
ODA-Assisted Calcutta Slum Improvement Project
Third IDA-Assisted Calcutta Urban Development Project
Environmental Sanitation Improvement Program
Eligible Couple and Children Register
Extended Special Out-Patient Department
Family Planning
Government of India
Government of West Bengal
Health Administrative Unit
Honorary Health Worker
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Information, Education and Communications
Management Information System
Municipal Corporation of Delhi
Municipal Corporation of Hyderabad
Ministry of Health and Family Welfare
Maternal and Child Health
Non-Government Organization
Private Voluntary Organization
Private Medical Practitioners
Regional Training Center
Regional Medical Stores
Social, Health and Environmental (Clubs)
Urban Basic Services for the Poor Scheme
Urban Family Welfare Center
Upgraded Health Center
United Nations Fund for Population Activities
United Nations Childrens Fund
Universal Immunization Program
Urban Revamping Scheme
World Health Organization
HEAL
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DEFINITIONS
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Crude Birth Rate
Number of live births per year per 1,000
population.
Crude Death Rate
Number of deaths per year per 1,000.
Natural Increase Rate
Difference between crude birth and crude death
rates; usually expressed as a percentage.
Population Growth Rate
Rate of natural increase adjusted for (net)
migration, expressed as a percentage of the
total population in a given year.
Contraceptive Prevalence
Rate
The percentage of married women of reproductive
age who are using a modern method of
contraceptive at any time.
Total Fertility Rate
The average number of live children that would
be bom per women if she were to live to the end
of her childbearing years and bear children
according to a given set of age-specific
fertility rates. The Total Fertility Rate often
serves as an estimate of the average number of
children per family.
Net Reproduction Rate
The number of live-born daughters a cohort of
females would bear under a given fertility
schedule and a given set of survival
probabilities, from birth to the end of the
childbearing years.
Perinatal Mortality
Mortality related to the period between 28 weeks
gestation and one week postnatal.
Infant Mortality Rate
Annual number of deaths of infants under one
year per 1,000 live births during the same year.
Child Mortality Rate
Annual deaths of children 1-4 years of age per
1,000 children in the same age group.
Maternal Mortality Rate
Number of maternal deaths per 1,000 births
attributable to pregnancy, childbearing, or
puerperal complications (i.e., within six weeks
following childbirth).
Morbidity
Any departure, subjective or objective, from a
state of physiological or psychological well
being. In this sense, sickness, illness, and
morbid condition are synonymous.
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This document has a restricted distribution and may be used by recipients only in the performance
of their official duties. Its contents may not otherwise be disclosed without World Bank authorization.
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DEFINITIONS (continued)
Morbidity Rate
The frequency of disease and illness in a
population.
Prevalence Rate
The number of persons having a particular
disease at a given point in time per population
at risk; usually expressed per 1,000 persons per
year.
Life Expectancy
Average number of years expected to be lived by
children bom in a given year if mortality rates
for each age/sex group remain the same in the
future.
Low Birth Weight (LBW)
Infant weight at birth less than 2,500 gr. LBW
may be associated with either pre-term (less
than 37 weeks gestation) of full-term but small
for dates (38 weeks or more) of gestation.
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Toxemia of Pregnancy
Group of metabolic disturbances occurring during -^)
gestation or shortly after delivery,
characterized by the appearance of hypertension
edema, and proteinuria (preeclampsia) and, in
severe case, convulsions and coma (eclampsia).
Puerperium
The period after completion of the third stage
of labor until involution of the uterus is
complete, usually six weeks.
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Puerperal sepsis
Infection of the reproductive organs caused by
septic childbirth conditions (also called
puerperal fever).
Risk
A probability that an unfavorable outcome
related to morbidity or mortality will occur
within a stated period of time or age.
Dependency Ratio
Population 14 years or under and 65 years of age -■
or over as percentage of active population (aged
15 to 64 years). Indicates proportion of
population that needs economic support.
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INDIA
FAMILY WELFARE PROJECT FOR URBAN SLUMS
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TABLE OF CONTENTS
PAGE NO.
BASIC DATA
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CREDIT AND PROJECT SUMMARY
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1.
FAMILY WELFARE IN INDIA
A.
B.
C.
D.
II.
A.
B.
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Health and Population Policy
The Revised Family Welfare Strategy and
Eighth Five-Year Plan (1992-1997)
Financing of Family Welfare
IDA-Assisted Population and Nutrition Projects
and Sector Strategy
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THE PROJECT
A.
B.
C.
D.
E.
F.
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GOVERNMENT PLANS AND POLICIES IN FAMILY WELFARE
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Introduction
Population Characteristics and Trends . .
The National Family Welfare Program . , .
Problems and Issues of the Family Welfare
Program in Urban Areas
Rationale and Strategy
Scope
Goals and Objectives
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Expanding the Supply of Family Welfare Services
Improving the Quality of Family Welfare Services . . . .
Increasing the Demand for Family Welfare Services . . . .
Improving the Management of the Family Welfare Program
Ijinovative Schemes
Preparation of Future Projects
Role of Women
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December 3-15, 1991 and February^25S-OM«rchB14raiQO9
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R. Cambridge, Principal Economist - Task Usnsnlr
Project Team Included Messrs.
Mrs. A. Hill, Senior Population Specialist (SA2PH)^ndf’ S*nlor Architect and
Dr. D. Foster, Human Resources Deve I opment• Ma
following consultant specialists;
Voluntary Organizations; Ms. W. Lynn Information* Fd. d*L’ Community Parti cipatlon and Private
Female Educat1on/Women In Development* and Ms P
Communication; Dr. K. Chowdhury,
Ms. S. P.k, Mr. Bill Keen. Znd 2^/chitteHI
>nd
nt.
Reviewers were Messrs.' J. Greene Princioal Nutrition c
1” PrePBr,n0 th* Report. The Peer
Population Specialist and S Stout Health Soarl.li ! Sp?u *1
S’ CochrBn*» Principal
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Country Department.
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•PPraleai Missions to India from
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r- R!c!;:rd
Melnz Vergin, Director, India
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IV.
PROJECT COST, FINANCING, IMPLEMENTATION AND DISBURSEMENTS
A.
B.
C.
D.
E.
F.
G.
H.
I.
V.
Costs
Financing Plan
Recurrent Costs and Sustainability Implications
Project Implementation
Monitoring, Evaluation and Studies
Status of Preparation ............... •
Disbursements
Procurement
Accounting and Auditing
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BENEFITS AND RISKS
A.
B.
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Benefits
Risks .
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VI.
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AGREEMENTS REACHED
TABLES
4.1
4.2
4.3
Costs by Component
Costs by Categories of Expenditure
Procurement Method ...........
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ANNEXES
1.
2.
3.
4.
5.
6.
,7.
8.
9.
10.
11.
12.
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Population Size and Growth 1961-1991 .............
Profile of Cities
The National Family Welfare Program
Organization and Management of Family Welfare Programs
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in Bangalore, Calcutta, Delhi and Hyderabad
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Status of Female Education in Bangalore, Calcutta, Delhi and
Hyderabad
Eighth Five-Year (1992-1997) Plans Family Planning and
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MCH Targets and Financial Outlays
. . .
.............
. .
The Urban Revamping Scheme ............................
Bilateral and Multilateral Assistance to Health and
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Family Welfare..............................
IDA-Assisted Population, Health and Nutrition Projects . .
Project Objectives, Targets and Indicators by City ....
Civil Construction Program by City - Phasing of Establishment &
Construction
Annual Training Plan by City
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14.
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22.
23.
24.
25.
Community Participation
Management and Initial Listing of Private Voluntary Organizations
to be Involved in Project Implementation
Information, Education and Communication
Schedule of Appointment of Additional Staff
Innovative Schemes
WID Aspects of the Project
Project Costs
. . .
Financing Plan by Component and by Categories of Expenditures . .
Incremental Cost Analysis
Supervision Plan
Forecast of Annual Expenditures and Disbursements
Procurement Plan
..............
Selected Documents in the Project File
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CHARTS
1-2.
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4-7.
Growth of MCH coverage under the National Family Welfare
Program
Organizational Structure and Action Planning of the Urban Basic
Services for the Poor (UBSP) Program
Organization of Health Departments in Bangalore, Calcutta, Delhi
and Hyderabad
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INDIA
FAMILY WELFARE PROJECT FOR URBAN SLUMS
BASIC DATA
(1990)
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INDIA
Total Area (k«2) 1/
3,287,263
844.0
Total Population 1/
Density per km2
267
3.9
Total Fertility Rate
Crude Birth Rate
29.9
Crude Death Rate
10.2
Rate of Natural Increase
20.5
Life Expectancy at Birth
55
80
Infant Mortality Rate
Maternal Mortality Rate
5
Urban Population as Percent
25.72
of Total Population
Literacy Rate (age 7 and above)
Males
63.86
39.42
Females
97.86
Primary School Enrollment
113.13
Males
Foma Ies
81.75
Ago Structure 1/
0-14
37.9
15-59
56.2
60 and over
5.9
Current Contraceptive
42*
Prevalence Rate 2/
Ag« at Marriage
18.3
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1/
2/
ANDHRA
PRADESH
DELHI
KARNATAKA
WEST BENG.Z
276,043
66.35
241
3.3
25.6
10.2
20.8
55.7
70
NA
26.84
1,483
9.37
6,319
NA
22.8
6.9
NA
NA
NA
NA
89.93
191,791
44.80
234
3.4
27.8
8.8
19.7
58.5
71
NA
30.91
88,752
67.98“
766
3.5
27.3
8.9
18.35
55.1
63
3
27.39
56.24
33.71
103.45
118.15
88.47
82.63
68.01
90.81
89.65
92.15
67.25
44.34
104.7
112.96
96.19
67.24
47.15
118.09
134.87 )
101.02 "
36.5
57.2
6.3
44.3
NA
NA
NA
40.4
37.8
56.3
5.9
46.9
36.3
58.4
5.3
17.3
NA
19.2
19.2 Q
0
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33-7 e
Bank estimate.
Operations Research Croup Survey.
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INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
CREDIT AND PROJECT SUMMARY
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Borrower:
India, acting by its President
Beneficiaries:
Governments of Andhra Pradesh, Karnataka, and West
Bengal; Bangalore City Corporation (BCC); Calcutta
Metropolitan Development Authority (CMDA); Municipal
Corporation of Delhi (MCD); New Delhi Municipal
Committee (NDMC); and the Municipal Corporation of
Hyderabad (MCH).
Amount:
SDR 57.7 million (US$79.0 million equivalent).
Terms:
Standard with 35 years maturity.
On-Lending Terms:
Government of India (GOI) to Andhra Pradesh,
Karnataka, and West Bengal in accordance with standard
arrangements for development assistance to States and
Union Territories to be passed on by the respective
States and Union Territory to BCC, CMDA, NDMC, MCD and
MCH respectively. At present, central assistance for
family welfare is provided on a grant basis.
Description;
The project would include the following components:
Increasing the Supply of Family Welfare Services,fo
slum populations through improvements in outreach
services using volunteer female health workers
recruited from the slum communities, and the upgrading
of existing and construction of new health facilities;
Improving the Quality of Family Welfare Services
provided to slum populations, by upgrading the
supervisory, managerial, technical and interpersonal
skills of all levels of new and existing medical and
para-medical workers through pre-service,
institutional in-service, and on-the-job recurrent
training; and increasing the availability of drugs,
medicines and other appropriate health supplies;
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Increasing the Demand for Family Welfare Services
through expanded information, education and
communication activities, increased participation of
the community in the preparation and implementation oj^
various project activities and increased participation
of Private Voluntary Organizations (PVOs) and Private
Medical Practitioners (PMPs) in the delivery of healthy
and family welfare services to the slum communities;
Improving the Management and Administration of the
municipal Health Departments through appropriate
upgrading of project supervision, management
information systems (MIS), information, education, an<>\
communication (IEC) functions, as well as integrating,.^
and/or strengthening co-ordination of health services
with the provision of environmental sanitation, watery
supply, education and other critical services;
Innovative Schemes which cover a range of additional <3
services including supplementary nutrition, creche
programs, environmental sanitation drives, female
(particularly adolescent girls) education and skill
training; and Preparation of Future Projects which
would support the detailed preparation and project
launch activities in another fifteen designated
cities.
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Benefits and Risks:
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The project would assist GOI to further refine its
Urban Revamping Scheme to develop operational models
for nationwide replication. It would also provide a
suitable vehicle for participation of urban slum
'communities in determining the mix of services which \J
are most appropriate to their felt needs. Further,
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the project would confer direct social benefits to
low-income slum dwelling families, particularly womef^j
and children, by increasing access to and the qualityx
of family planning and maternal and child health care
services. In so doing, it would promote a decline ii£|)
fertility, morbidity, and mortality among mothers,
infants and young children. The major risks would be1-'
institutional and relate to the capacity of
municipalities to implement the project, particularly
to develop outreach services and work collaboratively#
with slum populations and PVOs. To minimize these
risks, Municipal Health Departments would be
strengthened under the project. Arrangements would l )
made to increase the cooperation between State
governments, municipalities, private voluntary
organizations, slum communities and private medical *'*)
practitioners. Committees would be established with
representatives from each group, to provide inputs to^
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project design, implementation and supervision, as
well to undertake modifications if necessary.
Estimated Costs:
LOCAL
FOREIGN
TOTAL
US$ Millions
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Expanding the Supply of
Family Welfare Services
37.60
3.30
40.90
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Improving the Quality of
Family Welfare Services
8.98
1.03
10.01
Increasing the Demand for
Family Welfare Services
8.27
0.91
9.18
5
Improving the Management of
Family Welfare Services
2.62
0.52
3.14
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Innovative Schemes
7.23
0.53
7.76
Preparation of Future Projects
7.06
0.94
8.00
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Total Base Costs
71.76
7.24
79.00
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Contingencies
15.74
1.86
17.60
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Total Project Costs
87.50
9.10
96.60
GOI
17.60
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IDA
69.90
9.10
79.00
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Total Project Costs
87.50
9.10
,96.60
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Financing Plan:
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17.60
d
Estimated Disbursements:
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IDA FY
FY93
FY94
FY95
FY96
FY97
FY98
FY99
FY2000
Annual
Cumulative
8.00
8.00
9.40
17.40
12.80
30.20
12.50
42.70
12.40
55.10
11.00
66.10
10.70
76.80
2.20
79.00
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Economic Rate of Return:
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Not applicable.
INDIA
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FAMILY WELFARE PROJECT FOR URBAN SLUMS
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Introduct ion
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The proposed project is a critical part of IDA’S strategy of
supporting human capital development and poverty alleviation in India, It
provides IDA with the opportunity to extend rapid but targeted assistance to
the most vulnerable groups, about 1.6 million poor women between 15-44 years
of age and about 850,000 children between 0-4 years of age (Annex 1. Table 1)
who reside in urban slums and who are at risk of falling through the already
tenuous social safety net, during a period of severe budgetary constraints on
publicly-financed social programs, The special features of the project are
that it would: (a) assist the Government of India (GOI) in expanding the
coverage of family planning (FP) and maternal and child health (MCH) services
(family welfare) to previously unserved urban slum areas and beneficiaries;
(b) act as a vehicle of reform to improve the quality of services to be
delivered to the urban poor; (c) increase the demand for family welfare
services by substantially improving the participation of private voluntary
organizations and communities in the design, delivery and supervision of
family welfare services to be delivered to slum communities; and (d) institute
an Innovative Schemes program under which investments in female education and
training, nutrition awareness and environmental sanitation among others, would
be supported. These aspects of the proposed project would enhance policy dia
logue, monitoring, supervision and evaluation of the national family welfare
program. They would also lead to the more effective delivery of essential
health services, resulting in decreased rates of fertility, and infant, young
child and maternal mortality and morbidity.
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FAMILY WELFARE IN INDIA
Population Characteristics and Trends
1-02
Fertility and Population Growth. India’s population of over 840
million in 1991 (Annex 1, Table 2) is the world’s second largest. The
population has more than doubled since 1950, the result of long-term mortality
.declines combined with slower and less consistent fertility declines (Annex 1,
Table 3). Across India, the total fertility rate (TFR) for urban areas is on
average lower at 3.9 than the 4.6 rate for rural areas. However, the data
' available suggest higher TFRs among slum populations. The most important
factor in recent fertility decline has been increasing contraceptive preva
lence, which reached about 42Z effective prevalence in 19’90. Although the
current population growth rate of around 2Z per annum is modest when compared
with many developing countries, the base population is so large that the
absolute number added each year, some 17 million, is a serious constraint to
India’s development efforts. Even if India is able to achieve its goal of
replacement fertility in the second decade of the coming century, the momentum
of population growth will ensure absolute increases in the population for
several decades thereafter.
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Mortality. The maternal mortality rate in India is unacceptably
high, estimated at 500 per 100,000 live births a year. This compares with 280
per 100,000 live births for the world as a whole. There are more than 25
million births a year in India, and around 30Z-40Z of these are high risk
pregnancies. In the process, more than 100,000 women are estimated to die
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each year while over 1.6 million women suffer morbidity of varying degrees
Early marriage and early and frequent child bearing with short spaced preg
cies contribute to risk. These conditions are aggravated by over w
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.nalnutrition and anemia, low levels of female literacy and lac* °f *C
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health facilities. The situation with children is no better. The in
mortality rate (IMR) was 80 per 1,000 live births in 1989. Peri-natal
mortality rates are above 50 per 1,000 live births in the most populous
States, reflecting not only the poor health status and care of women dur ng
, but also the poor quality of services at birth. The child deatn
pregnancy,
g those below five years of age is estimated at 38.4 per 1,
rate among Though the infant mortality rate does not vary much with gender
children,
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children aged 1-5 years of age have been consistent-.-?
the mortality rates among
and reflect
reflect"
’ i, in both urban and rural areasi and
ly higher for females than males
of both the community and the health care system to the
the slower response cf tzth
health and medical needs of females.
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Urbanization. While India’s population has more than doubled
since 1947 to nearly 840 million in 1991, the urban population has grown
almost twice as fast. Today, over 200 million people live in about 3,600
cities and towns in India. Nearly one of every three u£ba“ ^dents liv
below the poverty line, and their ranks grow each year by *b°Ub
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About 50 million of these people live on pavements in poorly servi
They''??
tenement houses, in unhygienic slums and in illegal squatter col 1
work as street vendors, domestic servants, scavengers, small tim
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”gkp“k::” Ld pecfo™ . host of ctb.r activities co.prl.lng
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sector. About 68Z of the urban poor are women and children. T y
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vulnerable. Their large numbers and unacceptable living ^ondit ons c
both government and.the private sector to find solutions to bre
y
deprivation. It is accepted that a most critical point at which to begin iQ
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and
ability
to
secure
with the mother and child. Their survival, development
Ensuring'that they have access to ;
a respectable place in society is vital. ]
care, nutritional supplementation,'
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basic social services such ass Ihealth
---- —
in
overcoming
urban
and
income
is
key
to
the
success
-—
education, employment
want.
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** , The total
is
the
fastest
growing
city
of
India.
1.05
Bangalore
decennial growth rate of populatio^
population was 4.1 million in 1991. The <_
Karnataka in which Bangalore
compared
to 2.1Z for
State» of
located1 aThe°Tl^
epopulation
is the
estimated
to
be about
0.36 million.
million. Of
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l is
estimated
to
be
about 0.36
Of 4O
40x‘i
The
slum
population
1—
--i
’Ita., «ZP.r. located
Lcted in
1„ residential
resident!.! areas, »..JU
1--- - »*.« ■ > —
2.7Z in commercial areas. The Bangalore City Corporation JBCC
covers
oniy^
BCCL^
OVepop°^a^4)i
of these slums. Calcutta is the largest metropolis of India^with
The population of Calcutta Metropolitan Standard )
of 12.1 million in 1991. ’
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***five
» times between 1921 and 1991. The
Urban Area (CMSUA) increased• about
i
density of population is 8,132 per sq km
L which is one of the highest in
About 45Z of total CMSUA population (5.5 million) live in slums wh;jh
world*
been categorized by different names according to their composit on,
have
structure and nature. There are bustees, refugee colonies, fringe area
.
settlements with self help housing, pucca buildings with poor con
living, jute lines, squatter settlements and pavement dwellers. Del
capital city of India with an area of 1,489 sq kms. The population was
U
estimated to be about 9.4 million in 1991. About 3.5 million peop e livein
slums which are categorized into four groups: jhuggi jhompri, rese
colonies, walled city or katras, jhuggi jhompri clusters (bustees)
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unauthorized colonies. The majority of slum dwellers do not have access to
basic facilities or clean water and latrines. Hyderabad’s population is
estimated at 3.1 million in 1991. There are 662 slums in Hyderabad with an
estimated population of 0.7 million, Most of the slum population consists of
rural migrants and only 25Z of them are covered by safe water supply and
sewerage and solid waste disposal, A more detailed profile of the four cities
and slum populations is outlined in Annex 2.
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C.
I
1-06
The Indian Family Welfare Program was established in 1951 and is
one of the most extensive programs of its type in the world. The program is
managed by the Ministry of Health and Family Welfare (MOHFW) and provides FP
and MCH services to reduce morbidity and mortality among mothers and children
and to reduce fertility. Since its inception, the program has contributed to
reducing the infant mortality rate from about 135 per 1,000 live births in the
early 1970s to about 80 in 1989, and contributed to the decline in fertility
-from a total fertility rate (TFR) of almost 6.0 in the 1960s to 3.9 in 1988.
Despite its successes, there is a consensus that the program still needs to:
improve access to services, particularly to disadvantaged areas; improve the
quality and efficiency of services, especially the productivity of workers;
and maximize impact by increasing the provision of temporary family planning
methods to younger, lower parity couples. Towards these aims, the Government
of India (GOI) is promoting a Revised Family Welfare Strategy (Para. 2.02).
The term family welfare” covers two parts of the current program: Fami1y
Planning (FP) and Maternal and diild Health (MCH). The program promotes
family planning on a voluntary basis by making available family planning
methods, and maternal and child health care through immunization and other
preventive interventions, ante- and post-natal care and nutritional awareness.
In order to promote the small family norm and maternal and child health,
information and educational methods are used. The goals and achievements of
the National Family Welfare Program are outlined in Annex 3. The organization
and management of the Family Welfare Program in Bangalore, Calcutta, Delhi and
Hyderabad is described in Annex 4.
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1-07
India’s Family Welfare Program has grown rapidly during the Sixth
and Seventh Five-Year Plan periods (1980-1990). Improvement in the availability of services has resulted in steady growth in the performance of the
program. Besides the fact that over 40Z of the eligible couples in India
currently use some form of modern contraception, immuniza-tion coverage of both
pregnant women and children has improved substantially. Family planning
achievements from 1986-1991 are shown in Section 3 of Annex 3. The growth in
MCH coverage under the National Family Welfare program is shown graphically in
Charts 1 and 2.
D.
»
Problems and Issues of the Family Welfare Program in Urban Areas
rDespite
.
.
. .
the
achievements
in contraceptive prevalence, the present
level of infant and maternal mortality remains unacceptably high, partly due
to constraints in the Family Welfare Program. There has to be a de-emphasis
on the sterilization of older high parity women, the introduction of a wider
variety of contraceptives in the program, an expansion of the quantity and
quality of service delivery and strengthened management of the program. The
sources of supply of services also needs to be broadened. These issues and
1.08
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The National Family Welfare Program
■
4
possible solutions have been discussed1 at_ length in previous Staff Appraisal^
number
Reports. 1/ However, there are a i..
-- — of issues which are particular to
urban areas and these are discussed further, below.
1 09
Lack of Outreach.
The provision of health services to urban slur.
««d above all al... the negative attitude of the health vorh.r. tx> th,
urban slum clientele, have been identified as major reasons
tvoicK^
tion of government-supported urban health facilities. Slum dwelle
yp
y
resort to registered or unregistered private medical practitioners who provro
mainly curative care for fees. The result is that preventive and promotive
care offered from a facility, which is often devoid of any element of privacy
or is open only when people are working, is not utilized by slum dweliers.
The lack of an outreach capability, especially one staffed by medical and
para-medical staff who are not alien to the slum population, and who
willing to visit and counsel pregnant and lactating women and
P
in their homes in the slums, is a major underlying constraint. Where thi .h
outreach capacity has been systematically established and properly supe
,
positive results in utilization of service delivery facilities for prevents.)
i
i
and promotive care have been recorded.
t.:
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1.10
Inadequate Training. As presently organized, the Family Welfare?
program does not have an entity with the primary responsibility for addressing
the discrete health problems of urban slum dwellers. The major focus
«=
program's training efforts has been to develop health workers and
rurll India. This task, while not excluding the urban poor has
^n)
ad-hoc training for crises (cholera, typhoid) in the urban slu“"
strategy for coordinating the training of health and family welfare
G j,
with those of other basic social services delivered through the myria
national, State, urban and non-governmental agencies. The Health an
Welfare Training Centers (HFWTC), the newly constituted State Institutes f ^
Health and Family Welfare (SIHFW) under IDA-assisted Population P™Jects. and
the Auxiliary Nurse Midwife (ANM) Training Centers, all have a rural orient
tion and full-time training schedules. The Urban Training Centers ave
neither an infrastructure nor a system for training that is dedic
problems which are unique to the slums. Moreover,, the urban problem
and order, transportation, water-supply and sewage disposal have le
Sm
time, effort and budget for planners and administrators to address
health problems of the urban poor. Pre-service training, for examp e, s O
designed and carried out without reference to the particular problem
slums such as sexually transmitted diseases (STD), trauma from violence,
alcohol and substance abuse, continual rather than seasonal bacteria
tions, and rapid spread of contagious disease. Recurrent in-servic
ning
for health workers and volunteers in upgrading clinical skills, OUtrea ,
Ij
1/
1
b1
Child Survival and Safe Motherhood (Report No.9489-IN), pages 2- ;
Fourth Population (Report No.5523-IN), pages 7-14; Fifth Population
(Report No.7077-IN), pages 6-10; Sixth Population (Report No.7731-1
pages 3-11; Seventh Population (Report No.8385-IN), pages 6-13.
0
$
5
focussed care priorities, <or -•
•
liaison
with Private Voluntary Organizations
(PVOs) and Private Medical ---------Practitioners
- (PMPs) have not taken place.
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Lack of Community Participation. The design and delivery of
health and family welfare services in urban slums has been typically done on
the basis of norms established in the Center, modified by the States, and
adapted 'for implementation by the municipalities. This top-down directive
approach which develops pre-determined services to targeted beneficiaries, has
meant that the recruitment of staff and location of facilities are determined
with little reference to the needs and preferences of the urban slum dweller.
This lack of community participation in program design and implementation has
led to under-utilization (para 1.09), and problems of maintenance and the
ultimate sustainability of the program. The GOI has recognized that the lack
of participation has affected the implementation and success of the program,
The Revised Strategy (para 2.02) calls for more community participation. In
rural areas, progress has been made in involving local panchayats, Mahila
Mandals and other local representative groups in the family welfare program.
For most municipalities this involvement
------ hasJ not yet taken place. However,
where this rlearning
'
process approach" of community participation has been
undertaken as in Madras and Calcutta, progress is quite evident, What is
therefore required, even in the absence of a politically elected representative who can ensure to some extent that his or her constituency is served, is
the formation of slum dweller £groups to give voice to their legitimate demands
for health and family welfare services.. The Urban Basic Services for the Poor
Scheme (paras 2.05-2.06) is an initial step-in this direction.
1.12
Constraints to the Participation of Private Voluntary Organizations. There are mainly four types of Private Voluntary Organizations (PVOs)
operating in the slums of the metropolitan cities in India. These are: (a)
grassroot PVOs which usually lack technical, managerial and financial resources and are therefore limited to micro-projects; (b) community-initiated PVOs
such as Mahila and Yuvak Mandals which are government funded; (c) State-aided
PVOs which are project-specific and hence lack flexibility; and (d) natipnal/international groups such as the Red Cross and Lions which have an established
range of services. The GOI has encouraged them to participate in the fami 1y
welfare program. However, bureaucratic hurdles constrain the transfer of
resources from government to PVOs, and there are other obstacles to their
participation. First, the range of problems is so large and complex that the
typically small PVO can only tackle single or smaller dimensions of the urban
slum condition. Even when a PVO is successful, replication of their experi
ence on a larger scale is difficult to achieve. There is also the view held
by many in the government sector that unless the PVO is operating primarily in
the field of health and family welfare, their motives are questionable when
they come forward to work on government-financed family welfare schemes. In
brief, PVOs with some exceptions, are usually small organizations, flexible
and responsive to community needs, but resistant to the norms and practices
which govern the national family welfare program. A possible solution is to
find ways to encourage the many small PVOs to involve themselves in the
program, and for mechanisms to be developed by government which are more
amenable to the PVOs* desire to be flexible in dealing with the provision of
health and family welfare services.
1«13
Weak Information, Education and Communication Programs. Research
studies conducted in India indicate that despite years of exposure to health
1
6
education programs, urban slum dwellers remain ignorant about available h
services and health promoting behavior which can save lives J^^Xn area
mass media campaigns and interpersonal communication activities in urban
have been successful primarily in promoting awareness of the ne
f
P
family planning and in the use of permanent methods. J^y^P^^XicIs or
successful in increasing client use of maternal and child health
imDlemen_
the adontion of temporary family planning methods. Poor design and implemen
tation of IEC activities, budgetary constraints and weak >"anagement of huma
and material resources hamper program efficacy. This ^e not have to be
case. IEC interventions utilizing social marketing and °the^^^O“^ces
increase the demand for and utilization of health and other social services.,
^..ea .o=.pt.»c.
»se «£ '“*^.^”“4 ”t °
•-
Tn do this IEC programs must go beyond awareness generation among target
groinsPromoting desired behavior changes. There is a need also to adopt...
more focused, target-specific approach to the use of 1EC and
interventions. This involves the development of strong
ities to design and execute meaningful IEC programs; clearer
roles and; functions
of the
the various
service delivery
delivery ^ctionaries in conduct
•
j of
various service
ing
interpersonal
communication
and
utilizing
mass :media ^PP°rt, greater
ing interpersonal communication and utilizing mass
understanding of the various socio-cultural barriers to c^ent use of healtb^
understanding of the various t--- ----- “
services, and the acceptance by program implementors of a
.
approach to planning and implementing IEC programs
Better IEC ^“rven
wPith a strong focus on the social marketing
of loams'
effective in urban audiences. The government s Social Marxeting
and Oral Pills Program must be more specifically
specifically targeted
targete to
to sslum
um areas,
a
the private sector encouraged to further increase its :investment
in this
---
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market.
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Limited Female Education Opportunities. The linkages between
trnale literacy and fertility decline are unassailable. Although India has
expanded its educational system considerably since Jn^eP^^n^v“J^^ed *
of girls and boys has improved over the years, females still have
access to education and training opportunities. Almost 60Z, o
11
•
of India’s illiterates are female. Effective literacy rates (age 7 and ov<l )
39.4Z for females. Female literacy ra
y
are 63.9Z for males and the
States and rural and urban areas, as well as s^‘s
significantly between
Literacy rates among females from rural areas, c e ^.et
and non-slums areas.
and from urban slums are considerably lower in all the States.
enuer
Castes
disparities in access to formal education explain .this “tuatio
1
8 the gross enrollment ratio for girls in lower primary school (class I V)
77Z L against 108.8Z for boys. As a proportion of total enrollment girK
enrollments were only 41Z in primary and 35Z in upper primary schools, res
tivelv in 1986.
There are also regional, class and caste dispa
...^
schooling, with urban areas having a larger female participation t an
areas and poor urban slum girls having more limited access to schooling th,.?
do upper and upper-middle class non-slum girls. The Pr0^le^ ofPan scho'l
education for females are compounded by the fact that only 30Z of all schoteachers are female and only 15Z of the schools in the country are d dicat d
to females. Girls’ schools suffer from a paucity of trained ^a h
.
...
facilities, learning materials, equipment and inconvenient location. Evei
when cirls are enrolled, several factors operate against successful comply.!
and achievement; these include competing demands on their time
and pregnancy, a lack of positive role models, the poor quality of educat,
of women, and the direct cost as well as the opportunity cost of schooling
■V..1
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The status of basic education for females in Andhra Pradesh, Delhi, Karnataka
and West Bengal is shown in Annex 5.
*
II.
A.
GOVERNMENT PLANS AND POLICIES IN FAMILY WELFARE
Health and Population Policy
2.01
In 1983, the GOI established a rNational
‘
___y in the
Health Policy
context of the world-wide objective of "Health for All by 2000 A^.D."’ The
broad goals of this policy are to achieve by 2000 A.D.: (a) reduction of
maternal mortality to below 200 per 100,000 live births; (b) reduction to 10Z
or less of the proportion of low birth weight babies defined as those weighing
less than 2500 grams at birth; and (c) reduction in infant mortality from 94
to 50 or less per thousand. While many of these goals are amhi t i nns and may
not be fully achieved by 2000, substantial progress has been made in most
areas. With some reorientation of program design, implementation and financ
ing, targets could be approached by the end of the first decade of the twentyfirst century.
I
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B.
The Revised Family Welfare Strategy and The Eighth Five-Year Plan (1992
-1997).
----------------------
2.02
In 1986, the MOHFW revised its population (family welfare) strategy
in order to make the National Family Welfare Program more responsive to the
segmented market for the provision of family welfare services. The Revised
Strategy calls for new efforts to raise the average age of marriage of women
to over 20 years, by intensifying female literacy programs, curbing the school
dropout rate for girls, and offering better employment opportunities for rural
women. To supplement this, greater emphasis was to be given to IEC and an
effort made to move away from simple publicity to more targeted programs to
overcome provider and client resistance to temporary methods. Linkages were
to be established with adult education programs, schools, colleges, trade
unions, employers associations and PVOs which are seen as most effective in
motivating people at the grassroots level. The effort to reduce infant
mortality below 60 per 1,000 births was to be concentrated in the universal
immunization program (UIP). The goal was to immunize every child and expec
tant mother by 1990. However, by the end of 1990 coverage had reached only
70Z. A nutrition intervention program was also to be expanded to distribute
iron tablets, Vitamin A, and iodized salt. This has been less successful, due
mainly to a shortage of resources. The Integrated Child Development Services
program (ICDS) was expanded to provide immunization, nutritional supplementa
tion, nutrition education, maternal and child health check-ups, pre-school
education and female adult literacy to a larger number of deprived areas.
ICDS now covers 40Z of India’s rural blocks.
d
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2.03
- Under the Eighth Five-Year Plan (1992-1997), the important family
welfare goals remain as outlined in the National Health Policy and Revised
Family Welfare Strategy. To achieve these, the Plan includes: (a) promotion
of temporary contraceptive methods for couples for whom sterilization is
inappropriate; (b) intensive implementation of the Universal Immunization
Program (UIP); and (c) IEC efforts to increase knowledge and acceptance of
both family .planning and MCH components
of the program. In support of the
. -3 program.
family welfare program, female education would be expanded and compliance with
B
B
3
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3 for females and 21 for males, would
the legal ages for marriage, which i^lB
of the Plan call for increased involvement of
be enforced. Other features
-- --r organizations. A comparison of
local communities and private voluntary
Five-Year Plan targets and financial outlays is provided in
Seventh and Eighth 1-- Annex 6.
Z.qa’
The Urban Revamping Scheme. Questions concerning the inadequate
raised in
provision of health and family welfare services in urban slums
A
1982 during a meeting of the Central Council for ea
an
make
Committee .known .. the Kti.hn.n Co-lttee. w.» then '“"“““"““v health
recomnend.tlons .bout th. teotg.nit.tloh of tall, "el£“'
care services for urban areas, with emphasis on the need to provide family
.
welfare and preventive health services through an outreach program for the
poor. The Krishnan Committee’s recommendations which foCUS®d
P°^ic
'
based facility and staffing norms, have become de facto government P U 7
regarding urban health and family welfare services.
Seventh and Eighth Five-Year Plans, the Urban
The
“SX fX
e
:ell U
XiS
S
f g:hing;
provision for social workers to assist in the establishment and ^rengthe^ g
of community links. There are four types of HPs categorized as , .
depending on population size. Implementation of the URS varies
^nvid-'^
Htv
The HP represents the first systematic attempt by government to pr
taUtaS ”.1STd tally well... ...vice, to urban slum popol.t on. b„.d;j
il
b'b
Hl;
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2 05
Urban Basic
vices tor
Basic Ser
Services
for tne
the roor
Poor ^upor;
(UBSP)_.. This is a more recent G'O^
program which has as its principal objective eduction
low-income communities to take care of their own nee s w
£ x
d
the Municipality and other agencies. It provides ^(luJredr^^ieS organize
supervisory assistance to urban local bodies to help slum comun represLtin^
into Community Development Committees comprising women
J needs
every 20 to 25 households. The women volunteers regularly dis^aa ^fn"edS J
of their children and the community at large and, under the gu
full-time municipal field level -orker. pl.n and obtain ...l.t.nce from
_„t. The
various schemes available within and outside government.
----municipal fiel^0
committee, assists them Xti
worker trains the volunteers, organizes them into a <
conducting needs surveys, facilitates meetings with municipal and oth
officials8of various sectors, and obtains assurance of the ProvJa^°n
services for the community from each sector. These assurances f
implementation pl.n of each community. Under th. UBSP.
including Immunization, MCH, disability prevention, and early learni g
opportunities are supported, however, th. -PP«t a »
until more permanent and adequate services and facilities are Pr°
“
the concerned sectors. Each Municipality implementing the UBSP ^chem
expected to ensure that all Departments plan the convergence of Prim y H
Care services in the selected slums. Where sectoral agencies are unable t
extend the services immediately, funds under the Scheme can be used y
@
"e“^community group, to employ . doctor
doctor .„d/or
and/or .a nur.e/.ldulfe. on . p.rt•
ib
il
^v.
■
on concepts of interaction between the community and service pro
URS is outlined in Annex 7.
• _ — 1
m —«* *4
o ▼*
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9
}
time basis, to operate a health clinic in the community.
Structure and Action Plan for UBSP is shown in Chart 3.
The Organizational
*
)
2.06
The Community Development Committee network in each town provides
in-situ assistance to the sectoral agencies in identifying sites, the benefi
ciaries, voluntary support systems and also appropriate maintenance systems
where necessary. The program is financed by Government of India with UNICEF
support for the training component. In addition to the UBSP, the Government
has instructed the States to ensure convergence of the Environmental Improve
ment in Urban Slums Program and the Nehru Employment Scheme which jointly
provide nearly US$ 500 million per year to urban areas for shelter improve
ment, self-employment, wage employment through creation of public assets, such
as roads and pathways, drains, and also community centers to house health
clinics, pre-schools, women’s income generation activities, literacy and nonformal education, etc. UNICEF has pledged to provide a grant of US$ 20
million to improve the training and management capacity of the government NGOs
and the community volunteers.
i
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Financing of Family Welfare
2.07
The National Family Welfare Program is a centrally-sponsored scheme
which means that the majority of the capital and recurrent expenditures of the
program are borne by the Center, under the annual budget and Five-Year Plan of
the Ministry of Health and Family Welfare (MOHFW). Allocations over the last
two decades reflect the government’s commitment to the Program (Annex 6). The
share of family welfare to total health expenditures increased from 10Z during
the Third Plan to almost 50Z under the draft Eighth Five-Year Plan (1992-97)
and as a share of total public sector expenditures, increased from 0.3 to
1.8Z.
2.08
In the past, as public sector budgets increased, family welfare
competed favorably receiving more than proportionate increases. However,
during the current difficult budgetary conditions, allocations to the family
welfare program were reduced in 1990/91. The decline was the first in the'
history of the program and implies vulnerability during periods of fiscal
constraint and reductions in government budgets. However, in the 1992/93
budget, the Family Welfare program received an increase of Rs. 2,000 million,
an indication of the continuing commitment of the Government to the Program.
The proposed project will be one other vehicle to protect family welfare
allocations.
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2.09
International Assistance has supported health and family welfare
activities in India since 1963. Support has come from UNFPA, UNICEF, and WHO,
as well as from the governments of the United Kingdom (ODA), Norway (NORAD),
Denmark (DANIDA), Sweden (SIDA), and the United States (USAID). The Area
Projects program (para 2.10) is also being assisted by UNFPA, ODA, DANIDA, and
USAID (Annex 8). Specifically, USAID has assisted Punjab, Haryana and
Gujarat; UNFPA, Bihar, Rajasthan and Himachal Pradesh; DANIDA, Tamil Nadu and
Madhya Pradesh; and ODA, Orissa. The International Planned Parenthood
Federation provides financial support to the Family Planning Association of
India (FPAI). UNICEF has concentrated its efforts on UIP and has mobilized
and coordinated support from a number of bilateral donors for this program.
UNICEF also supports the UBSP Scheme, as well as several NGOs, in Delhi to
strengthen the health care delivery system among slum dwellers. UNICEF and
;
I
10
IDRC are also supporting action research efforts in Calcutta, Bombay and
Alleppey district to tackle urban malnutrition. Among private organizations,
the Population Council, the Ford Foundation, and the Rockefeller Foundation
support demographic and biomedical research. WHO provided US$0.3 ml
during 1990-91 for Family Planning and MCH services in urban areas and for
developing the Mid-Term Plan for the Prevention and Control of AIDS.
Japanese Government has provided about US$ 600,000 under the Japanese Human
Resources Development Fund (Japanese Grant Agreement) to assist the prepara
tion of this and other family welfare projects suitable for IDA financing.
D.
IDA-Assisted Population (Family Welfare) and Nutrition Projects and
Sector Strategy
2.10
Since 1973, IDA has supported seven population, one maternal and
(si
child health and three nutrition projects for a total of US$700.0 mil ion
(Annex 9). The First and Second Population and the Tamil Nadu Integra e
'3
Nutrition Project (TNINP) have been completed and Project Completion Reports
(PCRs) and Project Performance Audit Reports (PPARs) issued. The Thir
Population Project has also been completed and the PCR is under preparation.
The PCRs have shown that although these projects suffered delays in implemen
—X')
tation, each has achieved its principal objectives, although the gams were
only marginally higher than in non-project districts. Preliminary indication .
fo/the Third Project demonstrate that project objectives were fully achieved
in Kerala and that there were significant differences between project and non- J
project districts. Karnataka’s results seem to be more in line with
experience of the first two projects. Implementation of the on-going F
,
Fifth, Sixth and Seventh Population projects and the Child Survival and Sa
Motherhood project has been largely satisfactory. Very encouraging resu s
are emerging from the Fourth and Fifth Projects. In West Bengal, contracep
tive prevalence rates have increased and the training of staff and construc
tion of facilities have been implemented with a large degree of success.
Bombay and Madras, in addition to increases in contraceptive use, both citi v.
have pursued "beyond family planning" strategies including linking healt
education and IEC strategies for family welfare with parallel
"five
clean drinking water programs financed by the government, and with the active
cooperation of non-governmental organizations, private medical practitioner
and public health departments. The Sixth and Seventh projects are ^111
relatively new, but initial review of ^Ple^ntation has reported progress
most areas. The Tamil Nadu Nutrition project succeeded m halving th
f
severe malnutrition among young children and has been very influentia
design of other nutrition interventions in India, and elsewhere.
©
2.11
Lessons Learned. Previous experience with population projects has
given both technical and implementation lessons. On the technical si e, 1
j
has been shown that: (a) there is low awareness among pregnant and lac^ J
of th. need for effective o.«, Ineludlns »te-n.t.l
cX
nutrition, temporary methods of family planning, and the e
j
spacing; (b) maternal mortality and morbidity will remain at high level
unless there is prompt and adequate medical care for those who develop
obstetric complications; (c) the quantity and quality of MCH care is far e w
desired levels; (d) to achieve significant changes in performance it
desirable to forge linkages between training efforts and
use of management information and evaluation systems; (e) clinical ski
use of the referral structure and temporary methods of contraception are
S.-*1
11
among all levels of staff and can be improved through short-term in-service
training efforts; and (f) management interventions, including training efforts
and/or changes in performance measurement, require strong commitment and
support from top administrators.
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2.12
Implementation lessons show that (a) an analysis of local demographic
and sociological characteristics is fundamental ~to the"e'f fie lent use of
resources a£ local-levels; (b) skills and aptitudes in community mobilization,
which are limited among medical and para-medical staff, are nonetheless
critical to the success of outreach; and (c) it should be ensured that field
workers’ jobs are manageable and their daily and monthly routines clearly
defined. Experience has also shown that when population projects are prepared
with due attention to detailed design of training programs, IEC strategies,
and an appropriate service delivery model, including early selection of sites
for construction and the preparation of standard bidding documents for early
procurement, that some measure of success is ensured.
2.13
The proposed project takes account of these lessons as much as
possible, but would specifically assist the Government to develop and repli
cate a series of service delivery models designed to meet the specific health
needs of the urban poor.
Two models and experience which are more directly
relevant to this project were developed in Bombay and Madras under the Fifth
Population Project (Para. 2.10). Another model which would be used is based
on the health provision component of the Calcutta Urban Development Project
(CUDP III). This component was evaluated in September 1991 by the World
Health Organization (WHO), and rated as one of the most successful health
service schemes in the world which concentrates on urban slum populations.
Implementation experience with variants of this model, especially the ODAassisted health projects in Calcutta and Hyderabad as well as the evaluated
experiences of UNICEF, PVOs and PMPs in the provision of health services to
urban slum populations, has also been taken into account.
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The major lessons incorporated in project design are that: (a)
family planning services can also be effectively~delive’red by non-family
planning organizations; (b) a women-to-women approach increases client’s
accessibility to and acceptability of family planning in restricted societies;
(c) reaching women with information and services is enhanced when field
workers serve as informal support groups; (d) participatory management
i develops a sense of ownership among field workers and clients; (e) the
effectiveness of delivering family welfare services and the demand for these
services is enhanced when the outreach effort includes the involvement of
community groups, volunteer women and supervisors who are recruited from the
specific slum community; and (f) success is more likely when the management of
the health facility is undertaken by community personnel and the timing of
operation of the facility is adjusted s^o that it is convenient_to women who
work both in and outside of the home.
2.15
Sector Strategy
Strategy.. In January 1987, India and IDA agreed on a
Population Sector Strategy which would guide future collaboration in the
sector.
It was agreed that IDA’S broad goal in the family welfare sector is
to support GOI’s National Family Welfare Program.
Specifically, IDA support
would assist in (a) reorienting the family welfare program from its present
static facility-based orientation to include a larger element of outreach to
the communities in which the health and family welfare facilities are located;
”1
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12
(b) shifting the focus of the program from the sterilization of older, high
parity women to a more balanced mix of contraceptive methods emphasizing
increased use of temporary methods by younger couples; (c) increasing the
attention given to the implementation of the maternal and child health
elements of the program; and (d) supporting, as a priority, programs which
enhance service delivery, training and IEC, and are concentrated in urban
slums and backward high fertility States.
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The approach is to use each specific project, regardless of its size-J
2.16
s
and content, to seek changes> which would reorient and make the national
Starting
with
the
Fifth
Population
Project
in
1988,
program more effective. !_-and the Sixth, Seventh and Child Survival and Safe Motherhood Projects m
1989, 1990 and 1991, IDA has tried to assist GOI in improving policies and
A
programs concerning: training of health workers including personnel manage
ment; roles and work routines of health workers; target-setting mechanisms;
social marketing of condoms and pills; and involving PVOs more actively in the^
program. Under the Seventh Population Project, GOI and IDA agreed that the
current incentive structures which provide funds for motivators and acceptors^
of permanent methods (sterilization) needed to be reviewed and revised given
the new orientation of the program, and the results of this review provided tr
IDA by December 31, 1991. The GOI has informed IDA of the findings of this
review and has issued the appropriate directives/instructions to the States
and municipalities on the revised policy on incentives for sterilizations anc
the use of temporary methods of contraception.
2.17
In addition to supporting one population project each year since
1987, a program of sector work was also initiated. To date, three studies
have been completed: "Family Welfare Strategy in India: Changing the Signals1
(1989); "Improving Family Planning, Health and Nutrition Outreach in India"
(1989); and "Strengthening the Role of NGOs in the Health and Family Welfare^
Sector in India (1989)." Two other studies are underway: "The Status of
Women’s Health in India" and "Health Financing." In summary, through projec*^
lending, sector work and increased policy dialogue, IDA has supported a number
of important program developments. These include: reorienting the oyerempha^
sis given to sterilization; changing the target-setting system; increasing tb^
role of PVOs, the private sector (social marketing), and PMPs; and changing
the administration of program incentives. The proposed project reflects
<{.7
GOT to
continued movement along this path of cooperation and will allow GOI
address more clearly some of the systemic and policy issues which retard
effective implementation of the family welfare program.
I ! •
III.
A.
I
1
THE PROJECT
Rationale and Strategy
3,01
Rationale. There are several reasons for IDA’S involvement with the
proposed project. First, the project would be a critical part of IDA’S
strategy of supporting human capital development and poverty alleviation in..^
India. Second, it would provide IDA with the opportunity to extend rapid but
targeted assistance to the most vulnerable groups, poor women and children,
who are at risk of falling through the social safety net during a period ofsevere budgetary constraints on publicly-financed social programs. Third, the
project would support the Urban Revamping Scheme (URS) which takes into
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account the linkages between the provision of family welfare services with
other appropriate health interventions, specifically clean drinking water and
sewerage/sanitation facilities. Fourth, the project would be based on a mix
of successful local experiences in implementing health projects among slum
populations, while at the same time providing for trials and the introduction
of innovative models of service delivery. Fifth, the project would include
several areas where private voluntary organizations and local communities will
play a major role in service deliverySixth, the project would represent an
opportunity for continued cooperation between IDA and UNICEF, as well as the
initiation of closer coordination with WHO, UNFPA and ODA in India. This
would enhance policy dialogue, project monitoring and supervision, as well as
overall program evaluation. Finally the project would represent GOI*s initial
attempt to integrate community participation activities systematically in its
urban family welfare scheme. Without the project, it is likely that slum
dwellers of these specific cities would continue to lack satisfactory access
to appropriate family welfare services.
