URBAN SLUMS IN BANGALORE AND HEALTH CARE
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- Title
- URBAN SLUMS IN BANGALORE AND HEALTH CARE
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DEV S-T-T-
RF_DEV_3_PART_1_SUDHA
RAGPICKING - THE SURVIVzXL STRATEGIES OF URBAN POOR
Bangalore holds an immense attraction for investment in industry,
trade, transportation and technology due to its salubrious
climate, strategic location, availability of skilled manpower,
financial institutions and communication networks.
It is, there
fore, no wonder that child labour dominates the significant
portion of urban unorganised sector.
It was estimated in 1975 (WHO Study)
that the yield of solid
wastes in Bangalore city was about 0.5 kg per person per week.
The total yield was estimated to be around 300 to 400 tonnes
per week.
The task of collecting, conveying and disposing off
solid wastes was managed by the Corporation of the City.
It
employed around 4,500 persons (sweepers and supervisors) for
collecting and disposing solid wastes accumulated in about 3,000
dust bins and in all areas.
In 1987, it is estimated that the yield of solid wastes in the
city is about 0.3 to 0.4 kg per capita per day. The total yield
is about 1200 to 1600 tonnes per day.
The total workforce of
the Corporation has riseri to 8,700 with a fleet of 110 lorries
covering over 8300 dust bins.
This means today the city is
lowly manned in terms of solid waste i.e only one sweeper for
every 6,000 persons as against the standard requirement of one
sweeper for every 1,500 persons.
While the city needs 1 lorry
for 15,000 persons it has only one lorry for every 30,000
persons.
It is estimated that by the year 2000AD, the city
will produce around 2100 tonnes of garbage per day, necessitating
the employing of at least 20,000 sweepers with 16,000 dust bins
and a fleet of 300 lorries ( Annual Reports of B.C.C. 85-86,86-87)
The cost of these operations will be enormous; and will have
to be heavily subsidised. The city Corporation is in-no way
would be able to achieve this.
The increase in solid wastes are due to modern technology which
manufactures moee packed goods and tendency to pack most of the
consumables contributing the major share of the solid waste.
. .2..
2
Major solid waste are glass bottles, papers, paper packs,
plastics etc.
It is the rag picker who clears the additional garbage from
^e have
the dust bins and keeps the city clean in many senses.
to view the positive contribution of these child labourers and
rag pickers in this direction.
What are the positive contri
bution of ragpickers ?
a.
Minimising solid waste management to the Corporation.
All the dust bins in the main roads are visited by the
ragpicker and cleaned than by the Corporation staff.
b.
The sense of recycling - who else will go and pick the
’
rags from dust bine-xn kh which is fast catching up.
It is interesting to note that since the mid 70s many small
paper mills based on unconventional raw materials such as
agricultural residues, baggsse, industry waste or waste paper
commenced production.
The recycling industry has grown from
nil during 1970 to 242 ( Source s' Annual Report, Directorate
General of Technical Development)
as on 1.1.1986.
The
investment pattern in them in very low around Rs.3 to 5 lakhs.
These small units depend entirely on ragpickers for the supply
of raw materials. Further, big mills also depend on them for
paper or plastic recycling. Thus, in a way organised industry
depends on these children for their operation.
Therefore, child
labour is not unproductive; it is the inevitable consequence of 1
the demands putforth by the society through a complex of
situation .
Children become ragpickers because of economic reasons- it
is their parents' poverty which forces them to earn a living
and form a part of the family labour force.
The preponderance
of women in unorganised sector encourages the continuance of
child labour because children from an early age learn to
help their mothers, eg. women construction workers - their
children pick up carrying mud pots and do odd works.
It is
the insecurity of mother which forces these children to work.
Since even the unorganised sector faces stiff competition and
opportunities are less these children are pushed to streets.
.3..
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From the point of ragpickers three factors virtually affect the
development viz., the predominance of nuclear family and work
mothers leading to little care devoted the child during its
formative years; the nature of urban female occupations rarely
allow them to have kids with them, and also they need to travel
long distances.
Secondly, in rural areas children are assigned
such tasks as grazing of cattle, fetching water, wood etc.
These activities are more viewed with 'dignity* since adults
are also involved at times.
But in urban child labour a few
categories are reserved for children like ragpicking; generally,
after 25 no one wishes to be a regular ragpicker and may look
for some alternative even if it is less remunerative.
Thirdly,
in urban areas, there are several other potentially damaging
elements exists for the street child.
The rural child has a traditional culture and social fabric
( however bad it is yet conducive for living and growth)
family networks.
wide
For the urban child none of these exist -
there is cultural barreness and no security-structure.
There
are no institutional substitutes for home and for proper socia
lisation.
However, given the situation
government polices
and programmes can play a role.
Child labour and problems associated with it have been a subject
of concern among social planners, policy makers and researchers
alike.
Since street children/youth are a recent phenomenon
not much has been done.
The almost total absence of any
organised, broad-based rehabilitation/developmental schemes
in the country for the street children/youth must be considered
to be among the least edifying experiences, kot that isolated
efforts did not take up a few developmental programmes; in fact,
a few NGOs and Government sponsored schemes are functioning
with broad objectives :1.
to prevent exploitation of child labour by providing
facilities for proper sale of picked rags.
This
prevents the under-payment of the children/youth
by the other agents;
- 4 ii.
to wean the child of this hazardous occupation
by providing education and industrial training
in the centres set up by the organisations
during the hours when the c^ild is not required
to pick rags; and
iii
to protect and improve his health by providing
essential services like supplementary nutrition,
medical aid.
Paper prepared by the Documentation
wing of the Ragpickers Education
and Development Scheme, Bangalore.
Presented during tha workshop on
" Urban Poverty" organised by
ICRA 23-24 January 1988.
WORKING CHILDREN JN BANGALORE CITY
B.
R.PATIL"
Paper presented at two day workshop on "Urban Poverty"
between 23rd and 24th January '1988 organised by
ICRA & NCU.
Child labour is a phenomenon commonly found in all the
developing countries. In India its incidence has not only
been high but its magnitude is increasing from decade to decade
despite rapid industrialisation and modernisation of the
country. While in 1961 there were .14,469-million children as
counted by the Census of 1961, their number increased to
16.3 million in 1972-73 as was estimated by the 27th round of
the National Sample Survey, and to 17.36 million after another
ten years as revealed by the 38th round of the National Sample
Survey.
More than 80 per cent of the working children are employed in
agriculture and allied occupations including plantations?the
remaining live in urban society and are engaged in manufacturing
and service sectors, but primarily in the unorganised, informal
and small scale sectors. The variety and types of occupations
and jobs in which they are employed in any industrial-urban
society in India or any other developing'country have established
that "there is no occupation/job where a child is not employed."
Widespread poverty, adult unemployment, intermittent and
inadequate family income, death or disability of the principal
breadwinner of the family are some of the important causes of
child labour. These are also the factors that render the efforts
of the governmental and non-governmental agencies to prohibit
and eliminate child labour extremely difficult. It is commonly
felt that so long as child labour provides relief to fhe
economic compulsions and continues to help the employers to
derive economic benefits child labour exists.
The urban-industrial working children are confronted with the
work that is often difficult to comprehend, perform, and m ster.
In addition to denial of schooling and recreation more often
their working conditions pose serious threats to their
physical growth and expose them to various types of
occupational .and health hazards that shorten their working
lives and often life itself. The self-employed children like
the rag pickers are subjected to exploitation of the
middlemen to whom they must sell their collect'ons. They
handle items like broken glasses, rusted materials, etc.,
that are a regular hazard to them.
. * Dr.Patil is Asst., Professor - Indian Institute of
Management, Bangalore - 560 076.
2
In industries like carpet weaving, match and fire works, beedi
and agarbatti rolling, sari and zaradosi work, slate
manufacturing, hotels and small eating places, cashewnut proce
ssing, diamond cutting, etc, either only children are employed
or they out-numb'r the adult workers. In all these industries
and occupations, the exploitation of child workers is varied,
extensive and intensive.
A profile analysis of child workers in Bangalore reveals that
as a group they are closely comparable to their counterparts
in Bombay and Delhi in respect of their age, sex composition,
educational status, religion, family size and number of workers
in the family, occupational status of the parents/heads of
households, family income, etc., Similarly, they are
comparable on work/employment related variables such as the
nature of job, hours of work, wages, child-adult worker ratio,
as well as their job and career aspirations.
While in Bombay 67.7 per cent of the child workers are boys
(Musafir Sing g.t^clT ;1980:40) in Bangalore we found a higher
percentage of boys among the child workers ie. 79.67 per cent.
But-'iri Delhi only 14.7 per cent of the child workers happened
to be girls (I.C.C.W;1979;28). Our survey also reveals that
the percentage of girls among working children decreases with
the increasing age of the child workers indicating that girls
start 'working much earlier than boys but are withdrawn from
employment as they grow old, primarily because when a family
is forced to send their children to work and earn a supplementary
income, it is the girl child who is sent to work and only
subsequently the boys when the economic compulsions are hard. .
But a girl child is withdrawn from her job when she attains
puberty unless otherwise she works along with either parent or
any other member of the family or in exceptional cases the
place of employment is safe; a grown up girl is not sent to
work till she is married if there are no economic compulsions.
The age distribution of child workers reveals that while in
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Delhi 60 per cent of the child workers are ' above 13" years of
age in Bang lore 65.33 per cent are of the same age; but in
Bombay 71.3 per cent arc hbove 12 years of age (l.C.C.W;28.Singh
et el?40). In Bangalore 10.5 per cent of child workers ere
very young in age as against 4.41 per cent in Delhi and 3
per cent in Bombay.
The analysis of educational status also reveals that while
33.30 per cent of the working children in Bombay did not
have schooling, 34.16 per cent of the child workers in
Bangalore are illiterate. Whereas in Delhi 45 per cent of
the child labourers were found to be lacking the knowledge
of three 'R's. However, the child workers in Bangalore seem
to have a better educational background compared, to the
literate working children in the three cities, in Bangalore
7.16 per cent of the child workers have studied beyond
middle school level as against only 0.7 per cent in Bombay
and none in Delhi (Sing et al;41:1C.C.W;46).
This survey also reveals that the working girl children have
a poorer educational background as compared to boys - 52.45
per cent of the girls have had no schooling as against 29.49
per cent of the boys, while 26.22 per cent have had middle
school or secondary level education as compared to 34.5 per cent
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of the boys. This poorer educational status is only due to the
“ttitudc Of their parents toward their education. The poor
families and illiterate parents living in towns and cities do
not consider it important to educate their daughters.
Our survey further revealed that the occupational status of the
parents and the educational status of the child workers are
correlated. More manual the parent's occupation larger the
perdentage of illiterate and poorly educated working children.
In all the three cities larger percentage of child workers belong
to Hindu religion; but their percentage in Delhi and Bombay is
very high. While 83.8 per cent of the child labourers in Delhi
and 71.3 per cent of the working children in Bombay were found
to be Hindus, only 58.33 per cent of the child workers in
Bangalore city belong to Hinduism (l.C.C.W;19, Singh et al;41).
As many as 71.12 per cent of male child workers and 50 per cent
of the working girl children know two or morelanguages. It was
further discovered that as the educational level of the child
workers increases the percentage of those knowing two or more
languages also increases suggesting a nexus between the level
of education and knowledge of languages.
A comparative analysis of the size of the families of working
children from all the three cities suggests that a very high
percentage of the child workers are from smaller families. In
Bombay 9i per cent of the working children are from families
having upto 8 members while in Bangalore 67.5 per cent of the
child workers, come from the families whose size is less than 8.
Similarly in Delhi the average size of the households of child
labourers was found to be 5.5. This comparative data disproves
the myth that larger families contribute more to the child
labour population. Our survey also reveals that a larger
percentage of girls are from smaller families than the boys 81.15 per cent as against 64.02 per cent.
While the size of the families of the working children in
general is small, two-thirds of them in Bangalore have three
or more working and earning members including the child
workers. Among them the families of 55.74 per cent of the
working girl children have three earning members and an
equal numberof families of both male and female child workers
have cither two or more than three working and earning members.
Further, the families of more than 60 per cent of .the child
workers with different levels of education have three cr more
working and earning members. Similarly in Bombay ."the number
of workers per family ranged from 1 to 8. The majority of the
families (51.9%) had. 3 to 4 workers, 40.8 per cent one to two
workers and 7.3 per cent five or more workers" (Singh et al;50).
This only suggests that every employed member of the families
of the child workers in general is engaged in less remunerative
job forcing the children to seek wage labour to supplement the
inadequate income they earn.
The absence of an adult working member or the head of the
household is regarded as one of the important causes of child
labour. But only 5,67 per cent of the child workers in
Bangalore, 4.5 per cent of the working children in Bombay
(Singh et al;45) have had neither parent living. Thus the
general impression that the children take to wage labour mostly
on the loss of their parents is not a common phenomenon. Further,
it may be noted that 323.33 per cent of the child workers in
Bangalore and. 27.9 per cent in Bombay had either parents living,
while the large majority both in Bombay and Bangalore had both
the parents living.
The parents' -of child workers by and large are employed either
as wage labourers or c-ngaged in street trades and vending of
vegetables and fruits, etc? hence, their occupational status
in general is low. Our survey revealed that 32.17 per cent of
parents or heads of households are the wage labourers and 17.33
per cent the self-employed, while 33.33 per cent are the salaried
employees in government departments and private and public sector
undertakings, surprisingly whose percentage increases with the
increasing age of the child workers. The study by the Indian
Council .of Social Wertare in Delhi also found that while 8.82
per cent of the parents of the child labourers happened to be
professional, technical, administrative, managerial or while
4k
collar employees, 25 per cent were business men, manufacturers,
sales personnel, moneylenders, etc. (P.20 Table 3s3). This is
quite balfing a phenomenon. The only explanation that could be
given is the parents 1 desire to get their children employed before
they are adult youths especially when their performance in schools
is not satisfactory.
At least i3.83 per cent of the working children in Bangalore were
found to have been forced to get employed and take over the adult
roles of earning members due to the death, disability, ill-health
and partial or total dependency of the parents on the family
and in some cases because of irresponsible parents. While 60.46
per cent of the child workers in Bangalore have .'responsible1
parents, 60.66 per cent of the working girl children have adverse
family conditions forcing them to work. The educated among the
child workers feel that their parents are not as responsible
as they should have been toward the family. As a matter of
fact, 12.33 per cent of the child workers are required to
shoulder major responsibilities in their families, while 77.33 A
per cent have to assume marginal to major responsibilities.
Similarly, in Bombay the parents of 13.2 per cent of the
working children had no income at all, while another 20.6 per cent
were contributing less than Rs.100 per month to the family
income (P.44,Table 14).
Our study revealed that in 29.17 per cent families of the child
workers two or more children are employed, and that the
percentage of such families increases with the increasing age
of the child workers revealing the harsh reality that as
children grow in age are required to take to employment
at an increasing rate. The study by Musafir Singh and his
colleagues in Bombay also revealed that the average number
of child workers per family was 1.1 (p.50).
As for the family income is concerned, no comparison could be
made since the studies in Bombay and Delhi were conducted
when the rate of inflation was not high. Nevertheless it
may be noted that only small percentage of the families
of child workers in all the three cities have low income.
The survey in Bang, lore reveals that the familicsof only
11.17 per cent of the child workers have had a monthly income
of less then Ps.300 while another 13.50 per cent wore getting
upto Rs.500 per month. But the familiesof as many as 42.37
6
INDUoTRIES/EMPLOYMENTS/JOBS THE CHILDREN ARE ENGAGED IN;
According to our survey 27.83 per cent of the child workers in
Bangalore are employed in small scale industries or factories
and. workshops that are normally not covered under the Factories
Act, 1948. In Delhi 67.18 per cent of the child labourers are
employed in unregistered establishments (I.C.C.'WsP.42 Tabic 5:2).
Our data also brings out that 17.83 per cent of the child workers
are in automobile tinkering and fuelling stations, 14.67 per cent
in shops and commercial establishments, 12.33 per cent in hotels
and restaurants, and 10 per cent each in construction activities,
domestic services and traditional occupations like carpentry,
tailoring etc. This data reveals that in anurban society both the
working children and their parents/guardians prefer more
remunerative jobs. Our survey helped us to conclude that the
shops and commercial establishments, hotels and restaurant.- ,
automobile fuelling stations servo as the entry jobs for children.
Larger percentage of female children are employed in domestic
services (32.79%), beedi end agarabatti factories but as home
workers (27.8'’%) and construction ant allied activities (27.4 2%)
while a larger percentage of boys are found in industrial
employments (51.21%) because it was ascertained that while the
girl<’ children are in employment primarily to supplement the
inadequate family income the male children seek employments not
only to supplement the family .income but also to make a career
out of it.
Only 15.17 per cent of the child workers were found to be in
employment for less than one year at the time of t is survey
as against 23.33 per cent who had been in employment for over
five years; all others stated to have been employed for a
period ranging from one to five years. It was destressing to note
that hilf of the child workers below the age of 10 have had
completed five or more years of service at the time of this
study very vivdly revealing the economic compulsions their
families had to experience and the cruel world of child labour.
Only about one-fourth of the child workers w- re found to have
changed their employers and jobs; an import nt reason the
change was long distance the younger ones were required to
commute. But more commonly, heavy work, low wages, long heburs
of work, the parents 1 desire, and ill-treatment by the
employers force the children to change- their jobs and employers.
A larger percentage of boys change their jobs for low wages,
heav work and duo to ths desire of their parents, while the
girl children do so because of heavy ’work, low wages, and
long distance.
Although 61.5 per cent of the child workers have had been in
employment for one to five years and another 23.33 per cent
for more than five years, only one-fourth of all the child
workers were found to have been assigned independent jobs,
while more than 50 per cent were working as helpers, and a
little less than one-tenth doing only odd jobs. But our
analysis revealed that as the age of the child increases the
percentageof helpers and independent workers among the
children increases suggesting that the employers seriously
consider the age and experience of the child before asking
them to work independently.
5
per cent of the child workers have been earning an income of
Jta.1000 to cover 3000 per month. Our survey further revealed
that large percentage of working girl children are from econo
mically poorer families than the boys - 86.06 per cent as
against 5C per cent of the boys.
ECONOMIC COMPULSION IS NOT THE ONLY REASON FOR CHILD LABOUR:
It is generally ’relieved that the economic compulsions force
the child to seek employment and earn for the family. But in
case of 53.67 per cent of the child workers in Bangalore, the
economic compulsions are neither the immediately disposing off
nor the contributory causes of child labour. Similarly, in case
of 45.3 per cent of the working children in Bombay the economic
compulsions were not the reasons for those children in taking
to wage labour (P.78). Our survey points out that the most common
reason for taking to wage 1 hour in case of 37.17 per cent of
the child workers was the need to supplement the fam.i ly income
while only 6.33 per cent of the child workers were required to.
get employed to earn a minimum living for their families. It is
these 6.33 per cent of the child workers who are the sole
working and earning members of their families. Another 2.83
per cent of the child workers have taken to wage labour on
part-time basis to finance their own education besides
con ributing to the inadequate family income. Those children go
to school from morning till 3 p.m. and work as labourers between
3 and 10 p.m.
Whereas 42.33 per cent of the child workers in Bangalore have
been in employment because their parents wanted them to be
employed for reasons father than the economic compulsions. These
reasons include? stagnation of the child in schooling, loss of
interest in his studies, his illiterate status, desire of the
parents to get their children employed end trained in supposedly
lucrative trades and occupations, desire to wean away their
children from the influence of deviant children in the
neighbourhood, and the idleness of the child. Among these,
the threat of probable unemployment when children grow into
youth/adults is a strong one. It is this threat which forces
many a parent to get their children employed while they are
still in their childhood or teen-age. The study of working
children in Bombay also lists similar reasons for the children
being employed (T ,ble 44 p.78).
It was an interesting finding that 5.33 per cent child workers
in Bangalore have got employed out of their own desire to be
employed and earn for themselves. Eo also in Bombay 2.8 per cent
of the working children got employed out of their own will.
Our survey further revealed that while a larger percentere of
younger children and girl children work for earning a living
for the family, a larger percentage of older children and
boys are working to earn additional income for their families.
And a larger percentage of younger children and girls ere
working because their parents wanted. The survey also reveals
that with the increasing level of education children from
poorer families become more sensitive to the problems of
their families and t'ke up jobs on full-time or part-time basis.
7
HOURS OF WORK:; One common form of exploitation of child workers
is excessively long hours of work. Our survey reveals that
about two-thirds of the child workers arc required to work for
8 to 12 hours a day, and 10 per .cant work for still longer hours
or de not have any fixe< time to work revealing the fact that the
children are put to excessively long hours of work and the
consequent exploitation. The hours of work, however, decrease with
the increasing age of khe children, perhaps because the employers
feel that they could bxtract better work from the children only
■for about 8 to 12 hours a day.
In small scale industries, automobile workshops, shops and
commercial establishments the hours of work of children do not
exceed 10 per day since these types of organizations are covered
either under the Factories Act of 1948 or the Karnataka Shops
and Commercial Establishments Act of 1965. A little more than
40 per cent of the child workers felt that their employers are
always interested in work.
It is this type of employers who do not have any consideration
for the tender age of the child workers. They extract work from
the children as long as they could. It was al-o found from
12.67 per cent of the child workers that their employers illtreat them and are rather her h to them. Similarly, about
two-thirds of the working girl children and 50 per cent of tho
boys felt that their employers are unkind to them. Hence, about
45 per cent of the boys and girls and the children working as
helpers, learners, and doing odd jobs want to change their
present jobs and employers.
Child-Adult Worker Ratio; Children are employed primarily because
of the economic advantages that are far greater than the
advantages of employing adults. Vulnerable, flexible, and
unorganised child workers arc used for reducing labour costs
and maintaining competitive advantages and as a means of adapting
and responding to economic uncertainties and fluctuations in
demand. Yet no employer can afford to hire only children unless
he himself works along with the children asking them to do
all gdd jobs or when ho closely supervises their work and gets
the desired results through them.
Thus <bhr survey revealed that 17 per cent of the child workers
do not have any adult colleagues in their employments, while
27.5 per cent have equal number of adult colleagues with a
ratio of one child, to one adult. Only children are employed
with varying numbers in all occupations but construction
industry; among them, however, domestic services, shops and
other commercial establishments, traditional occupations,
small workshops, etc., predominate. It is also in these
employments that 1;1 ratio between children and adult workers
exists. One the other hand, 30.5 per cent of the child workers
are employed in occupations where the ratio between the tv/o is
1;2 and another 25 per cent in those occupations where the ratio
is 1?3 or more. Similarly, the study by Musafir Singh et al
found that the "percentage of child workers to adult workers was
as high us 1:1.67 in households, e.e. for every 6 adult workers
the households had employed 10 child workers. Similar seemed to
be the case with small hotels and restaurants. Here for every
100 adult workers as many as 156 child workers had been employed.
These figures indubitably demonstrate that households and small
hotels and restaurants prefer children to adults for employment
8
purposes. The percentage of child workers to adult workers ranged
from 8.7 to 29.5 in other kinds of establishments, the minimum
char ctorising commercial establishments and the maximum the
construction work" (p 90t91),
The children in employment arc exploited not only by their
employers but also by the fellow adult workers. At least 19.33 per
cent of the child workers admitted that their fellow adult
workers are not kind to them. Those c ildren are subjected to
physical abuse by adult workers both in and outside the work
situation.
Low Wages and Earnings; The economic compulsion or the need to
earn a wage to supplement the family income in many cases and a
? living in other cases generally forces the children intolabour
market. Moro importantly, child labour persists bee:use the
employer finds certain advantages in employing children. It is
due to these two factors that the children have been unable to
earn 'adequate' wages. Our study revealed that a large majority
of the child workers arc paid very low wages and that they have j
to work for quite a few months without any wages before they
"
are put on pay rolls. We could gather from these working
children that almost everyone has to go through a stage of
wagelcss employment for several months. The employers have
adopted the practice of keeping every child worker under a period
of 'probation ' for the first few months when the child is
expected to 'learn' the jo1. Hence no wages during the period
cc probation. Even after the expiry of this probation period the
children ere paid only nominal wages for seme more months.
Our survey revealed that w ile 4.17 per cent of child workers
are paid no wages ’’bout 2 0 per cent are paid only a nominal wage
of less than Rs. 50 per month and another 15 per cent receive Rs. 50
to 100 per month. But a little more than 45 per cent of the
child workers are paid a monthly wage ranging from Rs.100 to 300,
which rather seems to be the common rate of wages of children
in Bangalore - 45 to 70 per cent children employed in hotels,
shops, small scale industries, domestic services, and
traditional occupations are paid those rates of wages.
It was, however, gratif ing to note that a little more thab
10 per cent of all the working children get wages ranging from
Rs. 300 to 500 per month, and 3.17 per cent earn more than Rs. 500
per month, and 3.17 per cent earn more than Rs. 500 per month.
The ’ 'high wages' are earned by the children in construction
activities, traditional occupations like carpentry, small scale
industries including the automobile workshops and fuel stations.
In fact, in construction industry 38 per cent of the child
workers employed cam Rs. 300 to 500 and 24 pe r cent more than
Rs.500 per month. But the employment in this industry is
seasonal and irregular. In automobile fuel stations children
engaged to blow air in wheels of motor vehicles are not paid
any wages; they are allowed to collect tips from the vehicle
owners. It was gathered from these children that they collect
a minimum, of 10 paisc from the owners of two wheelers and 25
paise from the owners of motor cars and other light vehicles,
and that their earnings often exceed Rs. 20 per day.
Further, more than 95 per cent of the girls have been able to
earn wages only upto Rs.300 per month as against three-fourths
of the boys. Eutno girl works without azwage and without a
9
knowledge of how much is paid to her. Wherever boys arc working
as learners no wages are paid to them for the first few rm nths.
But once they are assigned independent work they receive better
wages.
About half cf the working children get only wages while nearly
one-third get wages and allowances such as transport and food
allowances? and another one-eighth get tips from the customers
in addition to wages and allowances.
Share of the Child. Workers in the Family Income■■ The wages earned
by the working children constitute a substantial part of the
income of their families - 6.33 per cent earn 100 per cent of the
family income being the sole earning members of their families?
18.33 per cent earn more than 50 per cent of the family income
and another 21 per cent have been able to contribute 26 to 50
per cent of the monthly family income. Those contributions are
no doubt a good supplement to the inadequate and. intermittent
family income. It is because of such a contribution that the
families of these children want them to continue injobs.Hence,
no wonder why children are sent to work.
Child Worker's Interest in Ed.ucation and Vocjtiona1 Training;
Child, labour means denial of education and training, denial of
opportunities for growth and development’, and. the denial of
childhood experience. The children who arc forced to work do
cherish a strong desire to got educated and trained like any
other child. Our survey revealed that 58.83 per cent of the
working children not only have an interest in continuing their
education but also a strong desire to go back to schools. Among
them majority are the children below 10 years of age, the teen
aged ones, the girls and those who have already acquired some
amount of formal uducat'on but wore forced to discontinue their
education. Thus the child, workers in Bangalore are not a lot
different from those in Bombay where 66.29 per cent had expressed
their desire to continue their education (Musafir Singh ot al 2
173) .
Among the child workers of Bangalore who arc interested in
continuing their education 45.25 per cent arc interested in
taking up their education on a full-time basis, 24.78 per cent
on a part-time basis, and 17.58 per cent through non-formal
methods of education, while 12.39 per cent prefer self-study
methods. Among girls 68.27 p_r cent are interested in continuing
their education on a part-time basis, through non-formal
methods and self-study.
As for job aspirations and career interests are concerned,
23.33 per cent of the child workers want to continue their
present j-.bs. But 25.67 per cent want to change to letter
jobs, and 22.67 per cent want to set up their own trade/
workshops te be self-employed. Among girls 31.88 per cent want
to change to better jobs and 25.52 per cent like to set up
their own business. Our data indicates that better the
educational background of the working children higher the
percentage of the child workers interested in better career.
Lastiy, 70.33 per cent of the working children are interested
in vocat onal training. Older children, larger percentage of
boys, and the better educated arc more interested inundorgoing
vocat onal training. All but 18.65 per cent of the child.
workers have a. fairly good idea aboiit the vocations they are
10
interested in. Only 13.09 per cent want to continue in their
present vocations, 21.46 per cent are interested in becoming
machinists, 16.50 per cent in automobile tinkering, 9.60 per cent
in wclding/fitting trades, 7.07 per cent in electricals, 5.57
per cent in carpentry, 7.6 per cent in tailoring, and about 3
per cent in electronics. But only 27.75 per cent areinterested
in vocational training on a full-time basis. And 43.96 per cent
are interested inundergoing the training on a part-time basis
and 28.27 per cent in 'on-the-job' training revealing their
concern for a regular income for their families and improvement
of their skills to ?.ecome good workers.
Our data further reveals that every male child working in hotels
and restaurants, shops and commercial establishments, or working
as domestic servant expressed his desire to become automobile
tinkers, tailors, radio and television mechanics or electricians.
Many child workers, though have a desire to have education and
vocational training, did not want to give, a positive answer to
our question seeking their willingness to pursue education and
training. They stated that they would consult their parents/
guardians in the matter and act according to the will and wish
of their parents,'guardians.
About 15 per cent of the child workers stated that they do not
find free time to pursue their education and training. They are
always engaged in their occupations so that they could earn a
little more money to have bettor income for the family. In case
of many of those children, it was gathered that, their employers
do not allow them to have weekly holidays.
The broad conclusions of this survey aro that the economic
compulsions arc strong reasons forcing about 46.33 per centof
the child workers to seek wagt labour, the remaining children
are in employment for other reasons, the important among them
being their parents " cr neern to see them employed when they
become of age.
Whether it is the economic compulsions or the threat of
unemployment, the children arc subjected to different kinds of
exploitat on b their employers. The employers, out of their
concern for maximising the advantages of employing children,
always try to extend the frontiers of exploitation. But more
inhuman is the exploitation of the- child by his family. It is
the compulsions' of survival, the- desire to have an ’adequate1
income for the family, and the fear,'threat of unemployment
that maintain the steady supply of child labour in the
informal, the unorganised small scale sector and often ensure
higher supply than the demand for it, enabling the employers
to exploit the ichildren in their employment. Hence, so long
as the supply factors continue to exist or are not eliminated,
we would never be in a position to prevent the exploitation of
child workers, and least to eliminate child labour. Till such
time it is more advisable and preferable to protect the
interests of child workers by regulating their employment and
working conditions and by providing for their education and
vocational training.