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3.02
Strategy. Improving service quantity and quality, increasing demand
for services, and assuring appropriately planned and implemented expansion
involves using project resources to influence both consumer and worker
perceptions of the goals and services to be delivered by the Health Depart
ments of the respective municipalities. All municipalities would therefore
focus on: (a) strengthening their capabilities to deliver health services in
general, and to deliver family welfare services, in particular, to younger,
lower parity families who__reside in slums, especially pregnant and lactating
women and children; (b) strengthening outreach capacity to slum populations;
(c) assuring that workers have the appropriate skills in both the educational
and clinical aspects of their jobs, especially to provide counselling and
follow-up services to slum families; and (d) varying service delivery and IEC
strategies to meet the local needs which may differ from slum to slum. The
proposed strategic approach to these issues will be to concentrate on increas
ing the participation of community groups and private voluntary organizations
in the design, implementation and supervision of the family welfare program in
the slums; increasing the involvement of women as workers, supervisors and
administrators in the project; and assisting the municipalities in improving
further institutional capacity to ensure that strengthened training efforts
are matched with appropriate changes in logistics, IEC, management information
and maintenance systems.
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B.
Scope
3.03
In early 1989, the GOI commissioned a study from its National
Institute of Health and Family Welfare (NIHFW) with assistance from WHO, to
assess the family welfare needs in selected urban areas and to determine how
the Urban Revamping Scheme could be adapted and expanded to meet these
14
needs. 1/ The Study, which covered 18 cities, was completed in August 1991.
Calcutta prepared a plan for the extension of the model used for CUDP III
(para 2.13). Bangalore, Calcutta, Delhi and Hyderabad were selected for this
specific investment operation and have customized the general models developed
by NIHFW to meet the specific needs of their slum populations. Through this
process, a set of criteria have been developed by which cities could be made
eligible for participation in the project. In addition to the community
narticipation dimension which is critical to implementation success, the
)
Fcriteria include detailed survey of Kpublic am private
‘
sector health facilirehabilitation requirements, development ofu
ties and preparation of new and/or
i
.
plans for inter-agency coordination, establishment of new and appropriate
beneficiary
management structures,. and
-- the initiation of more comprehensive
.
needs assessments to __
include both training_ and communications
needs
a?
■. / have been
’ andselected
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The
four
cities
wider cross-section of the slum community. L..---- ------ 0
because they are the largest metropolitan cities and logically follow Bombay
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They
and Madras which are being supported under the Fifth Population project,
met the established criteria for inclusion in the project as conditions
<--- ----- of
appraisal. The proposed project is therefore the second of a series of
proposed projects (para 3.23) designed to cover additional cities and assist
in meeting the particular needs of urban slum populations and is consistent
with the agreed sector strategy (para 2.15).
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Goals and Objectives
C.
3
3.04
Goals. The goal of the proposed project is to provide furtherspecificalsupport to the Government’s National Family Welfare
Program.. More
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ly, this project would provide
support to assist four municipalities in
adapting and"" refining the Urban Revamping Scheme to meet the particular needs
of slum populations in their jurisdictions, as well as to make it affordable
and sustainable given the weak financial status of the municipalities. A
particular aspect of this project’s goals would be to ensure that close
- V/j)
linkages are established with preventive health programs, including clean
drinking water and environmental sanitation.
3.05
Objectives
Obj ectives.. The major objectives of the proposed project would be
to: (a) reduce fertility among slum populations in the four municipalities;
and (b) improve maternal and child health, by helping to decrease maternal and
infant mortality rates among slum populations. These objectives would be
achieved by undertaking activities in five broad areas:
4^
(a) Expanding service delivery to slum populations through improvements
in outreach services using volunteer female health workers recruited^
from slum communities, and the upgrading of existing and construe- • )
tion of new health facilities;
"Plan for the Delivery of Family Welfare Services in Urban Slums based
on the Needs Assessment of Beneficiaries (Slum Dwellers), Communications^
Training of Staff, and Knowledge, Attitudes and Practices (KAP) of Private-J
Practitioners in Urban Slums of Cities with more than Five Lakh (500,000)
Population;" National Institute of Health and Family Welfare: New Delhi,
August 1991.
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(b) Improving the quality of family welfare services provided to sium
populations, by upgrading the supervisory, managerial, technical and
interpersonal skills of all levels of new and existing medical and
para-medical workers through pre-service, institutional in-service
and on-the-job recurrent training; and increasing the availability
of drugs, medicines and other appropriate health supplies;
)
(c)* Increasing the demand for family welfare services through an expand
ed program of information, education and communications (IEC);
increased participation of the slum community through their repre
sentatives and groups in the preparation and implementation of
various project activities; and the increased participation of
private voluntary organizations and private medical practitioners in
the delivery of family welfare services to slum communities;
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(d) Strengthening the management and administration of municipal Health
Departments through appropriate upgrading of management information
systems (MIS), IEC, training, civil works, and audit and accounting
functions, as well as integrating and/or strengthening coordination
of health services with the provision of environmental sanitation
and water supply services;
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(e) Supporting Innovative Schemes which cover a range of additional
services including supplementary nutrition, creche programs,
environmental sanitation drives, education and skill training
programs for females, especially adolescent girls; and
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(f) Preparation of Future Proiects which would support the detailed
preparation and project launch activities in another fifteen desig
nated cities.
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Project components, objectives, targets and indicators of progress by city are
shown in Annex 10.
D.
Expanding the Supply of Family Welfare Services (Proposed Outlay US$49.94
million equivalent) 1/
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3.06
In order to overcome the problems associated with the limited access
of slum populations to existing urban health facilities (para 1.09), and the
lack of demand for services, especially from public sector preventive and
promotive programs, each municipality, as part of its implementation of the
Urban Revamping Scheme, will develop an Outreach Program aimed at the slum
communities in their jurisdictions. All of the programs will rely on recruit
ing Female Workers (Bustee Sevikas, link workers, trained Dais, Honorary
. Female Health Workers) who would be residents of the slum community and be
responsible for working closely with the community and the health workers
(ANMs; LHVs) who operate the Health Posts (Hps), Health Administrative Units
(HAUs), Urban Family Welfare Centers (UFWCs) sub-centers and Maternity Homes.
The details of the Outreach Program in each city are given in Annex 7 Part C.
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3.07
Although a large part of the Outreach Programs will be staffed by
3.07
Volunteer Female Health Workers, they will be supervised by staff appointed to «»V;
operate the health facilities which would be located in or near the slums.
Further, to determine the impact of the various interventions proposed and
whether the benefits truly reach the intended beneficiaries, the municipalities
have each initiated Baseline Surveys/Community Needs Assessments Studies.
During negotiations, the GOI and Project States provided assurances that they
shall cause the project cities to: (a) furnish to the Association by June 30,
1993, baseline surveys and beneficiary and community needs assessments with
format and content satisfactory to the Association, and (b) promptly thereaf- w
ter suitably adjust the hours of operation of health facilities located in
slum areas in its jurisdiction. so as to be fully responsive to Ll
the
the above beneficiary and community needs assessment. The GOT also provided
an assurance that it shall ensure that the volunteer workers participating in
the Urban Revamping Scheme would be eligible to receive payment of honoraria
in respect of their work in the scheme (Annex 7, para 5). The GOI and Project
States also provided assurances that they shall cause the project cities to
provide staff according to a time schedule agreed with the Association, and
thereafter maintain adequate salaried staff and honorary health workers and
other resources as shall be necessary to ensure the effectiveness of its
outreach programs under the project.
3.08
Access to family welfare services will also be ex;:panded by upgrading
and rehabilitating a number of existing health facilities. as well as the
construction of a number of new health facilities which would be located in or
near the slums. The details of the construction program are given in.
Annex 11. The municipalities have each initiated Facility Surveys which would^
determine the location of all existing and proposed new institutions and the
extent of rehabilitation and renovation required (para 4.06). The municipali-,?j
ties have also developed Two-Year Construction Plans. During negotiations,
the GOI and Project States provided an assurance that they shall cause the
project cities to furnish to the Association by January 31 of each year,
.
commencing January 31, 1993,, for review and comment, and thereafter duly take
by the Association in respect of.an, annual
into account any comments provided
[
of
its immediately succeeding financial year.
plan for civil works in respect
service
delivery
expansion by financing the costs of
The project would support t__
civil works, furniture, equipment, vehicles, and the salaries of additional
staff on a declining scale.
E.
Improving the Quality of Family Welfare Services (Proposed Outlay
©
US$12.74 million)
3.09
The quality of Family Welfare services would be improved in the fou: J
cities by increased emphasis on four activities; (a) recruiting and training
the appropriate level of staff; (b) developing and implementing a systematic
recurrent in-service training program; (c) the recruitment and training of
slum dwellers as para-technical health workers for outreach; and (d) increased
involvement of PVOs and PMPs in training. These actions would enable the
municipalities to train approximately 21,000 health workers and local leaders.^
over the project period, as shown in Annex 12. The training system would be
based on appropriate studies and procedures as outlined in this Annex.
3.10
Bangalore would train over 2,500 persons, includingjmed.icaj._off icers, health workers, members of lhe^luiirClearahce~Board~ahd about 300
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private medical practitioners. Calcutta would train over 9,000 staff and
local leaders, of whom 75Z will be women from the community who would be
trained as Honorary Health Workers. Delhi would provide orientation and
recurrent in-service training to about 500 professional health worker staff,
and continuing on-the-job training to approximately 1,300 local women trained
as Bustee Sevikas. Hyderabad would train approximately 2,300 staff including
1,000 link workers and Dais, and 600 PblPs, both in orientation and recurrent
courses. During negotiations, the GOI and Project States provided an assur
ance that they shall cause the project cities to furnish to the Association by
January 31 of each year, commencing January 31, 1993, for review and comment,
and thereafter duly take into account any comments provided by the Association
in respect of an annual plan for training in respect of its immediately
succeeding financial year.
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3.11
The project would support the provision of essential supplies such
as health worker kits, disposable delivery kits, medicines and family welfare
supplies. The system of storage, distribution and logistic support developed
under the National Family Welfare Program would be used. At present, many of
the drugs are located at Regional Medical Stores and released periodically to
various health facilities. Municipalities would be given assistance for
improved systems of planning, ordering, monitoring stock levels and usage.
The medicines recommended for use in urban slums have been agreed to by the
Indian Medical Association (IMA) and the Indian Council for Medical Research
(ICMR). Since the recurrent supply of drugs and medicines, including mainte
nance of the operation of the health facility would be, in part, a responsi
bility of the community, the GOI and Project States provided an assurance
during negotiations that they shall cause the project cities to: (a) establish
by January 31, 1994, community-based management committees for facilities and
programs developed under the project; and (b) institute no later than April 1,
1994 such measures as shall generate resources from the direct beneficiaries
of said facilities and programs to support a portion of the operation and
maintenance costs thereof, including medicines. The project would support the
improvement in the quality of family welfare services by financing the costs
of medicines, equipment, local and foreign training, local and foreign con-,
suitants, and the salaries of additional staff and honoraria of additional
volunteers on a declining scale.
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4
Increasing the Demand for Family Welfare Services (Proposed Outlay
US$11.23 million)
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3.12
Increasing the participation of urban slum communities in the
design, implementation and supervision of the family welfare services being
provided to the slums would be a major activity of the project. As a first
step, to increase the involvement in project design, each municipality initi
ated a Beneficiary/Community Needs Assessment prior to appraisal (para 3.07).
It is expected that community groups will undertake and/or participate
significantly in these assessments. In further support of community input s to
project design, each municipality undertook a <series
’
* *
‘
of“ workshops
designed
to
increase community participation, and in which participants drawn directly
from the targeted slum communities commented on and recommended changes to
project design.
3.13
The community participation implementation methods to be used by the
municipalities can be grouped into four categories::
(a) the establishment of
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neighborhood committees on the UBSP model (para 2.06); (b) the promotion of
PVO partnerships; (c) the organization of supplementary health support schemes
such as sanitation and nutrition awareness; and (d) the strengthening of com
munity-initiated ideas by assisting with financial, material and staff
resources. Annex 13 outlines the approaches to be used by each municipality.
Given the importance of community participation in each phase of the projec ,
training in this area is required. A Technical Assistance Program m community participation is outlined in Section 2 of Annex 13.
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3.14
Increasing the involvement of Private Voluntary Organizations in the
delivery of family welfare services to slum communities would also be support
ed under the project. On-going schemes of the GOI will be expanded to some
extent in the slum areas. PVOs would also^ be given the_opportun±VLto rAC.OBimend and be funded for Innovative Schemes’_(para 3.22). A list of the PVOs
^hich have'been'identified already to participate in the project is outlined
in Annex 14, together with a description of the procedures to be used in
recruiting and monitoring them. As with the community groups, the
- ties have involved the PVOs in the workshops on project design. Further,
municipality has included representation in their Project Implementation
Committee from PVOs which operate in the slum communities covered by the
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project.
3 15
Increasing the Involvement of Private Medical. Practitioners (PMg_s)_
in the Delivery of Family Welfare Services. Experience in both Bombay and
Madras under the IDA-supported Fifth-Population Project demonstrated that wi
family welfare services to slum populations can be increased. Under the
project, Bangalore will provide, free of charge, f^ly
registered Nursing-Homes and Polyclinics operated by PMPs. In Calcutta
a'Fe’-^TFe'TdjTintricately involved as part-time volunteers in the delivery
services at HAUs and EPSODs. Hyderabad will provide training for
government hospitals and through the Family Planning Association of India
(FPAI). PMPs will be encouraged to undertake sterilizations, both vas.e
y
and tubectomy, IUD insertions, administration of oral pills and distribu ion
of condoms. They will be paid fees and_be_required to maintainjmdr|P
statistical information to the municipalities-. In DeTEi, there are _
gorles-of-TMPr^ITnctionlng'TirEna around the vicinity of Jhuggie Jhomprie Bustees. Those living and operating inside the Bustees are either unqualifi
qualified in ISM, but dispensing allopathic medicines. .Because of the lack
any curative services in the neighborhood, Bustee residents depend on these
vr)
unqualified PMPs for curative services. It is proposed that the
s w
in the Bustees would be given training in primary health care and Jealt
education and act as motivators for the family welfare program. The PMPs
operate outside Bustees are qualified to offer curative services and will be
motivated to play a greater role in preventive and promotive health care.
o
mented^o^eirth! differentiated perspectives and needs of segmented urban
clientele. Involvement of the community in TEC program design and executi
promoting the availability and benefits of maternal and child health and
,
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s^vices^icLntl" 1'65 h0.51^^6116^ *nd persuading them to utilize
services efficiently are critical to program success. Under the project, IEC
cells would be established in Delhi and Bangalore and
strengthened in
Hyderabad and Calcutta. A departure from traditional
approaches to the
Planning and execution of family welfare/IEC efforts would be stressed and is
detailed in Annex 15. Elements of the
program’s approach would be: (a) emphasis on * using IEC activities and r^''
messages to trigger and sustain attitudinal
and behavioral changes rather than to
_J imerely increase awareness about programs
and activities; (b) use of applied communications
-------- research to aid the design
and deveiopment. of appropriate programs to support media strategies and
'
1S de"lgns:.(c) enhanced communication training for the various
in the desivn Se7tce delivery personnel; and (d) involvement of the community
susSLahnf? andTlmP^ln^tatton °f IEC.activities to ensure efficiency and
y. In all the cities, a mix of mass media and interpersonal
communication activities would be undertaken
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beca“se °f ^e importance of providing specific messages and infort0 individual Client needa. emphasis would be pfaced on using
Outreach Teams comprised of slum-based health workers (ANMs), Bustee Sevikas
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nd thereafter dulX take into account any comments provided by the
e^fLicTr °f
annUal
f°r IEC in r6SpeCt °f its lately
)
bucceeamg tlnancial year.
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be one of ^easing female education opportunities has been demonstrated to
be one of the most effective ways to increase the demand for family welfare
services and reduce fertility, i Early childhood marriage, which still exists
in s°me communities in India, and the overall general low age of marriage in
XieUeffortset
7S ^lch.^hibit ful1 ac«ss of girls to education and
stymie efforts to reduce fertility. During negotiations, the GOI provided an
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?e ? ““T
workers would make one-on-one and group contacts
related to^CH
fp° PerSUade and motivate changes in attitudes and behavior
IIciH sXnrl
practices. Training in communications, behavioral and
their abiMtv
meinberS °f the breach Teams to enhance
wo
be e nfo “J
a
clients. The work of such outreach teams
ould.be reinforced and supported through well planned and executed media
dlmlnd8for
ln Une
the Pri°rity program areas such as increasing
demand for temporary contraceptive methods; promotion of maternal and child
at
C f^L^ "mplfanca with
Child Marriage Restraint Act. A new
LsnonS t Of.Dledla materials which are better designed and pre-tested to
respond to client educational and communications needs would be developed with
guidance from the Mass Media Division of MOHFW. More program planningPand
PVOTkt"8 reSP°nsability would be given to the private sector, particularly
II al b wflfL!am y Wllfare
prOViding interpersonal communication ' such
IEC ^raU
!
inS Snd motivati°n- Through the joint work of the
impart
t
within the project, small-scale process and
IEC nlov™
activities would be conducted to help adjust and shift the
SlorloII^d
?eeded’ The findings of such research and feedback would be
oCIilv
plans which would be developed on an annual basis,
thlv Ihln
the.G01 and Proiect States provided an.assurance that
they shall cause the project cities to: (a) establish by January 30 1993 IEC
refC^d lit ?
PmPleDlentlnS Committees with membership and terms of’
by jllulrv
of^aT
Assoelation; and (b) furnish to the Association
by January 31 of each year commencing January 31, 1993, for review and
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20
assurance that it shall develop by June 30, 1993, a program of measures to
improve compliance with its Child Marriage Restraint Act, 1929, as amen e
The municipalities have developed their own proposals on how to improve
compliance in their jurisdictions (Annex 5, Part 2). During negotiations, the
GOI and Project States provided assurances that they shall cause the projec
cities to: (a) develop by June 30, 1993, a program of measures to improve
compliance with the Borrower’s Child Marriage Restraint Act, 1929, as amended;
and (b) furnish to the Association by January 31, 1994 and by January 31 each
year thereafter, a report for review and comment by the Association on steps
taken in the previous year toward the said improvement.
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3.19 Programs which deal directly with the provision of formal primary and
secondary education are financed and managed by State and Municipal Director 3
ates of Education. Under the project, major investments in physical infra
• r) •
structure (school buildings, teacher training institutes) would not be
covered, but modest support would be provided to a selected few of a range of
programs which support increases in access (scholarships, incentives_to
parents, girls’ uniforms, free school textbooks, limited primary school con
struction/ rehabilitation) and improvements in the quality of basic education.
The out-of-school adolescent girls would be a special focus of the project as
they will soon be mothers. The details of the various education and training rj ?
^programs for females to be supported under the project are outlined in
:•)
Annex 5, Part 3. During negotiations, the GOI and Project States provide
assurances that they shall cause the project cities to furnish to the Associa
tion by January 31 of each year, commencing January 31, 1993, for review and
3
comment, and thereafter duly take into account any comments provided by the
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Association in respect of a report on progress achieved during the previous
year in basic education for females. The project would support activities
which increase the demand for family welfare services by financing the costs
of books, IEC and educational materials, equipment, vehicles, contracts tor
innovative schemes, local training, local experts, and the salaries of
additional staff and honoraria of additional volunteers on a ddeclining
“'"2 scale. ’
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G.
Improving the Management of the Family Welfare Program (Proposed Outlay
US$3.78 million)
3.20
While no major reo rganization would be necessary, the respective
Family Welfare Bureaus in the municipalities would have to be suitably str-,
engthened to expand services as envisaged under the project. The Bureaus will
also need to improve coordination with other municipal Departments providing
services to slum communities, especially those dealing with sanitation an wa-<rf)
,y.^
ter supply, education and nutrition. Coordination of activities with, an
providing funding for health and family welfare to PVOs, PMPs and the communi
ty at large, will also require the strengthening of coordination mechanisms.
The municipalities have established Project Implementation Committees with
such representatives and powers as agreed with the Association (para 3.14).
3
3.21
In addition to strengthening inter-departmental coordination, the
respective Bureaus will be strengthened to implement and supervise various
project activities. Special emphasis would be given to training, IE5’
management information systems (MIS), the supervision of Innovative Scenes
and Auditing and Accounting. The additional staff to be recruited, and the
schedule of appointment, are outlined in Annex 16. During negotiations, th
GOI and Project States provided assurances that they shall cause the projec
O
■/
21
X
5
>■
)
)
)
>
>
>
cities to establish within their Family Welfare Departments
F
or agencies in
accordance with a time schedule agreed with the Association,, and thereafter
maintain, cells with adequate staff and other resources with responsibility
for planning and implementing programs in each of the following areas:
training, IEC, grants-in-aid to PVOs and PMPs, women in development, manage
ment information systems and accounting and auditing. The staffing of Family
Welfare Bureaus has been determined according to norms developed under the
Urban Revamping Scheme (Annex 7, para 4). Unfortunately, these norms when
rigidly applied do not capture the varying needs of the individual munic
ipalities nor the large growth of urban slums since the norms were estab
lished. During negotiations, the GOI provided an assurance that it shall: (a)
under arrangements satisfactory to the Association to be instituted by June
30, 1993, examine issues relating to population growth, health and the
anvironment for urban areas; (b) undertake by January 31, 1994, a reassessment
of the Urban Revamping Scheme and the norms by which it provides support for
the said scheme; and (c) discuss with the Association the results of such
reassessment including the implementation of proposed actions resulting from
tbo said reassessment. During negotiations, the GOI and Project States also
provided assurances that they shall cause the project cities to: (a) prepare
in accordance with terms of reference agreed with the Association and furnish
to the Association for review and comment by January 31, 1994, a City Health
P!an covering the area under each city’s jurisdiction; and (b) discuss the
said Plan with the Association, including proposed actions for implementing
such Plan. The Plan will cover public and private provision of curative and
preventive health services and plans for their rationalization including
financing, a regime of fees, insurance, and subsidization. The project would
support improvements in the management of the family welfare program by
financing local and foreign training, local and foreign experts (city health
planning), equipment, vehicles, and
and the
salaries of
additional staff
the salaries
of additional
staff on a
declining scale.
H.
)
»
>
>
>
)
>
)
Innovative Schemes (Proposed Outlay US$9.54 million)
3.22
It has been recognized that one of the reasons for some of the
limitations of the Family Welfare Program is that ----it has been run
run as
as a gov
ernment program and not as a people’s program. With the objective of making
the program more community-based, a concerted effort would be made under this
project to secure greater involvement of private voluntary organizations. It
is recognized that these organizations can significantly increase the pace of
program implementation by supplementing governmental activities and bridging
gaps in communication between the municipality and the slum community. These
PVOs generally take up innovative programs by adopting strategies and method
ologies which are aimed at fostering social transformations, thereby generat
ing attitudinal changes and improving quality of life of women in particular.
Various Innovative Schemes have been suggested by the four municipalities and
these are outlined in Annex 17. During negotiations, the GOI and Project
States provided assurances that they shall cause the project cities, in
consultation with the concerned Project State and GOI, to prepare and furnish
to the Association for its approval prior to their implementation, all
proposed innovative schemes. The project would support Innovative Schemes by
financing the costs of the contracts_vhich the municipalities wouTd enter'into
'o™it^|roups_and_pMPs. Each municipality would establish a Reinitiaf
Account for Innovative Schemes and replenish it as and when the
initial allocation is exhausted.
)
)
)
! ’v ’.Ji'-
•!?
22
■- .-a
I.
Preparation of Future Projects (Proposed Outlay US$9.33 million)
3.23
As noted in paragraph 3.03, another 15 cities were also covered by
the initial study conducted by the National Institute of Health and Family
Welfare. These cities are Patna in the State of Bihar; Bhopal,.Durg, Gwalior,
Jabalpur and Indore in Madhya Pradesh; Jaipur and Jodhpur in Rajasthan; A8ra’
Allahabad, Kanpur, Lucknow, Meerut, Varanasi in Uttar Pradesh; and Auranga a
in Maharashtra. The project would provide resources so that these cities .can ‘ J
initiate and complete Beneficiary/Community Needs Assessments, Facility
Surveys and detailed Two-Year Construction Plans including detailed designs
and cost estimates for new facilities as well as for rehabilitation and .
additions. Where necessary, the preparation phase would include the acquisi-.
tion of land and final site selection. The cities would also be asked to
establish Project Advisory and Coordination Committees, and Project Implementation Committees with representation from slum communities and PVOs. The
slum communities would also be expected to have formed Neighborhood Committees
as called for under the UBSP model (para 2.05). The municipalities would also
be expected to use this project preparation phase to establish and staff their project implementation organizations including the appropriate Cells for ILL,
training, grants, accounting and auditing. The project would finance the cost
of consultant services, selected equipment, vehicles and furniture. Because
these "designated cities" would only undertake project preparation activiti ,
a separate disbursement category has been created in the Credit for these
resources. A condition of disbursement for the preparation of future projects
in "designated cities" would be that GOT shall obtain from each State of the
"designated cities" and furnish to the Association, a Letter of Undertaking i
a form and substance satisfactory to the Association which shall include,
inter-alia, the terms and conditions of their participation in the project.
J.
Role of Women in the Project
3.24
The health sector provides extensive opportunities for the involve
meat of women. The project would provide for women’s participation at *
.
levels of design, implementation and supervision. Women would play-a signi
?
cant role in motivating and providing health and family welfare services in
the slums. They would be involved in identifying needs thr°ugh active par
ticipation in the Beneficiary/Community Needs Assessment, and designing
strategies to provide services to meet those identified needs. The female
volunteer link worker, the ANM jndJLHVs are the main implementors of
project. Women also pl^mcey role in generating demand and in the admin tration and management of health services in the municipalities. The active
participation of female-led community groups and PVOs, and the large n
f„(
female PMPs, would help to ensure that family welfare services reach the
targeted population through training and IEC programs. All staff of the
administration, the community in general, and men specifically, would be
sensitized through training to the impact of gender issues on the implem
tion of the project. A more extensive analysis of the role of women in th
project is given in Annex 18.
^3
©
4^
23
3
3
5
5
3
IV.
A.
PROJECT COST, FINANCING, IMPLEMENTATION AND DISBURSEMENTS
Costs
^•01
Summaries of Costs. The total cost of the project would be
Rs. 3,044.44 million or US$96.60 million equivalent. A breakdown of costs by
component,and categories of expenditure is summarized in Tables 4.1 and 4.2.
Detailed costs by component, categories of expenditure and time are given in
Annex 19. Estimated project costs include physical and price escalation
I" contingencies (US$17.60 million). Physical contingencies- are estimated"at 10Z
of all physical components and 5X for salaries of incremental staffs training
costs, consultants and operation and maintenance. Price escalation contingen
cies are estimated as follows: for civil works, goods, salaries, and technical
assistance--foreign costs: 3.7Z in CY93 through CY99; local costs: 10.5Z in
CY92, 8.5Z in CY93, 7.5Z in CY94, 6.5Z in CY95, 6.0Z in CY96 and 5.0Z in-CY97
through CY99. The estimated cost of the project includes import duties and
taxes estimated at about US$2.90 million (3.0Z). The foreign exchange compo
nent of the project is estimated at about US$9.10 million (9.4Z).
>
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>
)
)
Table 4.1:
>
Component
Increasing the Supply of
F.W. Services
Improving the Quality of
F.W. Services
Increasing the Demand for
F.W. Services
Improving the Management
of F.W. Services
Innovative Schemes
Preparation of Future
Projects
>
>
>
>
>
>
Costa by Component
Loca I
Foreign
Tots I
_______ Rupee (Mill ion)----------T,015.07
89717
1,104.24
- 6 I-AV 6
Loca I
Forei gn
Tots I
US3 (Million)
37.60
3.30
40.90
242.57
27.71
270.28
8.98
1.03
10.01
12.7
223.26
24.63
247.89
8.27
0.91
9.18
11.6
70.75
14.04
84.79
2.62
0.52
3.14
4.0
125.29
190.48
14.22
25.46
209.51
215.94
7.23
7.06
0.63
0.94
7.76
8.00
9.8
10.1
BASE COSTS
Conti ngenci es
1,937.42
195.23
2,132.65
71.76
7.24
79.00
100.0
Physics I
Price
TOTAL PROJECT COSTS
141.79
689.91
2,769.12
18.61
70.50
284.34
160.40
760.41
5,063.46
5.25
10.49
87.50
0.70
1.16
9.10
5.95
11.66
96.60
7.5
14.7
4
>
>
>
>
>
)
>
I
v
^RsW*^**
>
K of Base
Costs
51.8
1
122.2
24
Table 4.2:
Coats by Categories of Expenditure
upee (Mil Il0n
Foret gn
Component_________ ____ Loca I
Investment Coats
45.40
360.68
Civil Wofks
16.25
Professional Fees
45.79
Department Charges
5.92
58.83
Furniture
99.60
263.03
Equipment A MCH Materials
4.29
42.56
Vehicles
21.79
192.59
Medicines
77.29
Land
7.31
Books A Training Materials
1.04
56.30
Local Training
303.42
Local Consultants
8.29
0.90
Foreign Training
8.34
0.91
Poreign Consultants
194.67
1,425.86
Subtotal
Recurrent Coats
351.41
Salaries of Increments I
Staff
138.29
Honoraria
0.56
21.86
Operation and Maintenance
0.56
611.56
Subtotal
BASE COSTS
Contingencies
Physical
Price
SubtotaI
iSt (M~T
of Baaa^
Coats__
15.04
0.60
I. 70
2.40
13.43
1.73
7.94
2.86
0.27
2.13
II. 24
0.34
0.34
60.02
19.1
0.8
2.2
3.0
17.0
2.2 .
10.1
3.6
0.3
2.7*
14.2
0.4
0.4
76.0
13.02
16.5
6.5
Tota I
Loca I
406.08
16.25
45.79
64.75
362.63
46.85
214.38
77.29
7.31
57.34
303.42
9.19
9.25
1,620.53
13.36
0.60
I. 70
2.18
9.74
1.67
7.13
2.86
0.27
2.10
II. 24
0.03
0.03
52.81
351.41
13.02
138.29
22.42
512.12
5.12
0.81
18.95
0.02
0.02
5.12
0.83
18.97
24.0
1.68
0.22
3.69
0.16
0.81
0.03
0.31
0.31
7.21
©
1-0 0
71.76
100.0
2,132.65
79.00
195.23
7.24
1,937.42
141.79
689.91
831.70
18.61
70.50
89.11
160.40
760.41
920.81
5.26
10.49
15.74
0.70
1.16
1.86
5.95
11.66
17.60
7.5
14.7
22.2
9.10
87.50i
oats includ'!• taxes an<
96.60
utles.
122.2
_______ 3,063.46
_______ 284.34
TOTAL PROJECT COSTS
2,^769^12
ue to rounding.
to
totalT
NOTEri Subtotals may not a.
B.
Total
Financing Plan
i million would be fi- O
I a 02
The estimated cost of the project of US$96.60
which would cover about
nanced by an IDA Credit^US$7±^^^equivalent
finance the
I 84Z of projec-t-^t-^r^TTaTes and
and duties.
duties. The
The GOI --would
•
The financing
costs
of
US$14.70
millionand_all taxes.
! remaining net project
costs
c_
outlined
in
Annex'
and categories'’of—expenartu7elsoutrined in Annex 20..
J plan by component c“J
4
Sustainability Implications
C. Ppcurrent Costs and
• » a total of ©
4.03
When the Project is completed in FY99, it would require
©
about Rs. 222.6 million (US$6.4 million equivalent) ^pnually in recurrent
of Karnataka for
by the State
costs. These expenditures would be borne fullyBengal
* *■ - , the
for Calcutta,
Pradesh
for
Hyderabad,
West
--Bangalore, Andhra 1----Assuming no real growth
9
of
Delhi
and
the
M0HFW.
Municipal Corporation c- is
in
the
project,
it
budget allocations, except for the proposed investments
estimated that the impact'of recurrent project expenditure s on the family wel-.J
shown in Annex 21.
fare budgets of the States and MOD would be ^gHgible
difficult t0 ensure
th^sustLnabriiJy^f^ny welfare
assu«nL|
Hr,::.—
• . However,
.. — o
,,
the National Family Welfare program as a cen^l Y*
Eighth Five-Year Plan (1992-97), several other
financed program during the L 6
First, additional nev^
factors provide positive indications of sustainability,
of existing staff and ''
staff have been kept to a minimum by the redeployment
the use of volunteer and part-time workers. Second^ the increasedof services .
participation of the community in the management and maintena
25
3
and the expanded role of PVOs and PMPs, should assist sustainability. Lastly,
as quality improves and demand increases, it may be possible to recover'“^T
funds from beneficiaries to use for system maintenance. Issues relating to
the sustainability of family welfare investments are being addressed compre
hensively m a Health Financing Study which is underway in close collaboration
1
witn GOi.
3
D.
Project Implementation
>
5
>
4^°I4 ,
The Ministry of Health and Family Welfare (MOHFW), the Directorate
of Health and Family Welfare in the respective States, and the Family Welfare
Bureaux/Health Units in the municipalities would all have responsibilities for
implementing the project. The MOHFW has a Division headed by a Joint Secre
tary, which is currently responsible for coordinating and monitoring the
implementation of all externally-aided family welfare area projects, and would
also coordinate all project inputs from other relevant Ministries. The
established a Project Advisory and Coordinating Committee
JPAAC) with representatives from the Women and Child Department, Ministry of
Urban Development, other key ministries, PVOs, and community groups for the
purpose of coordinating several project interventions. The respective States
have also established PAACs, headed by the Chief Secretary. At the municipal
level the project would be implemented by the respective Family Welfare Bu
reaux/Health Units with guidance from Project Implementation Committees which
include PVO and community group representations.
P/Ug
>
E.
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>
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)
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)
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)
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>
Monitoring, Evaluation and Studies
4-05
At present, 1"
the ---MOHFW collects information on all Schemes which make
up the national family welfare program, This level of monitoring would be
further supplemented under the Project, Currently, each scheme has some form
of built-in evaluation, and the implementing institutions utilize these to
make adjustments when and if necessary in their delivery of services. Overall
monitoring
and evaluation, such as the use of credit proceeds, and the
, ,
achievement of objectives would be undertaken by municipalities with the '
assistance of the State Directorate of Health and Family Welfare. As part of
its normal reporting responsibility, each municipality would submit SemiAnnual Progress Reports to IDA. The fo.rmat and content of these reports is
As regards evaluation,
1 , outlined as part of the Supervision Plan (Annex 22).
the Government has diScussgd_with the Association key indicators (Annex 10)
andalso_ingi?rteda2gir]^Ke?rTb--u^
a 1 studle~TTo det^rEiiTe
WjE!2££^£°S£gEybjlSti??r_are beidr^hig^IT—Rapid Low Cost StudieTTkhCS)
would_be_used^ a technique to achieve thiT^d. —I'hd maj oF^ZZE^which ..
in matemil and infant mortality and (
morbidity and the increase in contraceptive prevalence, especially the use of
temporary methods. Under the project, a number of these studies would be unb er a en, as outlined in Annex 22, Section 3. During negotiations, the GDI
and Project States provided assurances that they shall cause the project II
cities to: (a) utilize the Key Indicators agreed with the Association for i '
evaluating performance of the project; and (b) use rapid low cost studies as
agreed with the Association for the purposes of such evaluation. During
negotiations the GOI and Project Stater: also provided an assurance that they,
shall furnish or cause to be furnished t.o the Association by September 30, /
1
, a mid-term review of the progress of the project.
----//
)
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:
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•■.
••'
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26
F.
Status of Preparation
I
;
4.06
Prototype designs for the construction
ofr new health facilities
Each
municipality
has
initiated
a
Facility Survey to identify
already exist. 1
existing institutions which are to be upgraded/renovated and is preparing a
detailed Two-Year Construction Plan which would be completed within six months .
of the final Facility Survey, The Engineering Departments of the Municipalities will be responsible for the contracting and supervision of civil .
designs
were_ prepared
either by private consultants or
works, Architectural
j
_
_ .. ..
.
.
Locations
for the construction of
in-house architects of the municipalities,
"HI
^..1
;
facilities
have
been
identified in
. ..
the health facilities and medical stores
"Where
no
municipal
land
is
available,
.sites
would
be
.
acquired
.. .
all cities.
This is expected in Delhi and Calcutta. Lists for equipment, vehicles, medi
cines, and family welfare supplies (consumable materials) have been prepared .
by GOI and the municipalities and are based on standards used by MOHFW for the^
other seven IDA-assisted Population projects and the Child Survival and Safe
Motherhood project approved by the Board in September 1991. Draft terms of
reference for local consultants have been prepared and development of the
various types of training programs has begun. Beneficiary/Community Needs
Assessments, as well as Baseline Surveys have been initiated in all municipal
ities. Community participation workshops have also been undertaken in all
municipalities. The MOHFW, States and municipalities have formed Project
Advisory and Coordinating Committees and Project Implementation Committees. A
list of Innovative Schemes has been prepared. Arrangements for the procure
ment of goods and services are in place. Standard bid documents prepared tor
the procurement of goods and works under the IDA-assisted Technician Education
projects of 1990 and 1991 would be utilized as applicable.
J
G.
Disbursements
4.07
Disbursement Profile. The proposed IDA credit would be disbursed^
over seven years and is in line with the standard profile of population proje
cts in India and the Asia Regicn. The project is expected to be completed on »
March 31, 1999 and the Credit closed on December 31, 1999. The nature of the
project, including emphasis on community participation and experience with th.
implementation of other IDA-financed population projects, reinforce, the justification for a standard disbursement profile.
i
Disbursement Percentages and Required Documentation. The IDA Credi would be disbursed against 90Z of expenditures on civil works, 100Z of CIF ana
of local ex-factory cost or SOX of other locally procured equipment, vehicle^
medicines, furniture, IEC and MCH materials, 100Z of consultants’, PMPs’ and
PVOs’ services and training, and an average of about 70Z of total expenditure^
(90Z for Indian FY92-95, and 65Z thereafter) on the salaries of incremental
staff and honoraria for incremental volunteer workers. Disbursements in
respect of contracts for civil works and goods estimated to cost less than
US$50,000 equivalent would be made against statements of expenditure (SOEs)
certified by the municipalities. Documentation would be retained by the
..
municipalities and made available for review by IDA staff (headquarters and
NDO) during supervision missions. All other disbursements would be made
» against fully-documented withdrawal applications. A forecast of annual expeni ditures and disbursement is given in Annex 23.
t
©
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27
J
1
>
4.09
Special Account and Retroactive Financing. To accelerate disburse
ments in respect of IDA’S share of expenditures pre-financed by GOI, and to
allow for direct payment of other eligible local and foreign expenditures, a
Special Account would be opened in the Reserve Bank of India with an autho
rized allocation of US$4.0 million equivalent to cover four months of expected
requirements for IDA financed items. Retroactive financing up to SDR 0.4
million (US$0.5 million) is provided to cover eligible expenditures after
November 3b, 1991 for costs incurred in implementing appraised activities.
H.
I
Procurement
)
4.10
Procurement arrangements are summarized in Table 4.3. Project
related procurement for goods and services would follow procedures acceptable
to IDA. Project financed consultants would be selected according to IDA’S
guidelines for the use of Consultants by World Bank Borrowers. Procurement of
equipment, vehicles, furniture, medicines, MCH and educational materials would
be bulked to the maximum extent possible and any individual contract exceeding
US$200,000 equivalent would be procured using ICB.
)
Civil Works (US$18.80 million)
>
)
>
)
>
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>
>
)
I
)
>
>
>
>
>
)
)
>
4.11
Sixty percent of the civil works contracts, estimated at US$10.9
million would cost between US$50,000 and US$100,000 each and would be awarded
using LCB procedures acceptable to IDA. Forty percent (US$7.9 million) would
be for contracts below US$50,000 each and would be procured using appropriate
procedures including force account, community participation or LCB.
Furniture, Equipment, Vehicles, Medicines, and IEC and MCH Materials
(US$30.70 million)
4.12
Most of the equipment is medical in nature. Generally, it is
manually powered and includes such items as small clinical equipment and
tools, kits for nurses, syringes, needles, and other medical accessories and
would be procured annually based on identified needs. Contracts for equipment
and MCH materials (US$16.90 million) estimated to cost less than the equivalent of US$200,000 per contract, iup to an aggregate amount not exceeding
US$9.0 million may be procured on the basis of competitive bidding advertised
locally, Tn accordance with procedures satisfactory to IDA. Contracts valued
'at US$50,000 equivalent or less, up to an aggregate total of US$5.9 million
would be awarded on the basis of prudent shopping procedures, Specialized
medical equipment (US$2.0 million) would be procured using 1CB. Vehicles
(US$2.1 million) and furniture (US$3.0 million) would be procured over the
life of the project through LCB procedures acceptable to IDA. Medicines
(US$10.4 million) would be procured by LCB and other methods as explained in
i Annex 24. Contracts for medicines estimated to cost over US$50,000, up to an
■ aggregate of US$6.0 million would be awarded on the basis oT’LCB. Contracts
! estimated to cost US$50,000 or less, up to an aggregate of US$4.4 million
I would be awarded on the basis of prudent shopping procedures and by direct
contracting. Contracts for training and IEC materials costing US$50,000 or
JLess, up to an aggregate of US$0.3 million would be awarded on the basis of
prudent shopping procedures and by direct contracting. For all contracts over
US$200,000 procured using ICB, a 151 domestic preference or the prevailing
import duties, whichever is lower, would be granted to qualifying local manu
facturers.
>
gw
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28
Bank Review
review.
4.13
All items procured using ^wouid ^^subject•; to IDA’S prior
> prior review.
All LCB contracts over USS200,000 would b. subject
yincluding PMPs and PVOs, will be
ment of all consultants
- •
e The procurement 2arrangements which would be used in the proIDA guidelines.
IDA-assisted Population Projects and have
ject are similar
£ur.i_c._ to the previous -- -been found to be satisfactory.
Table 4.3:
Procurement Elements
Works
Civil Works
1.1
1.
1.2
Goods
2.1
2.
5:
J:l
Procurement Method
ICB
Procurement Method
lcb
OTHER
10.90
(9.80)
r.
i I'
7.15
(6.40)
2.2
Equipment & MCE Materials
2.3
Vehicles
2.4
Medicines
2.00
(1.80)
9.00
(8.10)
2.10
(1.90)
6.00
(5.50)
Training and IEC
Materials
Consultancies
PMPs
3.1
1Local
--- - Consultants,
and PVOs
Foreign Consultants
3.2
3.3
Local Training
3.4
Foreign Training
Miscellaneous
Additional Staff
Salaries of
(
4.1
Honoraria
of Additional Volunteers
and L^.■—■ •
and
Maintenance
Operation
4.2
Land
4.3
31.00
2.00
TOTAL
28.00
1.80
IDA
3.00
0_. 20
GO I
inane mg.
)A
in
parentheses
represent
NOTE: Figures
TOTAL
COST
-------18.05
(16.20)'^
2.10
2-10©
3.00
(2.70)’-J
3.00
(2.70)
Furniture
16.90®
5.90
(5.31)
(15.21^
2.10
(1.90’'9
10.40 ‘
(9.20,0
0.30 ’
(0.270
4.40
(3.70)
0.30
(0.27)
14.75
(14.72)
0.40
(0.40)
2.50
(2.50)
0.40
(0.40)
14.710
(14.72.1
0.4,0 ■*
(0.4OX
2.50-'
(2.50X
0.40^
(0.4&^
22.20
(15.50)
1.00
2.50
22.20
(15.50)
1.0^
17.75
45.85
96.^
15.68
2.07
33.52
12.40
79.0^.
17.0^
4.
i
N/A
Dept. Charges
2.5
3.
-
2’5^
I. Accounting and Auditing
4 14
The project would be subject to normal GOT accounting and auditing
vHeh are considered satisfactory to IDA. The audit reports for
?h:C’onTo0^population projects ar. In a form satisfactory to IDA and would
established accounting
this nroiect. The municipalities have all
nrocedlrls\nd systems which are satisfactory to IDA. They would maintain
separate project accounts and provide IDA with s^i-annual statements of
O
□
Zi)
1
29
5
)
J
1
5
>
>
>
>
)
expendituxesDuring negotiations, the GOI and Project States provided
assurances that they shall cause the project cities to: (a) have the accounts
and financial statements of the project, including Statements of Expenditure
(SOE) and the Special Account for each fiscal year, prepared in accordance
with sound accounting practices and audited by independent auditors acceptable
to IDA; (b) maintain supporting documentation for statements of expenditures
at least one year after the completion of the audit for the fiscal year in
which the last withdrawal was made; (c) include a separate opinion on SOEs in
the annual audit; and (d) furnish to the Association as soon as available, but
not later than nine months after the end of each fiscal year, certified copies
of the audited accounts and financial statements for each fiscal year,
together with the Auditors Report in the form of a Consolidated Report, IDA
will accept the Municip_al Chief Auditors of the respective project cities
(DMC, NDMC, BMC and MCH) a ^independent, and the Controller and Auditor
General (CAG) of India as an independent auditor for CMDA."
V.
BENEFITS AND RISKS
>
Benefits
>
)
>
>
>
J
>
)
>
>
>
>
>
>
>
)
>
5.01
The proposed project would assist GOI in further developing opera
tional models and refining its Urban Revamping Scheme for nationwide replication. It would also provide a suitable vehicle for the participation of urban
and slum communities in detemining the mix of services which are most appro
priate to their felt needs. Further, the project would confer direct social
benefits to low-income slum dwelling families, particularly women and chil
dren, by increasing access to and the quality of family planning and maternal
and child health care services. In so doing, it would promote a decline in
fertility, morbidity and mortality among mothers, infants and young children.
The project would also help to improve government and community responsiveness
to the needs of women and create a greater awareness among policy makers of
the impact of development on women.
B.
Risks
5.02
The major risks would be institutional and relate to the capacity of
‘municipalities to implement the project, particularly to develop outreach
services and work collaboratively with slum populations and PVOs. To minimize
\ these risks, Municipal Health Departments would be strengthened under the
project. Arrangements would be made to increase the cooperation between State
governments, municipalities, Private Voluntary Organizations, slum communities
and private medical practitioners. Committees would be established with
representatives from each group, to provide inputs to project design, imple
mentation and supervision as well as to undertake modifications if necessary.
30
VI.
AGREEMENTS REACHED
b.-)
6.01
During negotiations, the GOI provided assurances that it shall:
(a) ensure that volunteer workers participating in the Urban Revamping
Scheme shall be eligible to receive payment of honoraria in respect
of their work in the said scheme (para 3.07);
(b) develop by June 30, 1993, a program of measures to improve compli
ance with the Child Marriage Restraint Act, 1929, as amended (para
3.18); and
(c) (i) under arrangements satisfactory to the Association to be insti
tuted by June 30, 1993, examine issues relating to population
growth, health and the environment for urban areas; (ii) undertake
by January 31, 1994, a reassessment of the Urban Revamping Scheme
and the norms for it to provide support for the said Scheme; and
(iii) discuss with the Association the results of such reassessment
including the implementation of proposed action resulting from the
said reassessment (para 3.21).
©
©
6.02
During negotiations, the GOI and States of Karnataka, Andhra Pradesh . ?
and West Bengal (Project States) provided assurances that they shall cause the
municipalities of Bangalore, Calcutta, Delhi and Hyderabad (project cities)
to:
I
t
(a) (i) furnish to the Association by June 30, 1993, baseline surveys
and beneficiary and community needs assessments with format and
content satisfactory to the Association; and (ii) promptly thereafO
ter, suitably adjust the hours of operation of health facilities
to
be
fully
respon-..;
;)
located in slum areas in its jurisdiction so as
sive to the findings of the above beneficiary and community needs
assessment (para 3.07);
. .
©
(b) (i) provide in accordance with a time schedule agreed with the
Association, and thereafter maintain, adequate salaried staff and
be necessary to^j
honorary health workers and other resources as shall
?'
ensure the effectiveness of its outreach programs under the Project;
and (ii) establish within its Family Welfarq Department or agency iin^
—
accordance with a time schedule agreed with the Association, and
thereafter maintain Cells with adequate staff and other resources
with responsibility for planning and implementing programs in each 7)
of the following areas: IEC, management information systems, training, grants-in-aid to PVOs and PMPs, women in development and
accounting and auditing (paras 3.07, 3.21);
v)
•a
■
V
J
r
(c) furnish to the Association by January 31 of each year, commencing
January 31, 1993, a report on the following for review and comment,
arid thereafter duly take into account any comments provided by the
Association in respect thereof: (i) annual plan for civil works,
-J
training and IEC in respect of its immediately succeeding financial^
year; and (ii) progress achieved during the previous year in basic
education for females (paras 3.08, 3.10, 3.17, 3.19);
M
■
□ »:
31
5
>
>
(d) (i) establish by January 31, 1994, community-based management
committees for facilities and programs developed under the project;
and (ii) institute no later than April 1, 1994 such measures as
shall generate resources from the direct beneficiaries of the said
facilities and programs to support a portion of the operation and
maintenance costs thereof, including medicines (para 3.11);
(e) 'establish by June 30, 1993, an IEC Program Planning and Implementa
tion Committee with membership and terms of reference satisfactory
to the Association (para 3.17);
♦
>
>
3
3
)
)
>
>
>
>
>
3
3
1
»
>
(f) (i) develop by June 30, 1993 a program of measures to improve
compliance with the Borrower’s Child Marriage Restraint Act, 1929,
as amended; and (ii) furnish to the Association by January 31, 1994,
and by January 31 each year thereafter, a report for review and
comment by the Association on steps taken in the previous year
toward the said improvement (para 3.18);
(g) (i) prepare in accordance with terms of reference agreed with the
Association and furnish to the Association for review and comment by
January 31, 1994, a City Health Plan covering the area under its
jurisdiction; and (ii) discuss such Plan with the Association,
including proposed actions for implementing the Plan (para 3.21);
(h) in consultation with the concerned State and the GOI, prepare and
furnish to the Association for its approval prior to their implemen
tation, all proposed innovative schemes (para 3.22);
(i) (i) utilize key indicators agreed with the Association for evaluat
ing performance of the Project; and (ii) use rapid low cost studies
as agreed with the Association for the purposes of such evaluation
(para 4.05); and
(j) (i) prepare in accordance with sound accounting practices, and have
audited by independent auditors acceptable to the Association, '
accounts and financial statements of the project including state
ments of expenditure (SOE) for each fiscal year and the Special
Account; (ii) maintain documents supporting statements of expendi
tures at least one year after the completion of the audit for the
fiscal year in which the last withdrawal was made; and (iii) include
a separate opinion on SOEs in the annual audit. -The GOI would fur
nish to the Association as soon as available, but not later than
nine months after the end of each fiscal year, certified copies of
the audited accounts and financial statements for each fiscal year,
in the form of a Consolidated Report (para 4.14).