\JoG)ctiVC}
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Bgum^iW- A,
-J
PROJECT
D<2V 3--XS-
Responding to the needs of the needy
............
As I was in the Family Welfare Centre - St. Martha's Hospital,
assigned to counsel couples for NFP ( N atural Family Planning ) and thus
frustrated assignment led me to go out and share my little knowledge
and experience about life and its wellbeing with the people especially
w ith the women in the slums. First, it was an extension NFP counseling
programme for couples in their own houses sdne/that pee« the poor people
may benefit our counselling. Very soon, Jayamma,the staff and I were forced
to respond to the needs of the women and children, malnurished infected
with various communicable diseases due to unhygienic surroundings and
inadequate drinking water facilities and above all ignorance about their
situations, Diarrohea, disentry, typhiod, jaundice, polio, scabies, T.B etc..
were their day to day problems. As we began to responding to their needs
in educating to prevent and to cure with home-remedies and locally available
medicines , and referring cases like typhoid , T.B etc., to the hospitals
We also learned that many of our women suffering with atrocities, harassments,
sexual abuses from their husbands, in-laws and from other members of the
society. Many young women have to encounter with gang rapes, suicides, killings,
abortions, alcoholism, drugs, gamblings, moneylenders, oppressoonfrom
local
leaders aad politicians.
Very soon, KSDF ( Karnataka Slum Dwellers Federation )pame with a
request to start Eobile clinics in their slums. I said No and it took five
months to explain them and make them to understand that their people need
more awareness of their own situations and helping them to decide what steps
they need to take to solve their problems as suoh, instead of giving quick
remedies for their pains and aches, and such remedies were not lacking for them
in the cities.
The first training, we began in January 1991, at St. Marth’s Hospital
for p2 women and 2 men who were brought by KSDF. After having two phases of
each in duration of 2 weeks training with an interval of 1^2 months , they
realised the importance of having such wholistic approach towards their
problems
where they have to take responsibility as individuals and as a
community. They requested to give same training to the unmarried young girls,.
and they themselves brought 22 girls to St. Martha’s. After that they began
to ask to conduct such programmes in their own localities so that many more
women can benefit.
Though we found no privacy and much of inconvenences we began
where ever we got a little place to sit either on the
a
varantha of a public building or infront of a temple / chapel or under a
to conduct trainings
tree. Some times it was very difficult as we had to talk and discuss
gynecological/ social and political problems they are facing.
certain
2
We call this programme WkEPs ( Women’s Education and fmpowerment
Programmes. We are happy to say that we have given such training in a duration
6 days to 1200 women in 17 slums.
It is an ongoing awareness creating and
empowering programmes,
1.
2.
WEEPs
6
Health training; ( Sdays ) 1200 women
Health seminar ( 1 day ) . 700 n
Health seminar
( 1 day )
4.
Mahilasamajas
11 slums
5.
Savings
8
children
'•
. Mental health& Marriage counselling
7• Legal aid seminars
8.
Adult literacy centres
9.
Balawady
5
1
Mahilasamajas : Daring training trining programme we introduce the importance of
having a mahilasamaj where we can get them together for father discussion about^^
various matters when we meet them again. Also for any benefit from the government
they need to register the samaja.
^2Xi2a£"All our women do some small bussiness like vegetables or flowers selling
or some eatables after their household work. To get them for training for 6 days
it is not possible unless we give some incentives. Vie give Rs^Ofor 6days if they
attend with out failing. We ask them to put another Rs20 more each and start
savinngs. They rotate this aeny capital among members on intrest what ever amount
they have, aln one of the slums, our women have saved up to JO.OOORs/- within 8
months time. In all these slums women do not take money from moneylenders. We also
help them to get loans to do some bussiness from Working Women's Forum. Our
women have to take responsibility for running all these programmes. They are the/
office bearers and managers of their development.
As a result many of them ge4»g reduced ar even stoppd going for movies
using too®
much flowers in their heads, drinking too much coffes/teas and
chewing tobaco. They leanned to save and aware of the evil of the moneylenders.
Impact on health : In every slum, we have 2/p volenteers to take responsibility
of the area. The sick people who are really need of hospital care are to be
brought to the hospitals by these women leaders. We contact them to orgaise any
programme conduted by us or any other organisations. There are a lot of improve
ment in the personal and surrouding hygiene, and also nutritional status,concened.
■‘■'hey are capable of handling diarroeas, disentries, Jaundice, cold icough with
home remedies and herbal mediciBes. There would have been, better result if
government could have given proper houses, drinking water, and sanitary facilities.
It needs more organisational efforts and political approach.
5
iSiSSi^on^cntai^heaitb1
During the six days health programme, wu-diB'cnss
and in the mahilasamaj meetings, we discuss aoout mental health, and bow to
recognise their emotional problems, and how to channelise, their emotions for
a better purpose. Many women say that ^hey if they had this sort of training
earlier they would not have made this much of blunter in their lives. Now
many of them know how to resolve their anger, anxiety, resentment, and fear
and thes help them to prevent unnecessary misunderstandings and quarela. it
helps them to build up a oetter self-erteem and courage and motivates them
to be helpful to others, td-c
X /zi
women themselves have realised that
WidaPs
(women's education and empowerment Progs. ) are not enough for their liberation
and development, They have requested to have a programme for their husbands
too. As a result, we have conducted a day counselling session for 20 couples
and 10 singles at i.a.i. we are thinking such sessions more and more during
this year in joining to work with the international theme for the year of the
family, if families are set right the whole society will be in order, I- <
Adult literacy ; it is very difficult t> get women for adult literacy, They
do not have much time after their household work,and also they have to main
tain the homes since their husbands spend everything on their drinking and
their own self-enjoyment. let, we have 40-50 women in > centers who have
learned to read and write, many of them realised the value of literacy^
and send their children to the schools, and also they take responsibility
for their education and proper upbi-ingings.
s x'° create awareness on legal rights among women is a part
of
Witrs.bonetimes, we invite lawyers to our slums and other times, wd bring
women to I.Six to discuss about legal matters, we helped a few individual
cases with proper guidance and advices.
in one of the slums called riagasandra colony, the women
were treatend by some gundas in the night and we belprd She women to write
an apolication and submit to the police station, The S.l took a real interest
ana send the police men for protection. There was peace for a few months.
Again the problem began our women themselves got organised with out our
help and went to the police station. rhe b.l agreed to help them and was
happy for their courageous action.
dur 12oresi-ion_s Jayamma <1 I recall
often the first batch of women
who
usee co sky and shivering. To-day, most of those women are working mostly
as volentecrs and take lead xor their developmental programmes.They have
brought back a lew couples who were asperated lor years and helped them
to live as happy couples. They arc capable of organising, holding the meetings,
addressing certain gathenngs,managing with saving shemes and so on. Four of
them addressed to the conventoin held 19^5 by religious men Awomen of
Justice a Peace Forum oi Karnataka, at l.S.l. on women's liberation struggles.
Perhaps our attempt helps to buid a foundation, we encourage
tS'en to cooperate with anybody who helps the.i with other activities for
their development.
In momg 01 the slums, besides KS.Dli' hthe governmental and
non-govcrmental like
Peoples JsBuoation Society began with tailoring
night classes ter drop outs etc.. The' iainily Planning Association of India
has
started doing the similar health programme like ours in the same localities
and we are planning to go to other ares where there is nobody help the people.
he thought of visiting these slums where we had alkinds of programmes only
ocasionally.
Though aur approach looks like a few drops in the ocean, we do
belief that our programmes enoled them to respond many ways to solve their
problems. With out having a proper foundation no body can buia wails and
roof. v.i. are happy to Iook at the aohivements throuh our little input.
Reported by,
Sr. Marina Kalathil rgs.
Spiritual Well_being ; Spiritual health / well being is a part of total well
being accordin g to WHO. According to my own experience with-mys-e- as well as
the experience with others with whom I work I can say health is not completed
with out a spiritual well being.
We discuss about the superstitious beliefs and certain religious taboos and
practices that create many physical,mental ,socia}.,and economical problems.
At the same the need to have a right belief and attitude towards the God Almighty
the 0reator,who is supernaturaJ.ly powerfull and who is mercyfull: wtebe-whe-ie
who forgives our mistakes; who inspires right things; who giiles , provides and
cares for us>whom we can trust so that we do not need tn live in anxiety and
fear.which again af-Pecbe ou^+reaUb. We need to avoid selfish desires and
ambitions and search for truth, peace and harmonya ; and to see good in others and
£ do good oihews. for others
DBv
- IE
THROUGH THE URBAN LOOKING GLASS
THE IMPACT
OF URBANISATION ON HEALTH*
DR SUNEETA SINGH
Asst. Professor
St. John's Medical College
Bangalore 560 034
Cities,
the
at.least the
cradles
human
last 6000 years.
modern
standards -
people.
In 1950,
size
of
only
the
size of
for
large by
a
million
there were 10 metropolitan areas with population
were 33 cities with
By 1990 there
people or more,
15
with 10 million people
more and 6 with 15 million people or more.
in urban
have existed
Few ancient cities were
one achieved
of 5 millions or more.
size of 5 million
civilisation
population growth today,
or
The greatest increase
stems from
high birth
rates
with rural-urban migration playing only a secondary role.
In
a study conducted by the Population Crisis Committee in 1990,
58
of the world's 100 largest metropolitan areas have been found
to be in the developing world and of these 9 are in India.
All 9
were ranked "poor" using a cross-cultural
Urban Living Standards
* under publication of Physician's Updat .
Dec 1991
The Impact of Urbanization on Health
How does
rapid urbanization
impact on
health? Rapid
growth in
cities leads to:
- increased demand for resources
- increased utilization of available resources
- increased pressure on the physical environment
This results in 3 main groups of health hazards:
1} Those that are economic in origin
Ifirge income disparities, limited education, poor dietary
practices, over-crowding and insanitary conditions,al 1 of
which increase the risk of malnutrition as also diseases
of infective origin such as gastroenteritis,
acute
2)
respiratory infections,
typhoid, cholera,
tuberculosis.
Those that are related to the man-made urban environment
industrialization, pollution,
traffic, stress, alienation
which increase the risk of diseases such as chronic
respiratory problems, allergies,
traffic injuries, chronic
multi factoral diseases and psychological disturbances and
breakdown.
3Those related to social instability and insecuri tv
Promiscuity, prostitution, child labour, alcohol/drug abuse
leading to high rates of child deaths and illnesses, sexuallytransmitted diseases including AIDS and alcohol <? drug
dependence.
ME GEiLELdn- PRACTITIONERS
From
the point of view
VIEWPOINT
Practitioner,
of the General
this rapid
urbanisation may throw up a greater number of the following kinds
of cases
1)
Communicable Diseases
It must be understood that the Urban Community forms a single
ecosystem with intimate interconnections between the affluent
and poorer sections.
Thus while on the surface,
the
likelihood of such diseases as TB, Cholera & Dysentery and
Measles appears to be less amongst the affluent,
possibilities cannot be ruled out.
these
Certainly amongst the
marginalised urban poor, infectious diseases constitute the
bulk of all cases seen.
In fact,
viral infections are often
superceded by bacterial infections in those groups because of
greater exposure and lowered immunity.
2) Malnutrition
The incidence of malnutrition (both undernutrition and
overnutrition.) in urban areas is high.
The urban poor
suffer from undernutrition because of reasons of poverty and
ignorance.
The urban elite often suffer from overnutrition and
diseases relating thereto. In both,
this is the result of a
fast changing lifestyle, consumerism and a break from
traditional dietary practices.
3)
Lifestyle Diseases
Though urbanisation appears to increase the occurence of
lifestyle disease,
this may not. strictly be true
Early
and easy access to better diagnostic ano therapeuticmedical facilities may have a lot to do with this seeming
increase.
However, it cannot be denied that urbanisation does
affect a number of parameters which may increase the
possibility of developing lifestyle diseases eg.
ischaemic
heart disease, cancers, diabetes, stroke etc.
4)
Problems of women and children
Statistics show us that indices such as infant mortality
rate are much better for urban centers in India than the
rural areas.
This is with good reason.
The care facilities
of urban areas as well as the tendency of women & children
to present themselves to a medical practitioner is much
higher than in rural areas.
continuity.
The problem is really one of
Having a greater variety to choose from, urban
patients tend to drift from doctor to doctor with predictable
impact on the quality of care received.
5)
Sexually Transmitted diseases (STDs) including AIDS
Owing to greater promiscuity and the establishment of
prostitution secondary to poor social networking in
urban slums,
the incidence of sexually transmitted diseases
in these groups tends to be much higher.
Given the natural
connections between this group and middle class and
affluent groups - STDs are not uncommon in the entire urban
community.
One study in Vellore revealed that HIV positivity
rates among the general antenatal clinic population was as
high as 0.45/1000 as against the estimated national
prevalence rate of 0.64/100,000.
6)
Chronic irritant & Allergic Respiratory Problems
As the city grows in population, congestion and pollution
increases.
In the Population Crisis Committee Study,
rankings for air quality of Indian cities were amongst the
lowest in the world. Consequently many disease eg.bronchitis,
asthma etc. are endemic to large urban centers.
7)
Traffic related injuries
Increasing motorization and poor town planning in association
with large disparities in travel modes results in large
numbers of road traffic accidents.
While the pedestrian is
the most vulnerable, motorcycle accidents are fairly common.
Many of these are amenable to primary care by the general
physician.
With the Supreme Court ruling regarding the
primacy of medical treatment of victims over the processes of
law, care of road traffic accident victims has become less
onerous for the general practitioner.
8)
Alcohol/Drug Dependence & Psychological Problems
These are related to breakdown of traditional social networks
and the rapid rate of change in urban life.
Very often,
these
cases may present themselves to the general practitioner
under the guise of other more easily defined physical
symptoms. It would require a high index of suspicion and a
sensitivity on the part of the practitioner to identify these
problems which may require referral to specialist institutes.
CONCLUSION
Urbanisation in India is proceeding at an unprecedented rate.
Rapid growth puts inconceivable pressures on the infrastructure
and physical environment of urban areas leading to a demand for
resources unmatched by their availability.
This
results in the
leading
an
to
genesis of 3 main
increased
risk
of
malnutrition,
diseases,
lifestyle
diseases,
sexually
transmitted
diseases, chronic
diseases,
traffic
related
groups of health hazards
problems
of
women &
&
children,
& respiratory
irritant
injuries, alcohol
communicable
drug abuse
and
psychological problems.
A high index
of suspicion and
their impact on the lives of
urban practitioners
a concern for these
diseases and
their patients would help make
the
practice of medicine a more meaninful one.
Suggested Reading
1.
Population Crisis Committee: Cities - Life in the Worlds 100
Largest Metropolitan Areas: 1990.
2.
I.Tabibzadeh, A.Rossi-Espagnet, R.Maxwell: Spotlight on
the cities: WHO:1989.
'OG 'i
First National Conference of Health Officers
of Municipal Corporations
And Major Municipalities
1987
g©W®»
20th & 21st February 1987
ASHOKA HOTEL
Kumara Krupa Road, Bangalore
CORPORATION CONCERN ON HEALTH FRONT
Dr. G. N. DASAPPA
M.B.B.S., D.PH.
Deputy Health Officer, Bangalore Mahanagarapalike
Bangalore City which has grown by leaps and bounds during the last
decade is fast loosing its reputation as "GARDEN CITY”, "AIR-CONDITION
CITY" AND "PENSIONEER PARADISE". A combination of factors came into
plans and city leap-frogged to the population peak of 30,40,573 (1986 Mid
year) from its previous 1 6 lakhs in record time.
The fifth largest City in India and the Capital of Karnataka which is
located 931 meters above sea level (latitude 12-58' North and longitue 77.36'
East) has attracted people from far and near, it is also the base for several
industries large and small- The rise in numbers has in turn caused the
invitable growth in residential and commercial buildings, entertainment out
lets like theatres, clogged the city roads with more vehicles and lead to the
virtual dis-appearance of ponds and lakes in the City.
Yet another complex factor in the multi-dimensional growth of the city is
influx of people from neighbouring states making the city into a molting pot
of the culture.
Viewed against this background the task of the Bangalore City Corpora
tion to provide amenities to the citizen is quite formidable. The range of its
service is vast and varied, water supply and sanitary facilities, illumination for
roads, formation of foot-paths, parks, play-grounds, markets, schools and
health services. Besides it has to ensure clean environment. All these
services it may be stressed and fulfilled through the financial resources of
Corporation itself.
.
Foremost among the services of the Corporation is in safe guarding the
health of the citizens. This is done through the department of healthFollowing ate‘the highlights :—
C-7
. .
'
'•
' -
M.C.H. & Family Planning Services are given to the People of Banga
lore City through qualified doctors. There are 29 Maternity Homes and 38
Family Welfare Centres in the Corporation to provide M.C-H- Family Planning'
Services to the people in addition to the services given in five Govt, hospitals
and four private hospitals.
In these Maternity homes & Family Planning Centres, Health-Education,
Antenatal Care, Natal Care, Post natal care and laboratory services are given
to the people- 40% of the total delivers of the city are taken place in the
Corporation maternity homes onlyMuch attention has been given to the
Family Welfare Planning Work, as it is a National Programme wherein the
pregnant women are supplied with iron and Folic Acid preperations to prevent
Secondary Anaemia- Immunization of expectant mothers and infants/children
are done and Terminal sterlisation and other spacing methods are given- For
the year 1985-86 the Government of Karnataka has awarded the prize to the
Corporation having achieved 103 5% of the sterlization target.
To achieve this target special campagin was taken up and publicity
materials were made available- The press, T.V., AIR and Cinema slide adver
tisements were given and additional incentive were given by the Corporation
to the acceptors and motivators. There is a full pledged hospital for.M-C-H.
Care where major surgical procedures are taken up- Two paediatric Centres
are~functioning with the qualified doctor to provide services to the children.
100 Anganwadi Centres are established in southern portion of the City
where primary health care is given to children in each Anganwadi- Slum
children of 0-6 years age group are given milk and bread every day with
the assistance of social welfare department.
Universal Immunisation Programmes :
Bangalore has the distinction of being the First City to launch Mass
Immunisation drive in the Country, in Joint collaboration or Government of
Karnataka, Rotary Internal Dist 319 and Medical Colleges of Bangalore during
the month of November, December '86 and January '87, Though the compagin was a partial success it generated sufficient awarness among parents to
get their children immunisedStatement of MCH Work :
Years
Anc. Examination
Deliveries Conducted
1984-85
62147
56085
.1985-86
97037
51425
1986-87 Apl. to Jan. 1987
73325
41685
•'r'\
Stateme
Year
1984-8
1985-8
1986-8
April to Ja
Prevei
Sub-Healtl
tions are g
in these ce
Immurt
Measles an
including 1
People
tic; 1 Ayur
ries aided b
4 private ho
Slum ;
dispensaries
The cor
at Isolation I
ted and appr
the City. Tl
common in t
Statement
Year
1985
Jan. to De
1986
Jan. to De
1987
January
Statement of Family Welfare and Immunisation Work :
Year
1984-85
1985-86
1986-87
April to January
VC/TO
LTO
IUD
DPT/POLIO
TT (Preg)
2021 6
27379
24414
1293
2418
1690
12271
14361
13932
77844
74542
60524
49965
60206
47061
Preventive Health work is being carried out by qualified doctors in 12
Sub-Health Centres, wherein Anti-cholera, Anti-typhoid, Anti-Rabic innoculations are given, Birth and deaths are registered. The certificates are issued
in these centres.
Immunisation work against Six diseases, D.P.T., Polio, B.C.G., and
Measles are given in routine in all the M.C.H. and Family Planning Centres
including 14 Corporation dispensaries.
People of Bangalore City are getting their Medical services in 14 allophatic; 1 Ayurvedic, 1 Unani Corporation dispensaries, 25 local fund dispensa
ries aided by the Corporation in addition to the 12 Govt. Major Hospitals and
4 private hospitalsSlum population are getting their medical service through 4 Mobile
dispensaries.
The communicable diseases occured in the city are admitted and treated
at Isolation Hospital and Sanitoria. All communicable diseases are investiga
ted and appropriate measures are taken to arrest further spread of diseases in
the City. Throughout the year Gastro enterities and a few cholera cases are
common in the City.
Statement of Communicable Disease
Year
1985
Jan. to Dec1986
Jan. to Dec.
1987
January
Tetanus
Gastro Entorctis
D
A
Cholera
D
A
Jaundice
D
A
A
D
1458
38
153
9
40
9
148
53
2508
53
248
—
19
-
155
58
38
—
1
-
—
—
12
- 3
3
Year
1985
Jan. to Dec.
1686
Jac. to Dec.
1987
January
Year
Encephatilis
A
Dj
1
Diphitheria
A
D
128
1
23
82
10
1
Measles
A
D
113
2
2
Hydrophobia
A
D
31
14
Chickanpox
A
D
189
1
34
8
63
4
2
6
5
Musuges
D
A
—
—
Dhooping Cough
D
A
— ■
—
1985
Jan. to Dec.
—
—
—
6
29
1986
Jan. to Dec.
—
—
—
—
7
1987
January
Prevention of Food Adultration has been done as per P.F.A. Act. The
knowledge of food adultration has been convened to the people through
demonstrations, lectures and film shows in different localities of the city. In
Mahila Samaja's and Schools.
Regular food samples are collected from
different establishments by qualified 12 food inspectors. Each Food Inspector
has been given a target of 20 samples per month.
These food samples are being analysed in the Corporation food laboratory
by the qualified Public Analyst. Food samples given by private agency are
also analysed in the laboratory- The laboratory is helpful in detucting the
food adultration launching cases.
Mosquito
Under
throughout
1) W
done to eli
2) Re
maintain th
3) Di
out in the ti
4) Ga
Drinking w;
5) Fil
6) Py
the adult m
Under
in the slumr
out in all th
dispensaries
and positive
also coilectt
by the Staff
Health and
case- Maj*
Year
B.S
Statement of Food Adultration :
No. of Samples
No. of Samples
found Adultration
analysed
From August 1983 to March 1984
1200
1200
54
From April 1984 to March 1985
1854
1854
100
From April 1985 to March 1986
2234
100
2234
5288
426
Total 5288
No. of Samples received
: 5388
No- of Samples analysed
: 5388
No- of Samples found adultrated :
426
No. of Samples
Received
REMARKS
1984
1985
1986
Entomologi
Assessn
independent
Mosquite cc
every day an
larve, coverii
week- The f
Mosquito Control And Urban Malaria Control:
Under this scheme the anti-larval and anti-adult methods are adopted
throughout the city regularly.
1) Weekly larvicidl like (MLO Bytex, Abate, Paris Green) spray are
done to eliminate Mosquito breeding places in and around the city.
2) Regular desitting of small and big storm water drains are done to
maintain the free flow of water in the drains.
3) Deweeding of water Hyacinth and other vegetations is being carried
out in the tanks,
4) Gambusia Affins and Hebistes reticulatus are introduced into the
Drinking water wells, and pools and ornamental tanks and fountains.
5) Filling up of ditches abondend wells, queries are also done.
6) Pyarethrim spray has been taken up in some of the localities where
the adult mosquitoes density is more.
Under the Urban Malaria Scheme Active Survillance has been carried out
in the slums by the Dist. Health Staff- Passive survillance has been carried
out in all the dispensaries M.C-H. Centre by the Corporation and local Fund
dispensaries. The blood films are examined and data of blood smear collections
and positive cases of the major hospitals and Nursing homes in the cities are
also collected and recorded. All the positive cases are treated radically either
by the Staff of the Bangalore City Corporation or by the Staff of the District
Health and F.W. Officer, Bangalore depending upon the jurisdiction of the
case- Majority of the cases were found to be imported on investigationB.S. Collected and Examined
Year
Malaria Parasits Positives
Tota
P- Vivase
P. Vivase P1984
1985
1986
46,692
50,008
57,610
32
31
40
•
Faliparem.
4-36
1
32
2-42
Entomological Work :
Assessment of the Antilarval operation work is being carried out,
independently by 20 Insnct collectors working under the Sr-Biologist, Adulters
Mosquite collection is being carried out for two hours by each insect collector
every day and the mosquito- breeding places are checked for the presence of
larve, covering the whole area under the Mosquito Control Operation once a
week- The following Species of Mosquitoes are prevailing in the City.
6
(1) A. Culicifacies, (2) A. Stephensi, (3) A. Fluvistilis, (4) A.Subpictus,
(5) A. Vagus, (6) A. Hyricanus, (7) A- Turkhudi, (8) C. Quimquifasiatus,
(9) C.Hellidus, (10) C.Vishnui, (11) Armigees, (12) Lutizia, (13) Mansonoides
speciesand (14) AC-Aegepti. The highest density of mosquito is noticed
between August and November, the density of malaria vectors is below the
critical density.
Conservency Services:
Keeping the city clean is one of the responsiblities entrusted to the Health
Department- The people of Bangalore city are provided a clean environement
by keeping the city clean by regular sweeping of roads, foot paths, drains and
markets and transporting the rubbish away from the City- This work has been
done by 12 Asst- District Health Officers of the Corporation. 1500 to 1800
tons of rubbish is generated everyday in the City- Out of which 200 tons of
rubbish is utilised by Karnataka Compost Plant for the manufacture of manureThe rest will be dumped in the low lying areas on the out-skirts of the city.
In recent years, the Mechanical Sweeper has been itroduced to clean the
major roads in the City- Mechanical Compactor Machine and 55 Tipper
trucks have been introduced for the quick transport of rubbish from the city.
Financial constrant have in the way of going modern- Small tillers are also
used to collect the rubbish from the narrow lanes and by-lanes of congested
localities.
An agency has come forward to make use of the rubbish generated from
the City in producing gas. This project report has been submitted to the
Government for its approval-
Another agency has come forward to make use of the rubbish in preparing
pallets- This pallet can serve as cheap fuel substitute.
[
Bangalore City Corporation has constructed twelve "SULABAH SOUCHA- >
LAAYS" Public latrines and Bath Rooms in important places like Bus Stands
and slum localities to provide sanitary facilities to the Public- In addition to
this a number of public urinals have been provided in the City wherever it is
necessary.
Rabies is one of the deadly diseases transmitted to the human beings by
the bite of Rabid dogs. Stray dog nuisance and their bite to the public is
one of the problems of the city which has been tackled and controlled by
catching stray dogs throughout the city, every day an average 90 stray dogs
6
are caught t
days in the
to take the :
Statement
Year
1985
Jan. to Dec.
1986
Jan-to Dec
1987
Jaunary
The gro
big problem
only a nuisai
Allergic Boo
This has
up-rooting tl
by using che
has been tak
developed b
to control an
The City
people to dif
provided to
are 4 Ambul;
and burning
Corporation,
ictus,
iatus,
oides
>ticed
v the
ealth.
men|
and
been
1800
ns of
nurecity.
i the
pper
city.
also
isted
from
> the .
ring
are caught by means of 4 dog catching squad and these dogs are kept for 3
days in the dog pound and then elecicuted- An agency has been entrusted
to take the skin of the dogs for the manufacture of leather goods-
Statement of IStray Dogs :
Year
1985
Jan. to Dec.
1986
Jan- to Dec
1987
Jaunary
No- of Dogs Caught
No- of Dogs killed
23,072
22,238
32,660
32,373
2,594
2,557
The growth of parthenium plant in vacant places in the City has posed a
big problem to the people of Bangalore City. The parthenium plant is not
only a nuisance but also produces allergic reactions like Allergic Rhunitis.
Allergic Boonchitis, Bronchial Asthma contact dermatitis in some of the people-
This has been tackled by the health authorities as much as possible by
up-rooting the plant and burning. An attempt has been made to kill this plant
by using chemicals like Glycilbut, it is very expensive. Now a new approch
has been taken up by sowing an harmless "Cassia Serecia Seed" found and
developed by the Scientists of University of Agricultural Sciences, Bangalore,
to control and curb parthenium growth in Bangalore City.
The City Corporation has provided Ambulance Services to carry Sick
people to different hospital on nominal charges. Hearse Van services are also
provided to carry dead bodies to the burial grounds and burning ghats. There
are 4 Ambulances abd 6 Hearse Van for the use of public. 26 Burial grounds
and burning ghats including 3 electric crematoria are maintained by the
Corporation, Health Department.
HA*nds
n to
it is
s by
ic is
by
ogs
7
CROI
ORKSH
ON 1
IPATIO’r DURI
O’S & SLUM E
,'NITY PAR
,'.'S OF THE
O'S
son
ON
PROJECT FOR BANGALORE CITY SLl
MAYO HALL, AFTERNOON SESSION.
SUBJECT
SLUM
of slum dwellers:
Gr-ouo I
a)
b)
c)
Nfr. I!
Grown II
f-,
.S.D
J
Identify the felt needs of people
V.'hat is the proority in these nee'
What is the Health needs.
Proposals:
Dr . S . 3. NAGARAJ
What are your proposals to achi
Review the current proposals.
Is your proposal is included in
Do you want any change.
annincr & Evaluation:
.L.
: •< -- -l
C r
. GO
JU
KALLIGUDD
authorities:
IM
T HADA VAM U RT HY
i
3)
Who are the implementing a
b) Local commit tee formation nvolvmg corpor
c) Officials of corporate sta f PVO's and oth
agencies
d) '..'hat should 1be the functions of lo
core
e) Do you sugge:st any changes.
’.di no
’ho is no fund for this p
'hat is your contribution
ho has to operate the fui
’
1-roup IV
How to implement this proposal
Inputs for implementation
What is your role in this?
0)
DAS
(D
Dr.
PC-V 3.^*4
PLAN FOR DELIVERY OF FAMILY WELFARE SERVICES IN SLUMS
BASED ON THE NEED ASSESSMENT OF SLUM DWELLERS!IPP - VIII)
AS MOHAMMAD
Dept of Community Health
St John's Medical College
BANGALORE 560 034
EXECUTIVE SUMMARY
The Urban population of India is growing at an alarming
rate.
By the year 2000 AD it is estimated that about 350 million
population will
live in
urban areas.
Out
of which, about
40
percent
will live
in slums
with characteristic
over crowding,
poor
environmental conditions,
non availability
of
drinking
water,
absence of
proper drinage
system and
minimum level
of
residential
accommodation.
.
,
Bangalore
is a
fastest growing
city in India
with a
total population of 41 lakh.