>
>
>
>
3
6.03
During negotiations, the GOI and Project States agreed to furnish or
cause to be furnished to the Association by September 30, 1995, a mid-term
review of the progress of the project (para 4.05).
©
32
6.04
As a condition of disbursement for the preparation of future
projects in "designated cities," the GOI would obtain from each State of the
"designated cities" and furnish to the Association, a Letter
1---- of Undertaking in^*
form and substance satisfactory to the Association which shall include, inter
alia, the terms and conditions of their participation in the project
(para 3.23).
6.05
Subject to the above assurances, the proposed project constitutes a
suitable basis for an IDA Credit of SDR 57.7 million (US$79.00 million equi ;-‘3)
valent) to India at standard IDA terms with 35 years maturity.
*->)
®
0
>.-X)
I
©
M??)
■)
©
©
3
©
-I s'
O
Q
©
i
$
,...
■
'©
3
33
ANNEX 1
Page 1
3
9
INDIA
5
FAMILY WELFARE (URBAN SLUMS) PROJECT
Table 1:
9
BENEFICIARIES
>
HYDERABAD
BANGALORE
CALCUTTA
4.18
12.10
9.30
4.28
0.36
5.50
1.25
0.75
10
10
10
9.9
36,000
605,000
125,000
74,250
DELHI
9
Actual Population (1992)
(million)
Project Area Slum Population
(million)
Percentage of Children (0-4)
in-slums
Number of Children (0-4)
9
9
>
3
Percentage of married women (15-44)
in slums
Number of married women (15-44)
34Z
15.7Z
33.5Z
25Z
122,400
863,500
418,750
187,500
Total Number of Beneficiaries
158,400
1,468,500
543,750
261,750
>
>
9
Table 2:
>
Year
Census Population
(Million)
1961
1971
1981
1991
439.2
548.2
683.3
844.3
9
1
>
>
A
Population Size and Growth
Decadal change
1961-1991
Average Annual
Exponential Growth Rate
INDIA
21.51
24.80
24.66
23.56
1.96
2.20
2.22
2.12
>
>
>
BANGALORE (UA)+
1961
1971
1981
1991
1.21
1.66
2.92
4.09
64.17
54.57
57.09
46.18
>
>
9
9
•
■
A.’./;.
•r
as
3A
ANNEX 1
Page 2
4^
CALCUTTA (UA)+
1961
1971
1981
1991
5.98
7.42
9.19
10.92
10.48
43.80
42.65
67.04
DELHI (UA)+
1961
1971
1981
1991
2.36
3.65
5.73
8.38
53.49
37.88
75.56
39.87
■a
vJ ■
O'
HYDERABAD (UA)+
1961
1971
1981
1991
1.25
1.80
2.55
4.28
28.14
24.01
23.90
18.73
J
s■
Source: + Statement 23, Paper-2 of 1991 - Provisional Population Totals
Census of Inda
UA - Urban Agglomearation.
Table 3:
Demographic Data: India 1985-1991
-Q
INDIA
Year
CBR
CDR
IMR
ECPR
1985
1986
1987
1988
1989
1990
1991
32.9
32.6
32.2
31.3
30.6
29.9
NA
11.8
11.1
10.9
10.9
10.3
9.6
NA
97
96
95
94
91
80
NA
32.1
34.9
37.5
39.9
41.9
43.3
44.1
©
?')
BANGALORE
1985
1986
1987
1988
1989
1990
1991
26.8
25.4
25.4
25.9
25.1
25.3
25.4
7.6
36.5
7.2
41.0
7.3
7.1
7.2
6.8
7.3
44.0
34.0
36.9
32.0
26.7
43.8
43.8
54.9
47.3
54.7
©
&
&
■«w?
1
35
ANNEX 1
Page 3
CALCUTTA 1/
)
1985
1986
1987
1988
1989
1990
1991
»
t
>
I
20.5
20.1
20.9
18.7
18.4
18.3
NA
6.8
6.9
6.5
5.7
7.0
6.8
NA
46
55
53
43
53
42
NA
43.82
42.37
46.11
47.37
44.60
52.31
52.52
39.69
42.23
49.71
37.90
40.2
NA
NA
37.8
36.4
39.0
39.8
42.4
41.7
40.4
IMR
30.8
38.4
34.4
27.6
33.0
24.5
NA
ECPR
37.37
41.28
43.79
47.77
50.29
52.35
NA
DELHI
>
1985
1986
1987
1988
1989
1990
1991
)
)
>
)
27.93
26.97
28.31
29.08
28.02
NA
NA
6.71
6.39
6.63
6.86
6.77
NA
NA
>
HYDERABAD
Year
1985
1986
1987
1988
1989
1990
1991
>
>
>
>
)
CBR
37.6
35.8
39.3
38.5
37.4
37.4
NA
Table 4:
>
CDR
7.0
6.7
7.6
7.6
7.4
6.8
NA
Population Projections:
India, New Delhi, Calcutta, Hyderabad and Bangalore
1990-2000
)
Year
India*
New Delhi
Calcutta
Hyde rabad
(In Millions)
Bangalore
>
1990
1995
2000
843.6
923.7
1003.1
8.91
10.74
12.82
10.92
13.60
14.80
4.10
4.88
5.87
»
* For India, reference period is 1991, 1996 and 2001 instead of 1990, 1995
and 2000.
>
2.90
3.31
3.75
)
1/
Information on vital rates of Calcutta CMC are not readily available.
Calcutta urban Agglomearation’s population is about 70Z of urban population
of West Bengal. Vital rates given here are for urban population of West
Bengal.
36
ANNEX
Page 1
INDIA
r*-i«
FAMILY WELFARE (URBAN SLUMS) PROJECT
PROFILE OF PROJECT CITIES
Hyder^Js
Bangalore
Calcutta
Delhi
451
1,488
1,484
~ .a
2. DENSITY OF POPULATION
(PER SQ. KM)
9,099
8,132
6,314
14,24^
3. NUMBER OF SLUMS
401
2,200,000
1. AREA (SQ.KMS)
4. DEMOGRAPHIC DATA
Population (million)
1981 : Overall
Slum
2.9
9.2
3.3
5.7
1991 : Overall
Slum
4.1
0.3
10.9
5.5
8.4
3.5
4.'^
1995 : (Projected) Overall
Slum
4.8
0.4
13.6
5.9
11.4
3-0
Decadal Growth (Z)
40.6
19.7
50.6
2.0
5.0
0.^
.0
37-4
Population Structure (Z)
: 0-1 Overall
: Slum
4.3
: 1-4 Overall
: Slum
12.0
19.7
7.4
8.0
18.7
: 5-14 Overall
: Slum
20.2
31.4
23.8
23.5
28.5
27^
: 15-44 Overall
: Slum
43.4
50.3
44.4
43d
18.2
14.2
1 7Q
19.3
: 44 + Overall
: Slum
5.5 :
9^
0
o
o'
0
<9
&
LI
■A .-5
dr
I
37
1
5. ENVIRONMENTAL DATA
Z of Population supplied
safe drinking water
Overall
Slums ,
II,
ANNEX 2
Page 2
.nr.,
J .
95.0
86.0
80.0
43.0
90.8
60.0
25.0
80.0
10.0
35.0
90.6
33.3
60.0
25.0
75.0
15.0
73.9
85.0
10.0
30.0
46.0
Respiratory Disease
48.2
11.4
24.6
Fevers
21.2
Diarrhoeas and Dysentaries
11.0
26.1
Accidents
10.4
6.4
i
Tuberculosis
9.0
6.7
>
Infective Hepatitis
)
Z of population covered
by sewerage disposal
)
Overall
Slums
)
Z of population covere
by solid waste disposal
)
>
)
Overall
Slums
Z of population covered
by sanitary latrines
Overall
Slums
)
>
>
>
>
>
>
60.0
25.0
60.0
25.0
6. Morbidity Pattern
(major causes of Deaths Z)
1.8
11.0
2.0
1.61
15.7
1.9
^6. MATERNAL AND CHILD HEALTH AND FAMILY PLANNING SERVICES
'
Z of ANC cases registered
Overall
Slums
84.3
80.7
71.3
95.4
84.3
75.0
68.9
58.7
63.7
85.0
65.7
72.4
94.8
66.0
86.2
88.7
>
Z of cases receiving ANC
>
)
>
I
>
Overall
Slums
Z of Institutional
Deliveries
Overall
Slums
38
Z of deliveries conducted
at home
Overall
Slums
I .
,
ANNEX 2
Page 3
I . .
l I
t ■
i A
! “:
34.3
29.6
36.3
15.0
5.2
32.0
0.
Z of deliveries conducted
by Trained Personnel at
home
Overall
Slums
6.5
15.0
65.9
68.7
5.2
32. O’
71.4
54.2
86.3
80.0
41.0
Z of Children between 1-2 years
fully immunized
Overall
Slums
For 1989-90
Z of Family Planning Acceptors
(method wise) Conventional
contraceptives:
1.4
1.0
9.8
2.5 4)
Oral Pills:
1.0
0.1
0.4
0.9
IUCD:
7.4
1.4
9.1
2.8
Tubectomy/Vasectomy:
37.8
31.8
21.1
43.4
Hospitals: Public
Private
16
17
138
58
36
31
Dispensaries: Public
Private
92
75
367
19
73
27
22
8
.0
7. EXISTING HEALTH CARE FACILITIES
j'fe.
"
©
-- ..J
" ©
Polyclinics: Public
Private
10
Paediatric Centres: Public
Private
3
1
41
Nursing Homes: Public
Private
142
110
Urban family Welfare Centre:
Public
Private
37
73
Maternity Homes: Public
Private
31
1
17
Post-Partum Units: Public
Private
"A
©
-- ^r)
5
120 ®
34
-- ©
5
10 S>
26 ®
9
5
'_
39
ANNEX 3
Page 1
)
INDIA
)
FAMILY WELFARE (URBAN SLUMS) PROJECT
i
THE NATIONAL FAMILY WELFARE PROGRAM
>
>
Section 1:
Goals and Achievements
Goals
>
1990
2000
1.17Z
42.0Z
1.66Z
4.3
87
10.4
27.4
15 - 20
2-3
56.6
18.0Z
60 - 75Z
80Z
1.0Z
60Z
1.20Z
2.3
below 60
9.0
21.0
10
below 2
64
10Z
100Z
100Z
100Z
100Z
85Z
80Z
70Z
100Z
100Z
85Z
85Z
85Z
Achievement
1990
)
)
J
)
>
>
>
Net Reproduction Rate (NRR)
Effective Couple Protection Rate (ECPR)
Annual Growth Rate of Population
Total Fertility Rate
Infant Mortality Rate
Crude Death Rate
Crude Birth Rate
Young Child Mortality (0-4 years)
Maternal Mortality
Life Expectancy at Birth
Babies with birth weight below 2500 grams
Pregnant mothers receiving ante-natal care
Deliveries by Trained Birth Attendants
Immunization Status (Z covered)
1.6Z
44.1Z
2.0Z
3.9
91
10.3
30.6
35.2 (1987)
5-7
55
25Z
40Z
35Z
>’
TT (for pregnant women)
TT (for children)
DPT (children below 3 years)
BCG (infants)
Polio
>
)
65Z
65Z
80Z
80Z
76Z
)
)
>
i
Subcenter
Primary Health Center
Community Health Center
Health Guide
Trained Dai
1 for every 5,000 population 1/
1 for every 30,000 population
1 for every 100,000 population
1 for every village
1 for every village
>
>
>
NA = Not available.
1/ 3,000 in tribal and remote areas.
Source: Ministry of Health and Family Welfare; Sample Registration System.
>
4
5
■1
■■
- 60
ANNEX 3
Page 2
Section 2:
Schemes which Make up the National Family Welfare Program
JThe 26 Schemes which make up the National Family Welfare Program can be
categorized as follows:
©
(a)
(b)
Family Welfare Services including for Family Planning (i)
sterilizations (vasectomy, tubectomy), (ii) IUD insertions; (iii)
free distribution of oral pills and conventional contraceptives
(condoms, jelly creams, foam tablets, diaphragms) and for MCH,
(iv) immunization of pregnant women and children (tetanus, DPT,
Polio, BCG and measles), (v) prophylaxis against nutritional
anemia among women and children and against blindness due to
Vitamin A deficiency; and (vi) Oral-rehydration therapy.
Facilities to deliver these services: construction, furnishing
and equipping (vii) under the Minimum Needs Program, Community
Health Centers (CHCs), Primary Health Centers (PHCs) including
operation theaters, and Sub-centers including quarters for Female
Health Workers: (viii) Post-Partum Centers at district and sub
district Hospitals and selected Medical Colleges; (ix)
sterilization beds; (x) IUD Rooms at Rural Family Welfare Centers;
and (xi) Health Posts in urban slums under the Urban Revamping
Scheme;
-K-'
©
.J
(c)
Improving the Quality of Services delivered through the
appointment of new and upgrading of new and existing workers
•9
through specialized training programs for (xii) Female Health
Workers; (xiii) Female Health Assistants; (xiv) Nursing Tutors and’
Public Health Nurses; (xv) former Unipurpose workers to become
Multipurpose Workers (Male Health Workers and Assistants)^ (xvi)
□
Dais (traditional birth attendants) and (xvii) Village Health
Guides;
(d)
Improving the Management and Operation Systems through ensuring
the supply and distribution of (xviii) vaccines, (xix) cold-chain
equipment, (xx) vehicles; (xxi) contraceptives; and (xxii)
undertaking demographic research and evaluation; and
(e)
Increasing the Demand for these services from the public by
(xxiii) Information, Education and Communication programs (IEC);
(xxiv) increasing the involvement of Private Voluntary
Organizations (PVOs) in the program; (xxv) social marketing of
contraceptives (pills and condoms) and (xxvi) supporting family
welfare programs in the organized sector (Railways, Defense,
Labor, etc) and private sector companies.
9
fe)
3
3
&
©
61
5
ANNEX 3
Page 3
3
Section 3:
>
INDIA
»
SteriIisati ons
IUD insertions
Oral Pills Users
Conventional Contraceptive users
I
>
*
Family Welfare Statistics (in millions)
198$-87
1987-88
1988-89
1989-90
1990-91
5.04
3.94
1.83
9.83
4.94
4.36
2.06
11.34
4.68
4.85
2.42
12.42
4.18
4.94
2.74
14.19
4.12
5.32
2.49
14.71
26,901
61,699
1,768
205,134
28,971
64,246
2,509
235,737
31,456
69,402
3,328
370,217
31,917
70,630
3,484
318,301
33,368
71,454
5,612
298,883
29,248
10,655
56,386
11,531
34,621
13,342
44,638
35,739
26,159
12,740
33,401
12,973
26,244
14,170
25,044
15,391
23,307
13,621
18,212
28,960
28,991
6,545
1,751
6,911
27,881
7,554
1,671
6,968
28,605
7,385
2,283
10,933
27,437
7,151
3,456
13,498
30,133
7,874
3,780
13,986
31,393
17,489
3,312
4,223
25,118
16,673
4,357
10,963
16,289
16,878
4,731
11,601
10,833
18,661
3,452
9,370
20,208
18,767
3', 811
11,433
NEW DELHI (In actual nimbers)
SteriI 1sati ons
IUD insertions
Ora I Pills Users
Conventional Contraceptive users
>
5
)
CALCUTTA (In actual numbers)
SteriIi sati ons
IUD insertions
Ora I Pills Users
Conventional Contraceptive users
)
>
HYDERABAD (In actual numbers)
>
SteriIi sati ons
IUD insertions
Ora I Pills Users
Conventional Contraceptive users
BANGALORE (In »ctu»l numbers)
>
SteriIi sati ons
IUD insertions
Ora I Pills Users
Conventional Contraceptive users
>
>
)
>
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)
>
>
>
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m2
ANNEX 4
Page 1
3$
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
ORGANIZATION AND MANAGEMENT OF FAMILY WELFARE PROGRAMS
■
'BANGALORE
)
Bl
1.
The Bangalore City Corporation (BCC) functioning under the Karnataka
Municipal Corporation Act 1976, is a local self Government with an elected
Mayor/Administrator at the head of the administrative structure/policy making
body viz. the City Corporation Council. The Commissioner is the executive
head of BCC, and is assisted by 3 Deputy Commissioners. The Health FDepartment;'^
of the BCC, under the supervision of a Health Officer is responsible for
providing health and FW services, environmental sanitation health licenses,
vital statistics, and health education. Administratively the area under the
BCC is divided into 6 zones - North, South, East, West, Central and South
V..-)
west. Each of these 6 zones are supervised by 6 Deputy Health Officers
(DHO’s) who report to the Additional Health Officer (General). Each zone is
•S •further divided into two ranges, which is supervised by a Medical Officer
Health (MHO) each, and corresponds to a Karnataka Legislative Assembly
Constituency. The principal task of the MOH is environmental sanitation.
However DHO’s and MOH’s also supervise the Assistant Surgeons who look after
the maternity homes, dispensaries and sub-health offices. BCC is divided int.?(
87 divisions, each represented by a Municipal Councilor, For the maintenance
of sanitation and other public health programs, one or_ two Junior Health
,T
Inspectors are appointed for each division of BCC. Senior Health Inspectors* .:)
supervise 3 to 4 Junior Health Inspectors who work under the supervision of
. ii)
MOH.
One DHO designated as Headquarters Assistant, assists the Health. Officer
2.
in administrative work, also implementing the PFA Act. There is a separate 0
Surgeon MC with an MOH (MC), Entomologist, 5 Unit Officers, 25 Junior Health
Officers, 25 Head gangmen, 300 gangmen looking after malaria control. An
4.3
Assistant Surgeon is in charge of the 23 Dispensaries which provide curative^
services, and 12 sub health offices which are involved in the Public Health
work like anti-rabies, cholera, leprosy, T.B. tcontrol,, 5 Mobile Dispensaries
2 ISM, and 1 T.B. Dispensary, One Surgeon (FP) is working as Project Officer^
under UBSP scheme.
One MOH (MCH) is in charge of the City Family Welfare Bureau, and is
3.
3
responsible for Family Welfare and MCH activities. She supervises 30 MCH
Centers and 19 Urban Family Welfare Centers (UFWC’s). Of these, 16 are
4J
attached to maternity homes and 3 are independently based. The 30 maternity
homes together have 754 beds. They are staffed with 30 surgeons (Lady
doctors), 30 staff nurses, 13 LHV’s and 169 ANM’s). The UFWC’s have 16
assistant surgeons, 2 extension educators, 19 LHV’s, 57 ANM’s, one
statistician and one lab assistant. One Additional Health Officer (FP and
MCH) performs the overall supervision of FP and MCH functions.
o
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63
ANNEX 4
Page 2
1
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4.
The Corporation has a referral hospital with 30 beds functioning under
the supervision of a Medical Superintendent who has one pediatrician, one
obstetrician, one assistant surgeon, one staff nurse and 2 ANM’s to assist.
Besides this, referrals are also made to the 16 government hospitals and 17
private hospitals in the city.
5.
50Z of all ANMs, LHV*s and assistant surgeons are on deputation from the
State Government. The DHO’s, surgeons and MOH*s are Corporation employees.
The Health Officer has conventionally also been a State Government employee on
secondment. They all function under the overall charge of the Commissioner
who is invariably from the administrative service on secondment.
>
CALCUTTA
>
3
3
3
J
)
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>
f
1.
The CMDA shares the responsibility with the State Government in the
implementation of the health and family welfare program. The Calcutta
Corporation plays a major role in this as provided under the Calcutta
Municipal Corporation Act 1980.
2.
The Calcutta Metropolitan Area (CMA) is composed of three Municipal
Corporations, (Calcutta, Howarah and Chandhan Nagar), 31 Municipalities, 2
Notified Area Authorities, 70 Non-Municipal Urban Units and 390 rural mouzas.
3.
At present there are 138 hospitals with 23,112 beds available in
the CMA area which gives a bed ratio of about 2 beds per thousand population.
Facilities for referral services are mostly located in the city of Calcutta
and some in the Municipal towns. In addition there are 75 dispensaries and 73
clinics (T.B., Leprosy, MCH and Family Welfare Clinics and 5 Polyclinics
available in the CMD area. The hospitals include non-allopathic systems -Ayurvedic 3, Homeopathic 4, other systems 8.)
>
3
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4.
The Department of Health and Family Welfare headed by the Health
Secretary, with a Directorate of Health Services is chiefly responsible for.
Health and Family Welfare services. The Health Unit of the CMDA co-ordinates
the delivery of Health, FW, MCH and Environmental Services in the three
corporations, 31 municipalities and the 2 notified areas.
>
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3
3
3
3
•3
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5.
The Corporation area is divided into burroughs and wards. Each
ward has an elected councilor. These councilors take interest in the day-today supervision of their areas. The concentrated participation of the elected
representative is a unique feature of Calcutta and is due to the ruling
political party with a well-developed cadre at the local level.
6.
The Health Unit of CMDA functions under the Director, Health
Program Unit which is under the overall charge of the Chief Executive Officer.
The Director is assisted by the Deputy Director and four Assistant Directors
looking after Implementation, Financing, MIES and Supplies. The Assistant
Director, Implementation has one Sr. Assistant, Establishment and 1 Sr.
Accounts Officer to assist him. The Assistant Director, Training is assisted
by 1 Sr. Training Officer, 1 Jr. Training Officer, 2 Nutritionists and 1
Projectionist. The Assistant Director, MIES has two statisticians for
support. There is a Planning Directorate under a Director-General of Planning
and Development, a Socio-Economic Planning Unit and an Appraisal Monitoring
and Evaluation Unit.
6A
ANNEX 4
Page 3
7In the CMC, the Health Unit functions directly under the
x. V
’
‘3 to the
supervision of the Chief Municipal Health Officer
who
reports
• r chief Municipal Health Officer and,'.-?)
Commissioner. he is assisted by the Deputy <---.
uatt’s with
two Senior Medical Supervisors. One of these SMS supervises t..
the HAU s with
the help of two Junior Medical Supervisors. The
the SMS supervises
sunervises st
DELHI
• .
These are the Municipal Corporation
Delhi Cantonment Board, Delhi Administration
*
•
___________ t-Vio
Of these, the largest areas
Municipal Corporation cf
Pr. the Directorate of Health
Services,
of Del^
Delhi. «™
However,
.
responsibility of directing, coordinating and
Delhi Administration has the
monitoring these services.
care services in Delhi.
2
Health care services in Delhi are provided through a network of
z, There
Hospitals and Dispensaries, Tuberculosis and Leprosy Treatment Centers,
Leprosy
ore 417 Dispensaries 50 Hospitals, 12 T.B. Units, 6 STD Units and 8 1 .
182 x
'•ry
Sis'ndTnSbe^of'ciinSs through 4
Practitioners (PMPs) who are registered with the Delhi Medical
A)
However, the number of unregistered practitioners
to
Practitioners (RMP's) providing health service is unknown.
.
this for the delivery of Family Planning and MCH the government is run
g
Health 3
Among these are
Narayan Hospital and the Sanjay Gandhi Memorial Hospital.
The MCD being the largest provider of health services manages 9
@
q t p
cHnir«j 104 I.S.M. Dispensaries and
SStl’ i? ^“1“ a-.’. 102 pX
caters
33 Sub Caters^
3
The Health .nd ramlly Welfare s.relees in the BCD are h'“S
s: x:
~e
,J
reportin^to hla. one of ,ho. B.a.gee the delivery of Public he. th and th. ?
other Vho looks after th. hospitals. Dl.p.n.atl.s .»d .peel. Cl n cs
J «
is a separate D.H.O. who manages maternal and child health serv
,
V
There
are
separate
Planning, ICDS, Immunization and Nutrition. There are sep
..i’ *ftrea is
U:kl„BE;ftet
ant1...l.rl. .»d
O
after Anti-malaria
and T.B. Control Programmes.
_
There
are
10
urban
zones
further sub-divided into Zones.
Zonal Health Officer.
each of which 1functions
------- under the supervision of a 1--and monitors the health
\ and voluntary agencies
is headed by the
--'‘thSrSo^xx Xc:r7.8enea
XlX XX
h Xlees
is assisted by an Additional Director Health Services, Headquarte
&
^3
>4^
)
45
ANNEX 4
Page 4
>
Additional Director, Health Services/Family Planning. For administrative
services, the city is divided into 4 zones - North, East, West and South.
Each zone has 45-50 dispensaries and is managed by a Medical Officer who is
assisted by an Additional Medical Officer, 2 Pharmacists, 1 ANM and 1 staff
Nurse. All the Medical Officers report to the Chief Medical Officer, in
charge of Zones, who is supervised by the Additional D.H.S. Headquarters. The
Additional D.H.S. Family Welfare coordinates Family Planning and MCH services
with the help of an Assistant Director and an EPI Officer.
.)
>
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>.
HYDERABAD
»
1.
The Municipal Corporation of Hyderabad functions at present under
the over-all control of the Special Officer who is the Principal Secretary to
the Government in the Department of Municipal Administration and Urban
Development. The elected Mayor who held office until a few months ago,
completed his tenure and the State government has yet to announce the dates
for the next elections. The Corporation is headed by the Commissioner who has
^Additional Commissioners to assist him in looking after general
administration, Accounts, accounting, etc. There is a separate Additional
Commissioner for Secunderabad and one for the ODA project. The Commissioner
also supervises the Engineering Wing consisting of the Chief Engineer, 3
Superintending Engineers and 10 Executive Engineers; a divisional Forest
Officer, Chief City Planner, Chief Horticulturist and the Chief Medical
Officer of Health.
>
)
5
>
>
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2.
The Health Unit of the MCH under the Chief Medical Officer of
Health is responsible for providing health, family welfare, MCH and
environmental sanitation services. The area is divided into 6 circles, each
supervised by an Assistant Medical Officer of Health. Secunderabad has a
separate Medical Officer.
These circles are further sub-divided into 23
wards each having 8-12 blocks in it. These are supervised by 66 Sanitary
Supervisors who have 342 sanitary Jawans, 4,900 Sweepers and 641 Scavengers to
assist them in keeping the city clean. Besides this, there is an Entomologist
looking after malaria control and he is assisted by 3 senior entomologists, 9
sanitary inspectors, 5 health sub-inspectors, 85 field assistants, 225 field
workers and 9 insect collectors. There is a separate Medical Officer, Cholera
Control who has a staff of 9 Health Supervisors and 2 ANM’s to assist him.
>
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i
3.
The Health Care services of the city are provided by government
Hospitals and Dispensaries as well as private practitioner«s. There are 12
Teaching Hospitals (with 5,559 beds), 8 non-teaching hospitals (449 beds), one
ESI hospital (300 beds), 1 RTC hospital (70 beds), 5 PP units (70 beds), In
addition, there are 3 hospitals run by the Railways, Defence and CRPF (140
beds).
4.
The FP and MCH services are under the charge of the Additional
District Medical and Health Officer who is in charge of the City Family
Welfare Bureau. There are 15 Family Welfare Centres and 19 Child Welfare
Centres where the Ante-natal and Post-natal services are available. Of these
centres, 13 are attached to Maternity Hospitals under the government, 12 are
under the control of the Municipal Corporation and 6 are with Non-governmental
Organizations. The government also manages 34 Dispensaries and 33 ESI
Dispensaries while PMP’s run 1,200 dispensaries and 120 Nursing Homes.
>
>
■^Ki: -i
ft- -g•TVA*"
— —--
-.-_r
2* ~~
"** ~^*-?**~* ’
*~'
—“-—• - -
-—. -
■5
46
ANNEX 5
Page 1
INDIA
>
FAMILY WELFARE (URBAN SLUMS) PROJECT
STATUS OF BASIC EDUCATION FOR FEMALES
Table 1:
Percentage of Literate Population
(Aged 7 and Above in India, 1991) 11
•fl
Literate
India
AP
Delhi
Karn
WB
Total
Male
Female
52.1
63.8
39.4
45.1
56.2
33.7
76.0
82.6
68.0
55.9
67.2
44.3
47.1
67.2
47.1
Table 2:
©
Primary School Enrollment (Total and girls) in India, 1986 2.^
Lower
Primary(I-V) India
AP
Delhi
Millions
Kar
WB
Total
85.91
6.22
0.81
5.06
6.83
Girls
35.91
2.68
0.37
2.27
2.97
Z of Girls
41Z
43Z
46Z
45Z
' ,43Z
' Upper Primary(VI-VIII)
i!
4
i
Total
27.27
1.62
0.47
1.47
1.85
Girls
9.63
0.58
0.18
0.59
0.71
Z of Girls
35Z
36Z
45Z
40Z
39Z
Total Primary School Enrollment (I-VIII)
Total
113.18
7.84
1.22
6.53
8.68
Girls
44.69
3.26
0.55
2.86
3.68
Z of Girls
39Z
42Z
45Z
44Z
42Z
1/
2/
Source:
Source:
Census of India 1991, (series 1), p. 67.
Fifth All India Educational Survey, 1986, pp. 67-68.
©
..>w
X-
‘
^7
ANNEX 5
Page 2
I
SECTION 2; DETAILED FEMALE EDUCATION PROPOSALS
A.
i.
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$
BANGALORE:
1.
It is estimated that there are 48,000 girls in the age group 5-11
living indiums. Assuming that 25Z are not attending schools, 12,000 girls
would be provided "incentives" to attend school or provided with functional
literacy. However, the Baseline Survey which has already been initiated, will
reveal the number of boys and girls, in the age group 5-11 not attending
primary school. The Municipal Corporation will provide "incentives" such as
books and school uniforms to induce the girls to attend school. The
Corporation will also supplement "incentives" with grants to Private Voluntary
Organizations to provide functional literacy to girls in the ages 5-11
residing in slums and not attending schools. As a part of Innovative Scheme
L
Program, PVOs would be encouraged to promote vocational training and
^3 upgradation of skills among adolescent girls and women in slum areas.
)
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B.
CALCUTTA:
2.
The average female illiteracy rate in the low income settlement is
40Z. The reasons for relatively low levels of enrolment and high drop-out for
girl students include the following: (a) girls are to share household
responsibility of looking after their younger brothers and sisters and to do
the household work. The parents, therefore, are unwilling to send them to the
school; (b) girls in poorer families are employed as house-maids and sending
them to the school would deprive the parents of earnings; (c) women having
secondary role in the socio-economic scene are ignored in preference to their
male counter-parts. This also reflects in providing education to children;
(d) the school environment in many cases, is not comfortable for the girl
students. For instance, toilets for girl students are not available at many
schools; and (e) parents find that the type of education imparted in the
school does not help the girl in her future life either for work, or rearing a
family and caring for children.
3.
The strategy for improving female education would be to address the
.problem in a comprehensive manner by providing: (a) early child care;
(b) primary education; (c) non-formal education for adolescent girls; and
(d) adult education.
4.
The State Government has recently undertaken a massive program for
the eradication of illiteracy in the entire State. The existing schools under
the Local Authorities, State Education Department and under non-governmental
organizations are trying hard to impart education at the pre-primary and
primary levels both for men and women in different areas. To improve female
education both in qualitative and quantitative terms, the present project will
include the following actions: (a) the HHWs will be trained to motivate the
beneficiaries of the health program to promote education of the girls in their
families; (b) the IEC activities in the project shall include special programs
to make the community aware about the need and importance of female education;
(c) essential repair including provision of toilet facilities for girls would
be undertaken in the schools; (d) incentives would be provided to the girl
student in form of supply of school uniform, books for library, stationery,
3.
^2^
. ..... .
>
B
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48
ANNEX 5
Page 3
stipends and scholarships; (e) at the Block and Sub-block levels, efforts will
be made to link the women beneficiaries under the project with the Adult
Literacy program run by various organizations; and (f) efforts will be made as,,
part of the program to provide vocational training to entrepreneurs for income
generation.
5. ’
Non-formal Education for Girls in the Age Group 7-14 years and
Illiterate/"Below Primary" Adult Women to be organized by Local Bodies. .The
main objectives of the project in Calcutta include raising the health status
of women and children and supporting the National Family Welfare Program
among the economically weaker sections. Efforts to raise the literacy status^
of women living in slum areas would go a long way .towards meeting these
objectives. The educational levels in the slum areas are
generally
low. All the surveys and studies for slum areas undertaken recently, suggest
that female literacy rates are far below the overall literacy rates. Because
of the lack of education, women belonging to poor households are often not in;Q
ia position to benefit from the ongoing welfare activities undertaken by
Government, different NGOs and other welfare agencies. The success of the
Project hinges on effective communication with
1 mothers and generating
awareness among women. Raising the literacy levels of women would greatly
facilitate this task.
6.
The State Government has launched an ambitious project for
eradication of illiteracy in the State. But it will take time before the
gains of the project are adequately stabilized. Some limited attempts to
raise the literacy status of women in the project area are proposed as a part
of Innovative Schemes. Illiterate women, women who do not have "primary
level" of education, and girls in the age group 7-14 years who do not go to
school would form the target group. The program will be implemented through.* ;
local bodies situated in CMDA and benefit 25,000 women/girls in 5 years. The')
task of teaching will be entrusted to honorary teachers to be recruited by
respective local bodies. Classes would be held either in the courtyards
attached to houses or in some local institution. While designing the program;^
efforts have been made to keep the costs low so that some of the local bodies
could replicate the model from their own resources. The expenditures would
include teachers, training costs, payment of token honoraria to teachers,
costs of teaching equipments/facilities, providing learners with some reading/
writing materials and supervision costs. The program will be planned,
0
implemented and monitored in a decentralized manner. There will however, be
0
some competent specialists in the project to guide the local bodies and
facilitate monitoring. The methodology is outlined below.
■
Target
Duration
Methodology
<)
25,000 learners in 5 years.
12 months each.
•3
250 honorary teachers to work with groups of 20"'
learners - under supervision of local bodies - '7)
classes to be held in household courtyards or ..
premises to be made available by the community.-'
7.
Vocational Training to Women » to be organized by Local Bodies.
Enough data are available to suggest that the extent of unemployment and
underemployment in the slums of CMDA are high. Recently, some efforts have
been made by Government and Non-Government Organizations to generate skills
among slum dwellers and assist them in obtaining credit from financial
t.< .■•*5!s^9
o
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49
ANNEX 5
Page 4
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J
1
$
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)
institutions to establish small enterprises. Whatever income opportunities
were created appear to have been usurped by the men. Unemployment and under
employment among women are considerably higher than those for the overall
population.
The Project gives considerable emphasis to the motivation of women
belonging to the target group, and their participation in the planning and
implementation of the project. It will be extremely difficult to achieve this
unless certain steps are taken to improve the economic status of women.
9.
With a view to generating appropriate skills among women in poor
households and creating income opportunities for women, vocational training
courses would be organized by local bodies. Training in appropriate skills
would be imparted by master craftsmen and reputed training institutions under
the supervision of local bodies. During the project period 10,000 women
entrepreneurs/artisans/prospective entrepreneurs are expected to benefit from
this scheme. NGOs and PVOs would remain closely associated with this program
not only in conducting the program, but also in the identification of trainees
in post-training follow-up work. Although vocational training courses would
be organized in a decentralized ways, a small group of experts will be
included in the project organization to guide the training curriculum,
locating master craftsmen and organizing post-training follow-up work.
)
Target
)
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)
>
)
)
10,000 women entrepreneurs/artisans/prospective
entrepreneurs @ Rs. 2,300/- per trainee
(includes remuneration of master craftsman,
conveyance charges, raw materials, tools and
equipment).
10Renovation of Schools for Girl Students. The objective of women’s
education will be supported by adding to the existing infrastructure
facilities. It has been ascertained from the local bodies that about 100
schools, both primary and secondary, situated in the project area are in
urgent need of renovation/extension to facilitate women’s education. Toilets
for girl students will be constructed wherever needed. The average cost of
renovation/extension of schools has been worked out as Rs. 100,000.
>
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C.
)
11.
At present, Municipal Corporation of Delhi (MCD) operates 1655
schools with a total enrolment of more than 700,000 children. Out of these,
426 schools are situated in J.J. clusters and slum areas with a strength of
300,000 children out of which 140,000 are girls. In order to enroll 100Z
girls in primary schools, to retain them up to Class-V, and to improve their
achievement levels, the following are proposed under the project:
)
)
)
DELHI:
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12.
Opening of New Nursery Sections. At present, MCD runs 34 Nursery
schools and 735 sections attached to primary schools. However, there are
thousands of girls between 3-5 years of age who are not provided pre-school
education. It is proposed to open 100 new sections in schools situated in
J.J. Clusters and Slum Areas.
e.
50
ANNEX 5
Page 5
! free of charge to poor
School uniforms are suPPlied
10.0
million under this
Uniforms.
13 e
Free____
MCD
is
spending
Ks
.
who
do
not get uniforms
At present
and needy children.
thousands of girls
dditional
of 100,000 girls.
Nonetheless, there
are
is proposed
to cover an ad
Scheme. 1--under this scheme. It l .
T.V., wall posters,
Of Awareness. Mass media i.e., radio, creating awareness
be used for specially the girls.
14>
Creation "^""literacy marches will
1
their
children
hoardings, banners about the education of
among the parents
identify Juggi
It
higher^
„
h.rlv Chua
‘op.«t ratesto are
is rJUd
lower■
open 30t)^
female '"nd;
child. »
Each
than the average especiaily to
rimary schools in JJ
-n Nursery trained
X creches In che
«L1 be
ttached to one Primary
Creche looking after
.ximately 33 creches
creches will be a - Anganwadis/Balwadies,
teacher and 2 Ayas. APp*°XRes0U/ce center
Center ffor creches, this program to avo^
I
school which will serve
re, will also Ko
be brought
brought under
both present and prospectiv
and responsibilities.
?
of functions u—
.
pof^
overlapping
• L for Children.
cblldh-Aidnc^So^^
r-vicinity
Earl
habits in the slum
16.
J
schools located in the
pre-primary.^
Years.
’ proposed to
to be opened in
1> Primary
3.6 yeB„. Each
.
sections are ■3 for children in the ag 8
teacher
and one
have one
of JJ Clusters
consbtU of
-S arid PW'-"1 instruction^
section <-- _
Flexible curricula which vn
Aya.
will be adopted.
situated in the vicinity
Education. Many of the schools
This is a great
-17
primary -------- ^without proper toiler facilities. to provide 2tIt is proposed
jj clusters are atgirl
present
child attending school,
handicap for the
uucn-lOD non-fo^a
toilets in these schools.
It is proposed to open
the vicinity<§|f
• schools in
ial Education
.nd
-th..
. K "Ofit of flexible hours,
“in
thT^rimary
"“Sse
»»
center.^in h.r.
teducation ^e‘‘
*53
«>•
.„.J the
benefi
erial. ^P"
Proper ®
centers ’^5*.
trained instructors and through^th^Principal/Headmaster of f
• ' will be done
•X"T1
be P.ld
honorarium.
Will iuo
also be
paid honorarium.
w
I
ss^i—- -
4 1 Timing Centers fo^farene^S^^^-^h^
I9.
Of legal rights^
Generation
training to the 8irPs
first aid, home economy,
‘dn,“norms,
:^e.r
£.th.otLohood
second year ^T
- w
family
safe
mother o .
upgradation anc.)
social issues small fam^yc
related topicS. Skill upg^
nutrition, foo
for starting selfand bag making,
^^Xt^r’de. llhe’cottinF and tailors. 1«>1«^
-J,
preservation, etc.
3
1
51
)
ANNEX 5
Page 6
D.
3
HYDERABAD
20.
Adult Literacy Program. Under this program, one women will educate
ten women. This innovative program
j---started in October 1990, is to be
continued for about one and half years. There are 757,754 illiterate females
as per 19?1 census in Hyderabad City.
The dropout rate amongst girl students
at the primary level is very high. Only 42 out of every one hundred enrolled
in_ class one reach class five. Parents
Fuieuus assign
assign domestic
aomestic responsibilities
responsibilities to
girls at a fvery
----- -----•’
•believe
-•
young age and’ they
that education is of little value
to girls as their life is going
w,
« to be devoted
-- 1 t_
to marriage and motherhood.
There is also child labor in the slum communities.
3
>
>
>
I
I
r;
>
21 *
Primary Schools. The majority of schools have one or two rooms and
do not have ancillary facilities such as drinking water, urinals and
lavatories. This is one of the main barriers to girls having access to
education. At present, the State Government does not provide any incentive to
encourage female education. The majority of slum women work in the
unorganized sector like household work, daily wage earnings in beedimaking.
As a part of Community Needs Assessment Study, it is proposed to undertake a
special study to formulate Action Plans for female education with the
involvement of the Education, Women’s Welfare and Adult Education Departments.
>
>
>
>
)
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>
>
>
>
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r
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)
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56
Extension Educator
PEN
Statistical Assistant
Computer
UDC-cum-Store keeper
LDC-cum-typist
Attendant
ANNEX 7
Page 3
1
1
1
2
1
2
2
1
1
1
1
1
1
1
1
1
1
1
7..?
The Scheme was reviewed in December, 1985, under the Chairmanship of Un^r
5.
Health Secretary and it was <decided to impose a ban on filling up of the posts of1
Multi-purpose worker (male
(male)) and discontinuation of payment of honorarium
Voluntary Women Health Worker.
In a meeting held under the Chairmanship of Joint Secretary (S) on Septen^x
6.
26, 1991, it was decided that:
(a)
only ’D* type Health Posts would be established in future
population of 50,000 and at least 40Z of this population should be siui
or belonging to weaker section of the society;
(b)
the existing Urban Family Welfare Centers are to be re-organized iiitt
’D* type Health Posts and the staff would be adjusted in the
established ’D’ type Health Posts;
(c)
instead of appointing 6-8 Multi-purpose workers/ANMs (3-4 male and:rV
females) at the 'D’type Health Posts only 5 MPW (F)/ANMs would
appointed at each Health Post, in addition to one LEV/PHN/Heiirl
Assistant (F);
Q
(d)
a total of 1-3 posts of MPW (male) will not be required;
(e)
2 posts of Sweeper-cum-Chowkidar would be created in zorder to ioo’
after the cleanliness/security of premises of Health Post; and <3
(f)
the male MPWs already appointed would be transferred to the sub-cente r
functioning in rural areas.
@
••
'-3
e
$
©
7"
■
■
■
■
3
57
ANNEX 7
Page 4
3
PART B:
URBAN REVAMPING SCHEME AND PROJECT INSTITUTIONS
3
URS
>
’D’ type
Health
Post
BANGALORE
97 Health
Centers
CALCUTTA
DELHI
109 Health
Administrative
Units
25 Health
Centers
763 sub
centers
650 Health
Posts
6 Upgraded
Health Centers
>
18 Expanded
Special
Outpatient
Departments
>
12 Maternity
Homes
>
*
)
*B’ type
Health
Post
1
)
1
Other
Facilities
>
>
J
>
>
)
>
i
>
>
>
)
>
>
>
70 Health
Centers
’C’ type
Health
Post
¥
)
HYDERABAD
X
24 Maternity
Homes
17 Upgraded
Health
Centers
ANNEX 7
Page 5
58 -
PART C:
THE OUTREACH SYSTDj
bangalore
Community
Link Worker
Contact
1 per 5,000
population
Supervision
CALCUTTA
Honorary
Health Worker
1 per 1,000
population
DELHI
HYDERABAD
Bustee
Sevika
Link Worker
1 per
1,000
populati
on
1 per 1,000
population
b
ANM
Second-Tier
Supervisor
PHN/LHV
PHN/LHV
Public Health
Nurse (PHN)
Lady Health
Visitor (LHV)
Lady Medical
Officer at
Health Posts
(Health Center)
2 Part-Time
Medical
Officers - 1
per Health
Administrative
Unit (HAU) and
2 Part-Time
Specialists
per ESOPD____
Lady MO
at
Health
Center
Local
Authority
Medical Unit
Deputy
Health
Officer
Senior Medical^
Officer
CMDA Health
Program
Administrative
Group
‘Municipa
1 Health
Officer
Deputy
Director,
Urban Health
3’
Service
1st Level
2nd Level
3rd Level
Management/
Administration
r
First-Tier
Supervisor
ANM
Auxiliary Nurse
Midwife
Senior Lady
Medical Officer
(at upgraded
Health Center)
Medical Officer
(FP/MCH) in
Urban Family
Welfare Bureau
I
/■.
Lady MO at
Urban Health
Posts
vg
—------ ®
©
Additional
Director,
Urban Health y
Chief Medical
Officer
I
- 59 -
ANNEX 7
Page 6
5
Health Administrative Unit (HAU)
It is an iadministrartive unit for delivery of primary health care
services including outreach activities.
>
Features:
>
(a)
Coverage: Each unit will cover about 35,000 beneficiaries of
target population residing in areas under control of the Calcutta
Municipal Corporation and local bodies.
(b)
Administrative Control:
Local Authorities.
(c)
Responsibilities: (i) Identification of beneficiaries; (ii)
Primary selection of Honorary Health Workers (HHW); and (iii)
Overall administration, supervision and monitoring of the program.
(d)
Functions: (i) to act as administrative office to all health
activities except treatment of patients; (ii) storage facilities
for immunization materials, common drugs, family folders, etc;
(iii) compilation of monthly reports.
>
>
)
Elected local representatives of the
>
>
>
Sub-Center
>
It is an intermediary tier for service delivery and a nerve center
for delivering outreach services.
Features:
)
)
>
5,000 beneficiaries (i.e., seven sub-centers under each
(a)
Coverage:
HAU)
(b)
Administrative Control: One first tier supervisor recruited from
among the Honorary Health Workers (HHW) to supervise activities of
5 HHWs
(c)
Functions: (i) Medical check-up and immunization; (ii) Growth
monitoring and distribution of nutrition packets; and (iii)
Maintenance of eligible couples and children register.
>
Block
It is a well degined grass root level project area.
>
Features:
>
>
>
)
>
)
(a)
Coverage:
1,000 beneficiaries
(b)
Incharge;
Honorary health workers (HHW)
60 -
(c)
ANNEX 7
Page 7
Q
Functions:
(i) Linkage between HHW and PVO belonging to the
community; and (ii) Organizing community awareness and
participation.
Extended Specialized Out Patients * Department (ESOPIj
It will be an adjunct to existing hospitals or maternity homes.
Services to be rendered:
(a)
Phase I - Medicine, surgery, obstetrics and gynecology and
paediatrics
(b)
Phase II - Ophthalmology, ENT, Dermatology and Dental surgery
‘3
©
Advantages:
(a)
Will reduce overcrowding at existing Government Hospitals
(b)
Will minimize travel distance and time spent on travelling and
waiting by patients.
Regional Medical Store: It is decentralization of Central Medical Store q
ensure steady and regular supply of drugs.
Need: Due to increased number of indenting units namely HAUs, ESOPD andy^
Maternity homes.
Type *3* Health Post
O
•0
Functions:
(a)
To identify eligible couples and to motivate them toa ccept family/^
planning
(b)
List and motivate eligible children under UIP
(c)
Follow up and motivate non-acceptors of family planning and
immunization
©
O
$
©
■£>
©
■4^
©
..S'/?
1
61
ANNEX 8
Page 1
a
INDIA
)
FAMILY WELFARE (URBAN SLUMS) PROJECT
3
3
BILATERAL AND MULTILATERAL ASSISTANCE TO HEALTH AND FAMILY WELFARE
>
I
Donor
Amount
Period
Program
WHO
US$30.0 Mn.
1984-87
)
US2.08 Mn.
1988-89
3
3
US$0.3Mn.
1990-91
Biennium Program: provision of general
medical supplies equipment, educational
activities, including training of Indian
experts, supporting research projects.
For research under Human Reproduction Pro
gram
FW/MCH Services in Urban Areas
US$9.44 Mn.
1980-86
Support to MCH and Immunization program
US$29.0 Mn.
1985-90
Support to health programs, particularly
Expanded Proram of Immunization (EPI),
Sexually Transmitted Diseases (STD), Oral
Rehydration (ORT) and Primary Health Care,
support to health worker training, and
provision of vehicles, syringes, needles
and vaccines.
US$184.0 Mn.
1974-90
US$50.0 Mn.
1980-86
US$14.05Mn.
1989-94
Promotion of cash and kind to support
Family Welfare Schemes, manufacturing of
contraceptives, development of population
education programs, strengthening program
management, training lower-level Health
Workers, and introducing innovative
approaches in FP and MCH.
' • '
AREA PROJECT: Rajasthan (4 districts),
Bihar (11 districts)
Area Project Phase II Rajasthan (13 dis
tricts )
DK.2.0 Mn.
US$ 30.0 Mn.
1981-86
Dk.126.56 Mn.
1989-92
>
>
UNTCEF
>
>
>
UNFPA
>
>
>
I
)
>
)
x
>
DANIDA
>
>
ODA
Pd.Stg.170,000
>
>
3
SIDA
>
US$15.2 Mn.
Pd.Stg.20 Mn.
1981-86
1989-94
SK 125.0 Mn.
1984-89
Support to Leprosy Control Program.
AREA PROJECT: Madhya Pradesh (8 dists)
Tamil Nadu (2 dists).
Area Project Phase II: Madhya Pradesh, Tamil
Nadu. No new districts added.
Experts to support various health insti
tutions .
AREA PROJECT: ORISSA (5 districts)
Area Project Phase II: Orissa (5 districts)
Equipment and other support for TB, Leprosy
and Malaria Control Programs.
3
>
)
y’1
SB-'
J -
■
.
62
4
ANNEX 8
Page 2
I
Donor
Amount
Period
Program
NORAD
NK.378.5 Mn.
1969-88
NK.90Mn
1988-91
Support to post partum program in Urban
and Semi-Urban areas.
Training and Management activities under
Post Partum Program
US$ 20.0 Mn.
1981-
US$33.0 Mn.
1980-86
USAID
US$47.0 Mn.
1
Strengthening private and voluntary sector
to expand and improve basic and special
preventive health, family planning and
nutrition programs.
AREA PROJECT: Punjab(3 dists), Haryana
(3 districts), Himachal Pradesh(3 dists),
Maharashtra (3 districts)
Development of a Contraceptive Marketing
Organization.
>
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©I
0*
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=1
ar
*
9:
• - J)
o
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©
©
1
0
□
&
©
©
'
J,
V-;-
■'W
*
63
ANNEX 9
Page 1
3
INDIA
J
FAMILY WELFARE (URBAN SLUMS) PROJECT
IDA-ASSISTED POPULATION AND NUTRITION PROJECTS
>
)
Credit
No.
Name of
proj ect
Description
Effective
Date
Closing
Date
Total
IDA DisburProject Cr. sement
04/10/92
(In Millions of US$)
>
CR.312
>
>
>
)
>
>
>
CR.981
)
x
>
>
»
>
>
>
>
)
>
U.P.(6 dists)
Karnataka(5 dists)
1st Pop a)expansion of
05/73
ulation
health infrastruc
ture; b)provision
of additional supp
lements and testing
alternative patterns;
c) creation of two
population centres
to design a MIES,
evaluate performance,
and recommend changes;
d) technical assistance;
and e)creation of popu
lation units in two
established management
institutes.
A.P.(3 districts)
U.P.(6 districts)
2nd Pop Project was based on
07/80
GOI Model Plan(Area
ulation
Projects Program).
Included a)construction of facilities;
b) provision of staff;
c) training; d)IEC;and
e)monitoring and evalua
tion .
05/80
03/88
96.0
21.20
21.20
46.0
38'. 8
64
ANNEX 9
Page 2
Credit
No.
CR.1426
CR.1623
Name of
proj ect
Description
Effective
Date
Karnataka(6 dists.)
Kerala(4 dists.)
3rd Pop- a)Civil works in
selected districts
and on broader
state perspective;
b)training; and c)
monitoring & evalua
tion.
West Bengal(4 dists.)
4th Pop a)Civil works in
ulation selected districts
and on a state-wide
basis; b)training;
c)monitoring and
evaluation;d)demand
generation; e)service
delivery, and ^dev
elopment of a State
Institute of Health
& Family Welfare.
CR.1931 Sth Pop
ulation
05/84
Closing
Date
03/92
Total
IDA Disbur-^3
Project Cre. sement
04/10/92
(In Millions of US$)
123.5
70.0
82.14.
©
©
12/85
12/88
Bombay and Madras
a) construction of
new and rehabilita
tion of existing
health posts;
b) development of out
reach programs; c)re
organization of Family
Welfare Bureaus; d)trg
of all cadres of family
welfare workers; and e)
increasing PVO and private
sector participation in
family welfare through
grants-in-aid and innova
tive schemes.
08/93
89.9
51.0
42.52
e
Q
D
12/95
78.2
57.0
37.30
o
$
■a
o
9
O
u
©
©
3
O'.':®!
65
ANNEX 9
Page 3
)
Credit
No.
Name of
project
Description
Effective
Date
Closing
Date
Total
IDA Disbur
Project Cre. sement
04/10/92
(In Millions of US$)
1
)
>
Cr.2O57 6th PopLN.3108 ulation
Andhra Pradesh,
02/23/90
Madhya Pradesh,
and Uttar Pradesh.
a) const, furnishing,
and equipping of SIHFW,
Divisional (Regional)
Training Centers and
District Training Teams;
b) strengthening Direc
torates of Health and
Family Welfare through
creation of Human Resource
Development Cells, insti
tuting Personnel Manage
ment Information Systems;
c) rehabilitating and
building new pre-service
training institutes for
Male and Female Health
Workers; d) training of
trainers and development
of training materials; and
e) upgrading facilities,
equipment & vehicles at
PHCs and sub-centers.
03/97
182.0
124.6
26.55
Cr.2133 7th PopLn.3199 ulation
Bihar, Gujarat
03/19/91
Haryana, Jammu &
Kashmir, Punjab
a) increasing the
supply of services
through upgrading and
expanding the number
of Primary Health
Centers and Subcenters,
and increasing the supply
of medicines, equipment
and supplies for family
planning and maternal
and child survival
strategies; b) increasing
demand through the expansion
of the Social Marketing of
Contraceptives, increasing
the involvement of PVOs in
the FWP, and strengthening
06/98
141.5
86.7
10.0
11.55
>
)
y
>
3
)
>
>
»
>
>
>
>
>
I
>
i
>
»
>
>
»
)
x
Go
Credit
No.
(cont.)
Name of
proj ect
Description
Effective
Date
ANNEX 9
Page 4
Closing
Date
IDA Disbur
Total
Proj ect Cre . sement
04/10/92
(In Millions of US$)
the IEC efforts in each of
the States; c) improving the
quality of family welfare
services by upgrading the
training of all levels of
family welfare workers; and
d) improving management
through the strengthening of
each State’s Directorate of
Health and Family Welfare,
upgrading of MIEPMS, and
expanding demographic and
operational research directly
relevent to program manage
ment and implementation.
12/97
Tamil Nadu
12/05/90
Cr.1580 Second
a) Service Delivery
Tamil
to increase the range
Nadu
Integra coverage and quality of
nutrition and health services
ted Nu
to the target groups through
trition
improvements in the design of
software systems, provision of
nutrition and health education
and of health referral services,
supply of therapeutic food to the
malnourished, increasing the
availability of equipment and
drugs for maternal and child
health, and training for health
and nutrition workers and
traditional birth attendants;
b) communication and community
participation, to stimulate
demand for project services,
improve child feeding and care
practices and promote community
involvement, through support for
insitutional development, provi
sion of communeiaitons equipment
and materials, and support for
formation of women’s groups and
community education; and c) project
management and evaluation, to
expand and strengthen TINP I’s PCO,
to expand and strengthen the
existing monitoring and
'
'3
$
©
©
•
139.1
95.8
6.83
3
>4)
O
&
s
©
o
0
3
3
©
&
©
/
67
3
ANNEX 9
Page 5
5
3
>
Credit
No.
>
(cont.)
>
>
3
)
3
>
>
)
>
>
)
3
)
>
>
>
>
>
Name of
proj ect
Description
Effective
Date
Closing
Date
Total
IDA Disbur
Project Cre. sement
04/10/92
(In Millions of US$)
evaluation system, to develop
a new apex institution for
nutrition communications and
training activities in the
state and to provide support
for operations research.
Cr.2173 First In- Andhra Pradesh
01/28/91
12/97
157.5
LN.3253 tegrated Orissa
Child
a) service delivery, to
Develop. increase the range, coverage
Scheme
and quality of nutrition
and health services to target
groups through improvements in
the design and implementation of
software systems, training for health
nutrition workers, provision of
nutrition and health education and
health referral services, increasing
the availability of drubs and
equipment for maternal and child health
and the supply of therapeutic
supplementary food to malnourished
beneficiaries, and construction of
village nutrition centers, offices and
residences for key field staff; b) com
munications to stimulate demand for
project services and improve child
feeding practices and care through
production and dissemination of media
messages, provision of equipment and
materials and training; c) community
mobilization to increase local
participation in and support for project
services and activities through testing
of innovative women’s development
activities including activation of
village women’s groups, development of
income-generating activities, non-formal
study courses for women and development
of training programs for adolescent girls;
and d) project management and evaluation
to manage, monitor and evaluate the project
and conduct operations research to analyze
and improve aspects of project design.
96.0
10.0
8.55
>
3
3
S’?
J ■’
68
Credit
No.
Name of
project
Cr.2300 Child
Survival
and Safe
Mother
hood
Project
Effective
Date
Description
gj.^
ANNEX 9
Page 6
Closing
Date
IDA Disbur
Total
Project Cre. sement
04/10/92
(In Millions of US$)
329.58
The Project would 03/05/92 09/30/95
support enhancement
& expansion of GOI’s
MCH Program for the
1991-95 period. It would
cover the incremental costs
associated with the program.
It would be national in scope, ^ut
with an emphasis on specific districts
where maternal and infant mortality
rates are higher than the national
average. Its
Its specific objectives would
be to8enhance child survival, prevent
^n>.l Bortallty .nd »ort.l«ty .nd
increase the effectiveness of service
214.53
p
■w
■?
■d?'
17.95
1
&
delivery.
,€)|
€>|
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70
ANNEX 10
Page 2
rf
a*
PROJECT
COMPONENTS
HAHAQHierr
improvdott
IK40VATIVE SCHBIES
1 BANQALDREJ
CALCUTTA
Conversion of the City
Family Welfare Bureau
into an Administrative
■nd Monitoring Unit,
establishing IEC and
Training Units, reor
ganizing the manage
ment information sys
tem, and coordination
of MCH A FW services
with other health ser
vices like environmen
tal sanitation, con
trol of communicable
diseases, licensing of
food stc. at the level
of the rsnge Medical
officers of health.
Formation of an Imple
mentation Committee
under the chairmanship
of the Mayor to review
progress, the State
Monitoring Committee
under the chairmanship
of the Chief Secretary
to approve Plan of
Action, and Local Com
mi tteee under the
chairmanship of the
Local Counci I lore to
faciIi tate communi ty
parti ci pation.
Strengthening the
Hea I th Uni t ini the
Calcutta Metropolitan
Development Authority
(CDA) into five groups
- Health Program Ad
ministrative Group,
Planning Monitoring
■nd.Evaluation Croup,
Engineering Construc
tion Group, Informa
tion, Education and
Cosatun i cati on Croup
and Training Croup.
A
State.Project Advisory
Coordination CoaMaittee
under the Chairmanship
of the Secretary
Health A Rd, and the
Local Commi tteee under
the Chairmanship of
the Local Authorities
or nomi nsted represen
tative.
Nutrition awareness
for Pregnant and lac
tating aothers and
children 0-3 years;
Intensive Health Edu
cation aaong Urban
Poor; Promotion of.
Wosen’s Education in
Mi nor i ty Coavaun i ty
focussing on drop
outs; Sanitation drive
with Cos-unity Involvement: Health and
Faati ly Welfare Educa
tion asongst adoles
cent girls, non-forssl
education prograa;
Education Program for
Men on Women's prob
lems and iaoortance of
Nutrition awareness
for chiIdren between
0-6 years; Environmen
tal Sanitation Program
for upkeep of facili
ties and cleanliness;
anti-larval program;
creche program to be
attached to HAUs.
Promotion of basic ■ nd
non-formel education
for girls, non-formal/
vocational training
and incoM generation.
DELHI
HYDERABAD
Reorganizing and stre
ngthening of the Di
rectorate of Health
Services, Delhi Admin
istration. Establish
ment of a Project Co
ordination, training’,
MIS, IEC and Project
Administration A Plan
ning, Grants, Accounts
A Auditing Cells in
the Division of Public
Health of the Health
Department of Munici
pal Corporation of
Delhi'
A Steering
Committee with the
Chief Secretary as
Head and a Project
Advisory and Coordina
tion Committee under
the Corporation Com
missioner would be es-
Strengthening of the
City Family Welfare
Bureau in the Health
Unit of the Corpora
tion into 5 sections one each for Adminis
tration, Accounts A
Finance, MIES, IEC/
Training and MCH and
Public Health Nursing.
Commi tTwo Advisory C
tees wouId be■ eatabIi shed - one iat the
State Level headed by
the Chief Secretary
■nd the other at the
Corporation level
headed by the Corpora
tion Commissioner.
J
i
-I
3€9
tsbIi shed.
-
Sanitation prograe
with coNMiunity partic
ipation.
Strengthen
ing of eaieting strat
egy for control of
gastroenteritis.
Nonforsal education for
adolescent girls.
Nutrition awareness
program for pregnant
and lactating mothers
and toddlers; integra
tion of services of
ANMs and Anganwadi
workers; study of fer
tility behavior among
minority groups; sani
tation drive in commu
nity; income genera
tion among Women in
elume; clean hut com
petition^ well baby
clinics; study of the
incidence of Sexually
Transmitted Diseases
(STD). Basic educati on f or young and
adolescent girls.
i girl ch i I d .
MS
1
,©
a
1
•©I
*** ' if
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I
C$1
.n
W i
©r
©
I
i
.'■t
»
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© )
71
ANNEX 10
Page 3
SECTION 2:
INDICATORS OF PROJECT PROGRKS S
A.
Table 1:
>
BANGALORE
Number and Percentage of Couples Effectively
________ Protected Due to Family Planning Methods
I
Eligible
Couples
Z Protected
due to
sterilization
Z
Protected
due to IUCD
Z
Protected
due to CC
Z
Protected
due to OP
Z
Effecttively
Protected
1989
583.600
37.8
7.4
1.4
1.0
47.6
1995
731,700
40.0
13.0
4.0
3.0
60.0
5
>
>
J
Note:
>
The number of eligible couple in 1990 is low due to limited coverage of
urban family welfare centers. The existing 37 centers cover only 44Z of
the population of Bangalore Urban agglomeration.
)
)
Table 2:
Mortality figures in Different Age Groups
>
)
INFANT MORTALITY
AGE 0-4 MORTALITY
AGE 16-35 MORTALITY
Deaths per 1000 Birth
Deaths per 1000 Birth
Deaths per 1000 Births
Male
Female
TOTAL
Male
Female
TOTAL
Male
Female
TOTAL
1990
56.05
49.17
53.04
67.70
61.17
64.52
19.13
13.47
16.37
1995
46.17
40.96
43.63
53.91
48.42
51.23
14.06
9.36' ■ ’ 11.77
1
1
»
J
5
)
)
>
>
J
5
3
IO
Note:
The data presented in this table refer to Bangalore city, Simialr
information is not available for separately for slums. The proposed
Base Line Survey is expected to fill the gap. The estimate of
infant mortality from civil registration system for 1990 is 26.7 which
is an underestimate as compared to Sample Registration‘Scheme.
The estimates of mortality for 1990 are based on SRS estimate of
infant mortality of 53 for urban Karnataka for 1989. The SRS estimate
of infant mortality approximately corresponds to life expectancy of
68.5 for males and 72.5 for females. The deaths for other age groups
have been derived from South model Life Tables. The projections for
1995 are based on life expectancy of males 71.0 for males and 75.0
for females and South Model Life Tables.
ANNEX 10.
Page 4
72
Mt
4?^
CALCUTTA
B.
?J
Of Couples Effectively
Table 1:
Number and Percentage Family Plannin£jtethods
Protected Due to__
i.f?
Eligible Z Protected
due to
Couples
sterilization
1991
1 560,000
Projected
1997
1,820,000
31.8
47.0
I
protected
due to CC
Z
Protected
due to IUCD
1.4
1.0
6.0
3.0
z
* -i
Z
Protected
due to OP
Effectively '-I
Protected
0.1
34.3
4.0
60.0
y
ej
Table 2:
Mortality. figures
in Different Age Groups
OAGE 16-35 MORTALITY—
INFANT MORTALITY
_
--r 1000
Dea ths per
- — Birth
Female TOTAL
Male
50.0
48.0
52.0
1991
24.0
23.0
25.0
Proj ected
1997
AGE 0-4 mortality_
Deaths per 1000 Birth
Female TOTAL
Male
17.2
15.8
18.5
13.0
11.0
by
Note:
12.0
Deaths per 1000 Births
TOTAL
Female
Male
1.8
1.9
1.7
1.4
1.5
1.4
»ti«s
■
",
-■
conomic Indicators,
Dlr«etor.
have been worked out
1991 figures ■Seclected population: ,5'Ts K
given in the
profile Series West Bengal State
of India (Jan. 1
MOHFW, Government
CMDA Surveys.
19S> -i-
i
■
.5?)
1951
&
■
1’
73
ANNEX 10
Page 5
>
C.
Table 1:
DELHI
Number and Percentage of Couples Effectively
____ Protected Due to Family Planning Methods
>
>
Eligible
Couples
Z Protected
due to
sterilization
Z
Protected
due to IUCD
Z
Protected
due to CC
Z
Protected
due to OP
Z
Effecttively
Protected
1992
1,517,400
21.1
9.1
9.8
0.4
40.4
Proj ected
1995
1,750,000
31.0
14.0
12.5
2.5
60.0
>
)
Table 2:
Mortality figures in Different Age Groups
)
INFANT MORTALITY
AGE 0-4 MORTALITY
AGE 16-35 MORTALITY
Deaths per 1000 Birth
Deaths per 1000 Birth
Deaths per 1000 Births
Male
Female
TOTAL
Male
Female
TOTAL
Male
Female
TOTAL
1989
23.98
16.04
40.02
29.92
28.89
58.81
23.34
15.07
38.41
Projected
1995
NA
NA
NA
NA
NA
NA
NA
NA
NA
)
>
»
>
>
I
>
>
>
>
>
>
)
>
J
>
)
.)
ANNEX 10
Page 6
74
D.
•/)
HYDERABAD
Number and Percentage of Couples Effectively
Protected Due to Family Planning Methods
Table 1:
__________
Eligible
Couples
I Protected
due to
sterilization
1991
560,919
43.45
Proj ected
1995
573,711
45.0
J
Z
Protected
due to CC
Z
Protected
due to OP
Z
)
Effecttivejy|
Protected
2.82
2.55
0.93
49.71
5.0
5.0
5.0
60.0
Z
Protected
due to IUCD
Mortality figures in Different Age Groups
Table 2:
,e)
1990
Proj ected
1995
Source:
Note:
INFANT MORTALITY
AGE 0-4 MORTALITY
AGE 16-35 MORTALITY
Deaths per1 1000 Birth
Deaths per 1000 Birth
Deaths per 1000 Births
'”L
Male
Female
TOTAL
Male
Female
TOTAL
Male
Female
TOTAL
14.43
10.03
24.46
17.98
12.97
30.95
14.68
11.59
26.27
NA
NA
NA
NA
NA
NA
NA
NA
NA
(
'Y
-3:
V.S. Section, MCH, Hyderabad 1992.
■0
1990 totals - Events registed are reported in Table 2 77?
1 M.R. Registered rate (1990), 24.55 per 1,000 L.B.
©
©
&
:
■•■•'■■J'
75
SECTION 3:
ANNEX 10
Page 7
PROJECT OBJECTIVES, TARGETS AND PROCESS INDICATORS BY CITY
)
CALCUTTA
ACTIVITIES
OBJBTTIVES 1
>
SERVICE DELXV6?Y
Eatab 1 i sbiten t of new
EXPANSION
health centers
)
IhOICATORS
TARGET
IB
No. of new centers
ACTIVITIES
TARGET
IAOI CATOftS
763
No. of center* opened
IS
No. of ESOPOs a'
Open eubcentera
estab I ished
Strengthen eiieting
No. of centers
Expanded Special
health centers
strengthened
Outpatient Dept.
maternity homes
(ESOPOs)
at *1
Upgrade maternity homss
)
to upgraded health
fl-
centers
No. of Mternity horn-
Renovate eiisting
upgraded to upgraded
maternity homes
No. of renovated
25
maternity homes
health Centers
>
2
No. of RMC eatabliahed
4,400
No. of women trained
Establish Regional
Medical Center (RMC)
)
QUALITY IMPROV^STT
)
Training of medical
2,400
No. of pereon* trained.
Training of paratechnicaI
health worker*.
women as H-M
officers, health workers,
members of the slum
)
Training of staff
clearanc* board
1,200
No. of *teff trained.
3.SOO
No. of I
including sedical officers.
>
Training of Private
300
No. of PMR3
’■ i ned.
Medical Practioners
)
>
MANACEMBfr IMPROVe^efT
>
>
Conversion of the City
Establishment of Admin,
Strengthen!ng of the Health
Health Unit strengthened
Family Welfare Bureau
and Monitoring Unit
unit in the OOA into 5 groups
HPA Croup established.
into an Administrative
by establishing Health Program
and Monitoring Unit
Adsinistrativa Croup
Establishment of IB! and
Estab I i*hm*nt of IEC
Formation of Planning
Planning A Monitoring A
Training Unit
and Training Unit
Mornitori ng and Evaluation
Evaluation Croup formed.
Croup
>
Apei Cossi ttee fro«»ed
Formation of an Ape a
Eatablishi ■nt of IBI Croup
IEC Croup established.
Forsation of Training Croup
Training Croup established.
Coami ttee
Formation of a coordi
Coordination committee
nator committee
formed
>
EatabIishsent of Engineering
Engineering Construction
Construction Croup
Croup established.
Formation of Project Advisory
Project Advisory Coordi
Coordination Committee
nation Committee formed.
Formation of Local Coi
Local Coauai ttees formed.
li ttee*
>
>
DEMAhO EXPANSION
No. of days in a month
Use of community based
from the community
service* of link workers
Honorary Female Health
the services of >+*f
Workers
used
Involving local bodies/
•lu* bustee groups in
the outreach services
No. of local groups
>
>
No. of days in a week
Use of link workers
Building health center*
No. of health centers
in the slums
buiIt in the slums
involved;
level of
motivation,
)
leve I Of
changed impact on each
>
>
5
i
3
5v
■
4
>
•
J
76
ANNEX 10
Page 8
BANGALORS
AcrivrriES
MJKnYB
CALCUTTA
TAftCCT
DCICATQRS
TARGET
ACTIVITIES
DOICATORS
d&wc gs^ution
Employment of local
S of local
Uae of organized 'ajnadana'
(continued)
reaidantm in the health
No. of day* in a aeek
eapioyed
(voluntary labor)
voluntary labor uaed
Organ!xatlon of health
No. of groupa orgenixed
Building MAUa in the
education activitl
No. of HAU« built
for health education
COeeuntiy
Upgrading coaanini ty-baaod
No. of coaeijn I ty-baaad
Uee of coaaun i ty
Mtemity hooea
■atemity hooea upgraded
development eorkera
realdenta
canter*
'7}
wl th
the coMaunity
No. of daya the aar
uaed; at tha level
other aervicea used
Expansion of neighborhood
No. of com*;tteea formed
Ue* of informal, functional
commi ttoe acheme beyond
and functioning
group* of uaer faailie*
theee informal groupe ee.
for Joint aepagement and
with government ataff/
the 28 which preaently
No. of tiaea in a month
feedback on each of the
appointed volunteer woi
•pacific health Carvice
to give feedback
1
act!vitie* planned for
the project
Analyaio of local health
No. of aurveye commleted
noeda ualng the neighbor
hood coaaitteea
Involving local bodiea/
No. of local
groupa in the oureach
involved;
aervicea
SaIction of one initial
■oti vation,
Liat of the iaauoa
prob Iea/iaoue (aa deaon-
•elected and the actiona
atration) for coaaitteo
pl anned
action
groupe
laivel of
level of
change/iapact on each
Uea of elderly women from
No. of accompanied viaitij^)
the community to bring
In a month;
patient* to the center for
aaaignaent of ree*onai-
Liat* of peraona accept
bilitiaa for varioua
ing roaponaibiIity and
actlvitlaa to romauni ty
kind* of No. *f
permona
activitlea
No. of meeting* held
I Organization of Informal
I meeting* of famili**
prophyIaii*
Organixatione of apace
ba^keta and faaily planning
No. of apacea made
diacuaaion*
ay*i (able or. a
No. of perforaencea,
Orban? ution of local
diaevaaiona, preeonta-
aaota for •IBZ aKoaa*
tion held In a month
Ei tanai on of the U8SR
No. of Iov income
achaaa of Karnataka
noighborhoode added to
the program
Ua« of th« ICO
kHmm
anj •■tonoion of ouch
i
I
coritinoua baa! a
0-'
Organization of apace
No. of creche program*
for creche progna
carried out in donated
Donation of food and
TV
toy* for creche progra*
on an ohgoing baaia
IdentifI cation of troubled
area for tha anti-larval
No. of uneolicited report*
received from the citixe^^
Di aaeai nation of the enti
No. of informal aeetingi
pIacea
The extent of donation*
•
No. of Bnganaeadl
aorkere and center* wood
Involvement of eaiating
No., of organ I xatlona
-root* argan! xatlona
•n^ non-government support
In the project
organixai ton*
No. of aNorly vo«*an who
have taban auch action
•uppIemontary nutrition
larval
information ty
ho Id/epeechee given in
coeminity loader*
a month; th* level of
DI
Survey of the No. vho
■mlnation of Information
regarding the uee of
receive car* and their
■otemity hoaea/hoap i ta I e
aourcea of Information
,.©1
©
regarding euch
Minor rage?
of
aqvl»aant
i totion
No. of repaira done,
level of reporting
regarding repair*
neceaaary
No. of organized
training on health I
training aaaaioni
and their locale
I
-
® i
?
^,7
■
77
)
ANNEX 10
Page 9
J
BANCAUJRe
ACTIVITIES
08JKTIYES
>
CALCUTTA
TARGET
DOICATORS
ACTIVITIES
TARGET
INDICATORS
oe^Aho ceeuTiON
StuWy ta iWsntify ways in
Co-p I at I on anW utilization
(eontlnuaW)
which ths cosnun i ty
of the stuWy, use of citizens
>
any collaborata with
to unWertake parts of
public authorltiaa
ths survey anW nu—bars
i nvoveW
>
>
)
)
Involve—ant of aalating
No. of organ Izationa
grwaaroota organIxationa
with agraa-ants to
anW non-govern—ent —upport
participsta in tha
organ!rations
proj act
Using PNPs as rasourcaa
No. of Ways in a nonth
Using PHPa as raaourcas
No. of Ways in a son th
for tha Wai I vary of haalth
sarwicos of
for tha Waiivary of haalth
aarvicaa of ^Ps usaW
uaaW
sarvioas to tha coaaunily
sarvicaa to tha slua
■oanunity
>
imcvative scwees
Supp I aaiantary nutrition
Nuabar fo LBV babl
for pragnant anW lactating
Supp I i —notary Nutrition for
X of asInouriaaW
chilWrnn batwaan 0-5 yaaro
chi I Wren
■othara
)
Mjtrltlon prog ran for
No. of M InourlahaW
En»l rwiB^iUl an4
X of population covareW
chilWran 0-3 yaaro
shlIWran
Sanitation Prograo
with toil at, Wrainaga,
ooliW waata Wiapoaal
)
anW ssfa Wrinking vatar
faciIi ti as
>
»
Haalth Education a—ong
X of urban population
urban poor
raaalvaW haalth aWuca—
Cracha prograa
unWar cracha »rojr»»
tlon; No. of talks givan
>
>
Promotion of wooan *o
Litaracy rataa aaong
aWucation in ninorlty
si norIty wo-an
coaaijnl ty
)
Sanitation rfrivo with
No. of Wrivea
coaauntiy Inaolvaoont
unWartakan
Haalth anW faal ly wolfaro
No. of aWolaocant girls
oWucatlon anongat
aovaraW with Saw I th anW
aWolaacant girls on
faally wolfara aWuaatlor
)
)
>
I
NFC Prograo
\ Education progras for —an
I anW vo—n
Na. of •4uc»MT
talk.
Frobl.M
)
l« chi 14
Paonia ohllW -ortai I V
rata
i
>
>
>
>
J)
3
a
,X
■
J
,
X of chi I 4ran co*ara4
■■■
78
ANtrEX 10
Page 10
<^<5
oe_Hi
ACTIYTTIES
OBJECTIVES
TARGET
INDICATORS
123
Opening of healfch poah
SERVICE DEUIvefY
HYDERABAD
EXPANSION
Opening health center*
19
ACTIVITIES
No. of heel th posts
Renovation of ealsting
oeened
hwa I th centere
No. of health centers
Construction of
TARGET
INDICATORS
10
No. of existing health
center renovated
3®
new health centers
Upgraded health centers
8
19
MobiIs Health Clinic
(vans)
No. of new health
centers constructed
No. of health centers
Establishing upgraded
upgraded
health center
No. of sobile health
Stengthening
clInics in use
upgraded health centers
No. of medical officers
Training of medical
12
No. of upgraded health
i
centers
No. of upgraded health
isting
centers strengthened
n4 }
■'OJAUITr IMPR0V&O<T
Training of asdics I
300
officers and PMPs
and PHPa trained
1.900
No. of AAX. .nd link
workers trained
I Ink workers
NANACOAeCT INPROVetefT
No. of MCs A staff trained
800
No. of
offI ears
Training of PHPa
Training of AbPis and
170
1.800
Training of AAOis and
trained
No. of workers trained
•©1
I ink workers
Reorganizaing and
Strengthened and re
Estab I i absent of Units
Adsiniatration, Accountai*??
strengthening of Health
organized Directorate
for Adsiniatration
Department of MCD and
and Health Departesnt
Accounts A Finance,
A Finance, MIES, IB!/
Training and XH A Publi<?\)?
Directorate of Family Welfare,
MIES,
...............................................
Health Nursing Units
Delhi Adminietration
and MCH A Public
its-/Train i ng
“
>
ea tab I i shed.
Health Nursing
Establishment of project
Project coordinator
Coordination Cell
estsbIished
Establishment of a
Project Advisory A
State and a Cor
Coordination Cosei I
poration Project
os tab I i shed .
Advisory and Co
EstabIishsent of Administration,
Adsinistrati on-PIanning.
Training. MIS, IEC and
Training. MIS, IEC Calls
Hornitoring A Evaluation,
estsb I i shed
.01
ordination Committees
Grants A Accting and Auditing
Col la
Formation of Steering
and Advisory and Coordination
Steering and Advisory
Coaei tteee formulated;
No. of meetings held
OS^AHD EXPANSION
Invol veotont of Bustos
No. of Surotee Vikas
Use of link workers/
Vikas Kendras for
Kendras Involved
Dais froe the coeeunIty
No. of link workers/
©I
organization of social
prograeM in jhuggies
Construction of local
No. of garbage dhaI Iaus
Gilding upgraded and
garbage dhaI Iaus
constructed
Other health centers
other health centers
In co—uni by
built
Organization of Multi
No. of eoclati
purpose cooporatione I
organ!led
societies
<
No. of upgraded ind
0
Use private eedical
No. who serve as
practltioners (as
volunteers
Volunteers)
Use of community based
volunteer female health
Involvement of Meh I I a
No. who undertake a naw
workers (Bustee Sevlkas)
Mendelie, youth
slum-dwellers orientad
organizations and
activity
I
1
0
OI
religious organixatione
(ea i sb ing)
oi
r
el
•T:5"'' r‘ ’
. gfc7
.....
,
.
X:
79
3
A2TNEX 10
Page 11
?
3
DCLMI
ACTTYITIES
OBJBmVES
HYDSUaxD
tarcct
No. of trained daia
D&UhO EXPANSION
AcnvrriEs
DOICATDRS
(conti nued)
ibc i oroks
TARGET
Use of OTC (orientation
No. of camps which addrei
training campa) and their
the projects’
iaauea
leaders as communi ty
I
Sal action/Recruitment
X of AhMa froo the
of A>tHa f roe a luma
• IUM
>
educators
Uea of eaiating echoola
No. of cl••••• hold
for health and adult
education program*
>
)
>
Involvement of eaiating
No. of organ!xationa with
graaaroota organ!xationa
agreement* to participate
and non—government eupport
In the project
organ! xationa
>
)
Use of PMPs as health
No. of PMPa umad; No.
Uoe of PMPa and PVOa
educators and motivators
of people motivated
to deliver health aarvicea
No. of PHP A PV0« uo.d
to alum population
>
through a grant-in-aid
>
>
IWOVATIVE SQ4e€S
Saniation Pro<jr»o with
X of population covered
Supp I ementary nutrition
Coaauni ty partiaipation
with clean toilet,
program for pregnant and
drainage eolid vaate
lactating mother*
>
No. of LBV babi
dlepoaal and aefe
)
drinking water faclllth
>
>
Effectively Control
No. of people with
Supp I ementary nutrition
No. of caaaa of moderate
Caetroentari tie
gantroentari tica
program for toddler*
and eavere malnutrition
in children under*five
Integration of sorvlcea
s«r»;
>• IntoQrabod
of anganwadl workera and
AtPte
)
t
Study of fertility behavior
Fertility rate* aeong
aoong minority growpa
minority group*
Sanitation Drive ln
No. of ••nltabiort drive
X
)
Co aun I ty
>
Income generation activi—
% of woeten •■oloyad In
tie* among alum women
gainful em) loyoonb
study of the Incidence
X of
of eeaually tranaaittad
SID
>
>
in / *o*«n w • th
dioaeae (STD)
>
i
>
I
>
)
>
)
■'r
>
r-
§X'.:
.. ! ...
•.
.-.J
80
ANNEX 11
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
CIVIL WORKS PROGRAM
Bangalore
Type of Institution
TOTAL
Delhi
Calcutta
TOTAL
FIRST
2 YRS
TOTAL
FIRST
2 YRS
TOTAL
FIRST •
2 YRS
109
26
19
5
36
32
34
30
2
1
10
8
60 “
45
Renovation of Existing
Health Centers
37
22
Construction of
Health Post
7 -
21
Construction of
ESOPD
Construction of
Training Center
125
30
6
4
a
5
Construction of UHC
(Maternity Homes)
Renovation of
Maternity Homes
'Is
FIRST
2 YRS
Construction of
Health Centers
Construction of Quarters
for Upgraded H.C.
Hyderabad
17
25
6
18
2
.$‘>1
a
i
Construction of
Regional Stores
2
Improvements
to Schools
50
200
sl
3
□I
3
“S)
©I
®i
■
jtr—
' ■'
■=•■■■'
■■
81
)
ANNEX 12
Page 1
INDIA
)
FAMILY WELFARE (URBAN SLUMS) PROJECT
I
ANNUAL TRAINING PLAN AND CALENDAR BY CITY
>
Table 1:
Ingredients of a Comprehensive Training Program
)
Bangalore
Calcutta
Delhi
Hyderabad
I
C
C
C
I
I
I
I
)
Management, Coordination and
Monitoring Plan
>
>
)
>
>
Training Needs assessment (Compares
performance with job) requirement
and previous training)
Comprehensive Training Plan
Process of training
>
*
Categories & numbers to be trained
I
I
I
I
>
*
Trainers training
I
I
I
I
*
Methodology
(Lecture, Demonstration,Field Work)
F
I
I
Inc
Development & curriculum/
instructional materials
Inc
I
Inc -
Inc
*
Training impact
Inc
Inc
I
I
*
Venue for training/facilities
C
C
I
I
*
Training support (Housing, TA/DA)
C
C
I
I
I
I
I
Inc
>
>
)
*
>
>
)
>
Types of Training
* Pre-service
*
Induetion/Orientation
I
C
I
I
*
>
In-service (recruitment)
Institutional
I
C
I
Inc
)
On the job
I
c
I
I
>
1
&
I
ANNEX 12
Page 2
82
Content of Training
* Project goals/objective
I
I
Inc
I
* ’
Management/supervlsory skills
I
I
I
I
*
Clinical skills
I
I
Inc
Inc
*
Communication skills (including
motivation)
I
I
I
I
Record keeping statistical skills
I
I
I
I
Adequate Budget
Inc
I
I
Inc
Feedback Loop
I
I
I
I
*
C
I
Inc
J
- initial plan completed
- in process
- needs further study
'©
9
.O
■9
■y)
o
o
©
©
©
©
©
83
AIINEX 12
Page 3
BANGALORE
Annual Training Plan/Calendar
1
N'jcber to b« trained
Of Staff Categori
to be trained
Location
of
Training
Curriculum
Content Topics
y
Type of
Traing.
(P-Pre
Service
OOrientated;
I-InService
(OST)
>
0
1. ProJ. Hd. Stf.
NIHFW
0
2. Munic.Councillors
(0)
>
)
>
Duration
of
Course
(days)
19
92/
93
Plajinlng, M^roant.
3
12
BCCTC
Outreach
1
43
3. Sr. Mad.Officers
EFWTC
Health Ser.Aden.
2
24
4. Gynaecologists
BCCTC
Planning.Org.
2
24
24
I
3. Pedaetricians
BCCTC
Planning.Org.
2
12
12
I
6. Extd.Educ.Offers.
BCCTC
Planning. Org.
2
4
4
I
7. Lady Medical
Officers
BCCTC
Supervision,
Clinical
3
37
30
13
15
97
I
8. Staff Nurse
BCCTC
Supervision,
Clinical
3
38
30
16
12
96
I
9. LHV/PHN
BCCTC
Supervision
Clinical
3
37
30
15
15
97
I
10. ANM/MPW
BCCTC
Comtnuni cation.
Outreach,
Clinical
3
111
90
45
43
291
O
11. PMP
BCCTC
Outreach
1
120
90
45
45
300
I
12. Coraputers/clark
BCCTC
Statistics
P
13 . Link Workers
H.C./
BCCTC
0 .
14. NGOs
O
>
19
93/
94
19
94/
95
19
95/
96
19
96/
97
)
>
>
>
>
44
87
24
5
34
28
12
10
84
Outreach
Cooxnuni cation
Referral
(25) 5
370
300
150
150
970
BCCTC
Orientation,
outreach
1
90
50
30
30
200
15. Local Leaders
BCCTC
Orientation,
outreach
1
150
120
63
65
400
O
16. Anganwadis
BCCTC
Outreach,
Cotrwunicatlon,
Health promotion
5
76
60
35
30
200
1
17. Lab Tech.
BCCTC
Lab. management
3
9
8
7
O
18. School Teachers
BCCTC
Extension
approach
1
50
30
30
>
I
>
>
>
I
)
>
J
3
Total
No.
to be
trai
ned
12
>
>
19
97/
98
24
50
200
.'TA I
ANNEX 12
Page 4
84
‘■/J;
©!
Number to b* tr*ln«d
Type of
Trar.in*
Location
of
Traininf
Of Staff Categories
to
tr-'n-d
Curriculum
Content Topics
Duration
of
Course
(days)
19
92
19
93
19
94
19
95
19
96
19
97
Total
'
No.
(( >
to be 11'
tral■ .
ned
(P-Pre
Service1
OOrlentated:
I"In~
Service
(OST)
II
I
Trainin*
Strategiea
Hatariala,
Meaeurement
Apex
Inst.
19 Traineri
15
4
V
12
12
•A
—
3,152
GRAND total
1/ Orientation Training provided at the Project Launch
'Ll In-iervice provided annually.
o
©
©
©
X
D
0
222x0
........
.’P'
■
• ;■
I
■
Ill
1
85
ANNEX 12
Page 5
r
•)
CAL C U T T A
Annual Training Plan/Calendar
Number to be trained
I
y
)
Type
of
Trai
ning
(P=Pre
Servce
0=
Orien
tation
I = In
Servce
(OST)
Of Staff
Categories to be
trained
Curriculum
Content
Topics
Dura
tion
of
Cour
se
days
19
92/
93
19
93/
94
19
94/
95
19
95/
96
19
96/
97
19
97/
98
Total
Number to
be
trained
3
4
5
6
7
8
9
10
11
12
Hau/Mun i c i pa I
Office
- Objective
and goals
- Role & Job
responsibi Iities
- Methodo
logy
- Communica
tion
10
weeks
880
1320
1540
660
4400
• Job res
ponsi bi I i t i es
- Leadership
mo t i va t i on
& skill
• Monitoring
& Supervis i on
3
weeks
150
230
260
123
763
2
weeks
45
65
75
35
, 220
2 dys
20
30
35
15
100
3 dys
85
130
150
65
430
ning
2
P
Loca
tion of
T rai
H H W
>
>
>
P
1st Tier Super
visor
-do-
>
>
P
2nd Tier Superviser
-do-
-do-
0
Elected represen
tatives of Local
Authorities
(Chairman ♦ one
Commissioner to
be nominated by
Ch a i rman)
C T C
• Objectives
and goals
• Role
- Monitoring
and
Supervision
- Health Officer
- Medical Officer
(Part time)
- Specialists of
ESOPDS
HAU/Mun i c i pa I
Office
>
0
>
>
>
>
)
5
• Objectives
& goals
- Communica
tion
- Adminis
trative
Skill
- Monitoring
& Supervi
sion
ANNEX 12
Page 6
86
r
0
0
- Representatives
of PVO's
- Representatives
of Local
Advisory Commitees
-do-
- Executive &
Finance Officers
of Local Autho
rities
- Asst. Chiefs of
CMDA Projects
- Project IEC
Officers of the
Mass Media Wing
of Health
Deptt. GOWB
C T C
High level
officers of CMDA
♦ Health Deptt.
C T C
H H W
HAU/Municipal
Office
- Objectives
& goals
- Communica
tion
-Supervisi on
2 dys
960
1440
1680
720
- Objective
and goals
- Communica
tion
- Coordinati on
2 dys
20
30
35
15
4800
••
0
I
I
1st Tier
Supervisors
2nd T i er
Supervi sors
-do-
I
- Health Officer
- Medical Officer
(Part time)
-do-
I
I
*
I
1
- Nurse
- ANM
- Pharmacist
-do-
- CMDA Staff
- HAU Staff
- Local Authority
Staff
C T C
- CMDA Project
Officers
- Project IEC
Officers
C T C
Training of
Trainers
C T C
Grand Total
- Objectives
and goals
- Coordinat ion
1 dys
©
25
- Tools &
Techniques
- Monitoring
Feedbacks
- Communica
tion skill
1 wk
800
1000
1000
800
400
4u00
do
4 dys
150
190
190
150
83
76?
Adminis
trative
skill
Moni toring
feedbacks
yr)
2 dys
60
70
70
.55
Technical
skill
Communi ca
tion
Moni tori ng
& Feedbacks
3 dys
5
15
15
10
Account ing
& financial
mgmnt
Adminis
trative
skill
Moni toring
feedbacks
4 dys
4Q
50
50
40
20
5
5
5
5
Supervi
sory ski 11
Moni toring
feedbacks
2 dys
Skill upgradat ion
Communi cat i on
2 dys
25
■
5
,5°
■'7
v.d
50
120
120
150
60
Sb
167^5
)
87
ANNEX 12
Page 7
)
DELHI
Annual Training Plan/Calendar
Number to be trained
Of Staff
Categories to be
trained
Loca
tion of
Trai ni ng
Curriculin
Content
Topi cs
Dura
tion
of
Cour
se
days
19
92
)
Type
of
Trai
ning
(P=Pre
Servce
0=
Orien
tated;
I = In
Servce
(OST)
)
0
1. Pro], Hd. Stf.
MCD
Mgmt. Eval.
2
25
25
25
75
0
2. Munic. Ldr.
MCD
Urban Hlth.
1
100
100
100
300
1
3. Sr.Med.Offcrs.
MAMC
Management
5
1
2
3
6
6
18
1
4. Gynaecologists
MAMC
Outreach
Technology
5
1
2
3
6
6
18
1
5. Pedaetricians
MAMC
Outreach
Technology.
5
1
2
3
6
6
18
1
6. Lady M.O.
MAMC
Urban Hlth.
Care,Stra
tegy
5
2
12
24
36
50
50
174
1
9. LhV/PHN
MAMC
Supervi s i on
Clinical
5
1
6
12
18
25
25
87
1
10. ANM/HPW
Type D
Hlth
Post
Outreach
phc
5
8
10
83
136
200
200
642
0
11. PMP
MAMC
Fid.
Outreach
1
10
20
20
50
100
100
200
1
12.Computers
On job
MIES
2
5
5
5
5
5
5
30
1
13. Stat. Asst.
On job
MIES
2
5
5
5
5
5
5
30
P, (D
14. Dais (link
workers)
Type D
Hlth.
Post
Orientation
ANC, PNC
30
25
150
300
450
625
625
2,175
O
15. NGO
MCD
Outreach
1
3
3
3
3
3
3
18
O
16. Local LDR
MCD
Objectives
progress
1
100
100
100
100
100
100
600
O
17. Angan.
Type D
Hlth.
Post
Outreach
Referral
30
25
150
300
450
625
625
2,175
1
18. Trainers
MAMC
TOT
4
2
10
12
12
14
)
)
>
)
>
>
>
)
>
>
J
>
)
19
93
19
94
19
95
19
96
19
97
Total
Number to
be
trained
50
J
•' ’
■‘'■J
88
ANNEX 12
Page 8
•i>T)
Number to be trained
Type
of
Trai
ning i
(P=Pre
Servce
0=
Orien
tated;
IMn
Servce
(OST)
Of Staff
Categories to be
trained
Loca
tion of
Trai
ning
Curriculum
Content
Topics
Dura
tion
of
Cour
se
days
19
92
19
93
19
94
19
95
19
96
19
97
Total
Nirnbe!- co
Uair.^
\ *
)
«
19. Others
- 1st Tier Sup.
- 2nd Tier Sup.
- NGOs
- KSCB
MCO
Outreach
Clinical
5
1
0
20. Teachers
Prim.Health
I
21. Indian Tours
Service Lib.
I
22. International
Tours
Management
Health
Service
5
1
2
3
6
6
18 A
10
16
22
30
30
11?)
0'
GRAND TOTAL
6,1
•)
O
©
I.--
®
1
89
ANNEX 12
Page 9
)
)
HYDERABAD
I
Annual Training Plan/Calendar
*
)
Member to be trained
i
I
Type of
Tra i ning
(P=Pre
Service
OOrien
tated;
I=In
Service
(OST)
>
)
>
3
Of Staff Categories
to be trained
Location
of
Training
Curriculum
Content Topics
Duration
of
Course
(days)
19
92
I
1. Proj. Hd. Stf.
NIHFW
Management/Coor.
14
20
0
2. Munic. Ldr.
0 i rectorate
Orientation
1
25
1
3. Sr. M.O.
NIHFW
Supervision
Heal th Services
14
1
4. Gynaecologists
Med.Sch.
Clinical
1
5. Pedaetricians -
Med.Sch.
)
>
>
19
93
19
94
19
95
19
96
19
97
Total
Number
to be
traire
d
20
20
25
25
100
5
5
5
15
14
5
5
5
15
Clinical
14
8
6
6
20
Outreach
5
8
6
6
20
40
40
120
25
60
1
6. Ext.ed.off
I
7. Lady M.O.
CHC
Supervi s ion,
Clinical
5
40
I
8. Stf. Nurse
CHC
Clinical
10
25
I
9. Lhv/PHN
H.O.
Supervision, TOT
Clinical
10
30
30
30
90
I
10. ANM
H.O.
TOT Clinical
Hl th. Educ.
10
100
140
140
380
O
11. PMP
C.H.C.
Clinical
Refresher
2
200
200
200
600
12. Dais (link
workers)
On the
job
Outreach
Referral
12
250
250
250
250
1,000
O
13. NGO
H.O.
Outreach
1
50
50
50
50
200
O
14. Local LDRs
H.O.
Promotive Health
1
1000
500
500
500
O
15. Anganwadi/Sup
H.O.
Outreach
2
100
100.
100
100
16. Lab. Tech.
CHC
Technical
10
5
5
5
15
I
17. Pharmac.
CHC
Drug Management
5
5
5
5
15
>
P
18. Trainers
APEX
Methods/Materials
15
>
O
19. Others
Vari ous
Various
1
>
>
>
)
3
)
(P) I
I
>
>
>
J
A
3
3
a
■
■
•■J
J?”
20
20
20
20
500
500
105
3,500
400
30
100
100
150
350
ANNEX 12
Page 10
90
Nurber to be trained
Type of
Tra i ning
(P=Pre,
Service
0»
Orien
tated;
I»in
Service
(OST)
Of Staff Categories
to be trained
Location
of
Train i ng
C'irr' cu* 'jn
Content Topics
Duration
of
Course
(days)
19
92
19
93
19
94
19
95
19
96
19
97
Tr^l
Ik J8
to be
•9
_ r,'A.
GRAND TOTAL
©
-O
©
0
©.
©
,S:J
©
©
■:^
©
fi?
■sS
$
$
■: : -iSi
;■©
3
91
ANNEX 13
Page 1
3
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
SECTION 1:
>
OPERATIONALIZING COMMUNITY PARTICIPATION
>
The following tables reflect how each city plans to "operationalize
community participation" for this project. Six main strategies
have emerged. The "x" indicates information in the final proposal
submitted.
>
>
Key:
Table 1:
>
B = Bangalore; C = Calcutta; D = Delhi; H = Hyderabad
Persuasion as a Community Involvement Strategy
Strategy Proposed:
)
>
J
>
PERSUASION
B C D H
The use of public relations to convince the urban poor strata x
of: the need to become responsible for the delivery of their
local health care services; the need to address governmentidentified health care changes (e.g. family planning
methods, environmental sanitation); and the need to accept
government policies (e.g. Marriage Restraint Act), and
female literacy/education programs.
X
x
X
Mass media information campaigns.
Organization of National Population Commission and
complimentary State Commissions.
' •
Outdoor publicity activities and follow-up.
Joint Women's Programs. >.
Use of incentive payments to "acceptors". '
Use of "SHE" clubs.
Use of private medical practitioners.
Enumeration of female children.
Use of folk/traditional media.
Organization of training camps to create political will.
Use of incentive payments to "motivators’ for permanent
methods.
Use of special incentives for employees (e.g. one increment
in pay scale for permanent birth control methods.
Use of grant of special causal leave for adoption of family
planning method.
Use of "special" subcommittee to review compensation I
incentives.
Enhancement of motivators fee.
Organization of Health Education and Information Centres.
Registration of marriages.
X
X
X
X
X
>
>
Implementation Methods
Identified:
X •
)
>
>
>
>
>
)
>
i
•y- 'j .v-
X
X
X
X
X
X
x
x
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
92
ANNEX 13
Page 2
Government inputs:
IEC Cells/Units
X
IEC materials and equipment
X x |x
IEC cells - use of on-going/established.
X
Rupee payments for incentives.
x X ; .•*4’ix
Financial support to PVO's (e.g. SHE clubs).
X X
Free family planning supplies, equipment and materials to X
I
PMP's.^
Establishment of new IEC unit, personnel, equipment.
x x
vans, furniture.