This uprecedented, unplanned growth
has resulted in the growth of many slums (401) and
lack of basic
civic amenities.
Health
facilities due to lack of
resource and
lack awareness
about effective
utilization, have not
kept pace
over time.
Thus prevantable and communicable diseases are still
a major health
problem in slums.
This reflects
the paucity
of
organized and planned health services provided by the net work of
hospitals,
health centres,
maternity
homes
and
dispensaries.
Out-reach
services of
these
institution do
not
exist or
are
inadequate
to meet
the primary
health care
needs of
the slum
dwellers.
Bangalore
City
Corporation covered
only 64
slums.
Remaining 337 slums are left uncovered.
An
IDA team
of the
World Bank
visited the
slums on
October 12th 1991 of Bangalore city along with officials from the
Department of Health, Government of Karnataka and
the Health and
Engg.
departs officials
of the Corporation.
they were
able to
sense
the magnitude and
nature of the
problem on
a first hand
basis
and
had
thread
bare
discussions
with
the
concerned
implementing officials.
In response to
these problems, a
plan
for health care delivery has been
prepared.
This is based on an
attempt to satisfy the felt needs of the slum dwellers.
At
this juncture, it
is necessary to
make a thorough
introspection into
the health care delivery
system of Bangalore
City
Corporation, so as to
over come dificiencies
and meet the
challenges
of "HEALTH
FOR ALL
BY THE
YEAR 2000
AD. This
may
require
a little
restructuring of
health
services.
In the
present
proposal
efforts
are
made
to
identify
problems
to
strengthen the delivery of
integrated family welfare and primary
health care services to urban poor.
This
is consistant with the
objective of the ” National Health
Policy"
which aims at taking
the services nearer to the door steps
of the people and ensuring
full
participation
of
the
community
in
health
development
process.
It
is
proposed
to
reorganize
and
strengthen
the
existing facilities as per the requirement.
Strengthening of out
reach
services and
dynomic involvement
of community
in taking
care of its health development
needs are the main points of
the
present proposal.
Various objectives
and strategies for improving
the delivery of
integrated family welfare and primary health care services are:
Specific Objectives:
1.
To improve the quality of the family welfare,
health care services to the slum population.
2.
To strengthen the existing health and family welfare delivery
services in city and establishing new facilities.
3
To involve the Non-governmental organisations
Medical Practitioners in the delivery of family welfare
services in urban slums.
4.
To provide integrated services of MCH & FW by involving the
community in decision making planning and implementing.
5.
To provide quality of traini
regular inservice programme.
to staff
by comprehensive and
6.
To provide quality of training
regular inservice programme.
to staff
by comprehensive and
7.
To provide health education to community through the
involvement of local leaders and voluntary organisation
8.
To expand
City.
the family welfare and MCH services
MCH and primary
in Bangalore
Strategies
The following strategies will
goals and objectives:
1.
2.
3.
4.
5.
6.
7.
8.
9.
be used
to achieve
the above stated
Development of effective out-reach services;
Strengthening of infrastructura1 facilities;
Involvement of private medical practioners and PVDs;
Intensive IEC campaign.
Improving the Meternal and Child Health Services by providing
a comprehensive health care for 50,000 population by
strengthening the existing centres and opening new centres.
Improving the antenatal services by utilizing the services of
link workers/50,000 population.
Stream lining the management information system.
Strengthening the training and in service training facilities
Monitoring and evaluation and operational research.
A Health
Centre will cover a population
of 50,000 and
will be located in the slum
or periphery of slum for its optimum
utilization
by
slum
dwellers
or likewise
population.
This
community
based services
backed
by an
effective outreach
and
referral services will
provide preventive, promotive and
simple
curative
health
care,
leaving
a
small
quantom
of
curative
problems
that will require referral to hospitals.
Most of these
centres will
be located near
to or within
slum areas so
as to
improve the physical accessibility and utilization.
Family welfare and Primary health care services will be
provided through link workers, domiciliary visits of ANM/LHV.
To
back up the services, one
out of every four health
centres will
be upgraded to have in-patient facilities with 25 beds.
For this
purpose, some of
the existing maternity homes will
be selected.
The services will include:
treatment of specific
1.
Care of pregnant women
nutritional disorders
2.
Safe deliveries.
3.
Post natal
4.
Nutritional
5.
Immunization against vaccine preventable diseases.
6.
Advice,
7.
Health and nutrition education especially the need for breast
feeding and weaning practices, immunization, nutritious diet
during pregnancy and lactation, etc.
8.
Treatment of minor ailments of women and children.
9.
Knowledge of vaccine preventable diseases and diarrhoeal
diseases.
10.
including
care including care of new born
care upto the age of
five.
supplies and facilities for Family Welfare.
Detection of suspected cases of TB and Leprosy and
referral and follow-up.
their
SETTING UP OF NEW HEALTH CENTRES AND UP GRADED HEALTH CENTRES
It
has
been
estimated
on
the
basis
of
projected
population i.e. 48.78 lakh by 1993, that 97 health centres and 24
upgraded health centres
will be required.
The breakup of health
centres and upgraded health centres is as follows:
HEALTH CENTRE
STATUS
Required
Existing
Addl. requirement
UPGRADED H.C.
97
37#
60
24
30 Mat.Home
24#*
*
Strengthening in
contingencies.
*
Strengthening in terms of staff, equipment, ambulance,
staff quarters! only fof 6 centres) and contingencies.
drugs,
up of new
centre
terms of staff,
equipment,
drugs and
Strengthening of existing
centres and setting
will be taken in phased manner as follows:
YEAR
I
I I
III
IV
V
TOTAL
New centres (60)
Strengthening of 37 HCs
Strengthening of 24 UHCs
25
12
9
20
10
8
8
7
4
7
4
2
0
4
1
60
37
24
Strengthening of existing
HCs and
UPHCs and setting
up of
centres will be taken up from the pe riphery of the city.
new
MAYOR/ADMINISTRATOR
COMMISSIONER
HEALTH OFFICER
Chief Engineer
-------------- p
(for Civil Hork)
Additional Health Officer
Non-Governaent Organisations
(FH 4 MCH)
Private Medical Practitioners
1
Adiinistration 4 Monitoring Unit
Training Unit
I E C
Unit
Exit, prop.
-Apex training
Exit .Prop.
-Extn. Education Officer
-Surgeons (FN 4 MCH)
2
0
-Deaographer
0
1
-Extn. Educator
-Statistician
0
6
1
0
-Driver cut projectionist
-U D C
-Peon
5
0
teaa
1
2
2
4
Upgraded Health Centre
z/vv-izS-n
L-tAO i cf
L)
Sr. Medical Officer
)
.^Gynecologist cut Resd.LMO )
- 1
.''''Paediatrician
- 1
X Anaesthetist (part tiae)
.^Staff Nurse
- 1
Specialised MCH Care
- 4
Conduction of Noraal and
Out patient services
TASKS
- 1
Clerk
high risk deliveries
M T P
Lab. Technician
- 1
O.T. attendent
- 1
Sterilization
Inpatient care of 6ynae/0bs. cases
Laboratory services
Peon
- 1
Referrals
Sweeperess
- 3
Supervision of Health centres
ChoHkidar
Driver
- 1
- 1
Treataent of coanon ailaents of anther and children
Hea11Centre (HC)
HC
HC
including diarrhoea (aild dehydration)
HI
Ante Natal, Natal and Post Natal care
laaunization
Lady Medical Officer
Vit. A for prevention of blindness
1
LHV/PHN
1
ANM/Health Morker(Feaale)
3
Coaputer cua clerk
1
10
ORS for diarrhoea
TASKS
-* ^3ool~
Suppleaentary Nutrition
Faaily Planning
IUD insertion, Condos and Oral pill distribution
Urine (Albuain 4 sugar) and Blood Exaaination
Referral for Sterilization, High risk 4 coapleted cases
to upgraded Health centre and other Hospitals
Surveillance of vaccine preventable diseases I Diarrhoea.
It
is suggested to introduce
various records and
reports at various
levels, right
"from the field staff, HC and UPHC,
to monitoring unit.
So the
information can flow
both ways i.e.
from field staff
to the
decision maker and vice versa.
Training
is an impratant component
of the proposal.
objects
is
to
instal
an
out-reach/extension
bias
in
functionaries.
Training
will
be carried
out
at different
different categories of Health workers.
TRAINING
CATEGORIES
Its major
the
hea1th
1 eve Is
for
PLAN
TRAINERS
DURATION
National
Faculty
3 working
Institute of
Health and
from
VENUE OF
TRAINING NEEDS
TRAINING METHODOLOGY
TRAINING
1. Apex training
team
days
a| Emerging Urban Health needs and
problens of sluns.
Lectures/discussions
and group discussions
b) Project strategy for delivery
NIHflFWS
of Family Welfare Services.
Family
c) Conmunication Technology
Welfare
Services,
d) Planning and organisation of
training programmes and
NEW DELHI.
managenent techniques.
2. Sr.Medical
H.F.H.T.C.
Faculty
Officers,
fron
specialists,
H.F.H.T.C.
Lecturer/discussions
2 working
a) Motivational technology with
days
special reference to Family
Demonstration and
Helfare.
Field training
b) Inter personal connunications
Gynaecologist
Paediatrician
3. Extension
H.F.H.T.C.
Educator
a) Planning, organisation and
Lecture/discussions
fro#
evaluation of training
group discussions and
H.F.H.T.C.
communication techniques
in health and family welfare,
field training.
Faculty
4 Days
production and testing of
training 4 connunication
naterials.
b) Extension techniques, planning,
organisation and testing of
training/cosmunication centres.
4. LMOs, PHNs,
H.F.H.T.C.
Faculty/
5 Days
a) Problens of Urban Primary Health
Care, new approaches.
H.Officers
LHVs.
b) Use of cotmunication strategy
SHOs,
Lecture/workshop,
group discussions and
field experience.
in training.
Extension
c) Awareness creation, motivational
education
technology.
officer
d) Management techniques
e| Clinical update
f) Monitoring and supervision
5. Health worker
Health
SHU/MO
centre
Extension
Educator
5 days
a) Update in prevention and
promotive health care.
b) Antenatal checkups, deliveries
Postnatal check-ups.
c) Identification of high risk
mothers
Lecture/workshop
field experience and
practical training/
demonstration.
CATEGORIES
VENUE OF
TRAINERS
DURATION
TRAINING NEEDS
TRAINING METHODOLOGY
TRAINING
d) Care of new born 1 infants
e) Motivational techniques
person to person coanunication
f) Maintenance of various records
and reports.
6. Link workers
(Dai)
Health
PHN/LHV,ANM
Centre
Extension
30 Days
Educators
a) Contacting connunity for
Leelures/group discussion
awareness creating.
Deaonstration, Roleplay
b) Motivating wonen particularly
pregnant woaen.
Field observation and
c) Update on delivery aethod,
real situation.
practical training in
aseptic delivery, care of
pregnant woaen, postnatal
care, care of infnats and
care of ninor'ailnents in the
coanunity.
Health
Health
1 day
Office
Officer
orientation
NGOs and
consisted
/seninar,
Karnataka Sius
by extension
Clearence
educators
7. Private
practitioners,
a) Orientation to innovation
approach/extension approach
Lecture,individual
presentations and
discussions
Board (KSCB)
workers.
0. Anganwadi
worker
Health
LHV/PHN
centre
Extension
Educators
1 day
orientation
a) Contacting connunity for
awareness creating.
b) Motivating woaen particularly
pregnant woaen for ANC and
Lecture/Role play.
T.T. laaunization.
Pi survey conducted
in slums
of Bangalore revealed
that B57.
of
population is availing the services of Private Medical Practitioners (PMPs).
It is because of fact that they are in large number and have high
level of
local acceptance and respect, particularly in
slum areas.
So, the success
of
implementation
of the
programme
of strengthening
of
family welfare
services in
urban areas will
also depend
largely on
the involvement
of
PMPs and NGOs providing these services.
During
the
interviews
with
PMPs,
all
PMPs
expressed
their
willingness to
participate in the Government Health programme.
So,
it is
proposed in the plan to identify the PMPs and
NGOs and involve them in the
following activities:-
RmPs
'GtA/wtz'Y.
wwwl
K/i L aa4
b
.
6y\ Cb\^ LA zv^vitvvvvi<vVv'
I ”^
vvty
<vvv
'Vva-e-cU
Mo a>v\.
tte, ,
o~^
PLAN FOR
INVOLVEMENT
AREA
INSTITUTION
TASK
SUPPLIES
(f ree)
RECORDS
Immun i za tion
(free)
Nursing Homes
Polyclinics
c1inics/
dispensaries
Immun i za tion
of eligible
c hi 1d ren
a t tending
ins ti tu tion
Vaccines
Co Id c ha in
equ i pmen t
List of
UFWC/
area
Immun ised
c hi 1d ren
ANM
dose wise
Mothers TT
Fami1y
Pl anning
Nursing homes
Poly clinic
clinic/
Dispensaries
F.P.services
lUCDs
including
Oral Pills
MTPtonly
Condoms
Nursing homes)
Appropr i a te
regis ter
of servi
ces done
Area
UFWC/
ANM
MCH-ANC,
Na ta 1
PNC
Nursing homes
Poly Clinic
Clinic/
Dispensaries
Mo t iva tion
for regis
tration &
referral to
appropriate
insti tution
Appropri
ate regis
ter of
work done
Area
UFWC/
ANM
ORT
Nursing homes
Poly clinics
c 1 inics/
dispensaries
Assessmen t
of degree
of dehydra
tion and
trea tmen t
Appropriate regis
ter of
work done
Area
UFWC/
ANM
Hea1 th
Education
do
Iron and
Folic acid
and TT
ORS Pkts.
Motiva tion
Leaf lets
& advice
Pos ters
on Preven
etc .
tive Measures
----:---
REPORT
TO
—
To
strengthen the communication
support of
training activities
and inter—personnel communication for attitudinal changes it is proposed to
establish one
IEC unit.
This unit will
be responsible for
planning and
organization of Health education activities in the city and coordinate with
ANM/LHV and male worker in the conduction of health education activities.
—P CA_V\
1
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134
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CONTENTS
I
Status of Urban Poor in Indian Cities
1.
2.
3.
II
UBSP approach for achieving Middecade Goals
4.
5.
6.
7.
111
Operationalization issues
Recommendations
13.
VI
UBSP structures at Community Level
UBSP programme coverage
Convergence efforts in UBSP
Selective case studies
Operationalization issues
12.
V
Mid decade Goals
UBSP Approach
Municipal Government as Nodal Agency
Convergence
UBSP Programme
S.
9.
10.
11.
.!
Urbanization in India
Situation of Urban Poor
Family Welfare Facilities in Urban Areas
Recommendations for the Indian Public Health Association in the cont<.—.
of UBSP strategy
Annexure
References
Technical skills of Hygeia and Pankeia (godess who taught how people
could stay well and one who used medicines to heal the sick) are not enough.
Among the most important determinants of the success or failure of work in
health are government and community.
C
i,
1.
Urbanization in India
1.1
Urban Scenario (1991 Census)
Total population
1.2
Total urban population
217 million(26%)
Total urban agglomeration
3768
Decadal growth rate (1981-91)
percent of urban population
36
Absolute Increase since 1981
58 million
Million Plus Cities
Number of Cities
23
Population
7.067 crore
Percentage of total urban
population
32.5 %
Decadal Inc: ease in
population
1.3
844 million
Class I cities
Number of cities
67.68 %
300
Z'
Population
12.0 crore
Percentage of total urban 64 %
population
2.