Development of new IEC materials/software y
x X
Payments to professional organizations for the development x
of IEC materials/films.
Incentives for literacy for girls in form of books, uniforms. x X
supplies.Grants to PVO's for literacy teaching to females not in
X
school.-''
Use of ICD units and family welfare staff.
Motivator fees.
Review of present compensation/incentive system for
X |x
upward revisions and temporary methods.
Costs for organizing Information Centres.
Marriage registration incentive for records.
ANMs and PVOs
X X
4
>•4
4
X
Community Inputs:
oint Management
Structures:
"Coordination Cell" for IEC
Use of Monitoring Cell/Media studies
' ^roblems/Issues/Risks
Associated:
Negative political reaction if the community perceives it is
being manipulated on a particular topic/issue.
Benefits of the program are not clearly visible to the slum
dwellers.
Materials may be improperly designed and inappropriate.'
Use of incentives (for permanent methods)
Requirements to Increase
Demand:
Benefits Noted:
x
x'f
•,V*)
4
x
Further change in government authority's orientation
regarding the concept of community participation.
Review of government document terminology (e.g. ’to get
people to cooperate’, beneficiaries, targets, etc.).
Base program on identified needs and background of the
people (e.g. check assumptions).
Vital statistics system.
X (X
X
X
X
xr
x'fx
Does not raise community leaders expectations of
participating in the planning process.
Allows for gradual change in thinking and project
approaches by government sectors.
"Fringe slums" receive some benefits from "targeted" slums'
project.
Assumed
x
TI
x/A
X
xpc
JsL
'49
.J
I V. . .
(
I
93
ANNEX 13
Page 3
fc G b
)
>
>
I
I
y
Evaluation Indicators
Noted:
Additional Funding
Requirements:
x
Number of public reached in relation to the total the project X
is to affect.
Measurement of increased comparative.
X
Number of citizens with positive attitude towards project
information.
________ _
Materials production - part of LEC costs.
Government officers training.^
Attitudinal survey for evaluation purposes.
Needs identification process - focus groups.
X
x
X
X
x
x
X
X
X
X
X
X
X
X
)
>
)
Table 2: Education a$ a Community Involvement Strategy
)
)
Strategy Proposed:
The use of information dissemination and general
instruction to create an awareness of the health issues and
changes desired by the project.
>
>
>
EDUCATION
Implementation Methods
Identified:
>
>
)
)
)
I
'
>
>
>
>
>
J
>
J
J
Mg®
Involvement of private medical practitioners for
specialization backup.
Use of IEC cells/units.
Use of ANM training schools and Corporation Maternity
Homes.
Use of Mahila Swasta Sanghas/use of other agencies'
departments.
Use of "volunteer trainers" to go into communities to
deliver messages/Honorary Health Workers/Link
workers/dais/Bastee Sevikas.
Group presentations by link workers and counselling
sessions.
Use of voluntary and philanthropic organizations.
Use of "SHE" clubs.
Use of health centre and referral centre staff/PHP's.
Use of special environmental health and hygiene programs
(well baby and clean hut).*^
Use of ANMs/HHWs.
Counselling couples bedside/maternity centres.
Treatment of minor ailments, as a "bait" for preventive
health services.
Use of training needs surveys.
Use of health and family welfare committees (local).
Use of OTC trained leaders.
Use of upper primary students as "education task force".
B C D H
x
x x x
x
x
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
94
ANNEX 13
Page 4
i
Education Strategy (continued)
Government Inputs:
x
r X
Staff (Health Education Coordinator/Communications
Officers) salaries.^
X
Professional artists contracted/employees newsletters.
X X X
Leadership by medical officer to oversee IEC activities.
x X X X
Educational kits including audio visual materials for
outreach.
x x X X
Training for staff, NGO and local leaders/assessment of.
X X
Orientation (camps) with link workers and community
leaders.*^
X
Grants-in-and to voluntary institutions to educate and
■■1
supplement government activities.
X
Training from “Shramika Vidhy Peeth’.
x X X
Set up residential training centre - the staffing of such.
X X X
X
Development of training course materials.
X X X
X
Honoraria as incentives to outreach workers.
X X
X
Salaries of ANMs.
X
X
Honoraria to trainers.
■5)
X X
X
Board and lodging for trainers/allowances.
X X X
Marriage guidance and marriage counselling services.
X
X
Training surveys by identified organizations.
X X
Pre-testing of IEC kits.
X
Fertility behaviour rapid surveys.
X
Prizes as awards.
c
X
Training cell
X x x
Mahila mandals/Mohila Samriti
X
Youth organizations.
x X X -y;
Time and space.______________________________ _________
x X X l~
Integration of services of ANM's and anganwadi workers
.pv
for coordination.
X
X
X
Use of a project administration and management committee
(PAMU/PACC).
_
_
Technical information may not be properly communicated
for ease of understanding, thus limiting awareness levels.
X I 1
X
Use of honoraria.
High awareness levels by the citizens may create additional, X X X X 'Jadministrative demands on the bureaucrats.
A r■
X
Increased project costs for print/visual materials and
equipment for presentation (extensive investment).
X X
X
A long term strategy for results, thus time is an issue to
address.
•4
J
4-
Community Inputs:
_ oint Management
Structures:
Problems/Issues/Risks
Associated:
i ■
I,
•M
T:
xr:
1
?.
Requirements to Increase
Demand:
Involve education institutions (universities) in the training
process (e.g. Regional Institute for Urban and
Developmental studies).*^
Greater use of the local government system.
Easily accessible materials/information from national
ordering location.
Increase standards for those working with slum dwellers..^
Focus on integration of services (literacy, water supply).
Community development activities described in
“neighbourhood terms’ versus region/city/country
descri p tors.
______
X
X
X
■J \
X
X
X
X
X
X
X
X
i.
X
-
t
t■
XT
J
•
95
>
)
Education Strategy (continued)
Benefits Noted:
)
1
>
>
»
)
Evaluation Indicators
Noted:
)
)
)
Additional Funding
Requirements:
)
>
>
)
i
>
>
3
9
Amount of time actually spent by educators (groups) in
delivering the information.
The actual behaviourial change which occurs in a defined
region/community active targets.
Increased use of (government) health services.
Response from focus groups (in UBS project).
Test for ’understanding’ of the messages.
Display of performance statistics.
Development of performance skills.
Administration system for coordination.
Periodic message understanding tests.
Recordings of behaviour change in slum regions (e.g.
videos).
Measurement of use of health services by slum groups.
Materials - part of IEC costs.
Professional fees.
INFORMATION FEEDBACK
The distribution of information regarding a health-related
policy or government position or management scheme in
order to allow local leaders and citizens or staff to react; to
gain feedback.
j
>
x
Creates a foundation for increased involvement by the
urban poor in the future.
Enhances the effectiveness of existing government programs
of public relations.
Strengthens environmental consciousness leading to
community change (e.g. simple garbage projects).
X
Educators/educator groups/associations can be easily
identified and trained to form a part of delivery system and
network.
Promotion of Basti Sevikas to ward ayahs.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Table 3: Information Feedback as a Community Involvement Strategy
Strategy Proposed:
>
ANNEX 13
Page 5
Implementation Methods
Identified:
B
c D H
X
x x
Use of project monitoring cells.
X
Use of neighbourhood committees.
Household committees offer 'single line contact’ to women X
in the slums - gender awareness.
Vital statistics by dais.
x
Use of SHE clubs. - x
Revamping of MIS for quicker action.
X
Periodic surveys for impact of training.
X
Surveys for FW MCH content and targets.
Use of Slum Development Committees.
Upgrading of MIES and design of service delivery booklet.
Use of family folders.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
51
^-1
96
ANNEX 13
Page 6
Government Inputs:
Community Inputs:
Joint Management
Structures:
Problems/Issues/Risks
Associated:
Requirements to Increase
Demand:
Benefits Noted:
Evaluation Indicators
Noted:
Additional Funding
Requirements:
x ^4
Basic funding to committees.
Vital events honorarium.
CMDA Project Directorate/MCD.
Outside expertise fees for MIS assistance.
Outside consultancy fees for surveys.
MIS equipment and software.
Rapid Low Cost Studies.
x x
X
X
X
X
X
A
X
Time for committee work.
x
HAU
Decentralized institutional framework.
Project Advisory & Coordinating Committee
x x
X
J
"A
X
x
Individuals/bureaucrats are required to both distribute and
evaluate the publics responses.
Improper systems for recording inputs of the public.
Presentation of the information to the slum dwellers has to
be organized in such a manner as to receive ’useful’
feedback.
Failure to acknowledge in a demonstratable manner how
the slum dwellers and their leaders did affect the final
policy and planning process can jeopardize the project and
next phase working relationships.
Allow a suitable and adequate time commitment to receive
feedback and process the results.
Demonstrate and communicate the results of the feedback
(not necessarily the findings, but always the results).
Provides proof of ’government listening’.
Creates acceptance of the final decisions regarding the
projects.
Improves management decisions of authorities.
X
X
X
X
X
X
X
V'
l;
.‘p*
X
X
X lV-x
”rV
Xp
x
x
x k
x
X
Xp
Frequency of contact (numbers of meetings, telephone calls,
reports).
Measurement of local persons attitudes towards perceived
influence over government policy (sample survey).
Impact surveys.
X
X
X I
X
xb
Information mechanism for feedback loops to slum citizens.
Survey.
Clerical assistance.
Outside expertise fees.
Extra slum committee financial assistance.
p
X j
X
xk
X
X
xi;
--- vJI.
©
■
- ■ w
■ ;'-L\
97
ANNEX-11
Page 7
)
Table 4; Consultation
3 Community InvQlvpmf nt
)
Strategy Proposed:
>
>
CONSULTATION
B C D H
The use of formal dialogue between health authorities and X
the slum dwellers; to establish mutually accepted objectives;
to develop the overall frame of reference for the project and
to select 'participation methods’ appropriate to the region
and the project.
X
X
x
Use of ward level committees to bring slum committees
together and support local leadership.
Use of 'SHE’ committees/Bustee Vikas Mandals.
Use of elected Local Authorities.
X
X
X
>
Implementation Methods
Identified:
>
)
X
X
Community Inputs:
)
)
Joint Management
I Structures:
)
>
>
i
Problems/Issues/Risks
.Associated:
>
>
Requirements to Increase
I Demand:
j
J
‘ [Benefits Noted:
)
J
>
X
x
X
Go vernine nt Inputs:
)
>
X
Evaluation Indicators
Noted:
Additional Funding
[Requirements:
Committee members.
Identification for new facility sites.
Financial support of new clubs.
PACC's
”—
X
X
x
x
X
X
X
X
X
x
x
Organized pressure groups may be favoured. .
Lack of slum dwellers understanding as to their exact roles X x
and limits.
.
If ideas collected during community workshops & seminars X X
are unacknowledged, repetition may occur.
X
Dwellers and leaders may not be ’listened’ to.
X
X
X
X
X
X
Ongoing information/communication with the citizens about X
decisions regarding the project.
Recognition of the significant time commitment to obtain
slum dwellers input.
X
Use of NGO Sector Department program of MOrriw.
X
Local leaders are involved from the initial stages.
Establishes a system to begin participatory planning.
Some departments have a long history working in slums
thus raising confidence levels of health authorities. .
Local leadership is supported through committee efforts.
Innovative workshops will (continue to) be implemented,
(e.g. listening workshops).
Frequency of contact between leaders and authorities.
Output of the consultative process (e.g. project plan).
Trained facilitators for workshops with public.
(Additional) training workshops on participatory
consultation.
X
x
X
x
X
X
X
X
X
X
X
X
X
X
X
X
X
x
X
X
X
X
X
X
X
X
x
X
X
X
X
x
X
X
X
X
>
3
&
i
■T.
I ,
...
. : . - '-I';-;
I
i
i
98
ANNEX 13
Page 8
Table 5: Joint Planning of Design a_s_ a Community Involvement Strategy
OINT PLAiVNING OF DESIGN
Strategy Proposed:
x
X
Build on ODA Slum Improvement Project/Urban
Community Development organizations/CUPD models.
Use of existing Urban Family Welfare Centres structures
(e.g. 34 Hyderabad) with the management of six by
voluntary agencies.
X
Use of organized Registered Societies, NGOs in slums for
large regions.
Encouragement through Neighbourhood Infrastructure
Committees (young men).
X
Use of Monitoring and Coordinating Committees at State
government levels.
Use of Neighbourhood Committees (UBSP scheme/CUFD).. • x
x
Use of ‘SHE’ clubs of slums.
Use of issues-oriented workshops and in-house staff
meetings.
Micro planning joining ANMs and the anganwadi workers
for services.
_
_
___
Training for reorientation.
x
Financial support to clubs.
Assistance (by UCD staff) for local committee representation
selection.____________ ______________ ____ ___________
X
The use of share decision-making since the local slum
dwellers are, in this strategy, represented on planning
committees, given voting authority, and issue authority.
Implementation. Methods
Identified:
x
Government Inputs:
Community Inputs:
' oint Management
Structures:_______
Problems/Is sues/"Risks
Associated:
B C D H
Slum committee members' time.
Community organizer/fadlitator for committee units.
X
x
Coordination through slum committees.
Past project structures.
___________________
X
Clear definitions of the organizational setups and roles.of
government departments responsible for project; flexibility. ,
X
Development of appropriate materials for use by all the
committee members (slum dwellers' leaders) for meetings
and planning.
.
t
Little government experience working with NGO s/PVO s.
X
Use of incentives for PVO's.
X
Slums are not homogeneous; some are 30 to 40 years old
and as such cannot be treated as same.
X
Lack of formalization of known and existing coordination
mechanisms.
X
Men stopping women from representation on the
community development unit committees.
X
Improper nomination of committee representative.
Multiplicity of agencies and government departments in
field.
Linking of action plans to recurrent funds and striving to
meet year-end quotas.
Vested interests prevent people from coming together.
Barriers of caste, religion, language, and education prevent
open ness. _______________ _________ __ _____________
x
X
X
X
K
ra
ft
h
X
.a
PS
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
a
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
’fl
1I
Ia
p
4,
i
i
ppjv
W
1
S'-
ANNEX 13
Page 9
)
Joint Planning Strategy (continued)
>
)
Requirements to Increase
Demand:
>
>
I
*
)
)
Benefits Noted:
)
>
>
>
>
>
s
Evaluation Indicators
Noted:
>
>
Additional Funding
Requirements:
Acceptance of consensus building process by authorities.
Recognition by government department responsible for this
strategy of time commitment required for results.
Proper representation on the committees so the
recommendations are not questioned.
Creation of high visibility of the committee' representation
and its responsibilities for final acceptance by public of
recommendations.
Greater involvement of focal NGO's (e.g. Rotarians and
Red Cross).
Create linkages to National Commission on Urbanization.
Use of MOHFW's NGO Sector program funds.____________
x
X
X
X
X
X
X
X
X
X
Joint management is realized for inter sectoral cooperation x
X
Sensitivity to community problems and knowledge of
community constraints in solving problems is demonstrated.
Limited media-oriented investment.
X
High involvement of women at neighbourhood trustee
committee level (potential).
UBS staff can be used as trainers.
X
Forced government team-planning in order to integrate
approaches.
Able to build on the capacity of other community systems
and schemes (e.g. Scheme of Urban Wage Employment Nehru Rozgar Yojana).
Training available for facilitators.
_____
.
The degree to which the slum dwellers actually perceive
they had a voice via their representatives.
Recording of examples of committee's self-perception.
Design and implementation of a joint management plan.
Sites purchased by government as identified by locals._____
X
X
X
X
X
X
X
X
X
Training seminars - part of training costs.
Joint management costs.
Outside consultant fees for cooperation in building.
x
x
X
X
X
X
X
X
X
X
X
X
X
X
X
x
X
X
X
X
X
X
X
X
X
>
>
>
>
>
J
>
■« a1
100 -
■1
Qi
• .
ANNEX 13
Page 10
Table 6: Delegated Authority a$ a Community Involvement Strategy
Strategy Proposed:
Implementation Methods
Identified:
DELEGATED AUTHORTIY
B C
x x
The use of existing elements of self-help within the urban
poor communities in order to transfer responsibilities
normally associated with the authority to urban poor groups
or to another level of government (local)^__________________
X
Use of the participatory model (Workshop series in slums
involving NGO's local clubs, government representatives;
synthesization of ideas through use of bustee leadership
discussion groups; organization of an agreed-upon project
package; preparation of project documents).
Creation of slum dweller cooperatives (for 1,000
population).
Involvement of registered Non-Govemment organizations
in citizen coops as institutional members.
Use of RCV (Resident Community Volunteer) Committees
for geographical areas.
Use of Final Tier and Second Tier Supervisors.
Use of ’SHE’ dubs/Mahila Mandals.
Addition of more health officers to expand responsibilities
into community groups.
Use of creche scheme at slum level.
Vocational training (tailoring/knitting) schemes.
Availability of Revolving Fund Projects.
Use of ODA health services base.
Use of NGO special registers for future project
involvement.
Distribution of nutrition supplements by health workers
(volunteer/Department).
Child to child programs (i.e. fly collection project). ■ z ■
Use of youth organizations/Balwadi Teacher.
Use of female liaison officers/Bustee Vikas.
Use of regional medical stores/Central Store systems.
Use of ESOPDs.
Use of income-generation schemes.
Expanded anti-laraval program.
Use of mobile units (re cancer detection).
Add to Implementation Methods
Use of Training Cell
Use of 'house to house' surveys
Use of disabled persons support/NGO's
X
X
X
1^
X
X
X
X
t J* WXL
X
X
X
X
X
X
x
X
X
X
X
X
X
X
X
X
X
X
X
X
X
I
i
X
X
X
X
i-J
x Sx.
xiw
X
X
X
X
X
X
X
X
a
w
&
■ ‘
101
1
ANNEX 13
Page 11
Delegated Authority Strategy (continued)
)
Government Inputs:
>
»
>
>
>
>
>
•k!
>
>
Community Inputs:
*
>
>
X
Limited management assistance to citizens coops.
X
x X X
Equipment, medical supplies and expertise; supply of tools;
audio visual materials; medical personnel, training
materials.
X X X
Referral services (professionals).
X
X
Equipment - special (e.g. solar water heater).
X
X X
X
Waste management materials for health centres and people
of slums (trippers/dustbins).
X
X
Financial support to clubs.
X
X X
X
Buildings and furniture for facilities of the health
centres/matemity homes.
X X
X
Staff quarters (e.g. for nurses and chowkidars.)
X X
Salary for additional health officers and staff associated and X
furniture and equipment.
X X X
Costs for creche scheme.
X
Cost for vocational training program as submitted by PVOs. X
X
X
Availability of Revolving/Development Funds matching
grants.
•
■, ‘
Identification and registration of Grass Roots NGOs in each X X X X
community.
X X X
Nutrition packages.
X
Remuneration to children as incentives.
X
Local malaria lab.
X
Vocational Training Centre.
X
X
Women entrepreneurs programs.
X X
Supply of medicines to regional medical stores.
X
Costs of larvicide and equipment.
X X
Establishment of an ’Aids Cell", or Aids project.
X X
Costs for labs, mobile units, staff and equipment.
Land maintenance; labour; garbage scheduling; scramdans; X X X X
food, donations, emergency assistance.
X x x x
Committee/Club membership (people)
X
SHE Club subscription.
X
X
Parent payment for creche programs.
X x
X
Volunteer labour.
__________
>
>
>
>
>
>
J
J
9
CjOA/' I OS’
07503
) i
i K. A'-
fe /. >
I it
•i?
\
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4
102
ANNEX 13
Page 12
rv|p?atPd AuthQrisJaatggy (continued)
Joint Management
Structures:
x x
Joint monitoring of supplies and distribution.
Joint training of traditional birth attendant.
Informal functional groups of user families.
NGO's for remuneration to Bustee Sewika.
U« of Deputy City Family staff in micro work.
.
.
.
.
x
SHE Committees.
.
Coordinating
PVO representation on Project Advisory
Committees (PACCs).
paCCs
X
X
X
X
x *
: SJSZX-i—
C0*“X.« od-
.
d.P«n.« <«» “■»
X
X
—'
-
uSovemment representatives in cooperatives.
a mechanism to improve the quality of the project is
•
.
1
X
X
nJ
x I’J
Education Revenue Department (mtra-sectoral).
X X
CMDA Project Directorate/MCD.
X
Use of SCERT NCERT.
Use of NF Education Centre.
Use of Habitat Polytech (Construction).
X
Use of KVIC (Khadi Village Industries).
X
Policy Review Steering Committee.------------------- ------ X X
X
Accountability regarding finance® (^S^ith1o5S of’
with
loss
of
Threat to existing administrative structures
[Problems/IssuesfRisks
Associated:
X
X XI .1
X
.
.
4
x
x
x
X
X
X
X
X
X
0ft
r
■
rdty to do for s€lf.
Lack of project organization skills.
Lack of information.
Acknowledgement of migration. .
Need to Acknowledge qualitative indicators^----- ------------
X
x
X
x x
I
X X lx
X
—yT
X
Link to existing successful sche^“
7
Administrative and support staff to assist
Development .of appropnate applicatio
Requirements to Increase
I Demand:
. '(Calcutta
N'gg w’
•"
i
has made a beginning).
X
■y
"*
X
Continued decentralization (HAU).
Strengthening referral services.--------------------
Benefits Noted:
.
|
•
Evaluation Indicators
Noted:
I
T
.
4
X
X
>hus^
>»»•“ s-™’-"' “d
x
community) established.
of day-to-day problems x x
Sharing of solutions by slum leaders
(re a citing beyond local area).
Whether the project meets its
for problems by
Frequency of acceptance of responsibility
P
slum dwellers and their leaders. - ----—------------- —
kJ
L
©
5%
•
■■
......................
X
)
103
)
)
ANNEX 13
Page 13
Delegated Authority Strategy (continued)
)
)
1
)
>
)
y
>
)
)
)
)
>
>
>
>
>
>
>
)
>
>
>
>
»
>
J
J
a
d
Additional Funding
Requirements:
Tools, supplies - part of funds allocated for equipment, etc. X
X
Training - part of training costs.
X
Administration costs for innovative solutions.
Land rights costs.
X
Flexibility of Revolving Fund.
Coordination mechanism costs for departments/personnel to X
assist.
X
Innovative scheme fundings.
X
X
X
X
X
X
X
X
X
x
X
X
X
104
ANNEX 13
Page 16
SECTION 2:
TECHNICAL ASSISTANCE ON COMMUNITY PARTICIPATION
Background: Concern with local development activities is not new.
■
1.
Community Development: Though community development initiatives can
be traced to the 1920’s, it was the Etawah pilot project in India that brought'
community development (CD) into prominence in the post colonial era. CD programs
were introduced to the developing world during the 1950’s and were for the most
part abandoned by the 1960’s after a long list of documented failures
(i.e.targets were formulated centrally with little regard to the willingness of
the people to respond; little attention was given to institutional
linkages/policies which influenced village self-help activities).
Popular Participation: In the early 1970’s popular participation,^^
2.
became a priority in development as a response to the failure of the "trickle
down" theory. In this scheme, projects were/are aimed at providing services to
government funded and W
the poor as quickly and directly as possible through
1 nn cr 1 i c+• nF ’ SiS
administered extension services. This approach also has recorded aa long
list of
failures:
this was .
(a)
* *
*
'but,
‘ , in reality
plans stressed popular participation
largely precluded by the planning procedures themselves;
(b)
there was little or no accountability to the people who have a ’
direct interest in the actual outcomes; and
(C)
’Blueprint projects* emerged with key decisions regarding services,
facilities, inputs, schedules and outcomes which were centrally O
determined by experts who generally lacked the incentive and means'-:^
to obtain inputs from the poor beneficiaries. Therefore, . the only;<,^
form of participation for the poor, was in providing free labor or
materials to implement decisions in which they had no part.
Decentralization: Decentralization schemes emerged with theif^^B
3.
emphasis on implementing national’programs through local administrative units,
with efforts consisting largely of providing grants to local bodies, to be used
for small scale local projects. As with the other schemes, this decentralized'-;^
approach retains central control and ’community dependence* on central funding.^^
There is little commitment to political and administrative reforms which might
lead to self - managing local communities.
^-0
4,
Lessons learned: None of the approaches which were aimed
stimulating local initiative, challenge
the idea that the government doe^Jr^
development for the people who are then expected to respond with acceptance to
whatever guidance, information and assistance the government chooses to offer.’JKj
None confront the basic issue of local control and responsibility. There is,.vM
therefore, first, a need to apply the lessons learned from community development,^®
popular participation and decentraliation schemes, and second, there is a nee0'A;
to seek alternatives.
- ■
• 1
5.
Introduction to one alternative - Community Management: Community
management is different in concept and practice from community development and
&
%
BOBB ®V
J
105
AIJNEX 13
Page 17
i
)
»
popular participation endeavors. The term 'community’ refers to an interacting
population living in a common location. A 'community management system’ therefore
may be comprised of any number of different social units including households,
small companies, kinship groups, factions, local voluntary organizations & local
government bodies. The term ’community management*, therefore, is normally
applied when management control is broadly distributed among the 'system’. It.is
not applied when resources are being managed 'for* the community by groups
outside its boundaries, or by a small local elite group.
I
6.
i
)
1
Community management has several generic features:
(a)
assistance to each individual community group is designed and
managed as a discrete project activity. It has its own timetable and
is responsive to the particular situation of that group. It is based
on a careful study of existing practices, technical capacities,
resources available, and power structures;
(b)
the emphasis is on community control and management of its
resources. Every project intervention is geared to this outcome
including even legal confirmation of resource ownership and
recognition of the community group as a body with legal rights;
(c)
actual project design does not take place until the
constituents
are fully prepared to make their needs and priorities known. Project
implementation does not begin until the design is formally accepted
by some association of the constituents;
(d)
project organizing takes account of the existing community
structures, and builds on individual citizen strength - from the
bottom up - to insure broad-based participation and to avoid
domination by traditional leaders or corruption;
(e)
incentive systems are structured so as to strengthen accountability
of project staff to community groups; and
(f)
long term, systematic attention is given to debureaucratizing agency
systems and building their capacities to work flexibly as service
agencies.
)
)
)
)
)
)
)
)
>
>
)
)
j
)
J
>
)
)
>
>
7.
7
It is evident that a commitment to the community management approach
is not to be taken lightly by a public agency,
, • rPrograms should not readily adopt
a community management label without such a commitment,, as they are likely to
suffer all the deficiencies of past community development, popular participation
& decentralization schemes. Yet, there remains, at the same time, the need to
begin to examine such alternative approaches, as they appear to hold promise of
more positive results.
>
>
)
8.
Objectives of the Technical Assistance Program are to:
(a)
examine new project approaches and new organizational structures or
arrangements which encourage local initiative, accountability and
self regulation;
(b)
provide
)
3
3
I
?• ■
a
needed
reorientation
in
thinking
in
order
to
better
1
J
106 -
ANNEX 13
Page 18
I
local self-help
appreciate and understand the significant impact
actions can have on a projects’s outcomes;
J
. o
to understand more
communities are i—
and constrain
complex social dynamics that serve to both enable
c--the <
O
local activities; and
ernmeiiG in
and limitations of . government
to examine the potential
capacities.
implementing projects intended to strengthen community c
—
(c)
(d)
S
M
Methodology
9.
Training Workshops; In country series
(a)
5
Sessions
Durations - 3 days
4 Municipal Corporations (Delhi, Hyderabad,
Locations
Calcutta and Bangalore)
Numbers
50 per session
3
Expatriate Trainers
Local trainers -3-
(b)
■
P. Randall, R. McCamey, M. T.
Fuerstein.
- Thailand, Philippines, Bangladesh,
Locations of projects Kenya, Nepal +( emphasis on Asia)
x
Numbers - One selected per each
o
0
Training Workshop (Total 5)
&
Internal Fellowshjjpsj.
0
Duration - 6 days
0
Locations
Numbers
(d)
o-
-0
External Fellowships:
Duration - 20 days
(c)
,0
UNICEF)
To be decided plus national NGO’S (eg.
to be decided
2 selected per Training Workshop (total 10)
o
National Conference
Topic: Demand Expansion through Active
Government Commitment.
Community Involvement
&
Duration - 3 days
.•
■
....
..
.
.. .a.
107
13
Page 1°
)
Location
New Delhi
>
Numbers
400
Recommended keynote speakers - D. David Korten & D. Norman Uphoff
>
Special workshop series could include: BRAC (Bangladesh Rural
A<1 vhim
I
I I 1 nn ) , n WO • III II >P I V Is ’ >WF.n 9 ; D. D«v.i(1
Drucker; Kenya ’ w Nallnnal Ln v 11 < HUntni I :.t?» i c I u i 1 9 I .
>
>
*
(e)
Development Film/Video (for training)
Co-sponsorships a possibility
)
>
J
10.
11.
)
Budget
The total budget is US $ 565,400
should also be added)
)
12.
References
)
»
»
)
)
»
>
>
>
>
>
3
>
Experience.
Korten, D.C.
Community
Management
Asia
Perspectives. Kumarian Press, 1987
Midley, J.
Social
Community
Participation,
Development and the State, Methuen, 1986.
Indian Society of Health Administrators, Community Participation in Health, family welfare: Innovative experiences in India
1990
>
(a 10Z contingency
- Budget breakdown is given in Table 1.
>
>
Time Frame: 1992 - 1993 inclusive
.•ft, ‘--4h-■’St-
' ' ■
)
ANNEX 13
Page 20
108
Item
^4
Budget Breakdown
Table 1:
Preparation &
Training
Workshop
Internal
Fellowships
External
Fellowships
National
Conference
$U.S. ?;)
Totals .
■>
----------------------------------------------------
37/f?
FEES
• local consultants (3)
• e>ma triate consultants (3)
• administration (2)
• guest speakers
24,600
86,000
10,800
0
1,200
0
600
0
0
22,000
4,000
0
12,000
32,600
29,900
12,000
DISBURSEMENTS
• travel
- guest speakers
- delegates
- consultants local
- consultants expatriate
- administration
0
15,000
2,100
27,300
9,600
0
7,000
700
0
0
0
25,000
0
6,500
0
35,000
20,000
0
12,600
9,600
• food and accommodation
- local consultants
- expatriate consultants
- administration
delegates
- guest speakers
9,000
18,000
4,500
0
0
900
0
0
9,000
30,000
0
3,000
0
15,000
0
1,350
4,500
3,000
2,700
0
• transportation (ground)
100
100
300
50
11,000
30,000
0
0
0
0
5,000
0
16-^0
0
50
200
3,500
3<j0
0
0
0
5,000
500
50
2,000
500
igso
248,500
49,600
78,000
189,300
56^00
• materials
- regular
- video
• other
- entertainment, reception,
equipment, supplies
- room(s) rental
• communications
TOTAL
140,6^
45,3OJ
12,07.)
35
IB
11.
25,500
77’L'j
26*^
30, ua)
30;uuo
1
I
109
)
)
ANNEX 14
Page 1
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
I
MANAGEMENT AND INITIAL LISTING OF PRIVATE VOLUNTARY ORGANIZATIONS
TO BE INVOLVED IN PROJECT IMPLEMENTATION
>
Management of PVO Involvement
1
>
)
)
)
)
)
)
)
>
>
)
>
)
)
i
>
>
>
1,
The Government of India has evolved a standard-system for bringing
Private Voluntary Organizations (PVOs) into its social service programs.
Selected PVOs, which must be registered under an appropriate State or national
Act regulating PVOs in order to qualify for Government funding, are contracted
to provide certain services. In return, they receive a "grant-in-aid", which
covers part or all of their operating costs. All PVOs receiving grants-in-aids?
are inspected, their performance mon it ore^and their accounts audited_at
//
regular intervarsT~XE^pxesernr~neither~Telection procedures nor contract
formats nor monitoring procedures have been standardized, though work on this
is currently underway. The following paragraphs give details of how each
municipality proposes to implement PVO participation in project activities
within the framework of the existing Government system:
2.
Bangalore. Bangalore envisages a two-stage involvement of PVOs. In
the first phase, existing PVOs registered under the Karnataka Societies Act,
1954 have been shortlisted and then invited for exploratory d’iscussions to
ascertain their background and experience and interest in the project. A
verificatory workshop was then held to assess their capacity, interest and
desired area of operation. They would be deployed on the basis of their
interests and strengths. Contracts would be entered into only when the project
flow-of-funds is in place, but model contracts are under preparation. PVO
accounts would be audited by registered chartered accountants and furnished
annually to the BCCTPVO performance would be monitored through periodic
reports, monthly and quarterly-review meetings, and workshops; the LMO would
function as a first-level supervisor. A leading role of these existing PVOs
• would be to help slum dwellers set up and launch their SHE (Social, Health and
''Environmental) clubs, which would be associations of project service
beneficiaries for every identified slum.
3.
in the second phase, the SHE clubs would themselves register as new
PVOs and seek grants-in-aid under the same system to support their social,
health and environmental activities. SHE management committees would be
elected by the members, with the local Lady Medical Officer as an ex-officio
member. The club would also have the option to'co-opt PVO staff as committee
members.
>
>
J
..... .
no
1
ANNEX 14
Page 2
’-f-r
j
Calcutta. In the existing health programs in Calcutta under CUDP
PVOs
are not being directly utilized. However such a process has started
Ill,
under a similar ODA-funded program in the slums. Their involvement there is
mainly in training, and they are paid on a fee-for-service basis. For this
project, PVOs working in the health/family welfare area have been identified
through a survey. Their services will be utilized as and when necessary under
the normal financial procedures followed by the State government in its own
employment of PVOs.
4.
5,
Hyderabad. In Hyderabad, lists of PVOs for the project areas have
already been prepared. Final selection will be based on past experience,
credibility and capabilities; they must also be registered under the Society
Registration Act, with a specific set of objectives and headed by a board of
management capable of delivering the required activities. All the PVOs listed
are already in receipt of grants-in-aid and hence subject to periodic audits
and independent inspection. This would continue under their funding from the
project, in which their role will be to employ and manage community link
i
■1
d
workers.
6.
Delhi. Under Delhi’s current procedures for utilizing PVOs, ,
applications of PVOs are invited through press advertisements. The credentials
and background of applicants are examined, with particularreference to the
type of services provided and their field of operation. Guidelines to be
followed and basic requirements to be met in the final shortlisting and
selection process are laid down in a brochure produced by the Delhi
seeking grant-in-aid assistance must enter into
Administration. Selected
------- PVOs
xig
wiuh
uhe
a written undertaking with the Delhi Administration/ Municipal Corporation to
and conditions mutually agreed upon for implementation of < . yj
abide by the terms I
programs
with
targets.
They
grants-in-^|
specific tasks or
--- specific
--------- -----«
- then receive
.
.
aid to make up any deficit in their core operating budgets,
particularly
for
— e>--------- r
~
salaries
of
staff
employed
in
the.
staff salaries, and also to fund part of the
under
the
written
undertaking.
specific tasks and programs assigned to them
Their accounts are subject to both
b-'.l. internal
i-t;--- and external audit. Action can be, •' ,
and has been, taken against PVOs who fail to perform satisfactorily.
d
ei
7.
Under this project, a new set of procedures will be introduced for
PVO selection, specification of the services they are to provide, type o
assistance they will receive, etc. Work is underway on preparation of these
new procedures, which are expected to be more flexible in their operation.
@© l
Initial Listing of PVOs to be Involved in Project Implementation-
8
The following table lists identified PVOs (aided and non-aided), by
«
project city, which are likely to be involved in the project. These PVOs av-) |
already been associated with government-sponsored health/family weltare
H
programs in each city.
t
®I
>1e|
©
W
I
ANNEX 14
Page 3
• 111
)
)
BANGALORE
CALCUTTA
HYDERABAD
NEW DELHI
Lok Kalyan Samiti (1)
Indian Red Cross
Aided
Association
R.K. Miosion Sava
Pra tisthan___________
Andhra Mahila Sablia Rotary Club,
F.P. Association of
Need Trust
Panchsheel Park (1)
India
______ _
SECH (1)
Shramika Vidya Peeta Marwari Relief Society :amily Planning
Association of India
Love and Care (1)
Marie Stopes
Birla S.W. Scheme
Shishuraksha FHP
(Ultadanga)
_ Association of India
Privar Seva Kendra
Indian Medical
Birla S.W. Scheme
Rayapuram Slum
Association
_
Development Society (Phakuria)
Indian Red Cross Charistian Children's N. & S. Gandhi Peace Lion's Club of
_______
Hyde rabad________ Delhi (1)
Fund
_________ F o u n d a tions______
Family Planning
N. & S. Marie Stopes Rotary Club of
CM Al
Association, Delhi (1)
Society
_ Hyderbad
Parivar Kalyan Kendra
Paschim Banga Samaj Voluntary Health
Bosco Yuva Sangha
Association
of
India
(1)
Seva Samity (B.T.
Road)______________
ASHA (2)
Paschim Banga Samaj Vasoda
Deena Seva Sangha
Saeva Samity (E.R.
Avenue)
SHARAN (2)
Bangal Social Service Giants International
Women's Voice
League
Deepalaya (2)
Prosenjit Mem. Com. Health Action
Sumanhally Centre
H. Centre
WAFD (2)
-Vidyanagar (AMS)
Soroj Nalini Dutt
Joint Women's
Assoc.___________
Programs
CASE Plan (2)
Bagpiakers Education Cruse d__________ *Basheerbagh
SEW A - Bharti (2)
‘Begumpet
Note: Some 13 groups Vivakananda Sava
Samity
given in proposal
development scheme,
but 37 groups was the
seminar number
quoted for
involvement.
Centre for Research
and Development of
Dalits. .
>
I
F
)
)
)
)
)
)
>
)
>
>
>
>
>
>
)
>
>
>
>
J
)
)
)
J
“tea;.;
£)__________
ANNEX 14
Page 4
1.1 2
BANGALORE
CALCUTTA
Harmony
HYDERABAD
NEW DELHI
*Sanatnagar FPA1
HARSHA________
Matiabruj Seva Samity *Dr. Paul Das Centre
Rc Socy.
S.V.S. Marwari Relief *Lady Baston Centre
Socie ty____________ Rc Socy.
RMC S Beniapokur
RMC S Sastitala
RMC S Duff Street
RMC S Sokul Boral
Street
_________
RMC S R.K. Bose
Street
________
Virendra Gupta (2)
Guild of Services (2)
* Denotes Voluntary A.V. Baliga Memorial
Society (2)
organization
managing an urban
family welfare centre.
Delhi Catholic
Archdiocese (2)
J
ANKUR (3)
KATHA Educ. (3)
Rajir Neelu Kachwaha
Trust (3)
'-y i
■0.'
Non-AJded
Florence Day Centre
Butterflies (3)
Islamia Hospital
Street Survivors (3)
Bam India
Sulabh Inti. (3)
R.K. Mission
Sevas hram_________
R.K. Sarada Mission
Matri Bhava________
Nirman Bazdoor
Panchayat Sangam (3)
Lion's Multipurpose
Clinic
__________
Child Health Centre
NGO Centre for
Training (3)
Calcutta F.P. Centre
<5:
-■
.S’ 1
^1
Action India (3)
0I
SACH (3)
■
Jan Madhyancy (4)
Assoc. Medl. Women
I ns ti tu te___________
Souch Cal Child <Sc
Gari Society________
Tamana (4)
Society for Com. Dev.
P roj e c t_____________
Spastic Society (4)
" i
i
Sahan (4)
©
&I
a ■
I
■
.©
BOS
-
113
5
ANNEX 14
Page 5
>
BANGALORE
CALCUTTA
HYDERABAD
NEW DELHI
>
All India Women's
Conference
Akshaya Pratisthan
>
Cathadral Relief
Society
Lt. Amritalal Gupta
Char Disp.
Church Aux for Social
Action
Handicapped Welfare
Fed. (4)_____________
Blind Relief Assoc. (4)
*
>
w_______ _
Joint Women's
Program (5)
Sidhaswari Seva
Protisthan
SAHELI (5)
Kothari Foundation
Mahila Dakshta
Samiti (5)
5
Janata Medical Service
VHAI (5)
>
Bengal Rural Welfare
Service
VHAI Delhi (5)
>
Inner Wheel Club of
Calcutta__________ _
>
Calcutta Social Project
Vivekanand Kendra
^5)___________ ____
Ford Foundation (5)
>
Rotary Club of Cal
Dn. Town
Vishudhyananda
Hospital____________
>
)
>
>
>
)
>
Medical Bank_______
Sea Right Hospital
Thakurpukur M.C.H.
Centre______ _______
Bakhrahat
Himoabty Association
>
Mohananda
Bramhachari______
Lohia Matri Sadam
>
>
Matri Mongal
Pra tis than__________
Satya Sai Seva Samity
>
Kusua Kumari
Databya
_________
>
>
)
9
Inst, of Child Health
Kumartuli Seva
Samity
Mat. & Ch. Welfare
Advisory Clinic
Yuva Pray as (5)
Project Smita (5)
ANNEX 14
Page 6
11 /»
SI . !>/ ‘
BANGALORE
CALCLETTA
HYDERABAD
NEW DELHI
Cal. National Welfare
Organization
T
Selimpuz Nursing
Home
f;- V-
Notes Re New Delhii
(1)
(2)
KE 2 toe NCO?SlnXa S pSeU^eSto delivery and to^.ed he.dh
programs.
those NGO's engaged in specific activities (e.g. education, construction of
(3) Refers to
latrines).
(4) Refers to those NGO's working for the disabled.
(5) General NGO's.
J
'^ix ■
©
©
C)
©
•'•y)
i
"
©
0
©
s>
©
iiiiil
- 1.1.S
ANNEX 15
Page 1
7
INDIA
)
FAMILY WELFARE (URBAN SLUMS) PROJECT
INFORMATIONt EDUCATION AND COMMUNICATION
>
)
A.
BACKGROUND
>
1.
An IEC program can be the catalyst for community and client
involvement and acceptance of key project interventions to improve
opportunities for urban slum populations e.g. increasing demand and
utilization of a wide range of health services; improved education for girls;
delaying the age of marriage. However, IEC programs can be effective only in
an environment in which: (a) promoted program services are available at the
level and quality necessary for utilization by client and community; (b) IEC
implementing organizations have the resources and ability to plan and conduct
necessary program activities; and (c) the felt needs of beneficiaries are
given priority by program planners and implementors.
>
>
)
>
2.
Proposals from Bangalore, Calcutta, Delhi, and Hyderabad indicate
an appreciation of the need for these prerequisites to be developed under the
project and have outlined IEC activities aimed at addressing problems which
hamper institutional capabilities to undertake effective IEC programs at three
critical service levels: (a) the service center (including, PVO and public
sector hospitals, health centers and health posts); the client; and (c) the
community.
>
>
>
>
*
)
3.
On the supply side or service center level, training is needed in
communication skills to new outreach workers e.g. link workers in Bangalore,
Hyderabad and Calcutta and ANMs in Delhi, and the communication skills of'
existing program staff and service delivery workers have to be upgraded. New
‘ and existing cadres of care givers in all the municipalities require a variety
of IEC materials to: upgrade their knowledge of health technology; support
their interpersonal communication and motivation efforts with clients; and
support their promotion of new and existing services available in targeted
slum communities.
>
)
$
*
>
4.
At the client level, ignorance about the range of health services
available through the public health system; apathy regarding the need to
utilize such services in an appropriate and timely manner; pervasive
perceptions about the quality of care at public sector health institutions,
and concerns about poor service provider attitudes and behavior remain real
barriers to increased client utilization of services and program
participation.
>
>
>
>
5.
At the community level, IEC programs have to facilitate the
involvement of community-based organizations in program planning and
implementation. There is also to requirement to increase the knowledge of
health issues by opinion leaders and where necessary, change negative
attitudes and behavior so that these leaders can support the program and its
objectives.
)
i
■^.7
'
•<-
■
•
■
4 T
J16
B.
ANNEX 15
Page 2
GOI’s IEC STRATEGY FOR SLUMS
6.
The GOI’s Mass Education and Media (MEM) Division has determined
that the IEC strategy in slum areas has to be achieved through a mix involving
the electronic media, folklore through the song and drama,, and print including
items Such as innovative stickers and posters. The analysis, pre-testing,
development, implementation and revision of new materials will be undertaken
as part of the process of developing prototype material by the center.
Regionally sensitive variations in terms of culture and language for the four
cities would also be adapted from these prototypes.
3
• a
W
7.
An IEC infrastructure exists and State Media Officers, Exhibition
Officers, editors, audiovisual officers, painters, and photographers are
already available in each State. States also have basic media and audiovisual
equipment and offset printing presses for the production of regional
materials. The additional personnel which would be created under the project,
has been done in consultation with the State Media Officers. The Department
of Audiovisual Productions also organizes exhibitions in different places.
These exhibitions are funded by MOHFW would be organized in the slum areas at
appropriate times. Similarly, song and drama programs, screening of films on
16 mm projectors would also be organized in consultation with State Media
Officers. The State Media Officer is also on the Inter-Media Publicity
Coordination Committee where Doordarshan, All India Radio and other media
personnel are members.
V -
fl
i
3
f- -p
■• y-
8.
Inter-personal communication is critical in the GOI plan. Under
the project, link workers (volunteers) would work in every 20 households.
Their training should be organized and they will be equipped with flip books
and other materials to enable them to be more effective.
0?
9.
Communication research indicates that IEC activities should be
entertaining as well as educational. A base of the program will be
entertainment. There is therefore a need to produce good music and films and
funds will be provided for this. Entertainment and education will be provided
also by Mahila Swasthya Sang which are women’s health education groups. They
meet as an executive body once a month and organize innovative programs on
target groups such as youth,children, mothers and daughters-in-law, and
husbands. Some immediate funds are given for the monthly meeting and a onetime small non-recurring grant for buying musical instruments. The women
functionaries of different departments are members of this executive body such
as ICDS workers, rural health volunteers, lady teachers, and traditional birth
attendants. There are also 10-15 influential and important women who are
elected by the community.
o
a A;
■
10.
Training is an important activity. Under the MEM’s plan, all
health functionaries must be trained in communication. IEC officials will
also be trained. Portable simple educational materials would have to be
provided to all field workers. Distance, group and traditional training would
have to be undertaken. Audiovisual vans will be an asset in carrying this
program from door to door and also to make it a success. Song and drama
programs, like puppet shows, street plays, magic shows, song and dances are
also required.
,..5.
SA
■
0
t•
117
>
ANNEX 15
Page 3
0: THE IEC PLAN
)
Countering the low demand for temporary methods of contraception,
11.
utilization
of existing public sector health services, and client
poor
ignorance and apathy regarding healthful behaviors which can save lives, would
be the focal points of the IEC efforts in the four municipalities. To achieve
these goals, IEC programs will aim at changing negative health related client,
and community attitudes and behaviors and promote greater demand for new and
existing health and social services. The plan will be to: (a) supplement
efforts aimed at improving the quality of FW and MCE services provided at
various public and private health centers/posts by; (i) increasing service
provider (e.g. private medical practitioners, link workers, ANMs), skills in M
interpersonal communication and client motivation techniques through enhanced]]
training and use of specialized IEC materials, (ii) promoting and enhancing
new and existing health services also enhanced health care activities, e.g.
outreach services and worker routines for slum dwellers; and (b) generate
-increased demand and use of municipality health services and special programs
by; (i) changing health related attitudes and behaviors among providers that
are barriers to client health compliance; and (ii) producing media materials
for client health and family welfare information and educational needs. IEC
activities will utilize interpersonal communication approaches reinforced by
use of various mass media for:
>
>
)
)
)
)
)
>
)
)
)
A:
Advocacy and Awareness Creation of:
the project and its special programs;
the availability of new and existing health services in the
project area;
the presence of new health functionaries, e.g. link workers,
their work routines and schedules;
B:
Demand creation for utilization of:
specialized health services;
new and/or upgraded services e.g.primary education, literacy
programs, provided under the project.
C:
Behavior and attitude change for:
the adoption of modern temporary contraceptive
methods;
- improved MCE health compliance;
greater community involvement and support to health
care and special social service programs promoted
under the project;
- prompt action by clients in seeking curative health
care;
improved client use of existing health facilities;
increasing the age of marriage.
>
>
>
I
>
)
>
)
1i
)
i
>
>
>
>
12.
be:
>
At the health facility level:
J
>
3
3Mb- ■
General target audiences for IEC efforts in the four municipalities will
Medical officers
Private medical practitioners
118
ANNEX 15
Page 4
•5
'3
‘J
ANMs
link workers; Basti Sevikas;HHWs
dais
IEC Unit staff
.1
I
At the community level:
- local leaders
- NGO, PVO community
- cooperative members etc.
At the client level:
Identified slum populations with emphasis on:
- adolescent girls (13-16)
- women of fertile age
- mothers-in-law/sais
- males in general
13.
Key project inputs include:
(a)
Staff and consultants
(b)
Research and evaluation activities; e.g.Communication Needs
Assessments and process evaluation activities;
rl
to explore client and community perceptions, attitudes and
practices about specific health related issues
for creative media program and materials development
T -lig
to evaluate the efficacy and impact of IEC interventions
£■.31
(c) Training
IEC curriculum development for various lacunae e.g link
workers
training of IEC staff and manpower development
training for local leaders through OTCs and camps
communications training for health service delivery workers
(d) Material development
for use in lacunae training
for service provider client counseling and motivation
activities
for client use
for program advocacy efforts
(e)
■ •
'
-
•
'■
■i--
■’
.
■. - • • i
Special campaigns and program activities
: ; •
'•
a
i
'' r
%
119
J
5
ANNEX 15
Page 5
(f)
Hardware and supplies e.g. vehicles, audiovisual equipment
etc.
(g)
Technical assistance
for materials development
for conducting research and evaluation activities
assisting with training and other specialized program needs.
D.