Situation of Urban Poor
2.1
Urban Poor
Official estimates
Alternate estimates
51$ million (20.IS
83^ million (40.1s
Part I
Status of Urban Poor in Indian Cities
CHAPTER 1 - URBANIZATION IN INDIA
According to the provisional figures for the 1991 Census, the tc&J popular' i cl
Inaia is 844 million (as of March 1991). The total urban population in imul spren,.. . .-i
4089 tovvns and cities is 217 million. Some of the smaller towns (called census to..as)
are in fact constitutents of larger urban agglomerations. There are 3768 urban
agglomerations in 1991. The absolute increase in the urban population during 1981-91
du..i Jv ii iv tji.-cri of the order of 58 million that is decadal growth of 36 pei cent The
urban population in 1991 is 26 per pent of total population. Even in 1991 the uib.m
population of India is just over a quartpr of the total population. But in absolute terms the
total urban population is very high - 217 million. Inspite of the low level of urbanisation
in India, the urban population of India is almost the same as total population of USA.
I here are significant structural shill in the economy with the share of primaiy
sector declining to nearly one third in the economic output. In the past two decades there
h.-s .... a L\-c!i a noticeable shift in the structure of employment away from primary • >
seccncm\ ana tertiaiy sectors. The uiban population has grown from 109 mill.on in 10-17
io 217 m.Irion in 1991. The total urban population of 217 million resides in 3768 uroa.n
centres. But 23 metropolitan cities (cities with population above one million) account for'.
33 per cent of tne total urban population. These metropolitan cities alongv.ith other 23
ties aso.e 1 lakh population each account for 64 per cent of the urban population.
c.
Inspire of-slower rate of urban growth officially revealed by 1991 census, the population
m M,
bus shot up from 26.4 pci cent to 32.5 per cent, as the number oi :.uc;t c. .....
increased from 12 in 1981 to 23 in 1991. NCU report argued that one should ta-.e ;.
positive -io., of urbanisation in India, and me cities should be regarded as erm :•. ..
economic growth and generators of income and wealth. In fact the NCU cornea
acionvin GEi.V to denote generators'of economic* The objective spelt out by NOU mw
to make GEMs of as many cities as possible and in their prelimiary exercise NO J
identified 329 GEMS spread over 49 SPURS (spatial priority urbanisation legion).
2.5
Manifestations of Urban Poverty
Proliferation of Slums and Bastees
Fast growth of an informal sector
Increasing casualisalion and underdevelopment of labour
Crushing pressure on Civic Amenities
High rate'of educational deprivation and health contingencies
Retarded growth of physical and mental capacities A growing sense of
hopelessness among the urban poor resulting in rising crime rate and grouj^
violence
2.6
Reasons mentioned for Programmes not Reaching the Poor
-
Reasons
Poor
(N=190)
Total
sample
(N=335)
Corruption
Lack of proper publicity
Lack of administrative
commitment, inefficiency
Poor implementation
Political interference
Lack of funds
Beneficiary if defined
31.6
13.2
43.0
19.1
1.6
10.5
1.6
■ 6.8
28.1
23.0
9.2
7.5
5.7
t
•
CHAPTER 2 - SITUATION OF URBAN POOR
2.1
While- the urban centres contribute to nation's prosperity, this prosperity is not
equally shared amongst the urban residents. The urban centres present a strange
contrast of wealth and poverty.
The economic dominance of urfH centre:. :s
accompanied by widespread poverty, deprivation and marginalisation. The uiban p. ,.-i
residents are amongst the worst affepted segments of the urban population. Their
relative deprivation of income, employment and shelter is likely to be further exacerbated
in the initial phase of macro-economic reforms.
<
I
Inadequate shelter is one of the most vivid indicators of relative poverty in urban
areas. It is estimated that 21.2 per cent of urban population (51-2 million persons) lives
in slums. In larger cities 35-40 per cent of population lives in slums. Bombay and
Calcutta also have a large number of pavement dwellers who are denied even their basic
rights of being recognised as a legitimate resident of urban area for want of an address.
2.2
Urban Health Data
While no systematic urban health data exists at present, the information on urban
poor's health and intra urban differentials is still more difficult. The slum based
benchmark surveys have been undertaken by USSR in selected slum pockets of all UBSP
cities but the final compilation and analysis of data is still awaited. Sample surveys in
slums have also been done under National Institute of Health and family welfare in
'Million Plus Cities’ of Madhya Pradesh, Rajashtan and Uttar Pradesh in the year 1991.
Preproject studies including Baseline surveys have been done in the slums of cities of
Calcutta, Bangalore, Hyderabad and Delhi in the Year 1992. These surveys throw some
light on the various health indices of the population living in the slums.
i.
NIHFW Study: A sample of. 400 households having at least one infant was
selected in each city (Bhopal, Durg, Gwalior, Jabalpur, Indore, Jaipur, Jodhpur, Agra,
Allahabad, Lucknow, Meerut and Varanasi). The findings reveal that a significant portion
of surveyed households in all the selected cities of 3 states have 5 or more family
members. Awareness about family welfare services is lowest in Rajasthan. Immunizat.cr,
coverage in M.P. cities was more than 75% for BCG DPT and Polio but only 57% for
measles. In I Mjasthan and UP it was around 50% except for measles. Effective couple
protection rate was 40% in MP, 40% in Rajasthan 33 percent in UP. The major reason
for non-adoption of any family planning method was lack of awareness and because they
wanted more children. Majority of respondents in all states were for opening of new
facilities in their areas for providing family welfare services and providing free medicines
at these facilities. Some 'of the cities also mentioned regarding'behaviour of, staff posting
of lady medical officer, counselling regarding various FP methods and provision of
emergency services at the FW/MCH centres in the area.
ii.
IPP VIII Preproject Surveys - were done in the cities of Calcutta, Hyderabad,
Bangalore- and Delhi. Results have been available from all the cities except Calcutta.
The results show wide variations in the health indices of the slum population in 3 cities.
MCH Case Indices - Infant mortality rate was 100 and under 5 mortality rate was 146 in
JJ clusters of Delhi. The same was not calculated for other cities. Delivery by untrained
Dais was in 74% cases in Delhi while other cities reported 20% and 23%. Maternal
tetanus toxoid coverage varied from 57 pr cent to 88 per cent and maternal care from 55
per cent to 89 per cent. Immunization coverage for BCG DPT and Polio was around 6070 per cent while for measles it was 45 to 60 per cent. The couple protection rate varied
from 35 per cent to 50 per cent. Age at marriage was around 15 yrs and at 1 st child birth
around 16 yrs.
;
iii.
Results of Benchmark Surveys in one of the States
Mother and Child Welfare - Bulk of the females are married before 18 yrs of age. 40-50
per cent of women conceived before 18 yrs of age. Less than one fourth of the wives
and one tenth of the husbands reported using family planning methods.
Summit Goal - 1 - Infant and under 5 mortality
Diarrhoea and ARI diseases have the highest incidence in children. In age group 12-23
months 8-43 per cent males and 10-39 per cent females have not been immunised.
There are wide variations from town to town with regard to use of ORS to prevent^
dehydration from diarrhoea (2 per cent to 76 per cent)
Summit Goal II - Reduction of Maternal Mortality Rate
In some of the towns the report of pregnant women availing antenatal services was as
low as 2 per cent or 22 per cent. In others it ranged between 46 to 76 per cent. The
consumption of iron and folic acid was also on similar pattern. More than half of pregnant
women had not been immunised for tetanus. In most of the towns the assistance of
trainded person for conducting delivery was availed by nearly half to two third of women.'However proportion was quite low in'some towns (3 per cent; 14 per cent). Live births
with less than 2.5 kg weight were less than 10 per cent in most towns. But in some
towns it was 68 per cent, 34 per cent and 45 per cent.
Summit Goal III : Nutrition
Extent of severe malnutrition amongst children below 5 years ranged between 3% and
29 per cent. It was lelativoly higher in girls than boys. Modoiato nialimliition w..s
reported in the range of 19 to 35 per cent in most Towns. The proportion^ children
reporting use of supplementary nutrition was quite low.
Summit Gola IV - Water Supply and Sanitation
(
Household water supply was available to around 50% of households in some towns and
less than 50% in other towns. Generally open space was used for defeca. '.a.
Community Toilet facility was virtually non existent.
Summit Goal V - Universal Access to-Basic Education
Enrollment at primary level ranged from 41 per cent to 58 per cent. Drop out was very
high. At primary level it ranged between 47 per cent to 87 per cent. Enrollment of girls
was distintively lower than boys. Drop out rate was quite high. Non formal education did
not seem to have made significant impact.
Summit Goal VI - AdulLttleracy
"X
The enrollment percentage varies between 0.35 per cent to 5.65 per cent. The proportion
of adults enrolled and still attending adult education centres is disappointing.
Summit Goal VII - Protection of Children in 6-14 years.
The number of children who reported working in 6-14 yrs age group was quite low and
insignificant in all the towns/urban nits physical disability is the most important handicap
from which children suffer. The incidence of handicap in 1-2 per cent.
Status of water supply and sanitation facilities
2.3
2.4
PopulatiorKfovered by
water supply system (%)
82.88% - 1988
Percentage of population
covered by sanitation
(Latrine only)
43.51% - 1988
Percentage distribution of
households by latrines
No latrines
Using shared latrines
Having excessive latrines
36.82
57.60
42.40
Type of latrines
Service latrines
Septic tank
Flush system
Others
28.62
32.72
31.86
6.80
Accessibility of Water Supply in Bastees
(NlUA - 46, 1991)
Average number of persons
per facilities
Shallow handpump
Mark II handpumps
Taps
523
1661
315
Percentage of Bastees having access
to (total 589 in 16 states & UTs)
Shallow handpump
Mark II handpumps
Taps
v
27%
39%
59%
Sanitation and Garbage Disposal facilities
in Bastees (NlUA - 46, 1991)
Percentage of Bastees with Community Toilets
Men
28%
Women
z29%
Percentage of bastees with
rubbish depots
I
--->*•■x..»■> W - IiTLO &
41%
3.
Family Welfare Facilities in Urban Areas (MOHFW &3O!)
3.1
Urban Family Welfare Centres
3.2
3.3
Type I
Type II
Type 111
Central Sector
455
153
933
208
Total
1749
Health Posts for Slums
A
B
C
D
77
84
169
549
Total
879
£
City FWBU
Category of staff required in health posts
Lady Doctor
Public Health Nurse
Nurse Midwife
Mullipuspose worker(male)
Class IV
Computer
3.4
10
509
509
2539
2462
509
509
t_
Other facilities
All India Hospitals Post partum Programme at district and
state levels
India population project - V & VIII
PVOs supported by MOHFW
Health component of CUDP 111
ODA slum improvement projects
CHAPTER - 3 FAMILY WELFARE FACILITIES IN URBAN AREAS
3.1
Urban Revamping Scheme :
A working group on reorganisation of family welfare and primary health care
services was constituted by Govt, of India to give their recommendation for addition,!
requirements for improving the outreach in urban slums. The recommendations of the
working group were accepted by Govt, of India and were sent to various State Deptts. for
consideration and approval. As per the recommendations of the working group, the urban
areas have been categorised into 4 types of Health posts to be established according to
the population. Similarly city PW’Bufeau have also been categorised into 4 types
according to population of the cities. The cities of Bombay and Madras are being
assisted by World Bank under 1PP-V project. Under this 139 health posts in Bombay and
123 in Madias city have been appioved. Uibun revamping scheme was initiated in theyear 1933-84 and upto the end of 1990-91 adminsitrative approval of Govt, of India for
establishment of 936 Health posts and 14 city FW Bureaux has been conveyed to various
state Govts. The respective state Govts, have sanctioned a total of 879 Health Posts and
10 city FW Bureaux upto 31 st March 1991. In addition to these health posts 1749 urban
FW centres old type are also functioning in the country. It was felt that programme was
not picking up to the extent it should have been. So it was decided to assess the
FW/Prirnary Health care needs of urban population (especially slums) and formulation or
suitable proposals for their strengthening. To start with cities with population over jwo.
lakhs (1981 census) were selected for formulation of proposals for strengthening the
Primary Health care, FW & MCH Services. NHFW was assigned with the job. The
institute conducted workshops in various states for collecting necessary information
required to frame proposals for the cities under reference. J4IHFW has been requested
to frame the proposals for the cities under reference as per GOI norms (Krishnan
Committee Report). Other programmes like All India Hospitals Post pan'll Prograr ne
at Distt. and Sub Distt. Level Hospitals; IPP VIII; Health component of CJDP - III;
also providing services in urban areas.
3.2
Problem and issues of Family Welfare Programme in Urban Areas
3.2.1 Lack of outreach : Slum dwellers themselves are reluctant to visit the hospitals
and other health facilities which are available in all metropolitan areas. Ignorance of
Services available; The cost of travelling to these institutions,,*
negative attitude of health ’workers to the urban slum clientale have been identified as
major reasons for underutilization of government supported urban health facilities.
Unregistered private mi dical practitioners who provide mainly curative care lor fees.
The lack of an outreach capability, especially one sailed by Medical and para medical
staff who are not alien to slum population, and who are willing to visit and counsel
orecnant and lactating women and younger couples in their homes in slums, is a major
underlying constraints.
COVERAGE DIAGRAM
Figuie 9
(shows the Interrelalloiishlp of Availability, Accessibility, utilization aifivovniage.
1 lie Ideal cuive should ba vetikIn. 1
actual curve diners accotding to situation;
I
bo veitlcle
1 he
actual cinvo differs according to
3.2.2 Inadequate Training : Pre service training is designed and carried out without
reference to the particular problems of urban slums such as STD, trauma from violence,
alcohol and substance abuse, chronic rather than seasonal bacterial infections
interactiotis, arid rapid spread of contagious diseases (plague, cholera, typhoid, infective
hepatitis). Recurrent inservice training for health workers and volunteers in upgrading
clinical skills, outreach, focussed care priorities or liason with PVOs and PMPs have not
taken place. The major focus of Family Welfare Programme’s training efforts has been
to develop health workers and managers for rural India. The HFTCS, SIHFW (IPPs) and
ANM Trainign Centres all have a rural orientation.
3.2.3 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 predetermined services
to targeted beneficiaries, has meant that recruitment of staff and location of facilities a.e
determined with little reference to the needs and preference of the urban slum dweller.
This lack cf community participation in programme design and implementation has led tol
under utilization; Problem of maintenance and ultimate sustainability of the programme.
The revised strategy of family welfare programme (1986)
calls for more community participation. What is required is formation of slum dwe'C s
groups to give voice to their legitimate demands for health and family welfare services
UESP is an initial step in this direction.
3.2.4 Constraint to participation of PVOs : Bureaucratic hurdles constrain the
transfer of resources from Government to PVOs. The range of problems is so large and
complex that the typically small PVO can only tackle single or smaller dimensions of
urban slum condition. Even when a PVO is successful, replication of their experience on
a larger scale is difficultio achieve.