ORGANIZATION
)
I4*
in
In Calcutta and Hyderabad the proposed apex planning and
implementation organization for IEC under the project is the State Mass
Education and Media
Unit within
Statej’sCentral Health and Family Welfare
-- -------- the
-- ----Department. 7
‘
In Hyderabad the existing
Mass Media Unit in the Family Welfare
Bureau will be strengthened and its activities integrated with the Training
Cell in the Project management unit. Calcutta has a well developed IEC Unit
which was strengthened under IPP POP IV. Under this project, IEC operations
will be decentralized to the East and West Banks of the city by
establishing
small scale IEC Units in these areas. The State MEM Units and the various
collaborating public sector, private voluntary organizations and community
service provision agencies involved in the municipalities* projects will work
together under the auspices of an IEC program planning and implementation
committee. Terms of reference and scope of work of each municipality IEC
program planning and implementing committee will be defined individually by
each municipality.
>
>
>
15.
Neither Delhi or FBangalore municipalities have an IEC system for
primary health care and family
. welfare5 programs. These municipalities will
establish IEC Units to facilitate program implementation (Parses.16 of SAR).
In this regard, the projects proposed IEC program planning and implementation
committees will provide a preliminary institutional base until such time as
explicit IEC Units are established in the two municipalities.
>
>
)
1
3
>
>
>
)
>
)
16•
In Delhi the Publicity Wing within the Directorate of Family
Welfare organizes and coordinates some IEC activities for the Corporation.
However, such activities are related primarily to publicity of family planning
program activities. The Delhi Administration proposes the establishment of an
s IEC Cell in the Directorate of Health Services. The Delhi Cell will have
forty-three (43) new staff positions which will include helpers who will work
out of Health Posts in JJ clusters. The functions of this Cell will include
assessments of health education and other communication needs at Health Posts,
message and materials development, campaign implementation and evaluation
activities.
17•
Bangalore will establish and equip a new IEC Unit under the
control of the Corporation’s Additional/Deputy Health Officer and the addition
of seven (7) new posts. CCurrently the State provides the municipality with
two Health Extension Officers. Four fully equipped mobile audio visual vans
will be provided to support IEC outreach efforts in Bangalore.
18•
All IEC Units will be responsible for collaborating with the
various project Training Wings to develop integrated communications training
plans for in-house staff and peripheral workers who will be trained under the
J
1
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■
■
■
... .
120 -
ANNEX 15
Page 6
proj ect. Training of workers will be undertaken collaboratively by State MEM^j
staff. Additional training of service providers and other health cadres will_
be undertaken at regional Training centers. (See Paras. 3.09-3.10, Training).^
19.
Ongoing IEC research, monitoring and evaluation activities will be
developed jointly by IEC and Management Information Systems staff. A
/ strategy
'
‘
will be to develop, as part of the project’s MIES system, in-house activities^
and2 simple program assessment instruments
instruments that
that could
could be
be used
used by
by IEC
IEC staff
staff and
and
_ i
«4- 4 »-»•"» a 4 va o
r\ mnn©nr
rf nrmnrir P And
*
select
health functionaires
to
monitor ♦•'ho
the no
performance
and ilTIDaCt
impact Of
of IEC
IEC
activities on key segments of the target audience. Wherever needed, local
consultant firms from the private sector will be recruited to assist in the .
design and implementation of necessary impact studies and evaluation
activities.
0
-3
'0
KJ
©
v
0
©
0
■ ■ ■■ Wtet
121
■)
ANNEX 15
Page 7
3
3
TEC PLANS BY MUNICIPALITY PROPOSALS
PROGRAM
AREAS
BANGALORE
CALCUTTA
DELHI
HYDERABAD
Research
♦ Assessment of
cotamunications/lEC
needs as part of
baseline training
assessments
♦ Assessment of
communications/lEC
needs as part of
baseline/
communication and
training
assessments
♦ Conduct
communications
needs assessment
♦ Conduct
communications/lEC
needs assessment
>
♦ Conduct ongoing
impact studies
♦ Medical officers
prepare community
profiles for
health posts
)
Training
>
)
♦ Train key
categories, e.g.
link workers,health
workers, extension
educators, LHVs,
LMDs, PHNs, and top
level officers in
motivation and
communication
techniques.
♦ Train HHWs, HFOs
and first tier
supervisors in IEC
skills and
techniques.
>
>
♦ Re-train and
reorient training
staff in IEC
skills.
♦ Provide training
for ANMs in
principles of
Health Education
♦ Training for all
categories of
program staff,
e.g. medical
officers, in the
planning and
implementing of
IEC activities,
also in assessing
impact of
activities
♦ Conduct periodic
IEC seminars for
critical program
and service
delivery staff.
)
♦ IEC training for
NGOs, PMPs, and
community groups.
)
5
>
>
>
)
>
3
Strength
ening
IEC^
insti
tutions
♦ Development of
Annual IEC Action
Plans.
♦ Development of
annual IEC action
plans.
♦ Development of
annual IEC action
plans.
♦ Development of
Annual IEC action
plans.
♦ Establish an IEC
Unit in PMT under
project
coordinator.
♦ Decentralize the
IEC program to
East and West
Banks through
establishment of
small scale IEC
units.
♦ Establish an. IEC
cell within
coordination cell
of the IPP VIII
Project.
♦ Establish IEC
and Training cell
in CFWP project
management unit.
♦ Recruit 43 new
staff for IEC
cell.
122
'>• >
ANNEX 15
Page 8
BANGALORE
PROGRAM
AREAS
CALCUTTA
DELHI
♦ Coordinate IEC
activities of
government
departments, local
bodies, NGOs and
PVOs.
♦ Undertake
ongoing impact
assessments of IEC
activities.
HYDERABAD
'm*
Strength
ening
IEC
Insti
tutions
(cont.)
♦ Recruit 7 new
personnel for unit.
♦ Purchase 4
audiovisual vans
(fully equipped).
•
a
♦ Purchase
vehicles,
audiovisual
equipment and
software for IEC
cell.
♦ Decentralize
communicat ion
planning and
include all levels
of MOs, slum
community groups
and PVOs.
♦ Monitoring cell
to develop IEC
monitoring system
for IEC cell.
o
•
!? •
^3
Promot
ing
Services
/Demand
Gener
ation
♦ ANMs to provide
health, FP and
nutrition education
at health centers
♦ Outreach on
environmental
sanitation,
personal hygiene;
nutrition; MCH.
♦ ANMs and health
workers educate and
motivate community
groups and clients
on nutrition, HE
and FP.
♦ Client
information and
motivation on FP
methods and MTP.
♦ S.H.E. Clubs to
promote awareness
of MCH and FW
programs and
services
i
♦ Nutrition
education for
pregnant and
lactating mothers.
♦ Health education
for baby care.
♦ Basti Sevikas to
conduct 3 hour per
day health
education talks,
mobilize and
motivate clients
for MCH, FW,
immunization
Also
methods, FP.
importance of
breastfeeding, ORT
weaning and use of
supplementary
foods.
♦ ANMs, WHVs
Dais provided wi
medical and •
educational k^ts
and materials
their outreac,*^
work.
e
♦ Increased cli(
education onv
nutrition,
PHC also
environment a.^
sanitation
offices.
♦ Group
meetings/OT^A.
♦ HHWs to educate
mothers on use of
ORT.
©
©
©
......................................................
.
■
5
123
)
3
3
>
>
ANNEX 15
Page 9
PROGRAM
AREAS
BANGALORE
Promot
ing
Services
/Demand
Gener
ation
(cont.)
CALCUTTA
DELHI
♦ Educate
community about
new and existing
services.
♦ Promote
participation of
males in the
adoption of
contraceptives,
generally promote
advantages of
small family norms
and preventive/
promotive health;
generate demand
for services.
)
)
>
)
)
>
)
>
PVO
Involve
ment
♦ PVO involvement
in:
3
- Organizing and
implementing health
education programs
- Promotion of MCH
and FW programs
>
(Q Non-formal
3
education programs
for out-of-school
girls
3
>
>
>
>
>
3
3
3
3
♦ Organization of
well baby clinics.
♦ Medical officers
to organize
communication and
media activities;
govern group
meetings and other
health campaigns.
)
)
♦ One-on-one
counselling/
motivation.
♦ Trained dais to
provide health
education, also
educate mothers on
care of newborns
and promote breast
feeding.
3
)
HYDERABAD
♦ Through Joint
Women's Programme
educate slum
parents on the
dangers of early
marriage.
♦ PVO
implementation of
IEC component.
♦ Involve PVOs in
awareness
campaigns against
prostitution and
to counter spread
of HIV/AIDS.
♦ Private medical
practitioners to
undertake
increased IEC IHE
activities with
clientele.
♦ Involve PVOs in
planning of IEC
activities.
♦ Organization of
IEC Seminars and
workshops for
PVOs.
<4
124
ANNEX 15
Page 10
A
PROGRAM
AREAS
BANGALORE
CALCUTTA
DELHI
HYDERABAD
Commun
ity
parti
cipation
♦ Awareness
creation by S.H.E.
Clubs.
♦ Promote among
formal and
informal opinion
leaders positive
attitudes towards
MCH, immunization,
and nutrition
♦ Promotion of
community
participation in
IEC and Training
programs.
♦ Formation of HFW
committees.
♦ Community
involvement in MCH,
FW programs,
environmental
hygiene
♦ ANMs, VHWs and
Dais to motivate
local leaders for
involvement in the
health care of the
community.
♦ Propagation and
strengthening of
women *s
organizations.
♦ OTCs to involve
community in
planning and
execution of IEC
activities.
Si
♦ Involvement of
Local Dais and
community medical
practitioners in
IEC activities.
♦ Involvement of
Mahela Mandals, i&
influential women,
religious, youth
and professional Ah’
organizations in
conducting IEC
<•?
activities.
J
/.•■I
Child
Marriage
Re
straint
Act
V
rInnova
tive
Schemes
♦ IEC unit staff to
educate urban poor
on ill effects of
early marriage
♦ Environmental
health, sanitation
and hygiene
awareness program.
♦ Develop
comprehens ive
educational and
motivation
programs to inform |
and persuade slun>%^
dwellers and
.
community leaders
about hazards of
early marriage and''benefits of
delaying marriage
♦ Conduct media
and community
based campaign to
increase the
awareness of the
ill-effects of
early marriage
♦ Nutrition
Awareness program.
fl
1i
♦ Awareness
campaign tp
promote early
detection of
cervical and
breast cancer.
♦ Formulation of
lEC/Health Ed
squads comprising
upper primary
school students.
_ •....... ,..,w..... .• -
■.<<
X
!W i
- 125 ANNEX 15
Page 11
)
)
PROGRAM
AREAS
BANGALORE
CALCUTTA
DELHI
HYDERABAD
Female
Educa
tion
♦ S.H.E. Clubs to
organize non-formal
education for girls
not in school.
♦ IEC activities
to promote
community
awareness about
the need and
importance of
female education.
♦ Utilize mass
media, wall
posters to create
awareness and
motivate parents
re: need for early
child care for
females, primary
school enrollment
for girls, etc.
♦ Education of
adolescent girls/
counselling
practices scheme.
>
I
♦ Utilize
traditional art
forms and folk
theatre for field
based IEC
activities.
5
)
)
>
Campaign
/Mater
ial Pro
duction
>
(V)Development of
local language
videos and films,
educational games,
film slides, flip
charts, printed
materials, etc.
♦ Utilize
communication
efforts of other
departments, e.g.
social welfare,
education, etc. to
convey health and
FW messages.
>
>
>
>
I
)
>
♦ Utilize mass
media, community
education and
involvement
techniques for FW
acceptance.
♦ Develop a
comprehensive mix
of IEC materials.
i
>
♦ Conduct specific
HE campaigns/
camps.
♦ Implement state
level health
competitions.
♦ Utilize
traditional art
forms, folklore,
free publicity and
interpersonal
communication at
cluster level.
♦ Develop mix of
media materials
and audiovisual
aids in a
decentralized „
manner.
>
>
♦ Development of
display kit and
educational
materials aimed at
educating slum
dwellers about
hazards of early
marriage and
benefits of
delaying marriage.
♦ Develop special
kits for use by
Dais andHHVs.
♦ Develop kits for
use by ANMs.
♦ Develop kits to
contain
educational and
essential health
materials for
OTCs.
♦ Screening of
films and video
shows.
>
>
♦ Exhibitions.
>
2
Ou
iS? .'f-
>
1 < '?> yrT ’ ■' y? •**
c / mJx cH * ? < 7 -
! .
■‘4'
126 -
ANNEX 16
Page 1
■i
INDIA
■
FAMILY WELFARE (URBAN SLUMS) PROJECT
1
SCHEDULE OF APPOINTMENT OF ADDITIONAL STAFF
DESIGNATION
TITLE OF STAFF
TOTAL TO BE
APPOINTED
^4
1
1992
1993
1994
1995
25
4
12
20
4
20
30
8
2
8
16
370
9
9
9
1
5
1
4
1
300
8
8
8
150
4
4
4
7
2
7
8
11
110
2
2
2
2
2
1
1
1
1
2
2
2
14
20
6
8
1996
B AN GALORj
Health Centers/Health Posts
Lady Medical Officers
Paediatricians
LHVs/PHNs
Staff Nurse
ANMs
Link Workers (Volunteers)
Lab Technicians
0T Attendant
Anaestheologist (part-time)
Project Coordinator
Program Officers
Training Director
Training Officer
IEC Director
Training Officers
Extension Educator
Photographer
Driver/projectionist
Demographer/Statistician
Secretary cum Steno
Administrative Assistants
Driver
^Clerk
Sweeper/Watchman
NEW
60
12
47
58
11
970
24
24
24
1
5
1
4
1
4
4
1
4
2
1
2
1
441
65
1
20
30
4
40
1
1
1
J
3
1
-
4
7
■ ^3
w
■al
D E L H I
Health Centers/Health Posts
Medical Officers
Staff Nurses
ANMs
Lab Technicians
Pharmacists
Basti Sewikas (Volunteers)
Statistical Assistant
Lab. Technician
3
77
24
200
6
51
625
6
6
10
12
25
2
11
125
0
0
27
6
75
2
20
200
4
4
27
3
75
2
20
200
2
2
13
3
25
100
-S
"W
1
3
127
ANNEX 16
Page 2
J
DESIGNATION
TITLE OF STAFF
’J
3
¥
>
3
5
J
>
*
3
5
>
J
>
>
>
NEW
TOTAL TO BE
APPOINTED
1992
1993
1994
1995
6
37
25
12
6
0
8
5
2
1
1
4
12
8
5
2
2
2
8
5
5
2
2
9
7
2
1
1
i
i
1
1
1
2
2
1
1
1
2
2
DELHI (continued)
Health Centers/Health Posts
Lab. Assistant
Safai Karamchari
Chowdikar
Ward Ayah
Clerk
Driver
Coordination Cell
Project Director
Office Superintendent/
Head Clerk
Stenographer
U.D.C.
Driver
L.D.C.
IEC Cell
Communications Officer
Media Accountant
Health Education Officer
Extension Educator
Proj ectionist
Electrician
Driver
LDC cum Storekeeper
Training Cell
Training Program Officer
Health Education Officer
Medical Officer
Extension Educators
U.D.C.
\ Driver
Monitoring & Evaluation Cell
Medical Officer
Research Officer
Systems Analyst
Programmers
Operators
Statistical Officer
Statistical Assistant
Stenographer
Accounts Cell
Account Officer
Accountant
U.D.C.
L.D.C.
1
1
3
1
2
1
1
1
1
2
1
2
1
2
1
1
3
1
1
1
1
i
1
1
1
1
2
2
4
1
1
1
1
2
2
4
1
1
i
1
3
2
1
i
1
1
&
j
31
til
1
2
1
1
■
■'
1
1
1996
128
ANNEX 16
Page 3
T-.
DESIGNATION
TITLE OF STAFF
TOTAL TO BE
APPOINTED
1992
1993
1994
1995
1996
HYDER ABAD
Health Centers/Health Posts
City F.W.Officer-Jt.Dir.
Program Officers
Lady Medical Officer
Senior Medical Officers
Gynaecologists
Paediatricians
Anaesthetists
LHVs/PHNs
Staff Nurses
ANMs Lab Technicians
Operation Theatre Attendants
Link Workers (Volunteers)
Accounts Officer
Senior Accountant
Cashier (U.D.C)
Typists
Computer Program Assistant
Program Officer (Training
and Nursing Supervisor)
Projectionist cum Operator
1
1
3
26
5
2
3
2
60
20
172
5
5
690
1
2
1
2
1
2
2
20
10
35
3
2
150
1
1
1
2
1
2
1
1
1
1
2
4
9
8
4
2
5
2
1
1
1
13
6
19
6
1
1
1
2
2
1
10
2
3
10
2
2
1
6
1
)
20
10
50
2
3
200
20
12
75
^4
200
140
1
1
o
CALCUTTA
Project Director
Chief
Deputy Chief
Assistant Chief/Sr.Trg.Off.
Nutritionist/Project Officer
Training Officer
Accounts Officers/Accountant
Stenographer
Senior Accounts Assistant
Accounts Assistant
Program Assistant
Cashier
Typist cum Clerk
Clerk cum Storekeeper
Attendant
Packer
2
1
1
1
1
3
2
6
2
1
2
5
4
2
1
2
1
1
2
2
1
1
1
8
3
8
3
2
1
5
1
< >
©
•' •)
J
I
129
ANNEX ]7
Page 1
INDIA
)
FAMILY WELFARE (URBAN SLUMS) PROJECT
INNOVATIVE SCHEMES
»
A.
5
BANGALORE
1.
The main objective of innovative schemes in the project is not only to
supplement but also to strengthen sujstainability of the project. Promotion of
the status of women is given importance under these schemes,
______
To make the
schemes more effective, it is proposed to generate a r"Revolving
~
’ 1
(Development)
Fund" at slum levels with full participation of beneficiaries
_______ ; and benefactors.
Four schemes are proposed initially and are outlined below:
I
I
)
>
2* #
Social Health and Environmental Clubs - SHE Clubs in Slums, Under the
project, to promote effective community participation, "Social Health and
Environmental" clubs
"SHE" clubs would be formed in each of the slums, Slum
dwellers would be enrolled as members through the collection of a monthly
subscription of Rs. 5 per family. A Management Committee consisting of 5
members, of whom at least 3 will be women, with two member retiring every two
years. The Committee can coopt members of PVOs. The club will also be
treated_as_PVO__and_is_eligible to receive f inane ial^support. "SHE" Clubs will:
(a) create awareness of environment hygiene and develop coomunity-based
sanitation programs; (b) prepare a plan of activities for the health centre
based on the needs of the community; (c) coordinate with the health centre to
ensure availability of services; particularly freejnedical aid to the needy;
(d) discourage child marriage and early motherhood; (ej organise non-formal
education for out-of-school girls; and (f) maintain the funds~of"“the clubs for
community, A Lady Medical Officer will be an‘ex-officio
the benefit of the community.
member of the Committee.
)
)
>
>
>
>
>
>
I
)
>
V
>
>
>
>
1
3
J>
5
J
X
3•
Establishment of Creches in Slums. These will be promoted by'health
centres and established by PVOs and SHE clubs. ]BMC
-- is
* presently running 10
* creches and experience indicates that creches could be run effectively or
economically by PVOs or by slum dwellers themselves. It is proposed to cover
250 children per year in about 5-7 creches. The creches would be located
either at the health center, schools or in buildings owned by BMC in the slum
areas.
•
Vocational Training. Tailoring and knitting seem to be more popular
schemes among the women of slums, Adolescent girls and women are receptive to
such skill upgradation programs, SHE clubs and PVOs will be encouraged and
financed to organise programs for targeted
_
I groups. The estimated cost per
candidate for 12-15 weeks training programme is Rs. 1000/- and on an ave rage
1000-1500 candidates will be trained every year.
5.
Revolving Fund/Development Fund. The sources identified for
I generation of Revolving Fund/Development Fund at slum level would be:
I (a) monthly subscription to SHE club at five rupees per family per month;
I (b) contribution of parents leaving children at the creche at ten rupees per
\month; (c) matching grants to the slum from Bangalore Municipal Corporation,
J State and Central Governments.
130
B.
ANNEX 17
Page 2
P
CALCUTTA
6.
As a part of innovative schemes, certain non-medical services would be
--- .. The
The
taken up under the project to supplement the main efforts under MCH
following are the supplementary programmes designated as innovative schemes.
al
l
7.
Nutrition Awareness Program. The main purpose of this scheme would be
to generate awareness amongst beneficiaries about the need for taking a
locally available low-cost nutrious diet, rather than merely feeding
nutritious food. The scheme will help demonstrate among the target
beneficiaries that with cheaper local good grains, a nutrious and affordable
diet can be made. It is proposed that food packets of 500 gms, each
■iS
containing 400 gms of a roasted whole wheat flour and 100 gms of green gram,
will be prepared and distributed amongst the eligible mother and children.
While the children would receive one food packet every week, eligible women
f;1)*
would be provided with two food packets each week. This would provide 250
calories to a child and 500 calories to a pregnant and lactating mother per
day. A similar program under CUDP-III has been quite successful in generating
nutrition awareness iamong the women beneficiaries and has been able to
< **^1
demonstrate that it is feasible to prepare food packets of— sufficient
nutritional value at a relatively low and affordable costs, What is important
to do under this scheme, is to establish a mechanism by which mothersj can
evaluate and see for
l._ themselves the improvement in health standards of their
own and of other children. To do this, it will be necessary to maintain and
monitor records of weight, height, measurement of arms, preparation of charts
0'
etc. It is also necessary to ensure that the beneficiaries themselves can
prepare such nutrious foods with locally available cheaper ingredients.
PVOs/Local Clubs would be involved in implementing this Nutrition Awareness
Program. The HHWs who will have direct contact with the beneficiaries will,
however, be responsible to inform the latter about implementation of the NAP
through concerned PVOs/Local Clubs. The Nutrition Awareness Program shall be
run at sub-centre level in the present program. It is proposed that during
the project period the nutrition program shall be run only at 300 sub-centres. .^yj
I
8.
Creche Program. It has been observed that in low income settlements,
children of working mothers are left uncared for during the period their
mothers are engaged in work, This has resulted in various health and social
problems for the children. It is proposed to set up creches at the block
01
level, with direct involvement of the PVOs. This will provide an opportunity •, *■
w>
for the PVOs to monitor the various health measures envisioned for the
>
The
main
purpose
of
creche,
however,
would
be
to
keep
the
children
children. ’-- --- A
,
in a congenial environment during the time their mothers will be in work.
Under the CUDP-III Health Program, 6 creches have been established and are
already functioning. The experience has been good in that such facilities
The Creche Program will be run at 200-^|
havetbeen appreciated by the community,
sub-centres.
been I
9.
Anti-Larval Program (ALP). The Anti-Larval Program component has
envisaged for upgrading and expanding the Mosquitoes Control Program, This
particularly significant in view of the rising incidence of malaria, filaria
and encephalities in the urban areas of CHA. The prevailing measures have
been found to be ineffective in controlling mosquitoes, especially in the
municipal areas. The Government of West Bengal has taken up a program called
O'!
BfWS
131
ANNEX 17
Page 3
Malaria Eradication Program (MEP), to achieve the objectives of elimination of
deaths from malaria; reduction in the malaria morbidity; and maintenance of
the gain achieved earlier by reducing transmission wherever possible. The
following steps have been taken in the context of ALP: (a) areas where API is
more than 2 - Regular insecticide a spray with 2 rounds of DDT & 3 rounds of
BHC. Active and passive surveillance and presumptive and radical treatment of
cases; (b) areas where API is less than 2 - only focal spraying where
Falciparum cases are detected. Surveillance and treatment of cases; (c) urban
areas - intensive Anti-Larval Measures and drug treatment. This is done by
the Municipalities and Corporations. For containment of filaria, the
following measures have been instituted as anti-mosquito measures: (a) AntiLarval Measures - Recurrent Anti-Larval measures in endemic urban areas
including an extra 3km peripheral belt: (b) Anti-Adult Measures - Pyrethrum
space sprays as the vector have become resistant to DDT and BHC.
I
•I
V
)
>
10.
In order to expand the scope, coverage and efficacy of the above noted
programs, the following items would be included in the Anti-Larval Program
7ALP), as a part of the project: (a) training of the existing manpower of the
local bodies where they can, organize intensive anti-larval measures; (b)
supply of material like Abate (Temephos, Baytex (Fenthiion) Pyrosense Oil - E
etc. so that the corporations and municipalities can use these in a proper
manner and frequency to eliminate mosquitoes; and (c) in urban areas, along
with Anti-Larval Measures, it is necessary to
take action against adult
mosquitos where vector density is high, Thus, Malathion and Fogging Machines
may be supplied to the corporations so that they can participate in effective
vector control.
)
>
)
»
>
>
11.
All the measures mentioned above would be carried out by the
Government directly through the local bodies with logistical support in the
form of radicals in chemicals. The Municipal Authority will be responsible
for executing the works envisaged under this scheme. The program will be run
from the municipalities. For Calcutta Municipal Corporation and Howrah
Municipal Corporation, there will be need for more than one unit. The total
number of units for all the municipal areas and the corporations taken
together would be 50.
>
J
i
>
>
»
>
>
3
*
12.
Environmental Sanitation Improvement Program. To engage local
s communities in the maintenance of infrastructural assets and services within
the low-income settlements, the HHWs and PVOs will be authorized to register
complaints with the Municipal Authorities in cases of break down of services.
For minor repairs which do not require much of skill and expertise, the local
community shall put in voluntary labour to overcome the problem. The scheme
aims to undertake the following services with the help of voluntary labor from
the community: (a) effect minor repairs of tubewells; (b) replace missing taps
to prevent wastage of piped water supply; (c) cleaning of open drains to
prevent breeding of flies and mosquitoes through organized "Sramdan"
(voluntary labour by the community); (d) disposal of garbage; and
(e) introduce cheaper variety of smokeless chullies (ovens).
13.
Organization of the activities under the scheme would be left to PVOs.
The PVOs will have to maintain records and registers necessary for carrying
out the activities. The scheme is expected to have important impact on the
health condition of the people living in low income settlements. The records
and registers maintained by the PVOs will provide an opportunity to evaluate
5
Y/W''
$*
W':'-^
t
132
ANNEX 17
Page 4
if
the performance of the scheme at the later stage. PDur ing /he pro j e ct period,
the program would be implemented at 300 sub-centres out
_ _ 1ofa t o t a 1 k 7 6 .
14•
Program for Early Detection of Uterine and Breast Cancer, It is a
felt need of the low-income group of women in the proposed project areas iu
CMD area, that for generating awareness against cancer & early detection of
- -3
Uterine Cancer and Breast Cancer some activities be included in the project.
An overall scientific guidance, a regular feed back, continuous updating of
project personnel and involvement of the community in the general could
•5.)
L. proposed that local
provide a dost effective cancer control service. It is
voluntary organizations which have credibility and expertise» on this subject,
would be inducted in the program and entrusted with the task, Financial
assistance would be given as a grant to that organization to cover equipment
and staff cost, for the effective implementation of this program.
t
I
1
(
1
1
c
(
I
1
15.
I
The principal characteristics of the program will consist of:
c
/
(a)
preliminary training of MOs, HHWs and supervisory staff of HAUs,
ESOPDs and maternity homes;
(b)
Cystotechnician Training: a suitable group of laboratory and sub
centre related individuals would be given training in collection of
clinical smears. A major element in the mass screening program is
collection of samples for investigation. Whereas the specimen
collection protocol is a simple one to be learnt by any woman it has <r;)
.;.’X
to be carried out with care and integrity. Therefore, training
exposure would have element of examination of the proficiency in
collection samples. This program will be continuous and would
generate a sufficient number of trained technicians in the community;
(c)
Mobile Units with Cystologist: The mobile unit with cystologist,
r c?
cystotechnicians and mass instruction personnel will visit various
r subr-centres under the program to generate direct interaction between
I
c
I
/
c
c
*]
c
I
I
(
I
I ho
c.
(
s
I
c
/
I
nn>1
I lie
roroirnro
1ob<»rot<»fy.
Thio
oppi<»a»-b
ov p O O t O
Io
cUhUnuaity level,
(ii) expose the workers in practice to the specialists, and (iii)
’ grease confidence of the community;
't
J
f r.fnfBHn tl y
io (1) liidlnlaiii the ijUttlltij of beivlr.c Ol'fcitd Bl
(d)
a central static and two mobile units with mammographic equipment will^5
. be established for mammographic screening of project beneficiaries;
S:
(e) the facility will consist of (i) a CCentral1 7Reference
‘_____ ’Laboratory
*
under 55
the direct supervision of cystologist, and (ii) Regional Laboratories
on either side of the Hooghly River. Following a preliminary
screening, all douotful specimens would be placed before the
cystologist in any of the three laboratories. Preliminary screening
( will be carried out by the cystotechnician under the guidance of the 3
pathologist with primary observations and clinical record;
o
(f)
cases would be referred from the health centres and brought directly
by the health workers in cases of suspected malignancy. A detail
record will be prepared with particular emphasis on the probable
causative factors. Such records will be in a (computer coded form so
that proper statistical analysis and data retrieval would be -possible
©
i
;uc'
‘
‘
■'
!,‘^p
;
133
ANNEX 17
Page 5
(g)
an in-depth investigation would be carried out on patients detected
with early signs of malignancy. The process of follow-up will be
maintained;
(h)
awareness campaigns and continuous data processing techniques are
expected to provide guidance for further action. Awareness of
prevention of cancer and early detection will be created by personal .
contacts, meetings, seminars, workshops with HHWs, MOs and specialist
doctors. Peoples’ representatives and opinion leaders will also be
involved in these awareness campaigns;
(i)
cancer tests of all referred cases by MOs of HAUs, ESOPDs and
maternity homes under the project will be carried out and strengthened
by feed-back reports;
(j)
prospective follow-up studies to evaluate the project will be
undertaken;
(k)
epidemiological data about environmental/genetic/other factors ■ as
causes of uterine and breast cancer can also be utilized for the
purpose of both basic and applied research in the future for national
interest; and
(1)
as a back-up service for detected cases, arrangements, would be made
for the reservation of a few beds at the Cancer Home.
A
I
J
)
)
)
)
>
)
>
>
16.
Women Employment/Entrepreneurship Development. To promote increased
and effective participation of women in the family welfare programme, a
supplementary programme for development of women employment or
entrepreneurship will be undertaken. Provision of employment leading to a
reasonable earning can effectively bring down the fertility rate amongst women
leading to birth control. CUDP-III is running a programme of small-scale
enterprises, and the Calcutta Slum Improvement Project under the ODA Program,
also provides for employment and income generation activities. Under the
project, it is proposed to expand this program. This is specifically desgined
to attract women functionaries from low-income communities.
)
i
i
y
)
3
3
>
>
)
>
>
>
3
3
3
3
4
D.
DELHI
17.
A Revolving Fund of Rs. 2.1 crores will be established in the project
for funding of innovative schemes, PVOs and PMPs and the promotion of
community participation. Innovative Schemes are proposed to be implemented
through (a) different Departments of Delhi Administration and Municipal
Corporation Delhi such as UBSP, Social Welfare, Community Services Dept of
MCD; and (b) NGOs/PVOs and community organisation at slum Bastee levels.
18.
The project Director will interact with Social Welfare and other
Departments as well as NGOs/PVOs and community organisations to guide and
motivate them to prepare the different innovative schemes. Specific model
schemes and grants will also be prepared in consultation with relevant
agencies. After obtaining the proposals from a Departments and NGOs, the
Project Director will submit them to PACC for approval. The specific
conditions and guidelines for grants under this schemes will be prepared after
3
- ......... .
—' - - -~
136
ANNEX 17
Page 6
obtaining the views of the concerned Departments, NGOs and slum communities. iv.)
The Revolving Fund will be operated by the Project Director. The
process of submission, review and approval of innovative schemes shall be as
follows:
H
He
Ci
Pr
La
Se
Gy
Pa
An
LH
St
AN
La
Op
Li
Ac
Se
Oa
Ty
Co
Pr
a
Pr
(a)
1
either specific schemes will be prepared by Coordination Cell in
consultation with various specialised institutions, and PVOs and •otherC-J
agencies will be involved in their implementation; or
(b)
PVO & other Delhi Administration or MCD agencies may develop their owiy^
schemes and funding support shall be provided through the Revolving .
Fund of the project.
19.
The following agencies will be associated with the program:
Cl
Shramik Vidyapeeth (Workers* Education Centre) Ministry of Human
Resource Development: This organisation is engaged at present ii$)
training of the slum population in Delhi in various skills such
as tailoring, carpentry, plumbing, electrician, making of candles^
and aggarbatties etc. are taught.
(b)
Khadi & Village Industries Commission (KVIC): This is an
autonomous organisation created by a special act of Parliament.
Its mission is to create employment opportunities for the non
farm sector which are, at least, comparable to the prevailing
levels of wages in farm sector. It aims to produce saleable
articles, and to provide services for which there is effective
demand. The obejectives are to:
ensure employment at the doorsteps;
encourage production by masses;
harness humane technology;
preserve employment;
impart dignity of labour;
(vi) manage with low capital;
(vii) promote decentralised economic activities;
(ix) invite participation of women in economic activity.
(i)
(ii)
(iii)
(iv)
(v)
C
Pr
Ch
De
As
Nu
Tr
Ac
St
Se
Ac
Pr
Ca
Ty
(a)
'D
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■Q
O
20.
Some of the schemes under the purview of KVIC which are directly
relevant for women in the urban informal sector are as follows:
(a)
Group I:
Mineral based industry - including slate and pencil making'"’)
manufacture of paints, pigments, varnishes and distemper;
(b)
Group II:
Forest based industry - such as hand made paper,
manufacture of kattha, bookbinding, paper cups, paper
plates, bamboo St cane work;
(c)
Group III: Agro based industry - fruits and vegetable processing,
preservation and canning including pickles;
o
(d)
Group IV:
0
0
At
Pa
Polymer and chemical based industry - manufacture of
shampoos, detergents and washing powders;
©
flu
• IV
}
I IS
AIINHX 17
I’npo
■)
V:
('•)
G 1 l HI])
(f)
Group VI:
Textile industry, hosiery,
garments; and
(&)
Group VII:
Service industry,
7
Engineering and non-conventional energy, ca i ])i.,n L i y , papci
pins, safety pins, stove pins;
■J
)
surgical bandage.-:,
readymade
laundry, masonry.
21.
The -KVIC provides training and marketing support for all these
activities as well as financial assistance.
Large number of women in JJ
clusters come from rural iareas and have many traditional skills which can be
easily utilised if financial
and marketing support is organised by utilizing
-------the network of KVIC.
i
5
)
5
22‘ .
Habitat Polytech (Under Ministry of Urban Development).
This
institution is concerned with improving the skills of construction workers.
Training may be imparted to large number of women in JJ clusters working in
Construction Industry to upgrade their skill and thereby increase their income
. . _ status.
$ opportunities and promote their
3
23'
Environmental Sanitation and Personal Hygiene. An epidemic of
gastroenteritis took place in slums of Delhi in the summer of 1988.
Since
then, large investments have been made by MCD in the provision of safe
drinking water through piped water supply and India Mark-II hand pumps to
population of slum bastees including JJ clusters.
Though further epidemics
have been successfully averted in subsequent years, diarrhoea and scabies
continue to be an epidemic especially in the population of JJ clusters.
Though no investment is proposed in infrastructure of safe drinking water,
latrines and garbage collection through this project, a special component for
community mobilisation, promotion of environmental sanitation and personal
hygiene is being provided.
It will consist of: (a) provision of water testing
kits for testing the safety of potable water at conununity level; (b) promotion’
of the community and schools personal hygiene, especially the use of soap for
hand washing; (c) community mobilisation and collective incentives through
grassroot organisation/PVOs for maintenance of clean toilets and internal
garbage collection.
>
>
i
3
*
>
>
>
3
3
3
3
X->
24•
Early Child Care.
Large numbers of women are foroed to seek
employment outside the bastees and their children tend to get neglected in the
process.
Provision of Creche facilities is important for the welfare of women
and children.
Individual women will be motivated and trained to organise
creche facilities for working women in slums on a payment basis.
Suitable
one-time support shall be provided to them from the Revolving Fund for
necessary furniture/equipment. Alternatively, NGOs will also be motivated to
take up this activity in JJ clusters.
25.
Prevention of Alcoholism
and Drug Abuse
_________________
_____ . The slum population,
especially males, have alhigh prevalence of alcoholism and drug abuse which is
a major cause of economic and social disability,
The voluntary organisations
will be involved in prevention and eradication through community mobilization
and other specific interventions.
1 H.
AIINEX 17
Page 8
V-J
26 •
- The women in Jhuggie Bastees
become involved in prostitution because of economic and social pressures.
Though no specific data exist about its actual prevalence, this also makes
them vulnerable to the spread of AIDs. PVOs will be involved in national and
state programs to help the women in distress, and community mobilization
activities to increase awareness against prostitution and the danger of the
spread of AIDs.
-W
•)
27.
Formation of Mahila Mandals. Support will be provided to PVOs
involved in the stimulation of group activities for women and the formation of
women’s organisations or Mahila Mandals.
28.
Early Detection of Cancer. Support will be provided to NGOs for
developing and implementing awareness campaigns among women for the early
detection of cervical and breast cancer.
29.
Community Based Rehabilitation. There are a large number of disabled
persons in Jhuggie Bastees. Support will be provided to NGOs which take-up
community-based rehabilitation programs for the disabled in JJ clusters.
D.
■9
©
©
HYDERABAD
30.
Registration of Birth and Deaths. At present, no accurate statistics
regarding births and deaths among the slums and pavement dwellers. Local Dais
would be paid a modest honorarium for reporting these events to the Registrar
of the local area.
31.
Marriage Registration. At present, no statistical data is available
particularly in the slum community, with regard to the marriages and the ages
of the married couples. With a view to enforcing the Child Marriage Restraint
Act, local PVOs and the leaders would make informal registration of marriages
in their organisations indicating the names of bride and bridegrooms',' their
parents and the ages of the couple as per birth registration document. It
would be possible to collect this data by offering incentives to those
individuals or institutions who undertake the registration.
32.
No Pregnancy Incentive. Observance of contraceptive practices by
women in slum areas is usually far below the accepted average. A program of
motivation is needed to convince these women of the benefits of family
planning to them especially through the adoption of spacing methods either
IUDs or oral pills. Local Mahila blandals and women health volunteers would be
encouraged to maintain proper documentation in a confidential manner to ensure
postponement of pregnancies and also birth reduction. Incentives would be
offered to those institutions which will undertake counselling.
33.
Construction of Soakage Pits. The most common scene in the slum areas
is the flow of used sullage water which has stagnated leading to mosquito
breeding. The community would be motivated to construct soakage pits
depending on the nature of the soil and its percolation capacity.
Q
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36.
Depots of distribution of Chloroquine Tablets for Fever Cases and
Collection of Blood Smears. There has been in increase in the instance of
fever cases among slum dwellers. One member of one of the many local youth
e
137
ANNEX 17
Page 9
J
organizations or a Balwadi Teacher in the community would be identified to
collect smears and administer chloroquine or any other drug given by local
malaria unit. The identified worker could be trained in the collection of
blood smears by the local unit officer-in-charge of the malaria program.
3
35.
Education of Adolescent Girls and Counselling Practices. Girls in the
age group of 16-18 years identified by local mahila mandals and/or health
functionaries, will be educated with regard to health habits, home economics,
preparation of weaning foods and diets, child health care, personal hygiene
and coaching habits. This type of work can be carried out with the help of
the Women Welfare Department, NSS volunteers, and the staff of the Home
Science College.
3
3
3
>
36.
Literacy Component Among Women. Most of the women in slum areas are
illiterate. The local children, especially the adolescent girls who are
studying in high schools, can be identified and motivated to work as adult
education teachers and organise literacy campaigns. The use of resources of
the Adult Education Department, NSS units and the University’s Adult Education
Wing would be explored.
3
3
3
)
37.
. Innovative Schemes for Income Generation. In order to alleviate the
suffering of women, a few income-generation activities in association with the
local industrial units, State Government undertakings, and self-employment
units in the community would be undertaken, The activities/training programs
would include:
)
)
>
>
(a)
(b)
(c)
(d)
(e)
(f)
(g)
3
3
?
3
)
3
3
3
3
3
3
>
)
>
3
3
3
3
3
■a.
J .i>54)
>
(h)
I
(i)
tailoring and dress making;
silk screen printing;
toy manufacturing;
soap manufacturing;
organisation and women’s cooperatives;
establishment of canteens;
preparation of domestic necessities and kitchen/food materials like'
jams, pickles, nut powder;
preparation of agarbatties, envelops (paper cover), carpets with coil
fibre or <cotton including carpet weaving with wool, sweater making;
Apiary (bee hives).
38.
The duration of the training will vary from 1 to 6. months. The Women
Welfare Department, Urban Community Development, Andhra Mahila Sabha and other
associations connected with women care, will be involved and will work out the
details of the scheme. Periodical evaluation/review of the program will be
undertaken by the community.
, . A large number of organisations are actively
associated at present in the implementation of such income-generating
programmes and they are working with the Department of Women Development and
Child Welfare. To plan and organise these activities, a special cell would be
established under the control of Project Director, IPP-VIII and include the
following: (a) Liaison Officer (Female Literacy Education) on deputation from
Department of School Education/Adult Education; and (b) Liaison Officer (Women
Welfare) on deputation from the Women Development and Child Welfare.
4
ANNEX 18
Page 1
138
J
mJ
INDIA
w|
FAMILY WELFARE (URBAN SLUMS) PROJECT
..-q
WOMEN IN
A.
development
(WID) aspects of
THE PROJECT
background
--- shaped by sex-gender systems •
These systems influence
-nuenee^e^^
Uo
„„-s
role,
in
the very
1.
in subordination to men.
types i
that place women
access to social services as
women’s access to goods
ability of women’s offered to them. Therefore ^"^luding the right to
of social services
□ productive assets, and to
men are not. Variations,
and services, to 1
labor) is conditioned in a w y
_ tes region, social class
sell their
own 1in
- women’s access to re^“^/^men remain in the private
’ exist
however,
Socio-cultural factors ^^XcUve and nurturing roles, while men
and caste,
--r
_ -inside") becauseuf their
P^ d_
markets, and courts.
sphere ('with the public ( outside ) P
ibilities for child irearing and the
deal
o
•<4 )
o
wider range of activities
dichotomy, women
* j inside/outside
,
despite
the
ins
ide
/
outs
?0^ent, but in ©
2
Nevertheless
India’s economic and 1-—
. They tend
not captured0!^
contribute significantly
in the national
dervalued, or
ways that are
' r "invisible,"
or production of
therefore, to
defined'labor force,
female contributions
for granted,
added to those in the
points below the
family food crop
rate t
work for wages
Evidence
rate for men. 2/
developmeu$
burden of double
.
and
economic
do not. The contribution
f.„ of ..v«. culfoc.l, ln.tlfhfloh.1. physic.l *
is made in the
■'P
constraints .
India’s socio-economy
' to
capital investments, '•
in human
Lack of access
remain discriminatory.
dseuch Theaith and -poling, ^still^---^
.n continued high
resources, exacerbated byr repeated pregnanciibi
adequate health
health care
care andd other morbidity,
in
economically
le-ls of female mortality t...
oppcr
_,
ortunities
:
and heavy work burdens, which
I
I
1/
; ■ roles in Indian soc/Jt
V
n Plaborate discussion on how assigned gender
health, education etc., r
For an
resources, such as
I.--, „Country
study.
limit women's access
World
Bank
Study. Washington,
World
Bank
Country
Gender and Poverty m Indra. A World
D.C.: The World Bank, 199 •.
©
2/
Ibid.
1
-- 139
ANNEX 18
Page 2
V*
J
a
5
3
5
3
3
>
3
3
3
)
>
3
3
3
3
>
3
Studies show that there is systematically higher
malnutrition and morbidity among female children; boys receive favorable
" » allocation
of -nutrients;
and urban medical
treatment relative to girls in the
l-------—
for male children compared to female children
care facilities are used more 1__
j
is arBued that differential mortality
in the event of illness or injury,
between
males
and
females
is
the
major factor in female/male sexratio
rates L^w..—---- -- ----in India. Demographic data shows that there is a steady decline in this
ratio which has fallen from .970 at the beginning of the century, to .929 in
1991 (Table 1). This shortfall of females cannot be explained away as being
caused by differences in sex-ratio at birth, migration
mieration rates, or that females
Similarly,
the
age-specific
mortality rates shown
are grossly undercounted.
in Table 2 reveal that female death rates are substantially higher than those
for males. Data on sex specific infant mortality rates (Table 3) indicates
that the probability of survival of a male child is much higher by several.
years when compared to a female child. Evidence also suggests that there is
an overwhelming preference for male children and that the bias against female
children is leading, in some States in India, to the growing incidence of sex
determination tests followed by abortion of the female foetus.
productive activities.
4.
Gender based differences are also observed in literacy,
enrollment, educational attainment and achievement rates as well as the
quality of education provided for females as opposed to males. In general,,
women are more likely to be illiterate as adults than men (illiteracy rate is
61Z for women as against 36Z for men), while the enrollment of females.is
about one half that of males at all levels (Table 4). The gender gap in the
educational attainment is also evident at all levels (Table 5). Women are at
a particular disadvantage with respect to their legal status, Laws are often
inconsistent or in conflict with customary practices or sfimply
j\ not applied.
Further, women often cannot take advantage of the legal system to protect
their rights because of the lack of information and education.
5,
in summary, the major constraints limiting the productivity and
contribution of women to India’s economic and social development; are: (a) low
levels of literacy and education; (b) limited access to and the poor quality
of.basic health services; (c) early marriage; (d) the lack of knowledge
regarding legal rights as well as the ambiguity of their legal status; (e) the
lack of political power; (f) the burden of household and farming chores; (g)
£he lack of access to employment and to productive assets, notably.credit; and
(h) violence against women in the family and the community. Traditional male
attitudes toward the role and place of women in society also constitute an
impediment to expanding and improving women’s lives.
>
GOVERNMENT POLICY
>
B.
3
6.
The Government of India (GOI) has shown its concern about women’s
issues through a number of initiatives. In 1974, as a part of wider attack on
poverty, it produced The Report of the Committee on the Status of Women in
India (CSWI), which presented the generally disadvantaged-socio-economic
position of women. Since then several major Commissions and Reports have made
policy recommendations on women’s issues. In 1990, a National Commission for
the Indian Women was established to monitor and speed up the process of equal
representation for women; to enforce all legislation for women’s rights^.
including labor laws, and to check discrimination at all levels,
committee are the following:
functions of the Commission as an advisory
i
>
>
3
3
3
3
3
P
>
-T
140
ANNEX 18
Page 3
.--i
'i '■ W
suggest remedial legislative measures to meet gaps and shortcomings in
existing laws; address violation of the provisions of the Constitution and
other laws relating to women; examine specific problems arising out of
discrimination and atrocities against women; identify the constraints and
recommend strategies for removal of such. The Commission has been entrusted
with the power to make periodical reports on any issue concerning women, to
recommend strategies and corrective measures to formulate further policies and
programs, and to improve women’s accessibility to the Jaw by funding
litigation involving women’s issues. The reports of the Commission would be
placed before the State legislatures, so as to, make the executive accountable
to the representatives of the people in cases of non-implementation of the
recommendations of the Commission.
7.
Recently, the Government has also decided to amend existing laws
concerning women following a detailed scrutiny of the Dowry Prohibition Act
and the Commission of Sati (Prevention) Act. The Immoral Traffic (Prevention)
Act and the Indecent Representation (Prohibition) Act are also being examined
to rectify the loopholes. The amendments to these Acts would remove the basic
weaknesses and will make them more effective at the implementation level.
Progress has also been made in the field of research and data collection where
women’s contribution to socio-economic development is taken into
consideration.
8.
The National Health Policy enunciated in 1982, identified goals
for the reduction of mortality among different age groups, though not
separately specified for males and females. The target is to bring down the
infant mortality rate from about 125 per thousand to 60 per thousand; the
crude death rate from 14 to 9 per thousand; and the maternal mortality rate
from over 400 per 100,000 live births to under 200 by 2000.
All pregnant
women are to receive antenatal care, and all deliveries are to be conducted by
trained birth attendants. All the pregnant women and school children are to
be immunized against tetanus, and 85Z of the relevant target groups are to
receive DPT, Polio, BCG and DT immunizations. It is expected that as a result
of these improvement in health, life expectancy for both males and females
would increase to 64 years by the year 2000. The goal of a net reproductive
rate (NRR) of 1 and a crude birth rate (CBR) of 21 per 1000 by the year 2000
has also been established. It is expected that the average number of children
per family would decrease from about 4.4 in 1975 to 2.3 in 2000 in order to
stabilize the population.
9e
if the goals of the National Health Policy are to be achieved,
there is a need to work on both the supply and demand sides to improve women’s
access to health care. Increasing women’s access to health services is
critical for the achievement of the mortality, morbidity and fertility
reduction goals. The policy to increase women’s access to health and family
welfare services call for a woman-centered approach in its delivery system.
C.
J
■ i
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1
o!
'■9i
o
GENDER ANALYSIS AND THE ROLE OF WOMEN IN THE PROJECT
10.
To deliver the services effectively and generate demand among the
target/beneficiary groups, the States/municipalities must analyze gender,
issues in the project. Gender analysis is a systematic process of identifying
gender patterns for the purpose of understanding their implications for the
®l
^1
"^■1
“Z®
141
0
1
ANNEX 18
Page
4
design and implementation of the Eighth Population Project. 1/
The gender
analysis framework relies on four components as illustrated in Figure 1 below.
2/
First is the analysis of the activities which identifies the activities that
males and females do, and where and when they do them.
Second is the analysis
of access and control which asks questions on what resources people use to
accomplish their tasks and what gender patterns exist for access to and
control over such resources. The division of labor within the family and the
community, how and where people spend their time, and the resource base they .
rely on, their assets and security, directly affect the effectiveness of the
project delivery system.
These factors also indirectly affect the family
decisions that people make.
The decision-making process, in turn, affects the
design of a project delivery system.
3
<>
>
.
However, the context in which activities are carried out, is the
most important factor which influences the success of the project.
These
determining factors fall into four categories: (a) cultural; (b) economic;
(c) political; and (d) demographic. It is, therefore, important to know
which determinants are strong in the slums and how they shape components.
The
effect of the determining factors on project design and vice versa is through
effects on activities, on access and control pattern, or on decision-making.
>
)
3
I
)
>
>
>
>
>
>
)
)
>
I
■'■2. . In this project, the intended clients are slum women and children.
The activities analysis (i.e. who does what? where, when and how long do they
perform these activities? why do they do what they do?), assist us to know
where and when women and children can be reached.
From this analysis, the
daily tasks of women can be understood and the problems they will have if they
must travel long distances or wait in long lines can be anticipated.
It is
also critical to understand the times of day, or the days of the week, when
women can and cannot avail themselves of health and family welfare services.
It is not sufficient, however, to identify only female activities, since
gender interrelationships exist and can affect or be affected by the project.
Male activities must also be specified.
The baseline survey and
beneficiary/community needs assessment are designed to address these concerns
and to plan the project accordingly. The access to and control over resources
by women, affect.their status, and status influences their health and family
welfare.
In project planning, attention has been paid to gender patterns of
access to and control over resources,
because the use of a resource is'often
•' decided by the group who controls it rather than by those who use it.
)
>
)
>
)
>
>
)
1/
Table 6 reflects why and how gender analysis will be incorporated in
various stages and components of the Project.
2/
The.Gender Analysis Framework is adapted from UNFPA, Gender Analysis for
Project Design: UNFPA Training Manual.
Prepared for UNFPA by J. E. Austin
Associates and the Collaborative for Development Action, Inc., 1989.
>
)
)
>
'fU«; ■ ■ ■ -'.I: XW*:'. ?■ • ’
>
I
/
1.4 ?.
ANNEX 15
Page 5
YV,)
Figure 1: APPLYING THE GENDER ANALYSIS FRAMEWORK
A. Determinants
C. Resources
B. Activity
©
D. Decision-Making
Project Delivery System
Source: UNFPA,Gender Analysis for Project Design, p. 2.
13_
Because of the diverse roles women play in family welfare, they
will be involved in all aspects of the project decision making. The
evaluation report of CUDP-III by WHO indicates the importance of involving
women in decision-making positions. Their participation at the communitylevel in the type, design, quality, and other aspects of welfare services will
be crucial for the effectiveness and sustainability of services.
Therefore,
* in formulation of policies and programs for women, their active participation
as planners, managers, and staff has and will continue to be.sought..
Mechanisms through which women can voice their needs and their expectations ot
different levels of services will also be critical. These mechanisms not only
information gathering efforts, but the organization of
incorporate systematic
£
street discussions, user group meetings*and other
fora, including
:
view
participatory occasions,r that would allow women to benefit from others’
"and to mobilize themselves in a search of solutions to their problems, These
activities would be supported under the project.
€>
14.
Health care andJ family welfare services will be provided to women
xulcu xii
M7 establishing
Health Posts, Health Centers, Maternity
and children in slums by
es
■?.)
Expanded Specialized Outpatient Departments, and other facilities, and
Homes, 1
by using female doctors, female supervisors (Lady Health Visitors, nurses ,
female health workers (ANMs) and female volunteer health workers (link
workers, Bastee Sevikas). The objective of the project is to deliver services ■J
in the slums where women can be easily reached. This indicates that the
'.'y
project is gender sensitive. The project also takes into consideration the
fact that poor slum women often do not avail of existing health services
provided in publicly-financed/Government clinics and health centers. It
..y
1A3
ANNEX 18
Page 6
health and family welfare services are located in clinics requiring travel of
a long distance from home, and if transportation costs are high, then these
services will be "out of the reach" of poor slum women. Second, the fact that
all volunteer link/health workers will be female and will be selected from the
slum community, demonstrates that the project will be sensitive to the
cultural constraints women experience in India. Women link workers will have
easy access to clients* domestic setting for demand generation and service
delivery. Third, the supervision of link workers by ANMs, LHVs, and female
medical officers indicates that women will be actively involved in the project
implementation and supervision. Fourth, the inclusion of local women in
training programs and their recruitment as project personnel, acknowledges
that women will be contributors to the family welfare services rather than
mere beneficiaries of project resources. At the decision making level, the
participation of female-led PVOs and community groups in Project Advisory and
Coordinating Committees (PACC) at both the Center and State levels and in
Project Implementation Committees (PICs) at municipal level would ensure that
the concerns of women are expressed and taken into consideration in project
ptanning, implementation and supervision.
)
I
)
3
5
3
J
i5.
Bangalore, Calcutta, Delhi and Hyderabad are also aware of the
lack of access to resources such as education and employment by women. At
present, the low demand for contraception and utilization of existing health
services in the municipalities is largely influenced by slum women’s low
level of education. Similarly, there is a correlation between access to
income and fertility. As families become better off, they often decide to
have fewer children because they do not need to rely on them for old-age
security. And as they have fewer children, families are in a position to
offer better education, food and medical facilities for their children. The
project, therefore, incorporates female education and employment generation..
activities under the Innovative Schemes component.
*
>
>
)
>
>
>
)
>
>
3
)
*
>
I
>
>
)
>
>
)
16A project designed to serve women will be more successful when it
uses a woman to woman" approach or involves women’s groups in designing and
implementing the project. The example of the Family Planning Project by
Gujarat State Crime Prevention Trust, a women non-governmental organization in
Ahmedabad, India indicates that this approach strengthens the project by
responding to the real needs of women clients as well as by developing a
'Skilled cadre of women managers, supervisors and field workers. Slum women
when given accurate and culturally appropriate information and support,
accept family planning as a way of improving their lives anti those of their
families. The desire to offer family planning services, coupled with the
commitment of the PVO to the community, compensates for its lack of
experience. Lessons learned from Rajasthan indicates the importanrp of
women s group formation for building collective strength to gain access to and
control of resources. Further, the report (Sramshakti) of the National
Commission on Self-employed Women and Women in the Informal Sector as well as
the workshop on "Gender and Poverty in India" suggest the importance of the
organization of women’s group for demand generation. The Eighth Population
Project, is committed to involving female-led PVOs and the female community
groups in service delivery and demand generation. Although Staudtl/ points
)
)
3
3
1/K. Staudt, Sex, Ethnic and Class consciousness in Western Kenya"
Comparative Politics, Vol 14, No. pp. 149-167, 1988.
>/
o!
144
ANNEX 18
Page 7
^r)
I
out that working with women’s group does not automatically guarantee that
women will be empowered and that women’s organizations which are dominated by
elite women may be insensitive to the economic needs of the poor, nonetheless,
working with existing women’s groups has been an important factor in the
success of projects.
'■■X
•i
17.
The powerlessness of women, and especially poor women, is a
political reality.1/ Even when women’s organizations are powerful by their
numbers, with very few exceptions, the support of local officials (usually
men) is imperative iff women’s integration into development is lu
to be
uc realized.
xcaxx^c^.
and
also
women
(because
women
in
higher
positions
often do *
For this reason men i-- ---- -------------------- - ----.......
?
needed
to
be
not understand how gender relations affect women’s lives) are
The
project
will
include
periodic
gender
sensitized regarding gender issues. '
sensitization training for all the project personnel, government officials as
well as for slum population.
|
'1
■^1
I
’
^1
0|
I
'
€)
-j
S-a*
o
aI
@-
3|
■D|
1/S. E. Charlton, Women in Third World Development.
1984) .
(London: Westview Press,
______ tgy*
3
145
ANNEX 18
Page 8
3
3
4)
Table 1:
S.x Ratio’
(females/
males)
Year
5
>
)
>
Sex Ratio, fPercent of Literates and
Life Expectancy at Birth in India?, 1891-1991
Percent of Llterate«b
Males
FemaIes
Life Expectancy at Birthc
Difference
Period
Males
FemaIes
D1fTerence
1891
n. a.
n. a.
n. a.
n. a.
1881-90
24.6
25.5
-1.1
1901
0.972
9.9
0.7
9.2
1891-00
23.6
24.0
-0.4
1911
0.964
10.6
1.1
9.5
1901-10
22.6
23.3
-0.7
1921
0.955
12.2
1.8
10.4
1911-20
19.4
20.9
-1.5
1931
0.950
15.6
2.9
12.7
1921-30
26.9
26.6
0.3
1941
0.945
n. a.
n.a.
n.a.
1931-40
32.1
31.4
0.7
1951
0.946
27.1
8.9
18.2
1941-50
32.5
31.7
0.8
1961
0.941
40.4
15.3
25.1
1951-60
41.9
40.6
1.3
1971
0.930
46.0
22.0
24.0
1961-70
49.4
44.7
1.7
1981
0.933
56.4
29.8
27.4
1971-80
52.0
50.6
1.4
1991d
0.929
63.9
39.4
24.5
1981-90
n.a.
n.a.
n.a.
>
Note:
n.a.:
Not available
>
Sources:
)
X
)
b. ICSSR (1983) for 1901-1931 (includes
population aged 0-4).
U.N. (1982) for 1951-1971 (excludes population aged 0-4).
Census of India, 1981, for 1981 (excludes population a ged 0-4).
1991 figures are provisional (excludes population aged 0-6) .
c. U.N. (1982), p. 137 for the years 1881-1970
d. Provisional, excluding Jammu and Kashmir.
>
>
>
>
)
)
3
)
3
i
a. ICSSR (1983), p.3 for the years 1901-1971.
Computed from Census
reports. For 1981 computed for Census of India, 1981. 1991 figures
are provisional based on press reports.
it •.
- 1A6
Table 2:
ANNEX 18
Page 9
RATIOS OF AGE-SPECIFIC DEATH RATES, ALL INDIA,
1984
Rural/Urban Ratios
Person
Female
Age
Group ,
Female/Male Ratios
Combined
Urban
Rural
0- 4
5- 9
10-14
15-19
20-24
1.09
1.29
1.29
1.43
1.40
1.05
1.31
1.08
1.38
1.33
1.09
1.28
1.25
1.40
1.39
1.96
2.56
1.42
1.31
1.43
2.03
2.52
1.69
1.36
1.50
1.99
2.61
1.58
1.39
1.44
25-29
30-34
35-39
40-44
45-49
1.52
1.09
1.04
0.86
0.67
0.96
1.05
0.60
0.65
0.52
1.36
1.09
0.95
0.82
0.65
1.26
1.59
1.07
1.02
1.02
2.00
1.65
1.88
1.36
1.33
1.64
1.68
1.35
1.13
1.10
50-54
55-59
60-64
65-69
70+
0.69
0.76
0.86
0.84
0.94
0.72
0.66
0.76
0.76
0.89
0.70
0.74
0.84
0.83
0.93
1.18
0.95
1.03
0.98
1.08
1.12
1.10
1.16
1.10
1.14
1.15
0.99
1.08
1.03
1.11
All Ages
1.04
0.94
1.03
1.53
1.69
1.60
Male
Source: Calculated from Sample Registration Bulletin XXI. No.l.
Office of the Registrar General, Minsitry of Home Affairs,
Oj
.d
!5i
•91
New Delhi, 1987.
Table 3:
f.t J
Sex-Specific Infant Mortality Rates in India 1970-1978
I
Year
Males
Females
1970
1971
1972
1973
1974
1975
1976
1977
1978
131
129
132
132
128
140
124
126
123
126
129
148
135
119
140
134
135
131
Source:
Sample Registration System.
Females-males
Difference
'.O’
©
-5
0
16
3
-9
0
10
9
8
$
i
.14 7
ANNEX 18
Page 10
)
Table 4:
Percent of Boys and Girls Enrolled in Schools by Levels in India
*
1950-51 to 1986-87
)
I
Primary (class I-V)
1 Year
Middle (class VI-VIII)
Secondary (class IX-XI)
Boys
Girls
Difference
Boys
Girls
Difference
Boys
Girls
Difference
>1950-51
60.6
24.8
35.8
20.6
4.6
16.0
8.7
1.5
6.2
1960-61
)
^1970-71"
82.6
41.4
41.2
33.2
11.3
21.9
18.0
4.4
15.6
95.5
60.5
35.0
46.3
19.9
36.4
26.8
9.8
17.0
>1980-81
95.8
64.1
31.7
54.3
28.6
25.7
23.1
11.1
12.0
*1986-87
111.8
79.2
32.6
66.5
38.9
27.6
29.8
14.4
15.4
---
)
>
Note:
^Source:
>
a. Percent exceeds 100 because of repetition by some children
Education in India (various years), Ministry of Education and Culture,
Government of India.
»
I
Table 5:
Completed Level of Education of Men and Women
)
Aged 25 -59, India 1981
)
I
i
Level
Male
Female
Difference
1. Illiterate
47.35
78.47
-31.12
2. Literate below primary
10.92
4.96
-5.96
3. Primary
15.06
7.79
-7.28
4. Middle
9.58
3.87
-5.71
5. Secondary
12.78
3.44
-9.34
6. Graduate and above
4.31
1.22
3.09
)
>
>
>
)
)
)
)
148
AimEX 18
Page 11
TABLE 6: GENDER ANALYSIS OF THE PROJECT
Implementation Activities
5 Strategies
Project Component:
Design
’’
%
• Analyze determinants:
• Cultural factors: social norms, traditions,
religion, organizational and institutional
arrangements;
• Economic factors: The general level of poverty,
inflation rates, 1nfrestructure, the quality of
land and/or other environmental conditions,
economic organization;
• Political factors: power relationship and
control, government bureaucracy, legal systems,
systems for collective decision-making; and
j_ Demographic factors: migration pattern, life
expectancy, infant mortality, etc.
• Analyze Activities:
• Who does what? Identify the production job that
both male and female do which can affect project
design in the slums;
• Identify who In the family does the household
production tasks, i.e., building houses and
repairing, food preparation, laundering clothing,
fuel and water collection, child bearing and
rearing, providing family health care and the
like;
• Identify gender-based division of activities In
social, political and religious unctions, e.g.,
arranging and conducting special traditional
ceremonies and festivities, engaging in volunteer
community project and others.
• Identify where activities are done; when they are
done; (what time of day, during what part of a
year?). How much time does each job take? From
activities analysis, Tdentify where and when
should the project services be delivered? who
should deliver project services? what project
content would be most useful for the clients
(e.g., steri11zation, Injections with longer term
effectiveness, or provision of larger supplies of
pills or condoms)?
• Analyze access to and control of resources:
• Identify the basic resources which people use;
identify the gender patterns of access to and
control over these resources;
• Analysis of access to resources would again
influence location and time of project design.
(For example, if the family welfare services are
in a clinic requiring travel and transportation
costs, the poor slum women may not use the
services. The analysis of access to resources
would help to identify whether women have access
to technologies, such as radio and TV through
which women can be reached with IEC programs. IDo
women have the right to choose a program, or do
men always have the right to listen? Who will
hear about family welfare services If it is
advertised on th« radio?
• Baseline survey and beneficiarles/commun1ty neec.
assessment are underway in four municipalities to
dissagregate information by gender and age; to
■J
identify Income generating activities; to identify
household production activities; to Identify tir J
and place of the activities; to identify number of
female headed households; to Identify women’s
access to resources and technology, I.e. radio,
TV, etc.; to gather data on income by gender.
• Identified women’s accessibility to existing
health care institutions;
e Identified slum women’s needs for different kintxl*
of health services to be delivered;
• Taken measures to use flexible timing to reach ?><)
beneficiaries with services.
e Identified the location of the service delivery;^
e Used feedbacks from women to plan and design theJ
project components.
7)
.''j
.'■b
’<7^
If it la announced in
written form? The issue of advertising the
services to be delivered In ways that reach the
intended participants is just as Important as
reaching them rith the actual service.)
©
@
'
©
149
)
AhNEX 18
Page 12
x
>
Strategies
Project Component:
> •
5 *
Implementation Activities
Service Delivery Expansion
Establish health care facilities within the reach
of poor slum women and create outreach prograsis;
Use female link/health workers, honorary
health workers, female Doctors and nurses.
Construction of New Health Centers/HAU in slums;
Construction of Upgraded H.C.; Extension of
upgraded H.C.; Construction of maternity homes;
Construction of E.S.0.P.D.;Constructlon of
Collapsible H. Posts In slums;
Use of female doctors, female supervisors (Lady
Health Visitors, Nurses), female health workers
(ANM) and female volunteer health workers, dais
from slums to provide services effectively.
•
•
1
)
)
)
)
Project Component:
Quality leprovseant
* Arrange both technical and Gender sensitixati on
training of link/health workers, Anganwadl
workers, ANMs, medical officers, Private Medical
Practitioners and PYOs.
> • Arrange training of female staff In formulation an
>
design of activities as well as In continual
managerial and operational functions.
)
)
)
)
>
Project Component:
Manageeont Improvement
• Involve women In higher levels of decision making,
monitoring and evaluation positions;
I • supervision,
create WWID cell* for effective Implementation of
)
• Training needs assessment underway in four cities;
• IEC training for project personnel;
Pre-service training;
Induction/orientation training;
In-service training;
On-the-job training;
• Identified the number of project personnel who
will be trained by categories;
• Conder sensitization training for all the project
officials and slum population, local leaders,
bustee committees, etc., through periodical group
discussions, seminars, workshops, field visits,
distributing literature etc.;
• Taken measures for training of females in
designing activities as well as for managerial and
operational skills.
monitoring and evaluation of the project where
necessary; or ■main-streami ng" gender concerns In
planning and management In a routine and
systematic manner.
>
>
>
• Special Committee, Advisory committees (Block and
sub-center levels) comprising of women members
will be established to screen the decisions'to be
taken by the managers;
• Women’s representation will be ensured in Project
Advisory and Coordination Committees; Project
Monitoring and Evaluation Unit will periodically
meet the women Advisory Committees to collect
1nformati on;
• Measures will be taken to ensure women’s
involvement In the decision-making positions i.e.
In Apex Committees, Project Implementation
Conxaittees, etc.;
• Provision has been made to monitor and evaluate
the Impact of the project on women by creating WID
cell.
>
>
>
>
)
)
>
)
)
1
r:.. J
>
1
J nw’Z.- •< -.'
1
pl
150
ANNEX 18
Page 13
US, J
Imp Iementati on Activities
Strategies
Project Component:
D—»nd Generation
* Disseminate Information regarding the health and
family welfare services to women.
« organize IEC programs at a time and place where
women can be reached;
* Use ■woman-to-woman* approach where necessary;
* Organize women into groups or social network for
demand generation;
...
« Develop income generation activities to increase
women’s access to services Including making them
responsible for the delivery of health-care
servi ces;
* Increase female education;
* Introduce time-saving devl ses (i.e., fuel
efficient stoves, communal we I Is, etc.), to enable
women to avail family welfare services or attend
IEC programs;
e Establish a mechanism through which women can
express their needs and their expectations of
different levels of services.
(These mechanism,
should not only Incorporate systematic Information
gathering efforts, but the organization of street
discussions, user group meetings and other
participatory occasions, that would allow women to
benefit from others’ views and mobilize themselves
In search of solutions to their problems.)
* Take measures to reduce violence against women In
the family and the community so that women can
aval I the services.
Project Component:
0
Innovative Programs
* Identify women’s needs in the community regarding
nutrition, environmental aanitation and water,
creche programs and the like and involve community
to meet such needs with project support.
*
j
• Use of Uahila Mandala, neighborhood committees,
teachers of Balavadis, Anganwadi workers for
demand generation;
• Formation of women’s groups to demand services, to . )
reduce violence against women, and to create
awareness of women’s rights;
$?)
• Use of Link workers for motivation;
e Use of female-led PVOs, community development
workers, local bodies, groups for outreach
services;
e Study to Identify ways in which the community may
collaborate
collaborate with
with public authorities;
e Involvement of existing grassroots organizations
•
-A. ___
I6H$!
and non-government
support
organizations;
• Use of female PMPs as resources for the delivery
of health services to the slum community;
training camps) and their
e Use of OTC (orientation
(
leaders as community educators;
...
.
• Use of existing schools near slums
t------ for
--- health
-------- and
adult education programs.
• Education programs for slum women and girls;
e Provisions for women’s empIoyment/entrepreneurshih
development program;
.
)
a Sanitation program with community participation, ;.
• Provisions for control gastroenteritis
effectively;
•
.
,
•• Sunnlementarv
Supplementary nutrition
nutrition program
program for pregnant and
lactating mothers;
e Supplementary nutrition program for toddlers,
• Integration of services of anganwadi workers and^
ANMs*
• Study of fertility behavior among minority groups.^
e Sanitation drive In Communities;
....
b Study of Incidence of sexually transmitted d‘s«as.e,.
(STD) •
• Health and family Welfare education amongst
adolescent girls;
^ki.™«.
• Education program for men and women s problems,
• Importance of female child;
• Creche program.
■P
.... ,
Il;
3
.151
*
ANNEX 18
Page 14
TABLE 7:
STRATEGIES TO INVOLVE WOMEN IN THE PROJECT
A.
PROJECT DESIGN
STRATEGY
£
1.
Analyze determinants
(a)
(b)
>
(c)
(d)
2.
Analyze activities
(a)
)
(b)
)
Cultural factors: customs, traditions, religion, social norms
etc. ;
Economic factors: general level of poverty, inflation rates,
economic organization etc.;
Political factors: government bureaucracy, legal systems etc.;
Demographic factors: life expectancy, infant mortality,
migration.
(c)
(d)
Identification of production jobs that both males and females
can do and which can affect project design;
Identification of distribution of household production tasks
between males and female;
Identification of gender based division of activities in social,
political and religious functions;
Identification of place and time of activities and thereby
convenience of place, time and content of project services.
>
3.
Analyze access to and control of resources.
Identification of gender patterns of access to, and control of basis
resources which will influence location, time and type of project'
design, so as to reach the beneficiaries appropriately.
ACTIVITIES
*
>
>
>
x
(a)
(b)
(c)
(d)
(e)
Baseline survey;
Beneficiary/community needs assessment;
Identification of location of service delivery;
Information about income by gender;
Identification of women’s movement in development of various
components.
B.
>
>
SERVICE DELIVERY EXPANSION
STRATEGY
(a)
(b)
Establishment of health care facilities within the reach of poor
slum women, including outreach activities;
Make services more acceptable to the beneficiaries.
07503
- 152
ANNEX 18
Page 15
ACTIVITIES
(a)
(b)
(c)
Development of infrastructure, e.g. construction of new health
posts, upgrade/expand health centers, etc;
Use of female doctors, supervisors, lady health visitors, ANM,
female honorary health workers, dais etc;
Identification of acceptable type and time of service delivery.
<1
QUALITY IMPROVEMENT
C.
STRATEGIES
(a)
(b)
©
©
Technical and gender sensitization training of all health
personnel;
Training of female staff in formulation of a design of
activities and in continual managerial and operational
functions.
‘*9
ACTIVITIES
(a)
(b)
(c)
Training needs assessment;
IEC training;
,
. ,
Pre-service, induction, in-service and on the job training.
D.
MANAGEMENT IMPROVEMENT
•o
STRATEGIES
(a)
(b)
Involvement of women in higher levels of decision making,
supervision, monitoring and evaluation;
Creation of "Women in Development (WID) cells.
©
e
ACTIVITIES
*
(a)
(b)
Formation of Apex Committee/Project Implementation
Committee/Steering Committee;
Establishment of project coordination committee, training, MIS,
IEC and monitoring and evaluation cells.
E.
©
i'.)
DEMAND GENERATION
□
STRATEGIES
(a)
(b)
(c)
(d)
Dissemination of information regarding health and family welfare
services by IEC programs, woman approach etc;
Organization of women into groups or social network;
Development of income generation activities to increase women’s
access to services and to make them responsible for delivery of
health care services;
Increasing female education;
£5
O
e
___ ©
r
a
■
- 153
)
ANNEX 18
Page 16
)
(e)
)
>
Establishment of mechanism through which women can express their
needs and be protected against violence, e.g. street
discussions, user group meetings etc.
ACTIVITIES
>
(a)
>
(b)
>
(c)
)
(d)
Use of neighborhood committees, link workers, mahila mandals,
PVOs, local bodies etc for motivation;
Identification of methods for collaboration between community
and public authorities;
Use of female PMPs for delivery of health services and
orientation training camps (OTC) leaders as community educators;
Use of existing schools for health and adult education programs.
)
)
F.
)
STRATEGIES
)
(a)
)
(b)
)
Identification of women’s needs regarding nutrition, safe
drinking water supply, environmental sanitation, creche programs
etc;
Involvement of community to meet their needs with project
support.
>
ACTIVITIES
>
(a)
>
(b)
(C)
(d)
(e)
I
>
>
>
>
>
>
)
>
J
■
*
»
■
■■-■
■
-•
..........
INNOVATIVE SCHEMES
Environmental sanitation program;
Income generation activities;
Integration of services of anganwadi workers and ANMs;
Creche program;
Supplementary nutrition etc.
/ft
156
A.
1.
2.
3.
4.
5.
Activities
B
C
H
D
Baseline survey
Beneficiary needs assessment
Identification of location of
service delivery
Information about income by gender
Identification of women’s involvement
in development of various components
X
X
X
X
X
X
X
X
X
X
* '.ft
X
X
*o
SERVICE DELIVERY EXPANSION
1.
2.
3.
4.
5.
6.
7.
Construction of "D" type health posts
Construction of "B" type health posts
Upgrade maternity centers
Use of female doctors LHV/ANMs/HHV
Use of dais
Construction of ESOPD (Extended)
specialized out patient department)
Health administrative unit
C.
QUALITY IMPROVEMENT
1.
2.
3.
Training needs assessment
IEC training —
Pre inducting, in-service and
on the job training '
D.
MANAGEMENT IMPROVEMENT
1.
Involvement of women in project
management positions
Formation of Advisory/Apex
Committee
Establishment of MIS, training, IEC
and monitoring and evaluation cells
3.
/ft
PROJECT DESIGN
B.
2.
ANNEX 18
Page 17
E.
DEMAND GENERATION
1.
2.
3.
4.
5.
6.
7.
Use of mahila mandals
Use of balwadi and anganwadi teachers
NHC, female volunteers
Involvement of PVOs/PMPs
Involvement of OTC trained teachers
Female education
Formation of social health and
Environment (SHE) clubs
-ft
X
X
X
X
X
X
X
X
X
X
X
©
X
X
<9
Q
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
O
©
X
@5
a
)
- 155
ANNEX 18
Page 18
)
)
F.
INNOVATIVE SCHEMES
Activities
1.
2.
3.
>
I
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
>
)
>
)
)
)
)
>
B
Registration and detection of vital
events
Marriage registration
Family formation practices and
fertility behavior
No pregnancy incentive
Integration with ICDS
Community sanitation programs
Kitchen gardens
NFE for adolescent girls
Female literacy
Income generation activities
Creche programs
Revolving fund
Support to community based
rehabilitation for disabled in
slums
)
>
B = Bangalore
C = Calcutta
D = Delhi
H = Hyderabad
)
>
)
)
>
)
>
)
>
>
)
>
)
1
V
C
H
D
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
- 156
ANNEX 18
Page 19
SUMMARY
A.
BANGALORE
The project is aimed predominantly at females and administered by
females. The project beneficiaries are children, unmarried girls and married
women res iding in slums and they account for over 40Z of total beneficiaries.
The majority of personnel involved in service delivery at the top, middle and
junior management levels, and also at supporting paramedical and construction
workers levels, are females. Posts of LMO, PHN, ANM and link worker would be
filled through appointment of women. Social Health and Environment clubs "SHE’’ clubs-at slum levels provide for women’s participation in management
council. Workshops will be conducted to familiarize municipal staff with the
needs of poor women, The Project Management Committee is responsible for
monitoring impact of the project on women.
B.
CALCUTTA
&
■J
In the implementation of the project, women will play pivotal roles from
the grass-root level where community-based health workers will be.only women
up to the level of health administrators and managers. The majority of
trainers for training of personnel at different levels will be drawn from
practitioners or operating staff, and these are mostly women, At both block
and sub center levels, an Advisory committee comprising women beneficiaries
will be set up to screen the decisions taken by managers. The Project
Monitoring and Evaluation Unit would periodically meet Women Advisory
Committees at sub center units and collect feedback from them. Women will be
the beneficiaries in programs connected with primary and adult.education,
entrepreneurship development and nutrition awareness. In running creche
programs, PVOs would engage women drawn from local communities, Amdng the
beneficiary population, the majority will be women.
C.
4j>
©
0
•D
DELHI
For implementing the project, Bastee Sevikas, Trained Dais and AlWis will
all be women. Half of the doctors are expected to be women and 40Z of the
construction workers will be women
women.. Formation
Mahila Mandals and Bastee
O
1------------- of
-- -------Vikas Mandals would directly benefit women. Specific provisions, have been
er?
made to ensure female participation in the management positions of,the
.project. Women’s Organizations, Women’s NGOs
1__ and Mahila Mandals will be given
representation in Project Advisory and Coordination Committee (PACC).. Special
to monitor the
*1)
indicators will be developed in management information system to mom
impact of-the project on women.
e
o
G
■
..J
- 157
ANNEX 18
Page 20
)
)
?)
->
*
>
J
)
j
)
)
)
)
)
I
>
>
>
>
)
>
>
)
)
>
>
)
>
)
>
>
>
>
>
>
)
)
>
D.
HYDERABAD
The target beneficiaries under the project would be females living in the
slum areas and therefore involvement of beneficiary community in every
component of the service delivery system would be guaranteed. The
personnel/staff at Health Posts and Upgraded Maternity Centers would be women.
There would be 750 women health volunteers with project with each covering
2,000 population exclusively in the slum communities. Training officers will
be preferably women officers. Women belonging to the slums will be given
preference in civil construction works at worker level. In addition to women
health volunteers, teachers of Balavadis, Anganwadi workers and other
functionaries in ICDS project would help in organizing women’s groups, demand
generation and the delivery of services. Awareness of the needs of poor women
would be created through periodical group discussions, seminars and workshops
among project personnel.
Increased female participation in project management positions at City
Family Welfare Bureau level and in special units like IEC and training would
be ensured. In all urban Health Posts and upgraded Maternity Centers,
services will be provided exclusively to women and children. It is proposed
to constitute a special committee to supervise and monitor the impact of
project on woman. Apart from the project management staff, the special
committee will associate representatives of local community, PVOs, PMPs and
members of local Mahila Mandals. The Chairperson and member secretary of the
proposed committee will also be female.
153
ANNEX 19
Page 1
INDIA
(Zr’
FAMILY WELFARE (URBAN SLUMS) PROJECT
^3
PROJECT COSTS
TABLE 1.
SUMMARY COSTS BY COMPONENT AND TIME
(RS 'OOO
Total
tsse Costs
92/93
93/94
94/95
95/96
96/97
97/70
RS
90/9?
(iri 'ooo)
A. INCREASE SUPPLY OF FAMILY WELFARE SERVICES
1. BANGALORE
2. CALCUTTA
3. DELHI
4. HYDERABAD
Sub-Total INCREASE SUPPLY OF FAMILY WELFARE SERVICES
B. IMPROVE QUALIU OF FAMILY WELFARE SERVICES
1. BANGALORE
2. CALCUUA
3. DELHI
4. HYDERABAD
Sub-Total IMPROVE QUALITY OF FAMILY WELFARE SERVICES
C. INCREASE DEMAND FOR FAMILY WELFARE SERVICES
1. BANGALORE
2. CALCUUA
3. DELHI
4. HYDERABAD
5. CENTER
Sub-Total INCREASE DEMAND FOR FAMILY WELFARE SERVICES
D. MANAGEMENT IMPROVEMENT
1. BANGALORE
2. CALCUUA
3. DELHI
4. HYDERABAD
5. CENTER
Sub-Total MANAGEMENT IMPROVEMENT
E. INNOVATIVE SCHEMES
I
X
1. BANGALORE
2. CALCUUA •
3. DELHI
4. HYDERABAD
Sub-Total INNOVATIVE SCHEMES
F. PREPARATION OF FUTURE PROJECTS
1. CENTER
Sub-Total PREPARATION Of FUTURE PROJECTS
Total BASELINE COSTS
Physical Contingencies
Price Continsencies
Total PROJECT COSTS
Taxes
Foreisn Exchange
157,807.6
433,$9776
343,212.9
169,623.3
5,844.7
16,059.2
12,711.6
6.202.3
45,632.8 125.014.3 177,320.1 224»713.2 200»634.0 150»217.3 159»079.6 1»104.241.3
45.397.8
314.0
7,605.6 5,000.1
5,000.7 12,722.6 10,776.6 7,605.6
7,263.4 16,233.0 23,080.0 30,336.0 33,136.1 33,107.8
7,075.3 9,671.4 9,671.4
2,010.0 3,012.0 5,999.4 7,075.3
5,047.3 5,847.3 5,847.3
3,749.8 4,012.0 6,196.7 5,047.3
44,561.5
151,214.3
1,650.4
39,953.6
34,555.5
1,479.8
1,279.8
6,790.6 18,911.9 J7,5C0.5 46,053.4 51,664.7 54,463.0 54,020.6
270,284.0
10,010.5
10.449.2 24,429.0 33,241.1 32,759.2 23,016.6 10,830.6
10.500.2 40,706.1 75,338.4 87,090.2 78,672.9 56,452.9
8,070.0 41,070.2 61,769.7 73,795.7 60,963.3 46,900.0
7,043.4 10,008.2 26,970.9 30,260.129,901.220,033.8
1,445.9
2,175.5
914.0
2,255.1
15,081.1
76,036.8
41,044.0
27,717.8
5,600.5
t1?)
0
65,3/7.7
2,421.4
6,468.4
TSTHTT 2,412.1 .13 ’
5,242.2
3,100.8
63,050.3
25,607.3
20,637.8
2,335.5
30,426.0 46,107.0 41,516.0 39,467.9 32,033.2 29,333.0 28,153.7
247,807.7
9,101.0 -
5,954.9
21,675.4
22,101.1
.13,404.3
21,577.6
220.6
802.8
3,140.5
7,110.5 10,041.0 9,646.7
9,646.7 9,644.9
11,370.3 12,041.2 10,734.3
10,734.3 8,608.0
6.520.2 14,353.1 12,199.5 12,199.5
2,626.0 4,163.1
4,163.1 4,231.9
4,231.9 4,231.9
2.782.2 4,703.6 4,703.6 4,703.6
9,644.9
7,503.2
7,230.5
4,231.9
4,159.7
9,644.9
7,503.2
5,242.2
3,100.0
3,037.0
9,644.9
3,697.4
307.2
3,248.0
3,004.9
1,649.1
2,157.8
307.2
3,243.0
3,004.9
1,649.1
1,070.0
307.2
3,240.0
3,004.9
1,530.5
8,923.4 19,426.6 15,192.8 13,463.8 10,366.9
9,279.2
0,140.6
84,793.3
1.722.4 2,503.6 2,583.6 2,503.6 2,503.6 2,503.6 2,503.6
TTian 11,311.6 14,650.0 18,433.6 10,535.7 20,473.5 27,000.9
5.293.4 15,880.1 15,030.1 15,000.1
1,566.9 2,350.4 2,350.4 2,350.4 2,350.4- 2,350.4 2,350.4
17,224.3
2,380.1
2,222.1
2,096.0
1,417.1
2,031.0
3,502.5
4,260.3
2,624.6
7,000.3
307.2
2,221.3
3,004.9
2,651.1
7,000.3
307.2
3,905.6
3,004.9
1,832.9
4,333.3
13,051.5 32,125.7 35,472.1 39,247.3 23,467.7 33,407.5 31,934.9
113,6817?
52,933.7
15,669.3
209,509.3
951.4
1,060.7
821.5
I
496.5
799.2
637.9
|
4,530.8
1,960.5
I
|
580.3
7,759.6
21
87,602.9 128,333.9
7,997.7
5
193,257.2 370,721.4 327,031.6 363,746.1 310,968.7 276,750.0 ^IZ?,* g^l"
32,655.2. 70,907.2
160,400.r 5i940,8
14,550.2 27,063.1 25,924.03 23,137.4 23,557.7 20,150.2 20,201.3
760,413.0 11,645.9
89.352.0
18,544.6 69,662.9 E
--------- 130,107.6 137,643.3 145,601.4 169,501.2'
j
226,360.0 460,247.4 442,350.4 521,991.1 400,169.7 442,510.4 471,83b?
|
215,930.8
87,602.9 120,335.9
«SZ3»S
--------------------
X=S73ZSZ3 II——ZX--==S— a —-a--— --
-
7,599.2 14,671.3 13,120.9 15,462.5 13,634.2 13,201.7 13,967.7
24,241.2 52,594.8 45.531.7 51,745.4 39,399.2 34,510.4 36,313.2
91,737.4
234,343.9
2,908.7
9,084.0
Hay 18, 1992 16156
res
$
A
159
ADNEX J 9
Page 2
)
TABLE 2.
SUMMARY COSTS BY CATEGORIES OF EXPENDITURE AND TIME
4
Base Casts
(RS Million)
i
Foreign
Exchange
72/93 13/14 94/95 95/94 94/97 97/78 9C/99 Total
J
Aaount
L INVESTMENT COSTS
»
3
A. CIVIL WORKS
B. FURNITURE
C. VEHICLES
D. EQUIPHENT
E. HCH MATERIALS
F. PROFESSIONAL FEES
G. LAND
>
h. ms
)
>
3
3
>
>
I. LOCAL FELLOWSHIPS
J. LOCAL ADVISERS
K. FOREIGN FELLOWSHIPS
L. FOREIGN ADVISERS
M. BOOKS AND TRAINING MATERIALS
N. DEPARTMENTAL CHARGES
O. CONTRACT FOR INNOVATIVE SCHEMES
P. LOCAL TRAINING
Total INVESTMENT COSTS
3
3
3
3
3
3
)
>
18.7 70.1 106.2 94.7 61.6 21.2 25.5
4.4 B.5 15.5 I7.l 7.4 5.0 6.1
H.2 14.1 9.8 7.0 2.0 1.2
40.5 60.6 22.0 23.3 ll.2 7.1 6.7
9.3 16.7 19.6 20.1 31.7 44.7 40.3
3.3 3.4 3.3 3.1 3.1
2.4 12.6 17.2 17.2 17.2 3.0 7.0
3.7 8.0 22.3 34.3 45.1 40.0 51.8
4.2 7.1 6.3 6.3 5.0 5.0 3.0
45.0 70.3 12.7 10.0 9.0 7.8 9.3
O.l 2.0 2.0 2.0 0.0
0.6 2.2 2.2 2.2 1.1 0.6 0.4
0.7 1.3 1.3 l.O l.O 1.0 1.0
0.7 8.7 0.7 0.6 7.6 3.4
13.6 20.3 20.3 28.3 12.5 12.5 12.5
8.2 12.3
406.1 H.2 45.4
64.8 9.2
5.9
46.0 9.1
4.3
172.4 35.4 61.0
190.3 20.3 .. 30.6_
16.3 0.0
0.0
77.3 0.0
0.0
214.4 10.2 21.8
36.9 0.0
0.0
167.4 0.0
0.0
. 9.2 90.2
8.3
9.2 90.2
8.3
7.3 0.0
0.0
45.0 0.0
0.0
136.1 0.0
0.0
20.4 5.1
l.O
174.6 335.6 277.4 284.0 218.0 164.0 164.1 1,620.5 12.0 194.7
II. RECURRENT COSTS
A. SALARIES OF ADDITIONAL STAFF
B. HONORARIUM
C. OPERATION AND MAINTENANCE OF VEHICLES
D. OTHER OPERATION AND MAINTENANCE
E. RENT OF HEALTH CENTER
Total RECURRENT COSTS
Total BASELINE COSTS
Physical Contingencies
Price Contingencies
Total PROJECT COSTS
16.0 27.9
u
54.9 67.7 75.2 76.3
2.2 5.7 12.0 20.5 28.4 32.9 36.5
0.0 0.2 0.6 0.9 1.1 1.2 1.2
0.2 0.3 0.4 0.8 1.4 1.4 1.4
0.2 0.9 1.4 1.9 2.2 2.2 • 2.6
71 1
Uw •
351.4 0.0 '
130.3 0.0
5.2 ,5.1
5.8 5.1
11.4 0.0
0.0
0.0
0.3
0.3
0.0
10.7 35.1
47.7 78.9 lOl.O H2.0 512.1
HO.O ____
O.l
O'. 6
193.3 370.7 327,I 363.7 319.0 276.0 202.I 2,132.7 9.2 195.2
14.6 27.9 25.9 28.1 23.6 20.2 20.2 160.4 ll.6 10.6
10.5 69.7 09.4 130.1 137.6 145.6 169.5 760.4 9.3 70.5
226.4 460.2 442.4 522.0 400.2 442.5 471.8 3,053.5
9.3 284.3
—=== ===X ===== ===== ===== ===== ---rr—7
>
>
3
3
3
3
9
3^^
Taxes
Foreign Exchange
Hoy 18, 1992 16:56
7.6 14.7 13.1 15.5 13.6 13.3 14.0
24.2 52.6 45.5 51.7 39.4 34.5 36.3
91.7
204.3
0.0
0.0
0.0
0.0
160
TABLE 3.
ANNEX 19
Page 3
SUMMARY COSTS BY COMPONENT AND CATEGORIES EXPENDITURE
(RS Killion)
PREPARATION Of
FUTURE
PROJECTS
IMWVATIVE COOES
(WiAGDOT IHPRO’OENT
BANGALORE CALCUTTA DELHI HYDERABAD CENTER BANGALORE CALCUTTA DELHI ITTXRABAD
■■■! ■
RJUTX**JEB
UEZXX1X3
Phvtical
Continstncias
I
A*oani
64.0
46.8
172.4
190.3
16.3
77.3
214.4
36.9
167.4
9.2
9.2
7.3
45.0
136.1
20.4
10.0
10.0
10.0
10.0
10.0
10.0
0.0
10.0
5.0
5.0
5.0
5.0
10.0
10.0
5.0
5.0
40.6
6.5
4.7
17.2
17.0
1.6
0.0
21.4
1.8
8.4
0.3
0.5
0.7
4.6
6.8
1.0
197.6 1.620.3
0.4
135.4
351.4
130.3
5.2
5.8
11.4
5.0
5.0
5.0
5.0
0.0
17.6
6.?
0.3
0.3
0.0
SEXTO? ToUl
W W TWTT yw
INVESTMENT COSTS
A. CIVIL WORKS
B. FURNITURE
C. VEHICLES
D. EQUIPMENT
E. MDf MATERIALS
f. PROFESSIONAL FEES
6. LAND ’
H. DRUGS
0.1
1.3
1.7
1.0
2.1
1.4
1.0
0.6
3.3
1.5
0.4
0.2
2.0
0.7
1.4
2.3
I. LOCAL FELLOWSHIPS
J. LOCAL ADVISERS
K. FOREIGN FELLOWSHIPS
L. FOREIGN ADVISERS
M. BOOKS AND TRAINING MATERIALS
N. DEPARTMENTAL CHARGES
O. CONTRACT FOR IWWVATIVE SCHEMES
P. LOCAL TRAINING
2.2
al INVESTMENT COSTS
3.4
7.1
6.4
4.?
A. SALARIES OF ADDITIONAL STAFF
B. HONORARIUM
C. OPERATION AND MAINTENANCE OF VEHICLES
D. OTHER OPERATION AND MAINTENANCE
E. RENT OF HEALTH CENTER
0.6
14.6
12.6
8.1
ul RECURRENT COSTS
jI BASELINE COSTS .
’h-rticaTContinStncirs
‘rici Ccntinstncies
0.6
6.0
J1 PROJECT COSTS.
Taxti
«
'ortisn ExchaoSe
0.6
12.3
61.7
7.2
0.6
68.8
5.4
5.4
5.4
5.4
?6.0
17.2
50.2
32.?
13.7
20.4
21.6
17.2
120.1
52.?
13.7
0
0
. RECURRENT COSTS
i
18.4
3.6
0.1
0.8
2.2
0.3
0.1
14.6
21.7
1.3
8.0
13.8
22.2
1.3
7.7
8.5
13.4
0.9
4.6
21.6
1.1
6.4
17.2
7.7
31.0
31.2
18.?
2?.O
24.4
0.4
1.2
0.4
1.2
0.6
2.1
0.4
1.0
13.2
13
3.6
123.7
9.7
54.9
52.9
2.6
13.8
15.7
0.8
5.8
1Q.4
512.1
215.9 2.132.7
160.4
14.9
760.4 '
33.1
4.9
7.5
0.0
7.2
25.0
160.4
0.0
54.6
18C.2
6?.4
22.2
263.9 3.053.5
7.0
'215.0
91.7
204.3
9.1
3.7
8.3
24.8
7.8
23.4
9.4
31.0
'
a
18. 1??2 16:56
0
e
$
....... JI.
0
161
TABLE 3-
)
ANNEX 19
Page 4
SUMMARY COSTS BY COMPONENT AND CATEGORIES EXPENDITURE
(Continuted)
(RS Killion)
INCREASE SUPPLY OF FAMILY WELFARE
DPR0VE DUALITY OF FAMILY WELFARE
SERVICES
SERVICES
*
r
INCREASE DEMAND FDR FAMILY WELFARE SERVINS
BANGALORE
CALCUTTA
DELHI
0.1
10.2
0.1
20.5
0.1
2.1
1.2
0.1
0.9
4.2
30.8
25.1
1.9
1.4
12.9
40.9
BANGALORE
CALCUTTA DELHI
HYDERABAD BANGALORE CALCUTTA DELHI HYDERABAD
KnaonBXMH
iubxiu baku
uuauji
150.7 115.9
6.0
45.5
9.5
10.7
51.7 10.6
42.6
5.8
5.0
48.8 25.3
35.9
1.2
1.4
2.8
1.6
1.8
BnxiDrvn
» wctct
ujxi
HYDERABAD CENTER
unctm
I, INVESTMENT COSTS
)
)
>
>
)
A. CIVIL WORKS
B. FURNITURE
C. VEHICLES
D. EQUIPMENT
E. MCH MATERIALS
F. PROFESSIONAL FEES
. 6. LAND
H. DRUGS
I. LOCAL FELLOWSHIPS •
J. LOCAL ADVISERS
K. FOREIGN FELLOWSHIPS
L. FOREIGN ADVISERS
M. BOOKS AND TRAINING MATERIALS
N. DEPARTMENTAL CHARGES
”0. CONTRACT FOR IIWATIVE SC®£S
P. LOCAL TRAINING
) Total INVESTMENT COSTS
62.54.3
6.1
19.1
5.8
3.1
8.12.0
0.5
1.0
10.4
0.4
13.8
5.6
2.3
0.3
0.3
0.1
3.2
140.2
0.3
1.0
0.5
30.1
1.1
1.0
5.2
3.5
5.1
10.7
5.2
5.4
6.0
2.7
3.8
17.1
1.0
0.5
3.2
108.5
324.5 236.3
47.9
42.4
146.6
34.1
31.8
33.0
12.8
0.5
• 2.9
11.9
87.9
1.1
89.4
15.5
2.0
107.4
11.5
1.1
0.6
0.1
0.3
0.7
3.6
0.3
3.0
2.8
0.0
2.6
2.1
44.6
5.9
40.0
3.6
18.8
2.8
34.6
3.1
14.3
12.0
4.1
3.3
1.
0.9
63.9
63.3
37.5
6.2
1.4
1.0
25.4
19.5
1.7
18.5
7.5
0.3
20.6
II. RECURRENT COSTS
>
)
)
A. SALARIES OF ADDITIONAL STAFF
B. HONORARIUM
C. OPERATION AND MAINTENANCE OF VEHICLES
D. OTHER OPERATION AND MAINTENANCE
E. RENT OF HEALTH CENTER
’0.3
1.7
0.8
8.2
57.3 I
109.1 106.9
433.6 343.2
32.6 26.4
158.7 128.6
121.7
169.6
10.8
67.7
[16.0 j
4.6
151.2
14.6
71.1
JtoUI PROJECT COSTS
228.5
624.9 490.3
240.1
64.6
236.9
62.4
52.0
Taxis
Fonisn Exchan**
6.6
22.7
16.9
61.2
12.6
41.1
2.2
7.0
3.1
7.5
15.7
23.9
3.6
6.9
3.1
5.4
Total RECURRENT COSTS
*ToUl BASELINE COSTS
X
Plmicjl-Continstncits
Prici Continiincits
jMa« 18/ 1992 16156
>
>
J
5
I
>
49.3
157.8
.0.2
0.1
0.0
0.2
1.8
65.1
5.6
21.5
25.5
63.1
5.0
20.7
19.5
25.7
1.6"
9.2
28.6
2.0
10.5
•93.1
92.2
00.8
36.5
41.2
0.8
1.4
4.1
12.6
2.0
6.7
0.7
2.6
1.1
11.4
1.5
65.4
©
16?.
ANNEX 20
Page 1
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
TABLE 1:
FINANCING PLAN BY COMPONENTS
(U£$ zW0)
GOVERNMENT OF
INTERNATIONAL
INDIA
DEVELOPMENT AGENCY
ToUl
Amount
For. Exch.
I
Local (Excl.