3.2.5. Weak Information, Education and Communication Programme: lEC
interventions utilizing social marketing and other approaches can increase the demand
for and utilization of health and other social services as well as promote increased
acceptance and use of family planning methods. To do this IEC programme must gog|
beyond awareness generation among target groups to promoting desired behavioral^
change. There is also a need to adopt more focussed, target specific-approach to the
-Use of IEC and social marketing intervention. This involves the development of strong
institutional capability to design and execute meaningful IEC programes; Clearer
definition of the roles and functions of various service delivery functionaries in conducting
inter personal communication-and utilizing mass medial support; greater understanding
of various sociocultural barriers client use of health services; acceptance by programme
implemented of a comprehensive approach to planning and implementation of IEC
programes; better IEC intervention with a strong focus on social marketir'&approac' .is
proved particularly effective in urban audience.
'3.2.6. Limited Female education Opportunities : Poor urban slum girls are having
more limited access to schooling than do upper and upper middle class non slum girls.
Thu problem oi primary education tor females are compounded by the fact that only 30%
of all school teachers are female and only 15% of the schools in country dedicated to
females. Girls school suffer from a paucity of trained teachers, facilities learning
materials, equipment and inconvenient location even when girls are enrolled, several
factors operate against successful completion and achievement. These include;
competing demands on their time; early marriage and pregnancy; lack of positive role
model; poor quality of education of women; direct cost as well as opportunity cost or
schools.
'
-
4.
1995 Goals (MID-DECADE GOAL)
4.1
Infections
1.
Achieving and Sustaining Immunization coverage >80%
2.
Elimination of Neonatal Tetanus
3.
Reduction of Measles
morbidity by 90%
4.
Elimination of poliomyelitis
5.
Achievement of 80% usage of ORT
6.
ARI - Access to correct case management in all health
facilities
mortality
by
95%
and
O
4.2
measles
f■
Nutrition
7.
Making all hospitals and maternities "baby friendly" as
defined by the ten steps to successful breastfeeding
8.
Virtual Elimination of Vit A deficiency
9.
Universal Iodization of Salt
10.
Reduction
of
1990
levels
of
severe# and
moderate
malnutrition by 20% or more
4.3
Safe Water and Sanitation
11.
Increase water supply and sanitation so as to narrow the
gap between 1990 levels and universal access by the year
2000 of water supply by one fourth and of sanitation by one
tenth
12.
Eradication of guinea worm disease.
4.4
4.5
4.6
Education
13.
Strengthen basic education so as to achieve reduction by
one third of the gap between current primary school
enrollment/retention rate and the year 2000 goal of reaching
universal access to basic education and achievement of
primary education by atleast 80% of school age children '.»d
reduction of gender gap in primary education by one third
14.
Awareness of HIV/AIDS among > 50% of the population
Maternal Care & F.P
15.
Family planning services including birth spacing methods
available in all immunization points
16.
Effective emergency obstetric care accessible to pregnant
women in 50% districts
17.
Significant progress towards reduction and elimination of
child labour in 80% of the states
18.
Ratification of convention on the rights of the child
CHAPTER 4 - MID DECADE GOALS
4.1
HFA and Primary Health Care approach :
International conference on Primary Health Care jointly organized and sponsored
by World Health Organization and United Nations Children’s Fund was hold from 6-12
September, 1978 in Alma Ata of the Kazakhstan (formerly USSR). The conference
declared -that health status of hundreds of millions of people in world today is
unacceptable, particularly in developing countries. More than half the population of world
does not have the benefit of proper health care. In view of he magnitude of health
problems and the inadequate and inequitable distribution of health resources between and
within the countries and believing that health is a fundamental human right and world
wide social goal, the conference called for a new approach to health and health care, to
close the gap between the 'haves and have note’, achieve more equitable distribution of
health resources, and attain a level of health for all the citizens of tine world that will
permit them to lead a socially and economically productive life. Conference affirmed that
primary' health care approach is essential to achieving an acceptable level of health care
throughout the world in the foreseeable future as an integral part of social justice. Thus
the goal of Health For All by the year 2000 would be attained.
The package included at least 8 essential elements:
i) Immunization ii) MCH & FW iii) Nutrition iv) Health education v) C.pntrol of major
communicable disease vi) Environmental sanitation and personal hygientMii) Avails: ty
of essential drugs,
cA
G'QAxerAs
The primary health care methodology meant the following :
i)
ii)
iii)
iv)
Universalization and equitable distribution of health services.
Community self management - Planning, implementation and evaluation
Inter sectoral contribution
Appropriate and low cost technology.
The total package could never become the prime concern of the health
functionaries. Different sectoral departments have been involved in implementation of
different activities. To monitor and evaluate the progress of its member states towards
the Goal of health for all by 2000 A.D., WHO has developed 12 Global indicators which
have been adapted for South East Asian Region”:
i.
ii.
iii.
iv.
v.
Health for All is continuing to receive endorsement as policy at the highest level.
Mechanisms for involving people in the implementation of strategies are fully
functioning or are being further developed.
Percentage of gross national product spent on health.
Percentage of the national health expenditure devoted to local health services.
Resources for primary health care are becoming more equitably distributed.
vi.
vii.
viii
ix.
x.
xi.
xii.
The amount of international .aid received or given for health.
Population coverage by primary health care for all identifiable sub-group, with at
least the following :
Safe water in the home or within reasonable access and adequate ex<_ 4a
disposal facilities available;
immunization.
local health services, including availability of essential drugs, within one
hour’s walk or travel; and
attendance by trained personnel for pregnancy and child birth, and care for
children upto at least 1 year of age.
Percentage of Newborn weighing at least 2500 grams at birth, and percentage of
children whose weight for age and/or weight for height are acceptable.
Infant, maternal and under five mortality rates in all identifiable subgroups.
Life expectancy at birth, by gender, in all identifiable subgroups.
Adult literacy rate, by gender, in all identifiable subgroups.
Per capita gross national product.
Goals for Health & Family Welfare Programme; Levels as Quoted in
National Health Policy - 1983
Infant Mortality Rate
Below-60
Perinatal Mortality
Cruet death rate
Pre school child
ncrx.lLty (1-5 yra)
30-35
9.0
(80, urban)
51. 1990
49.6 1990
9.6 1990
10
Maternal Mortality
Below 2
Life Expectancy at
Birth (years)
Hale
64
Female
64
Banies witn birth weight
below 2SG0gm(percentage) 10
CruCc birth rate
21.0
Effective couple
protection (percentage) 60.0
Set reproduction rate
(KRR)
1.00
Growth rate (annual)
1.2
Family size
2.3
Pregnant mother receiving
antenatal case (t)
100
Deliveries by trained
birth attendants
100
58.1
59.1
29.9
44.1
2.03
4.0
60
40-50
Immunization Status
I Coverage .
TT for Pregnant women
DPT (children below 3 years)
100
85
78.16
98.19
Polio (infants)
BCG (infants)
Leprosy percentage of disease
arrested
Cases out of those detected
85
85
98.86
101.51
80
24.66
TB percentage of disease
arrested cases out of those
detected
90
66.00
Blindness incidence of (I)
0.3
4.2
Goals and Components of National Child Survival and Safe Motherhood
Programme:
Infant Mortality rate - from 80 to 75 by 1995 and 50 by 2000
child (1-4 yrs.) monality rate - reduced from 41.2 to < 10 by 2000
Maternal Mortality rate - from 400 to 200/1,00000 by 2000
polio eradication by 2000
Neonatal Tetanus elimination by 1995
Measles - Prevention of 95% deaths and 90% cases by 1995
Diarrhoea - prevention of 70% deaths.-& 25% cases by 2000
Acute Respiratory Infections - prevention of 40% deaths by 2000
4.3
World Summit for Children 1990 :
On Sunday, September 30th, 1990, 71 Presidents and Prime Ministers come
together for the- first World Summit for children. In this largest global summit meeting in
history, representatives from 159 nations made a world declaration on the survival,
protection and development of children. A commitment was made to try and end child
deaths and child malnutrition on the prevalent scale by the year 2000 and to provide
basic protection for normal physical and mental development of all the world's children.
This overall goal was refined into more than 20 specific targets. The plan of Action Tor
Implementing the Goals of the World summit of children in 1990's mandates appropriate
mechanisms for regular and timely collection, analysis and publication of data required
to monitor relevant indicators relating to the well being of children. These are intended
to record the progress being made towards goals set forth in the global plan of action and
corresponding national programmes of action. This global monitoring is expected to fulfill
the following objectives (i) Advocacy for improving the well being of children (ii) Resource
mcoilization (iii) International Corporation and (iv) Managementof National progremmes.
A minimum set of common indicators have been suggested by the UNICEF-WHO joint
committee on Health policy for each of the health related aspects of the child summit
goals. It was recognized that 2000 (HFA) would be a major source of monitoring
information.. WHO has agreed to incorporate the summit indicators into its third HFA
monitoring in order to facilitate reporting on summit goals and reduce duplication.
Wherever feasible, HFA indicators which are already in place have also been adopted for
monitoring the summit goals. Efforts are also on for suggesting appropriate strategies for
desegregating the data on occasional or regular basis. This is important for monitoring
gender and other disparities like urban/rural residence and identifying the urban under
privileged.
4.4
National Plan of Action - Govt, of India : India joined the community of nations
in the successive reaffirmation of global commitment to the cause of children in 1939-90.
The UN convention on the Rights of child in November 1989, the WorldgConference on
Education for All at Jomiten in March 1990, the global consultation on water'-jid
sanitation in autumn of 1990 and the SAARC summit on children soon after the world
summit were all part of this reaffirmation process which transcended national barriers.
India is a signatory to world declaration (September 1990) in the survival, Protection and
Development of children and the plan of Action for implementing it. National Plan of
Action of India identifies quantifiable targets in terms of major as well as supporting
sectoral goals representing the needs and aspiration of almost over 300 million children
in spheres of health, nutrition education and related aspects of social support. The goals
for children are promoted necessarily within the broader framework of national
development planning. The social development objectives of the 8th Five Year Plan
(19^2-97) are population control, employment generation and basic human needs
particularly health care, literacy including elementary education and drinking water which
is closely linked to sanitation.
;g
the
CHAPTER 5 - UBSP APPROACH
half of
;eases
py or
i were
Jases.
better
Jntary
edical
tional
ealth
ries
t and
t has
f the
life.
ALS.
While the 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 3600 cities and towns in India. Nearly one of eveiy three
urban resident live below the poverty line and their ranks grow each year by about 15
million. About 50 million of these people live on pavements, in poorly serviced tenement
houses, in unhygenic slums and illegal squatter colonies. They work as street vendors,
domestic servants, scavengers, small-time mechanics, rag pickers, and perform a host
of other activities comprising the informal sector. About 68% of urban poor are women
and children. They are both vulnerable and exploited. Their largo numbers and
unacceptable conditions challenges both government and private sector to find solutions
to break the cycle of deprivation. It is accepted that a most critical point at which to begin
is with the mother and child. Their survival, development and ability to secure a
respectable place in society is vital. Ensuring that they have access to basic social
services such as health care, nutritional supplementation, education, employment and
income is key to the success in overcoming urban want and exploitation.
While the issue of community participation and community self managemem'
(planning, implementation and evdld'tion has been given adequate emphasis by health
planners, the same has not been seen in practice. The reason is that, during the
education and training the health functionaries have acquired a narrow biomedical or
technocentric view point on the health interventions and the larger issue of behavioral
aspects of health has not been grasped by them. Wherever, there is failure in this,
respect, the blame is always passed on the otherside. The poorest and disadvantaged
groups become the special largest of the criticism of health functionaries.
It would be important to reiterate here that improvement in the environmental
sanitation and personal hygiene, Nutrition and family planning which are essential
components of the primary health care require comprehensive behavioral change at the
community level. For this the implementation structures require a proper communication
planning and strategy. Such is totally lacking today, the present structures are totally
misfit for such a) task (see figure). It is important to realise here that the health
functionaries still claim their responsibility till availability of services only. Their mental
make up is not geared towards reaching the last person in order to achieve effective
universal coverage. The present location and timings also suit the upper strata and the
convenience of the providers not of the beneficiaries. Hence there is a large gap in
availability, access, utilisation coverage and effective coverage.
In order to meet the alone challenges the ‘bottoms up’ strategy o|,,formation of
community structures in UBSP becomes most important. In the iniitSi stage . ;
community is dispersed.
The Community Organiser in interacts with a group of households and asks than Ukenn
to identify volunteers amongst them who will be ready to voice the needs of the
.1
Philosophy of Basic
Middecade Goals
a)
Services
Approach
for
Achieving
the
Mckeown - Dramatic decline in IMR and CSMR in 1st half of
20th century, especially those due to infectious diseases
occured before the advent of modern chemotherapy or
effective immune prophyeaxis. Major causes of death were
diarrhoed, pneumonia and other critical infectious diseases.
Their decline followed trends more consistent with better
nutrition, improved hygiene and sanitation 2nd voluntary
birth limitation with relatively little help from medical
establishment.
View - Health wilLcome as a result of development
b)
Child survival package
<
riding GNP band wagon towards improved national
income does not necessarily lead to improved health
economic growth is slowing in developing countries
we have the means in our hands to reduce infant and
child deaths by 50% or more. The road to health bus
short cuts low cost and appropriate technologies
ORS
Immunization
Family planning
Antebiotics for
infections
Measures to prevent low birth weight
c)
The UBSP approach is a MIXTURE or MIDDLEPATH of the
above two. Its ultimate goal is to improve the quality of life.
In the process it also aims to achieve MIDDECADE GOALS.
5.3
The community participation continuum
i)
The 60s Model Passive
ii)
The 70s - 80s Model Interactive
iii)
The 90s Model Dynamic
communities and take the important messages to them. In this way one RCV is identified
for 20-40 households and she acts as two way communications channel between the
residents and the providers. These RCVs are provided the necessary training and
orientation. 10 RCVs form a neighbourhood committee (NHC) and elect its governing
body. These leader RCVs become the representatives and spokes persons for the
community, and articulate the needs and demands of the community in different forums
and with technical help, make mini plans for the NHC. Depending on the geographical
location the different NHCs may come-together to make a community uavelopmr. 1
society CDs and pool their miniplans to form a community plan. Thus a ground
prepared for rational action by different sectoral departments for efficient investment of
their resources according to the needs of the community, the maintenance of the assets
by the community, community contribution and not merely quantitative inputs but
improvement in quality of the goals. Without simulating the above process at the ground
level, the planners grope in the dark, and leads to inefficiency allocation and utilization
of resources, no maintenance and low quality.
-ln
H£Alth pepawtst^vctuqls
freSerA
TAecAVcoL
o^-V'CCF'
UocAy \AeS CAV\ VluLr
huxXQAarN WrLe-
Auxxttary VAurie
GHVJ
/
CorrxfnurxAy
/■
U&SP STRUGTUR.E.S-1
UBSP OUTLINE 7 STRUCTURE
1/20.-25 HH-200 PEOPLE
RCV
(Resident
Community Volunteer)
NEC
(Neighbourhood Group)
’ “
NO. RCVL-200.-25Q HUE1000'PEOPLE
[CD society leader (s)
*C organizer (1/10,000 people')
health, public health, education, social welfare,
UFA, Water etc. officials]
DUDA : COLLECTOR' 4- DISTRICT STAFF
.AND CITY REPRESENTATIVE (s)
SUDA : STATE’SECRETARY stall' of State Departments
AIMS OF UBSP
AS PER THE REVISED GUIDELINES, OBJECTIVES, OF UBSP ARE:
1.