Taxes)
Duties f -A
Taxes
Aaount
I
Aaount
5,650.5
14,326.5
11,446.4
5,618.2
70.0
73.0
73.6
72.8
7.5
1,596.4 22.0
5,095.2 26.2 19,421.6 20.1
4,109.7 26.4 15,556.1 16.1
2,097.3 27.2 7,715.5 8.0
1,917.2
1,286.9
257.7
6,292.5
16,971.9
13,075.9 '
7,334.9
37,041.6
74.2 12,890.5 25.3 ^49,940.1 51.7
4,199.7
44,525.1
1,215.3
1,845.4
6,299.6
1,657.2
09.7
07.8
07.7
1,436.3
08.9
212.2 10.3 .2>057.4^ 2.1
7.4
876.0 12.2 ‘7,175.7
----233.4 12.3 1,090.6 2.0
179.3 11.1 1,615.6 1.7
721.9
214.4
169.4
1,721.5
5,979.0
1,567.6
1,349.2
474.3
100.6
97.0
11,230.5
88.2
1,501.0 11.3 12,739.4 13.2
1,343.0
10,617.2
779.2
2,067.7
2,700.3
2,200.0
866.1
1,251.0
97.6
90.8
3.0
43.9
400.8
222.1
03.4
2,068.2
,?:P
:=
A. INCREASE SUPPLY OF FAMILY WELFARE SERVICES
1. BANGALORE
2. CALCUTTA
3. DELHI
4. HYDERABAD
Sub-Total INCREASE SUPPLY OF FAMILY WEUARE SERVICES
- B. IMPROVE QUALITY OF FAMILY WELFARE SERVICES
1. BANGALORE
2. CALCUUA
3. DELHI
4. HYDERABAD
Sub-Total IMPROVE QUALITY OF FAMILY WELFARE SERVICES
C. INCREASE DEMAND FOR FAMILY WELFARE SERVICES
1. BANGALORE
2. CALCUUA
3. DELHI
4. HYDERABAD
5. CENTER
Sub-Total INCREASE DEMAND FOR FAMILY WELFARE SERVICES
D. MANAGEMENT IMPROVEMENT
1. BANGALORE
2. CALCUTTA
3. DELHI
4. HYDERABAD
5. CENTER
Sub-Total MANAGEMENT IMPROVEMENT
E. INNOVATIVE SCHEMES
1. BANGALORE
2. CALCUUA
3. DELHI
4. HYDERABAD
Sub-Total INNOVATIVE SCHEMES
F. PREPARATION OF FUTURE PROJECTS
1. CENTER
Sub-Total PREPARATION OF FUTURE PROJECTS
Total Disburseaent
Mas 18, 1992 16:56
77.1
74.9
96.1
71.6 2.4 2,939.3.
274.7 9.2 ‘2,975.0
654.0 22.9 2,862.0
290.1 25.1 1,156.2
50.4 3.9 1,301.4
737.9
364.5
1 ,340.9 11.9 11,234.0 11.6
1,122.7
9,026.4
263.5 0.3
^777T 1.0
992.9 1.0
39.7
211.6
923.4
■897.2
555.4
516.5
9,093.1
BS.l
241.6
750.3
657.6
456.9
335.2 33.8
945.2
91.7
77.6
66.2
75.7
100.0
3,059.7
SO.9
692.4
5,16075'
2,075.0
21.9 8.3
219.2 22.4
3.0
1.2
1.3
393.3 it?
72.9
©
93.0 @
j
------
2,433.2
2,574.2
1,049.2
901.6
3.1
216.5
532.6 .
65.7
23.6 •
^2^
204.9.
12. l4-’^
603.4
0.6
945.2
1.0
41.4
73.4
33.8
428.6
722.7 19.1
3,702.4
3.9
617.0
3,104.2
61.
76.9 10.0
609.0 10.6
230.6 10.0
70.0 10.0
769.3
5,\9.5
2,305.6
499.0
.0.3
’ *
6.0
2.4
0.7
704.7
769.3
4,829.3
235?®
629.9
90.0
89.4
90.0
90.0
0,557.7
89.7
986.5 10.3
9,544.2
9.9
704.7
0,604.0
235r)
8,740.0
93.6
593.7 6.4
9,333.7
9.7
1,096.9
7,904.3
332.6
8,740.0
93.6
593.7 6.4
9,333.7
9.7
1,096.9
7,904.3
332.6
70,530.5
61.3 13,043.3 10.7 96,573.9 100.0
9,004.0
------84,581.2 2,908.7
146.5 24.3
S33ZS3S3 ==•==
f;
2,305.6
699.8
XSS33—* X===
■0
©
*
- 163
TABLE 2:
ANNEX 20
Page 2
FINANCING PLAN BY CATEGORIES OF EXPENDITURE
5
(US* Million)
INTERNATIONAL
DEVELOPMENT GOVERNMENT OF
AGENCY
INDIA
>
Aiount
Z
17.0
2.7
1.9
7.0
8.2
0.7
90.0
90.0
90.0
90.0
90.0
90.0
Local
For. (Excl. Duties 1
Aaount Z
Aaount *
Exch. Taxes) Taxes
===== ===== ====== ===== ===== ====== =======
Total
)
L INVESTMENT COSTS
5
y
>
>
A. CIVIL UORKS
3. FURNITURE
C. VEHICLES
D. EQUIPMENT
E. MCH MATERIALS
F. PROFESSIONAL FEES
G. LAND
H. DRUGS
I. LOCAL FELLOWSHIPS
J. LOCAL ADVISERS
K. FOREIGN FELLOWSHIPS
U' 'EIGN ADVISERS
S AND TRAINING MATERIALS
N.
TMENTAL CHARGES
O.
.CT FOR INNOVATIVE SCHEMES
P. LUCAL TRAINING
Total INVESTMENT COSTS
1.9 10.0
0.3 10.0
0.2 10.0
0.3 10.0
0.9 10.0
0.1 10.0
2.5 100.0
1.0 10.0
5.4 90.0
0.9 100.0
0.0 10.0
2.1 100.0
0.6 10.0
0,0 0.0
13.0 19.5
3.0 3.1
2.1 2.2
7.8 8.1
9.1 9.4
0.7 0.8
2.5 2.5
10.2 10.6
1.6 1.7
7.3 7.5
0.4 0.4
0.4 0.4
0.3 0.4
2.1 2.2
6.0 6.2
0.9 0.9
0.0
16.2
2.7
l.S
4.3
6.6
0.7
2.5
8.5
1.6
7.3
0.0
0.0
0.3
2.1
6.0
0.8
63.0 85.8
10.4
73.4
9.1
61.4
11.1 70.0
4.4 70.0
4.8 30.0
1.9 30.0
0.2 100.0
0.3 100.0
0.5 100.0
9.2 90.0
1.6 100,0
7.3 100.0
0.4 100.0
0.4 100.0
0.3 90.0
14.2
76.0
2.1
0.3
0.2
2.7
1.9
1.1
0.4
0.4
0.6
0.1
0.1
0.8
0.6
0.7
2.9
II. RECURRENT COSTS
>
>
A. SALARIES OF ADDITIONAL STAFF
D. HONORARIUM
C. OPERATION AND MAINTENANCE OF VEHICLES
D. OTHER OPERATION AND MAINTENANCE
E. RENT OF HEALTH CENTER
Total RECURRENT COSTS
Total Disburseaent
>
0.0
0.0
15.5 67.0
7.7 33.0
0.0
23.2 24.0
78.5 81.3
10.0 18.7
9.1
96.6 100,0
====== ===== === ===== ===== ===== =====
>
>
15.9 16.5
6.3 6.5
0.2 0.2
0.3 0.3
0.5 ‘0.5
Has 18> 1992 16156
>
)
J
..,-j
-r
15.9 •
6.3
0.2
0.3
0.5
17 n
» 4.
84.6
2.9
sssixasss
164
ANNEX 21
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
INCREMENTAL COST ANALYSIS
TABLE 1:
STATE FAMILY WELFARE EXPENDITURES 1985-91 AND PROJECTED (Rs MILLIONS.^
PROJECTED)
1998/9,
STATES
1985-86
1986-87
1987-88
1988-89
1989-90
1990-91
KARNATAKA
251.06
250.85
318.58
293.16
333.83
353.84
513 .Ofnj
WEST BENGAL
248.57
267.21
305.60
329.64
380.89
507.05
731.5®
DELHI
ADMINISTRATION
246.19
276.63
278.38
280.80
372.12
410.62
595.4^
339.03
386.42
438.83
514.91
738.31
1,070.5^
-------
ANDHRA
PRADESH
3
TABLE 2:
RECURRENT COSTS OF PROJECT IN FINAL YEAR OF PROJECT
(RS million)
CITY
1998/99
BANGALORE
CALCUTTA
DELHI
HYDERABAD
M0HFW
TOTAL
24.4
65.1
78.3
52.0
2.8
222.6
a
*^3
©
X
TABLE 3:
A.
B.
C.
D.
IMPACT OF PROJECT RECURRENT COSTS ON PROJECTED STATE AND MUNICIPALITY BUDg&T-
Project as
Project as
Project as
Project as
X of Projected Karnataka Family Welfare Budget = 4.7
X of Projected West Bengal Family Welfare Budget =8.9
-5
X of Projected Delhi Administration Family Welfare Budget = 13.1
1 of Projected Andhra Pradesh Family Welfare Budget = 4.8
©
&
I
/
d
3
165 ANNEX 22
Page 1
3
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
SECTION 1:
SUPERVISION PLAN
i
1.
)
Since the Project incorporates several new elements which were not
included in previous IDA-assisted Population Projects, IDA staff will closely
monitor (supervise) the progress and impact of these elements. Community
participation in project implementation, female education and gender analysis,
the use of Revolving Funds for special studies, PMPs, PVOs, and Innovative
Schemes, will require expertise in these areas to be included in supervision
missions from time to time. The expected skill requirements and staff inputs
are summarized in Table 1.
)
>
)
IDA
)
>
2.
>
To supplement IDA staff supervision efforts, MOHFW, the States and
Municipalities would prepare semi-annual reports (Part 2 of the Annex) under
the coordination of the MOHFW Area Projects Division. Semi-annual reports
will be submitted by the municipalities and States and consolidated by the
Area Projects Division. These reports will provide data on progress in
implementing inputs i.e. civil works, materials, training, financial outlays
and expenditures, procurement of goods and services, etc. The States will
also form PACCs and the municipalities will form Project Implementation
Committees to assist in the planning, management and monitoring of Health
Posts, Maternity Homes, and Upgraded Urban Family Welfare Centers. These
tasks to be undertaken by these entities, will allow IDA staff to focus ' , :
supervision missions on implementation progress at the three levels and on the
major policy and program issues.
>
>
>
?
)
)
5
>
)
>
>
)
>
J
5
9
I
Borrower
166
ANNEX 22
Page 2
Supervision Outline
Approximate
Dates
Activity
Expected Staff
Requirements
Staff Weeks
Estimates
FY 93 (1)
Supervision Mission
(Initial Start-up)
Task Manager/Economist
Architect/Engineer
Public Health Spec./MD
Women’s Dev. Spec.
Community Participation
Training/IEC Specialist
24
FY 93 (2)
Supervision Mission
Population Specialist
Public Health Spec.
Health Economist
10
FY 94 (1)
Supervision Mission
Population Specialist
Architect Engineer
Community Participation
Specialist
Medical Education/
Training Specialist
12
FY 94 (2)
Supervision Mission
Public Health Spec./MD
Women’s Dev. Spec.
IEC Specialist
12
FY 95 (1)
Supervision Mission
Population Specialist
Architect Engineer
Community Participation/
Public Health Specialist
FY 95 (2)
Supervision Mission
Medical Education/
Training Specialist
Women’s Dev. Spec.
Monitoring and Evaluation
Specialist
12
Population Specialist
Architect/Engineer
Community Participation
Spec .
Public Health Specialist
10
Supervision Mission
©
©
o
12
FY 96 (1)
■o
©
o
©
©
167
)
ANNEX 22
Page 3
)
)
FY 96 (2)
Supervision Mission
(Mid-term Review)
Population Specialist
Architect/Engineer
Public Health Spec./MD
Women’s Dev. Spec.
Medical Education/
Training Spec.
Community Participation
Specialist
24
FY 97 (1)
Supervision Mission
Task Manager
Public Health Spec./MD
Health Economist
12
FY 97 (2)
Supervision Mission
Monitoring and Evaluation
Specialist
Demographer
Community Participation
Specialist
12
FY 98 (1)
Supervision Mission
Population Specialist
Women’s Dev. Spec.
Community Participation
Specialist
Public Health Spec./MD
12
FY 98 (2)
Supervision Mission
Women’s Development
Public Health Spec.
IEC Specialist
12
FY 99 (1)
Supervision Mission
Population Specialist
Public Health Spec./MD
Health Economist
12
FY 99 (2)
Supervision Mission
(Project Completion
Report Preparation)
Population Specialist
Public Health Spec./MD
Architect/Engineer
Women’s Dev. Spec.
Monitoring/Eval. Spec.
Med./Training Spec.
20
>
lr
)
)
)
)
)
)
)
)
)
)
>
)
>
>
>
)
)
)
)
x
>
>
>
>
J
^■30
168
ANNEX 22
Page 4
e
SCHEMATIC ORGANIZATIONAL CHART
Covernnent
of
India
o
□
National Popula
tion Subcommit
tee on urban
Revamping Schem
Common ity
Croup.
MOHFV
NATIONAL
LEVEL
Women A Child
Department
(ICDS)
Project Advi»ory
and Coordination
Committee (PACC)
I
Area Project.
Division
Ministry of
Urban Develop.
(UBSP)
Mini.try of
Education
(Ferna I• Educ.)
©
Other External
Agencie. (ODA,
UNICEF, WHO)
4
State Directorate
of Health A Fem.
Welfare
PVO»
D
State
PopuI a t i on
Commii on
I
Directorate, of
Educati on/Urban
Project Advi.ory
and Coordination
Committee (PACC)
STATE
LEVEL
4
*••
PVO»
9
—I Community Croup.
Mu n i c i p • I
Corporati on
T
4
I
T
Health Bureaux
Unit
MUNICIPAL
LEVEL
Proj act Imp I.
Commi ttee
(PIC)
Project Director
I
n
I
I_____
I Component |
| Component |
I Component I
I
|
I
HEALTH POSTS
(Nee Construction
Add i t i on./Rehab.)
TRAINING
Drug/Med i c i ne
Supply
•3
UBSP
ICDS
4
PVO.
4
PHP.
—
©
Common i ty
Croup.
! E C
Commun i ty
Pa r ti ci pa ti on
>3
PVO.
Innovati ve
Scheme.
©
■3
O
©
II ■•■;
•
I
O
;
169
ANNEX 22
Page 5
3
3
SECTION 2:
OUTLINE OF PROGRESS REPORT
1.
Key Indicators are divided into two categories: (a), overall
proj ect impact on the beneficiaries; and (b), project obj ective/activity
achievements.
>
(a)
Beneficiary Impact indicators would be:
contraceptive prevalence rates by method, .source and
prevalence,including decreasing extrinsic incentives;
immunization coverage;
ante-natal care provided;
post-natal care provided;
institutional delivery/delivery by trained personnel;
growth monitoring;
births by percentages of birth orders;
female literacy;
numbers paying for some services;
age of marriage increase.
>
)
(b)
Project objective/activity achievement indicators would be:
)
1.
Service Delivery Expansion: numbers of:
*
health centers/posts opened/upgradedj
*
maternity homes/PP Centers upgraded/provided;
★
Outreach Services increase.
2.
Quality Improvement: numbers of:
*
persons trained, by category, topics, duration, frequency;
*
increase in quantity/quality/availability of
drugs/medicines/supplies.
' . '
3.
Increasing the demand for services: the kinds and extent pf:
*★
community participation in project activities, management
and assessment;
*
PVO involvement;
*
PHP participation;
*
IEC activities;
★
female education.
4.
Management Improvement: Actions taken to:
*
strengthening the health department;
*
improving the MIS and use as a management tool;
★
monitoring and evaluation data and refinement of project
policies/practices.
5.
Innovative Schemes: funding of and application of findings.
6.
Female Involvement and Measurable impact: women advisory
committee frequency of meetings and agendas related to
improvement of services.
I
i
)
>
)
>
1
i
>
>
>
>
>
>
)
. 1“
r111"’""1.
■I s1.:1!1/-;,.1 A •
1 70
ANNEX 22
Page 6
2.
Progress Reports will be prepared by each City (Bangalore,
Submission should
should be
be
Calcutta, Delhi and Hyderabad) on a semi-annual basis. Submission
to the GOI/MOHFW and the World Bank by January 15 for the six month period
ending December 31, and by July 15 for the six month period ending June 30.
The ^reports should compare progress against the targets developed each year
in the required Annual Action Plans to be submitted to the World Bank by
January 31 each year. These reports should be an integral part of the
management/MIS system for implementing the project rather than as a separate
activity. The reports are intended to :
(a)
document \rogress in achieving Project Goals and Objectives;
(b)
identify problems and constraints; and
(c)
outline recommendations, policies and practices to be incorporated
for solving the problems encountered.
©
©
©
3.
Since the
has five
five major
major components,
components, the Reports should be .j
Since
the Project
Project has
organized into five discrete chapters, including tables and annexes as
appropriate. A sixth Chapter should be added to summarize the financial .
’
aspects of the project such as budget allocations, expenditures and submission^
oZwithdrawal applications. Information on contracts awarded or in process may
also be mentioned.
The Chapters should begin with a statement of the objective, the
project activities by which the objective would be achieved and the ways of
determining progress in meeting identified and time bound targets. The
following is the proposed outline.
o
.•■C'
e
■f)
‘i)
l
'
©
C)
o
©
&
9
171
ANNEX 22
Page 7
3
OUTLINE FOR SEMI-ANNUAL PROGRESS REPORTS
CHAPTER I
3
OBJECTIVE:
3
3
3
3
3
3
3
3
3
3
EXPAND THE SUPPLY OF FAMILY WELFARE SERVICES
1.
This would be achieved by:
Bangalore
(a)
(b)
(c)
(d)
Calcutta
(a) opening of new subcenters/Health Administrative Units;
(b) increasing the number of "Expanded Out-Patient Departments"
(ESOPDs) at existing Maternity Homes/Hospitals ;
(c) renovation of existing and construction of new Maternity Homes
to include satellite units (neo-natal and PP Centers)
(d) construction of two Regional Medical Stores;
(e) expanding the outreach program through Honorary Health Workers
and local committees.
Delhi
(a)
(b)
(c)
(d)
Hyderabad
(a)
(b)
(c)
establishment of new Health Centers/Health Posts;
strengthening existing Health Centers;
upgrading Maternity Homes to upgraded Health Centers;
expanding the Outreach Program through link workers and
community participation.
>
>
>
)
3
opening of 650 Health Posts;
establishment of 25 Health Centers, including
including 66 upgraded;
upgraded;
provision of 19 Mobile Health Clinics3 (Vans);
(Vans);
expanding the outreach program through Link Workers and local
cooperatives.
construction of 56 new Health Centers;
renovation of 14 existing Health Centers;
establishment of 13 new and strengthening 4 existing upgraded
Health Centers;
(d) expanding the outreach program through community based Link
Workers.
2.
The Implementing Authority should report on each of these listed
'.activities. Progress should be measured against Annual Targets which will have
been developed by January 31 of each year. Charts and Tables should be used
whenever possible. For example a Table could be developed as follows:
J
>
Bangalore; Establishing, Strengthening, Upgrading
___________ Health Centers, Maternity Homes
>
>
Total in
Proj ect
Total in
1993
60
37
24
15
20
16
Achievement as
of 6/30/93
Z annual
achiement
)
)
established
strengthening
upgraded (Mat.)
)
)
)
5
n
■
8
25
12
53Z
120Z
75Z
- J 72 -
ANNEX 22
Page 8
3.
a Table should also be created showing the appointment of staff
crossfor the expansion of outreach capacity. These data may be cross-referenced
with other chapters such as Training for greater detail.
4,
The Chapter should conclude with two or more paragraphs, (a)
problems encountered, and (b) proposed solutions to be taken during the next
period.
CHAPTER II
&
OBJECTIVE:
IMPROVING THE QUALITY OF FAMILY WELFARE SERVICES
1.
This would be achieved by:
Bangalore, Calcutta,
Delhi and Hyderabad
(a)
(b)
<□
Training all categories of Family
Welfare Workers, including
Community Volunteer Workers, PVOs
and PMPs; and.
Improving the supply, variety,
budget, and distribution of drugs,
medicines, and supplies.
2.
This Chapter should provide information on all the training
2.
activities being undertaken by the Project. Annex 12 outlines an Annual
Training Plan format with targets for
the number of persons; to be trained each
the
areas
in
which
they
are
to
be
trained, and the location and duration
year,
•
*
1 as an essential
of training. This draft plan should be revised' and‘ updated
feature of the Annual Training Plan.
©
©
□
J
The reporting which will be undertaken semi-annually should be
measured against the targets established for the Annual Training Plan and an
appropriate Table should be included showing the annual training levels
proposed compared to actual achievements.
4.
This Chapter also should indicate efforts taken to recruit and
train Trainers, progress in developing curricula and instructional materials,
and collaboration with PVOs, Medical Schools, and other public or private
training institutions.
©
5e
This Chapter should describe efforts taken to improve the supply,
budget, variety ,and distribution of drugs, medicines, and supplies. It
initially might include the standard lists of medical stores and subsequently
indicate revisions and improvements in the system.
The Chapter should conclude with Problems and Proposed Solutions.
o
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€
1
Pa&e
■yyc;.;;;
»A!<
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INCRE^sI1,G tUE
DEMAND for
eahiey VELFARE
Calcutta, Delhi and
OBJECTIVE:
„o„ld be •*le’'‘d
services
in Bangal°re»
This
^ted activities
»s desigua
b*
,4
designed
community-ua
volvement
in
o£
c
_
„„lt,
(a) commicommunity .
and implementat
*
management and
organization uin the project’s
*
activitie^ inv01vement
numbers of
increase
community
.
• - steps taken
taken to
.
*
on-&oin&
pVOs including
1VOlvement of
pr-J 6Practitioners .
involvespatin& in the /JoVl
aCttivities
ticipatmg
kinds
(b) PVOs parti
P0£ private
ivate Medi
ticipating, th ’ other
nof the
i
(c) process to increase
11dertaken
ken, and the
including the
un<
• n programs^{.e addressed, and
^Cronal^ot^^iz^^^od'communication
ional orga— _
audience to v
ised -where
n education
Pinformation
r°£t.Mnn,
tat&et
.ured andrev
TEC
interv-""
(d)
”,s
spec
in
of
the
results
or
program elements train
how
materials.
including spe
aPPr°pria
2!’ ■
education,
creches_JoPen cente
female
stipends, free
y. c«'lSHSM4
(e)
early cbi
child
ca
construction,
*
lies)
*"s)ea«c«tio»
tbooks
training,
*
centers t
. tteacher
not-fXVeducation ( open c
,
activities
★
seif.employmen
on e8C\C«es vhere
Hydera.bad by-
"“■‘’'Tui S'o£ 'M w
)
)
The Reports s^£erences to
5
•0
2.
outlined
indicated^
which is
i- to
•vSSs“-s“s^
4
0
Chapter 1-
tered in each .
-3 encoun next reporting
probleins
during the
employed o-
The Chapter
3.
iand the propc
activity
period.
CHAPIER_IV
&
0
0
O
management
SERVICES
OBJECTIVE:
1.
©
VELFARE
TMPROVING THE
e
1®
OF FAMILY
Bangal0^.
an
id be achieved by.
Bureau into
vould
De
This
f the City Family Velfare
unit;
conversion °
and Monitoring Units;
(a) administrative
IEC and Training
establishing
(b) reorganizing the HIS;
(c)
*,
■ 174
ANNEXE
an Apex
p
age io
Mayor and a
Committee r
:
Coo
rdinati
O
n
-^unde^
Commissione
committ
r t0 review
Calcutta
Progres S °f the Project P°rati0n
(a) strengthe
ning the Monitr
jUnit in the
Oring and
Ca
lcutt
Computer Cell •
-a Metr
(CMDA);
-ropolita.
(b)
establishment of
(c) formation
of
Committ ees for an
Units (HAUs)*
Ward level.
Delhi
Co°rdinat'ion
(a) --to be
determined
ees at the
at aPPraisal..__
Hyderabad
(a) establishmp- ■
‘ent of a f_
JCect
Proj
Unit
--- of the cCorporation!
Impi
(b) establish
Unit in
three
’’CO v *
Health
units in
Training.
and r
•"■I fwiuauo"''
1" “'“very.
for
Monitoi
ring
___ _
formation
of a r
Projec t Implementati
Committee
under th
—1 Chai tmanship Of ,°n and Coordination
Commissioner.
the Corporation
2.
Each City should
respective
r
staff as r._ units, ceUs and , report on the Progress
in
committees.
This
outlined
i
n
Information
-1 Annex 15. The r
shoX
StHbUshing their
•
3
can
be
—1 on the
‘ reports also <sh°uld include^detaS1 °f
aCtivities of the
—- units, cells
33 and committees
ed
rne'functioning, r-..
and evaluation
activiti
Sh°ufd be described
es and ;results
—
for that year. The
and compared
°f the MIS,
•
uPon, Particularly “se of Rapid Low
monitoring
to the Annual Plans'
r
Cost
f'
J
Nation in theyProject! StUdieS are - - Studies
J Prepared
should
bein
being used (RLCS)
in
be reported
—1 Planning,
4.
management tand
The Chapter
encountered and the
should conclude
Proposed Solutions with
reporting Period.
to be eD>Ployed°durIng^h^ Problems
& me next , :
(d) formation of
y "1
^’i
^4
1
•w
OBJECTIVE.
**
1.
Hangalore
CHAPTER y
o
o
o
innovative SCHEMES
This Objective
would be
achieved by:
(a^
suppleme ntary nutrition
children
for Pregnant
(b) Intensive u“3 years of r
and iactating mothers
age;
Health Educatl
(c)
and
Promotion
:-°n among the
urban pfocussing of women's educate
Poor;
°n in the ^inorit
community
dr°P-outs;
(d) c
~
--y community,
,
(e) Health ty involvement in o
--1 and Famil v C in sanitation
a "on-fonnal education f\EdUcati°n drives;
education r
(f) an •““'■tl™ progran,
^ng adolescent
girls in
Program
for
Importance
---• of the
girl
°n
women’s
L:-“
child.
problems and the
©I
© i
$
®I
e
175 ANNEX 22
Page 11
3
3
3
3
3
3
3
3
3
3
3
3
3
Calcutta
(a)
(b)
(c)
(d)
Delhi
(a) sanitation program with community participation;
(b) strengthening program for control of gastroenteritis.
Hyderabad
(a) supplementary nutrition program for pregnant and lactating
mothers and toddlers;
(b) integration of services of ANMs and Anganwadi workers;
(c) study of fertility behavior among minority groups;
(d) sanitation drive in community;
(e) income generation among women in slums;
(f) clean hut competition;
(g) well baby clinics;
(h) STD studies.
supplementary nutrition for children between 0-5 years;
sanitation program upkeep and cleanliness of facilities;
anti-larval program;
creche program to be attached to HAUs.
2.
Each City should describe how its Revolving Fund for supporting 1
innovative schemes is administered, including the review process, grant
I
procedures and a listing of all schemes funded and to whom, and for what
purpose and duration. The frequency and amounts of replenishing the
Revolving Fund also should be reported.
>
3.
>
>
>
>
>
>
>
>
)
)
)
)
r
’
-
-
-
-
--
Each City should describe fully activities completed in each
innovative scheme, and how effectiveness
------- ---- ; was or is being measured. Exemplary
scheme’s results
i
should be analyzed and reported upon fully, and schemes
lacking effective results and
-- abandoned
------- J also should be described.
This Chapter should conclude with a description of Problems
encountered and Solutions to be employed for remediation.
- 176
SECTION 3:
ANNEX 22
Page 12
SPECIAL STUDIES
further anlysis if data exists or involve limited new data collectio .
results from the four
Special studies will be finalized after the study of the J---. ,
—3 for .
initial Baseline Survey, which by themselves provide rich data source
analysis. The list below is illustrative of the kinds of special studies the
project municipalities would pursue:
(a)
determinants for Child Marriage;
(b)
in school;
determinants of enrollment and retention of girls
(c)
operational research, evaluating the proposed strategy of PVO
identification and training of PMPs;
(d)
KAP of birth spacing;
(e)
cultural/social practices influencingj maternal and child health
with special emphasis post-partum icall
-- and child rearing;
(f)
male KAP of MCH and family planning; and
(g)
Mother-in-law KAP of MCH and family planning.
’y)
©
a
©
-i.'T)
©
*':3
©
©
i ",
©
©
&
'L'
177 -
ANNEX 23
5
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
5
FORECAST OF ANNUAL EXPENDITURES AND DISBURSEMENTS
5
IDA FISCAL YEAR
5
5
5
FY 93
1st -Jul 92
2nd -Jan 93
Dec 92
June 93
4.15
4.15
8.00 /a
8.00
FY 94
1st -Jul 93
2nd~-Jan 94
Dec 93
June 94
4.15
8.05
8.30
16.35
2.50
6.90
10.50
17.40
FY 95
1st -Jul 94
2nd -Jan 95
Dec 94
June 95
8.05
7.25
24.40
31.65
6.90
5.90
24.30
30.20
FY 96
1st -Jul 95
2nd -Jan 96
Dec 95
June 96
7.25
8.25
38.90
47.15
5.90
6.60
36.10
42.70
FY 97
1st -Jul 96
2nd -Jan 97
Dec 96
June 97
8.25
7.30
55.40
62.70
6.60
5.80
49.30
55.10
FY 98
1st -Jul 97
2nd -Jan 98
Dec 97
June 98
7.30
6.50
70.00
76.50
5.80
5.20
60.90
66.10
FY 99
1st -Jul 98
*2n'd -Jan 98
Dec 98
June 99
6.50
6.75
83.00
89.75
5.20
5.50
71.30
76.80
FY 2000
1st -Jul 99
Dec 99
6.85
96.60
2.20
79.00
>
>
>
>
>
>
)
EXPENDITURES
DISBURSEMENTS
SEMESTER CUMULATIVE
SEMESTER CUMULATIVE
(US$ MILLIONS)
)
>
>
)
/a
>
>
>
)
)
)
)
>
Includes Special Account and Retroactive Financing.
ANNEX 24
Page 1
6^
OF SELECTED DRUGS
-n
178
INDIA
FAMILY_WELFARE (URBAN SLUMS) PROJECT
SECTION I* RATIONALE FOR RECOMMENDED methods of procurement
thresholds required for
Generally the normal Bank methods and
Some exceptions are
projects in India will be applicable to this project,
of
drug
(vaccine, medicine
because of the special nature cf
warranted, however,
manufacture
and supplyand vitamin) 1..
---is unlikely that
,
Vaccines. There is an economic reason why it
Indian market for
In contrast to
these vaccines. There is no nam^
the orivate sector,
sector, the
other pharmaceuticals where there is so^ £reventlve medicines, do not combat
vaccines needed for the project,
P
t li£e and they are
illnesses that are considered an immediate
.
the general level of
included only in government programs aimed at
|
*oorest levei of
health in the population.
X£hat even in the developed world,
society for these programs with the result
,
Therefore, there
prices tend to be controlled and profit
because manufacturers
L usually little idle manufacturing
lnes whe„ other It...
s,: it....
Jo„i6„
o
list.
t approach
key factor in deciding what procurement
Justified by
Logistics are a key raccor x» u<=v^—b --- .
Use of local sources5 to the maximum extent
exten
J vaccines
is appropriate,
the risk of loss during transport alone.
al°n®d
a
$
the need to reduce
must be
be shipped
shipped in
in a refrigerated state an
. ,
covered by the project
shelf life ot destroy
to heat can either drastically
reduce its
^osed,
'
brief exposure In addition, the Government
controls which
P.
j
r standards
■j)
it completely,
, ensure
actual cost.
combined v- —
are kept and that the prices charged
.j and each has been
a
The market situation affecting each vaccine
•Motherhood Project (Cr.
considered previously by IDA [Child Survival and Safe ..
2300-IN) of September 1991].
(a)
Oral Polio: There are three existing local auPP^“’ of oral
needs.
^K^^ine which do not as yet meet ail of MOHFW
These firms are (i) a Central ^-“^Xterial it needs
in3
which has a collaboration and imports the raw m
Ha£fkine)
bulk from Russia; (ii) a State Government enterpris
foreign sources
which procures its raw material from
■) a private sector
selected through competitive
which has bidding;
a foreign collaboration with ^d
company (Radicula)
-t materials from an Italian
^NICEF^s
obtains its raw
is covered by imports purchased by
less than 10Z 1
office using their global competitive bidding
i inB
Copenhagen
o
©
a
1 T)
)
£
ANNEX 24
Page 2
)
procedures and offered to the Ministry on a grant basis.
There
are delivery losses with some of these imports because .of failures
in maintenance of the "cold chain." The use of the existing LCB
P.P.oce(^ure—regardless of estimated contract value has been accepted
by the Bank under the CSSM Project because of the importance of
minimizing the distance between supplier and end-user.
)
(b)
DPT—and.TT:
There are five or six
six WHO-approved
WHO-approved local
local suppliers
suppliers
respectively for these vaccines.. All
All have
have proven
proven that,
that, they
they can
can
deliver acceptable quality vaccines with a minimum of loss due to
refrigeration problems during delivery. The use of LCB procedures
regardless of the estimated contract value has been accepted by
the Bank, for the same reasons as for the polio vaccine.
(c)
BCG:
There is only one WHO-approved source of BCG supply in
India: BCG Laboratories India, Guindi, and only nine others in the
world.
There is a current shortage of supply worldwide.
Procurement of BCG by direct contracting from BCG Laboratories
India has been accepted by the Bank because of delivery problems.
In any event, given the world supply situation, ICB would be
unlikely to result in lower costs. Any shortfall in supply should
be made up by international shopping.
(d)
Measles : There rare two strains of measles vaccine in the world,
E-Z and Schwartz,. WHO recommends use of E-Z in India because it
can be administered to children younger than 9 months,
There are
only two manufacturers of the EZ strain in the world: a
Yugoslavian firm and the Indian firm preferred by MOHFW which has
a collaboration with this Yugoslavian firm,
-To avoid delivery
problems the Bank has previously agreed 1to procurement by direct
contracting from any Indian manufacturer.
>
)
)
>
>
»
J
>
)
J
>
>
>
>
>
)
5.
_________
Vitamin A. MOHFW has opted for ease of administration to young
• children and to achieve better overall. compliance,
compliance, to
tu dispense the Vitamin A
V •* covered by
the
project
during
clinic
visits
in
liquid
.
—
-- 1 form.
The most common
alternative, soft gelatin capsules which are generally used in the West are
prone to degradation under the extreme temperatures prevailing during much of
the year in India with consequent loss of potency. Vitamin A in liquid
formulation is not available elsewhere in the world.
The Bank has previously
agreed to the use of LCB for procurement of Vitamin A from all approved local
manufacturers.
-----------
180
ANNEX 24
Page 3
y'-v)
e
SECTION 2: LCB PROCUREMENT:
DEFINITION OF ROLES AND RESPONSIBILITES BETWEEN
MINISTRY OF HEALTH AND FAMILY WELFARE (MOHFW) AND
DIRECTORATE GENERAL OF SUPPLIES AND DISPOSAL (DGS&D)
C)
Pre-Procurement Activities
1.
2.
3.
4.
5.
6.
7.
8.
9.
Schedule of requirements
Technical specifications
Packaging specification
Dose specifications
Delivery schedules
Post qualification technical
criteria
Quality parameters
Preparation of bid documents
IFB
MOHFW
MOHFW
MOHFW
MOHFW
MOHFW
MOHFW
MOHFW
DGS&D
DGS&D
Procurement Processing
Relase of tenders
Bid opening
Comparative analysis of bids
Bid evaluation - MOHFW to be involved
in technical evaluation
Tender award
Follow up of supplies
Dispute resolution
DGS&D
DGS&D
DGS&D
J-.-')
DGS&D
DGS&D
DGS&D
.fY)
Post Procurement
Inspection
Quality testing and sampling
Receipt and verification
Distribition
©
©
MOHFW
MOHFW
‘ MOHFW
1_„ and1
.
" and dispute resolution
1 DGSD has the necessary expertise i.
in procurement
because of its special role as tthe
-- GDI
--- ’s
/ can, exercise leverage on suppliers
i ..
P principal procurement or ganization.
©
1
's?' •
J
181
ANNEX 25
Page 1
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
SELECTED DOCUMENTS AND DATA AVAILABLE IN THE PROJECT FILE
>
)
A.
GENERAL REPORTS, STUDIES AND DATA COLLECT10NS
A-l
Health and the Cities:
A-2
Health of the Underprivileged.
July 1990.
A-3
Evaluation of the Health Program of the Calcutta Metropolitan
Development Authority; a Component of the World Bank supported Calcutta
Urban Development Project III (CUDP III). Evaluation Team led by the
World Health Organization with participation of the World Bank (Third
Draft) - December 1991.
A-4
Report of the Interregional Meeting on City Health: The Challenge of
Social Justice Co-Sponsored by Aga Khan University, FINNIDA; METROPOLIS,
UNICEF, UNDP, WHO. Division for strengthening of Health Services, WHO
Geneva. November 1989.
A-5
World Health Quarterly - Volume 42, No.4, 1989 - WHO, Geneva.
A-6
World Health Quarterly - Volume 43, No.3, 1990 - WHO, Geneva.
A-7
Urban Basic Services Programme in Andhra Pradesh - Ganesan, N.; Regional
Center for Urban and Environmental Studies, Osmania University,
Hyderabad.
' ' '
A-8
Special Study - Reaching Urban Women with Family Planning Services in
Ahmedabad, India; The Center for Development and Population Activities;
October 1991.
A-9
National Workshop on UBS Implementation: Ministry of Urban Development,
UNICEF, New Delhi, December 1989.
A-10
Report of The National Commission on Urbanization - Volume 1,
August 1988.
A-ll
Early Childhood Mortality and Perinatal Period Management in Urban Poor.
Report submitted to the Ministry of Health and Family Welfare (under
USAID Child Survival Programmes) by Department of Pediatrics, Maulana
Azad Medical College, New Delhi, September 1991.
)
A Global Overview.
WHO, Geneva, May 1991.
Country Paper India.
WHO Geneva,
>
)
>
>
>
>
>
>
>
>
URBAN BASIC SERVICES
A-12
$
B
Urban Basic Services for Poor: Selection Process for Appointment of APOs
and COs. Hyderabad Field Office, UNICEF, February 5, 1992.
182 ANNEX 25
Page 2
A-13
National Institute
Urban Basic Services Program: A Reference Manual
of Urban Affairs in Cooperation with UNICEF, New Delhi, July 1989.
A-14
Process of Community Mobilization: The Hyderabad Experience, UNICEF, New
iDelhi, 1990.
A-15
The Efforts of UCD Project, Municipal Corporation, Visakhapatnam, to
Improve the Health and Socio-Economic Conditions of Urban Poor through
* ; on Development of Women and
Neighbourhood Committees with Emphasis
Future
Children in Visakhaptnam City - F---- Visions and Plans, A Profile and
Case Study, Subba Rao, D.V.
•
r
CM. '
>
*
?■
A-16
A-17
A-18
A-19
B.
Case Studies in Bihar - Urban Basic Services for Poor, Department of
Urban Development, Government of Bihar, Patna.
® §
® I
Accessability and Utilization of Basic Services in Selected Urban Slums
with Special Reference to Women and Children: Summary Report Operations Research Group, Baroda, 1988.
&
„
f
Urban Basic Services program in Bhilwara and Banswara Districts An Assessment, UNICEF.
*
Accessability to Basic Services in Slums of Five Urban Centers - with
Special Reference to Women and Girl Child, Bhawanipatna, Kanpur,
Kumbakonam, Madanrting and Raykot - Operations Research Group, January
1990.
reports and studies relevant to the project
«■;
6-.
o
i.
a
BANGALORE
B-l
Plan for Delivery of Family Welfare Services in Urban Slums based on the
Needs Assessment of Beneficiaries (Slum Dweller), Communications,
Training of Staff and KAP Study of Private Practitioners in Urban Slum
of Cities with more than Five Lakh Population - National Institute of
Health and Family Welfare, New Delhi, August 1991.
*?-‘
a
■
<
1
«■
B-2
Plan for Delivery of Family Welfare Services in Urban Areas - Bangalore
Summary Report - N.I.H.F.W., New Delhi, July 1991.
© k’
B-3
Proceedings of the First Meeting held with World Bank mission at Mayo
Hall, Bangalore, August 8, 1991.
B-4
Plan
Plan for
for Delivery of Family Welfare Services in Slums based on Need
Assessment of Slum Dwellers in Bangalore city, Department of Health,
Bangalore City Corporation, October 12, 1991.
©
© •'
B-5
Plan
Plan for
for Delivery of Family Welfare Services in Slums based on Need
Assessment of Slum Dwellers in Bangalore City, Department of Health,
Bangalore City Corporation, October 30, 1991.
B-6
Additional Information/Clarifications for Eighth Population Project Department of Health, Corporation of City of Bangalore,
November 30, 1991.
J*
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©
©
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S'*
5
„ .■ i .it:-' •
Ia
183
ANNEX 25
Page 3
>
B-7
World Bank Aided Eighth India Population Project: Bangalore, Municipal
Corporation, Feburary 1992.
CALCUTTA
>
B-8
Background Paper on IPP VIII for Calcutta Metropolitan District over a
1990°d °f 5 yearS’ Calcutta Metropolitan Development Authority - July
B-9
Integrated Health Programme for Calcutta Metropolitan Area (Proposed IPP
VIII) Project Proposals; Calcutta Metropolitan Development Authority for
Health Department, Government of West Bengal; September 1991.
B-10
Integrated Health Programme for Calcutta Metropolitan Area (Proposed IPP
VIII). Supplementary input to project proposal of September 1991;
Calcutta Metropolitan Development Authority for Health Department,
Government of West Bengal; November 1991.
B-ll
India - Eighth Population Project in Calcutta Metropolitan District
Government of West Bengal - Health Program Unit.
B-12
Integrated Health Program for Calcutta Metropolitan Area (Porposed IPP
VIH) Final Project Report - Calcutta Metropolitan Development Authority
tor Health Department, Government of West Bengal, February 1992.
>
)
J>
)
3
)
)
)
)
>
>
>
DELHI
>
B-12
Primary Health Care for Urban Poor - Delhi - A Project Proposal; Medical
and Public Health Department, Delhi Administration, October 1991.
B-13
Delhi-Plan for the Delivery of Family Welfare Services in Urban Slums,
Basedon Need Assessment of Beneficiaries (Slum Dwellers Communication,
Training of Staff and KAP Study of Private Practitioners in Urban Slums
with Cities with more than 5 Lakh Population. NIHFW, Delhi, July 1991.
>
)
)
>
HYDERABAD
)
B-14
Assessment of Family Welfare and Primary Health I'Needs and Formulation of
Proposals for their Strengthening in Hyderabad City. Supplement to
Revised Proposals: Directorate of Family Welfare, September 1991.
B-15
Assessment of Family Welfare and Primary Health Needs and Formulation of
Proposals for their Strengthening in Hyderabad City. Supplement
Supplement to
to
Revised Proposals: Directorate of Family Welfare, A.P. and Municipal
Corporation of Hyderabad, November 1991.
B-16
Strengthening of Family Welfare and Primary Health Care Services in
Municipal Corporation, Hyderabad. India Population Project VIII: Final
Proposals - Municipal Corporation of Hyderabad, February 1992.
Supplement to Final Proposals, Municipal Corporation of Hyderabad,
February 1992.
)
>
>
>
)
>
)
*
»
-
Bu
184
W-.'jj
ANNEX 25
Page 4
B-17
B-18
B-19
B-20
B-21
Rl
>^1
Hyderabad Slum Improvement Project - Implementation Manual (O.D.A (UK
Govt. Funding)) T. Rajagapala, Consultant. Hyderabad, 1990.
gW)-
Report on Health Education Workshop for ODA Slum Improvement Programs,
’Regional Center for Urban and Environmental Studies, Osmania University
- April 1991.
ib s
Ira
Report, Recommendations and Follow-up Actions on Workshops for Health
Personnel by V.K. Consultants - Hyderabad Slum Improvement Project:
Mathur, 0., Reddy, S.
Assessment of Family Welfare and Primary Health Care Needs and
Report on
rxuuuoolo for their Strengthening in Hyderabad City Formulation ox
of Proposals
Raju, R.S., *.
1 . Director of Medical and Health (DEMO), Directorate of
Family Welfare. Hyderabad, July 1991.
^■'^1
WS
Hyderabad Slum Improvement Project III - Baseline Survey (sponsored by
the Municipal Corporation of Hyderabad and the ODA, UK). Regiona
Center for Urban and Environmental Studies, Osmania Umversi y,
Hyderabad, 1991.
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185
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CHART 1
)
INDIA
)
FAMILY WELFARE (URBAN SLUMS) PROJECT
>
MATERNAL AND CHILD HEALTH SERVICES BENEFICIARIES
IMMUNIZATION PROGRAM (1970-1989)
)
In Milliion
)
30
)
25
)
20
)
15
>
10
)
)
5
>
0
70-71
>
75-76
80-81
87-89
Year
TT-Expectant Mothers +DPT & DT - Children * Polio
)
>
>
>
>
»
■d
■
'ft
BCG
186
CHART 2
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INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
MATERNAL AND CHILD HEALTH SERVICES BENEFICIARIES
PROPHYLAXIS PROGRAM (1986/87-1987/88)
In Million
50
40-
©
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302010-
0
1987-88
1986-87
Year
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liAgainst Nutritional Agaemia among
mothers & children (completed)
2:Against Blindness-Children-Vit. A Def.
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- 187 -
CHART 3
Page 1
)
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
)
ORGANIZATIONAL STRUCTURE OF THE URBAN BASIC SERVICES FOR POOR PROGRAM
)
>
INCHARGE
UNIT
20-25 HH
y
)
NHG
5
RCV (Voluntary)
10 NHGs
)
NHC
)
Secretary (Voluntary)
10 NHCs
)
CO
BASTI
>
5 COs
>
J
3
I
X
TOWN
PO
DISTRICT
District UBSP Co-ordinator
STATE
Secretary Urban Development
CENTER
Director - UPA
Ministry of Urban Development
>
>
>
>
>
3
J
&
&
a
UBSP
HH
NHG
NHC
CO
PO
Urban Basic Services for the poor
Households
Neighborhood Group
Neighborhood Committee
Community Organizer
Project Officer
188
CHART 3
Page 2
ACTION PLAN FOR UBSP ACTIVITIES
10 NHG
NHC
Mini Plans (2 weeks)
10 NHC
BASTI
Basti Level Plan
(CO coordinates the plan)
(2 weeks)
TOWN
Town Level Plan
(PO coordinates the plan)
(2 weeks)
5 BASTI
©
©
DISTRICT
District Level Plan
(Dist. UBSP coord, finalizes
the plan and directs a plan
of action)(4 weeks)
TOWN
PO formulates plan of action & ^2)
coordinates with other depart
ments for convergence)
(2 weeks)
BASTI
CO initiates the activities at
the Basti and coordinates
various components
a
i
NHC
The beneficiaries participate
in the activities
©
Total estimated time taken from formulation of mini
plans to the beginning of activities - 12 weeks.
©
J
189
)
CHART 4
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
BANGALORE: PROJECT IMPLEMENTATION ORGANIZATION
STEERING/EMPOWERED COMMITTEE
)
>
)
MAYOR/ADMINISTRATOR
)
)
)
)
COMMISSIONER
PROJECT ADVISORY
AND COORDINATION
COMMITTEE
HEALTH OFFICER (BMC)
PROJECT
IMPLEMENTATION
COMMITTEE
)
)
)
>
)
>
>
CIVIL WORKS
UNIT
NGOS/PMPS
UNIT
TRAINING
UNIT
Additions I
Health Officer
Apex Training
Team
)
Chief
Engi neer
)
ADMINISTRATION
AND
MONITORING
UNIT
>
i
>
)
HEALTH
CENTERS
>
>
?
>
*
HEALTH
CENTERS
UPGRADED
HEALTH
CENTERS
HEALTH
CETNERS
HEALTH
CENTERS
IEC UNIT
Extension Edu
cation Officer/
Educator
4
190
CHART 5
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
4
CALCUTTA: PROJECT IMPLEMENTATION ORGANIZATION
J
• €
STEERING/EUPOWERED COMMITTEE
SECRETARY, DEPARTMENT,
AND FAMILY WELFARE
WEST BENGAL
C
M
D
PROJECT ADVISORY
AND COORDINATING
COMMITTEE
A
PROJECT
IMPLEMENTATION
COMMITTEE
HEALTH UNIT IN CMDA
PROJECT DIRECTOR
»
PLANNING,
MONITORING
AND
EVALUATION
GROUP
HEALTH
PROGRAM
ADMINISTRATIVE
GROUP
ENGINEERING
CONSTRUCTION
GROUP
INFORMATION,
EDUCATION
AND
COMMUNICATIONS
GROUP
!
TRAINING
GROUP
i
e'
SUB CENTERS
HEALTH
ADMINISTRATIVE
UNITS
EXPANDED
SPCECIAL
OUT-PATIENT
DEPARTMENTS
MATERNITY
HOMES
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- 19 J CHART 6
INDIA
,■5
FAMILY WELFARE (URBAN SLUMS) PROJECT
DELHI: PROJECT IMPLEMENTATION ORGANIZATION
3
3
STEERING COMMITTEE
5
>
PROJECT ADVISORY
AND COORDINATION
COMMITTEE
COMMISSIONER (MCD)
>
3
3
3
ADDITIONAL
COMMISSIONER (HEALTH)
(MCD)
>
>
COORDINATION CELL IN
DIVISION OF PUBLIC HEALTH
DEPARTMENT OF MCD
>
3
>
IEC CELL
TRAINING
CELL
>
PLANNING
AND
ADMINISTRATION
CELL
MANAGEMENT
INFORMATION
CELL
>
X
>
>
HEALTH
CENTERS
>
>
>
)
>
)
HEALTH
POSTS
HEALTH
CENTER CUM
MATERNITY
CENTERS
INNOVATIVE
SCHEMES
GRANTS,
ACCOUNTS AND
AUDIT SECTION
192
r
CHART 7
INDIA
FAMILY WELFARE (URBAN SLUMS) PROJECT
■i
HYDERABAD: PROJECT IMPLEMENTATION ORGANIZATION
®I
STEERING/EMPOWERED COMMITTEE
<?)
■
p' ’
PROJECT ADVISORY
AND COORDINATION
COMMITTEE
COMMISSIONER (MCK)
A'
©
K
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© I
PROJECT DIRECTOR
CITY WELFARE BUREAU
PROJECT
IMPLEMENTATION
COMMITTEE
© I
T,
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ADMINISTRATIVE
SECTION
ACCOUNTS
SECTION
MONITORING
AND
EVALUATION
SECTION
HEALTH
EDUCATION,
IEC AND
TRAINING
SECTION
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POSTS
HEALTH
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UPGRADED
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