TO
EFFECTIVELY
ACHIEVE
THE
SOCIAL
SECTOR
GOALb
INCLUDING THE NATIONAL PLAN OF ACTION AND THE Mid
DECADE GOALS.
|
2.
TO ESTABLISH AND SUPPORT SELF-RELIANT COMMUNITY BASEL
WOMEN’S AND OTHER ORGANIZATIONS.
|
3.
TO PROMOTE CONVERGENCE THROUGH SUSTAINABLE SUPPORT.
SYSTEMS.
I
ALL ACTIVITIES SHOULD ENSURE PARTICIPATION OF THE TARGET
GROUPS IN IDENTIFYING NEEDS, PRIORITIZATION, PLANNING,IMPLEMENTATION, MONITORING AND FEEDBACK.
’i
CONVERGENCE OF APPROPRIATE GOVERNMENT SCHEMES AND'
4.
"
6.
7.
"
PROGRAMMES TO ENSURE THAT THE URBANfy POOR
4RE
SPECIFICALLY TARGETTED AND REACHED.
(THIS
INCLUDES
CONVERGENCE
OF
ALL
URBAN
DEVELOPMENT/UPA PROGRAMMES).
CHILD-MOTHER FOCUS TO ENSURE THAT THE MOST VULNERABLE
AND POOREST GROUPS ARE TARGETTED.
PROGRAMME COVERAGE TO BE EXTENDED TO REACH aUL URBAN
POOR,
INCLUDING
THOSE
LIVING
IN
SMALL
SCATTERED
CLUSTERS
AND
COLONIES,
UNDEVELOPED
SETTLEMENTS,
PAVEMENT DWELLERS, STREET CHILDREN AND ANY OTHER
RELATED CATEGORIES WHICH ARE UNDERSERVED BY ONGOING
PROGRAMMES. SPECIAL ATTENTION TO SC/ST/BC AND OTHERS
AS IDENTIFIED IN RESPECTIVE STATES TO BE ENCOURAGED.
T-4
UBSP QUTLINE: STRUCTURE
EACH SLUM COMMUNITY,
BASED ON THE LOCAL NEEDS AND
RESOURCES,
MINI-PLANS
AFTER
PREPARES
APPROVAL
THE
FROM
AND IMPLEMENTS
HIGHER
THEM
BODIES.
LEVEL
BY
INTEGRATING THESE MINI-PLANS OF ALL SLUMS, A CITY PLAN OF
ACTION IS FORMULATED.
AT THE TOWN, DISTRICT, STATE AND
NATIONAL LEVELS, THERE ARE COMMITTEES FOR COORDINATING
AND MONITORING THE PROGRAMMES REGULARLY.
HOWEVER,
THERE ARE WIDE VARIATIONS IN THE NATURE AND COMPOSITION
OF
THESE
COMMITTEES
AT VARIOUS
IN
LEVELS
DIFFERENT
STATES.
CENTRAL TO THE UBSP PROGRAMME IS THE NEIGHBOURHOOD
COMMITTEE,
THE
COMMITTEE
IDENTIFIES
z
NHC,
SERVING
THE
200
EVERY
NEEDS
OF
FAMILIES.
THE
THIS
COMMUNITY,
PRIORITIZES THEM KEEPING IN VIEW THE RESOURCES, PREPARES
AN ACTION PLAN AND IMPLEMENTS IT AFTER GETTING APPROVAL
FROM THE CITY COMMITTEE.
THUS, DECISION-MAKING IS BASEDON THE COLLECTIVE WISDOM
OF THE PEOPLE. THE NHC ASSUMES LEADERSHIP AS WELL AS'
RESPONSIBILITY ONASELF-HELP BASIS FOR THE WELL-BEING OF
THE
COMMUNITY.
ONE
RCV
FROM
EVERY
15-20
FAMILIES
REPRESENTS THEM IN THE NHC.
EACH MEMBER OF THE
COMMITTEE LOOKS AFTER AN IMPORTANT ACTIVITY %KE HE. _.TH,
EDUCATION,
NUTRITION, ETC. AND TRIES TO ARTICULATE
PROBLEMS
OF
IMPLEMENTATION.
THE
PEOPLE
AND
THEN
ENSURE
THE
ITS
1-mPOWERMENT OF COMMUNITY, ESP.WOMEN
■
ONE OF THE MOST IMPORTANT FEATURES OF THE NHC IS THAT
THE WOMEN
OF THE COMMUNITY
MEMBERS
CONSTITUTE
THESE
COMMITTEES. THIS WAS A CONSCIOUS DECISION TAKEN, BASED ON
THE FOLLOWING:
HEART
THE
AND
SOUL
OF
UBSP
IS
THE
ORGANIZATION
OF
WOMEN AND THERE IS NO UBSP IF THIS IS MISSING.
UBSP
IMPROVING THE QUALITY OF LIFE OF THE
EMPHASIZES
URBAN POOR, WITH SPECIAL FOCUS ON WOMEN AND CHILDREN,
9
WHO CONSTITUTE 68% OF THE URBAN POOR.
THE
PROBLEMS
OF
WOMEN
&
CHILDREN
ARE
BETTER
UNDERSTOOD AND MANAGED BY WOMEN THEMSELVES.
WOMEN ARE THE POOREST OF THE POOR AT THE FAMILY LEVEL
AS THEY ARE SUBJECT TO EXPLOITATION AND DOMINATED BY
MEN IN POOR FAMILIES, DUE TO THEIR LACK OF EDUCATION AND
FREEDOM.
STATUS
OF
WOMEN
CAN
BE
IMPROVED
EFFECTIVELY
BY
EMPOWERING THEM.
COMMUNITY INVOLVEMENT AND PARTICIPATION
KEY AREAS OF COMMUNITY PARTICIPATION ARE:
FORMATION OF NEIGHBOURHOOD GROUPS
SELECTION OF RESIDENT COMMUNITY VOLUNTEER (RCV)
DETERMINING NEEDS AND PRIORITISING THEM.
DECIDING INPUTS (SERVICES) AND WHO SHOULD PROVIDE, I.E.
CONVERGENCE/COMMUNITY/AND/OR
UBSP
&
FINALIZING MINI-PLANS
IMPLEMENTING THEM
MONITORING AND EVALUATION
/
6.
Municipal Government As Nodal Agency
6.1
Historical role of Local City Govts, to the health of the cities
Health of the towns movement 1840s & 50s bottomsup affair
Role of Municipal Govt, in Independence movement
6.2
74th
CAA and
municipalities
6.3
Orientation to municipal officials and corporators in
devolving
of
powers
and
functions
to
Middecade goals to be built up in decision making process
high degree of public participation and control in decision
making
sensitization to the needs of urban poor
6.4
Preparation of city plans for urban poor
CHAPTER 6 - MUNICIPAL GOVERNMENT AS NODAL AGENCY
,
rffalr
to
ess
'ion
The major institutional requirement for city health care seems to be to accord
primacy to municipal authority, with supportive roles for the central and state
governments, voluntary agencies and major employers. It is necessary to formalise these
interests under a City Health Authority with responsibilities for planning coordinating,
financing and evaluating a medium term city health plan drawn up in tune witn
government planning cycle. The nodal administrative agency for implementing city healtn
plan should be the city municipal corporation with responsibilities for ^-erse sen ces
such as : service provision (environmental and preventive health), facilitation (pn."-•t.ry
health) and coordination (curative health). It would be necessary to have a legislative
back-up to cover the planning regulation and implementation tasks of city health care
services in tune with social development under item 3 of the 12th schedule of 74th CAA.
Similar approach is adopted through the creation of a community development
wing 'within the municipal corporation, working under the technical staffing, materials and
other parameters of cognate municipal funacional departments, such as water supply,
engineering, health, education and so on. The obvious level of decentralisation of city
services is the municipal wards with a population of 30,000. The municipal community
development department need to be located at the ward level to mobilise political support
(councillor) with administrative and functional back up from ward officer.
All
neighbourhood (and slum area) services need to be coordinated from the ward offices of
city community development department. At the neighbourhood level, there is a need for
networking with a number of community based organisations and voluntary 'workers to
supplement the extended municipal services (one ANM and two VHWS suggested by K.
committee for urban PHC).
v
The multipurpose community development for undertaking urban PHC is preferred
in view of demonstrated success of the urban community development experiments in
Hyderabad under UNICEF assistance and in Indore under British ODA support ■:
responding to the needs of urban PHC. This is also borne by International e.xperiem. <_■
as summarised below:
community development approach can be effective in meeting the social and
health needs of the urban poor in a cost effective manner
despite poverty, it is often possible to mobilise resources from the slum community
by sensitive community workers
““
the key to success in community development is the staff who are to be properly
selected and trained
need for coordination is critical for most effective use of community, local
government and external resources
the importance of certain basic linkages among physical and social programmes.
voluntary organisations, the communities and slum residents with formal financial
institutions.
7.
Convergence in terms of intersectoral collaboration
7.1
Intersectoral collaboration is inherent in all sectoral programmes
today:
i)
ICDS
ii)
Health - (Eight essential components, primary health care
methodology, stress of female education and empovyerment
in family welfare programmes)
iii)
Education - Basic learning needs - besides literacy,
numeracy, health education, education- for skills training,
cultural tradition & ethos)
iv)
SCP - 10% of all departments expenditure on reaching the
poor
But it is not the actual perspective of implementers today.
needs to be recognized and changed
This
7.2
One department may be given explicit recognition as voice of
urban poor by all other departments
7.3
Area level planning, at wd level should become part of every
departments administrative activity
ii
Part III
UBSP Programme
Community Level
The Neighbourhood Group is the smallest
community
level
within
the
UBSP
programme framework. It comprises of 20
to 25 households. There are 33568 such
groups in exsistence.
Each Neighbourhood Group selects one
Resident Community Volunteer, usually a
woman. A total of 33568 RCVs have been
selected so far.
Ten RCVs comprise a
Development committee.
such NHCs in existence.
I'^LighboiC - ood
There are"3-109
A slum unit of about 2000 families forms a
Community Development Society.
There
are 247 CDS registered till 1994.
460
Community Organizers,93 Project Officers
Chapter 9 - UBSP Programme Coverage
In order to achieve the universal and equitable coverage of 240 million urban population
in India the urban health planners must focus on the 54 million slum population in the
3696 cities and towns in India. In this overall context the following, information about ii.x
UBSP will be important for the urban health planners at the National, State, District ano
City level.
9.1
Extent ot Programme :
UESP at present is intensively working in 280 cities of the country in siurnpoci.'
having a total population of 5 million which is 9.4% of the total slum population or t.w
country.
9.2
UBSP Functionaries
. Besides the grassroot voluntary workers UBSP has the support of full time paid
functionaries which are called community organizers and project officers. At present there
are 460 community organizers, each covering about 10,000 population and 93 Project
Officers. It is expected that in nearfuture, in many of the slum areas the NHCs and CDs
will take over partial responsibilities and COs will be free to move to newer areas for
formation of community organisations.
9.3
The Bench Mark Surveys
The reports of Bench mark surveys are being aggregated at the state ano central
levels, it would be interesting to have a look at some of the trends which show large gap
which exists in the health status of slum population and the coverage of the National
Goals. The benchmark data have become a ground of discussion in several cities and
states between state departments of UBSP and health deptts. However in many
instances the health deptts. have yielded ground and tried to extend trie necessary help
to UBSP to improve immunization coverages in these areas (see case studies).
9.5
Municipalization of Progrmme: The preventive and proniotive health have been
the traditional responsibilities of the Municipalities. The Municipal structures have played
a big role in sanitation and provision of clean drinking water to urban citizens. Each
municipality have sanitation and CD departments under them.
O'
,
In many cities, the UBSP is trying to work directly with the municipal sysN'-^md
this approach has paid rich dividends.
9.
UBSP Programme - Coverage
9.1
Coverage of Class l-VI cities
City
Total no.
UBSP coverage
Class I
300
145
Class II
345
58
Class lll-IV
3051
77
Total
3696
9.2
280
Slum pockets
2742
Coverage of Slum Population in Different Class or Cities
City
Percentage
(Total)
Percentage
(UBSP Cities)
Class 1
9.6
20.7
Class II
10.6
56.8
Class lll-IV
6.7
76.5
Total
9.4
22.7
~~~x___________________
Total Urban Population 23,87,65,122
Total Slum Population 5,35,43,982
Population Coverage in UBSP - 50,17,237
CHAPTER 10 - CONVERGENCE EFFORTS IN UBSP
10.1 The City Plan for Poor : From its focus on selected clusteis in selected cities n
the iiu.cpion stages, the UBSP is giadually progressing to the City level appiouch, t,
prepare- city level plan for the urban poor such plans have already been pi epare J in ma:
cities and other cities are in the process. A National Consultation on city plan tai pcoi
was held at N1UA on May - 1994 to have a look at this process. In the icvise t N.iti..- ic.i
UBSP guidelines, the recommendation has been made for adopting a city level approach
in order to achieve total coverage in the city. The city level plan aims to analyse me
present availability and distribution facilities in order to set up an agenda. It aims to bring
together all the sectoral inputs at city level in order to attain the universal coverage.
10.2
Training and Communication (UNICEF support)
in order to train the 30100 RCVs to become 2 way communication a_ :ni, network
of Training Institutions has been created all over the Country. To date 11 FTIs have been
functioning. Two national Institutions NIUA and RCEUS Hyderabad have been assigned
the task of Trainers the trainers for UBSP.
Tiie FTIs are Responsible for training a Network of TOCs - ‘Trainers on calls' in
eacn of the 280 cities who in turn will train the RCVs to spread the messages to the last
households.
10.3
Advocacy and Convergence (UNICEF support)
STIs are responsible for inviting the middle level and senior officers, municipal
officers and municipals councillors to orient then in UBSP. These STIs have been
instrumental in mobilizing the support and level for the programme.
10.4
Research (UNICEF support)
ImpuiUuil research studies have been conducted and documents have been
brought out on Uiban Poor, women and children.
i’c
In addition communication material has been prepared for the RCVs in me form oi i .ash
cards.
Audiovisuals in different languages have also been prepared. An operational manual of
UBSP and Training Manual arc the next on agenda.
10.
Convergence efforts in UBSP
Community level - Mini Plan<Snd Community Plan
City level - City Convergence Plan
Distt. level - DUDAs
State level - SUDAs
Central level
National consultation on coverage of programmes for
urban poor - Feb. 1994
Formation of Interministerial task forces (pending)
UPE programme of P.M.
CHAPTER 11 - CASE STUDIES IN UBSP
itbe important to give some examples of the UBSP activities in selective cities
to create a live picture of the UBSP strategy:
11.1 Kanpur City: 16 Community Development Societies and 160 Neighbourhood
Committees have been formed in Notified slums of Kanpur in order io icach 32,000
households or 1,60,000 population.
NGOs are being promoted io work in the
unauthorised slums. One of the most discesnible feature of the programme is construction
of Jansuviaha Complexes of a very innovative design made by the Non-ccnventional
Energy Development Authority (NEDA). Till date 13 such complexes have Peen made
operational, where none had existed earlier. This effort has the potential to provide total
solution to a problem which had defied all solutions in the past. The maintenance of
these complexes is excellant, for this household pays Rs. 15 per month. The RCVs have
been given training in immunization, nutrition and family planning. The pie-school
education and non-formal education is being given in newly constructed community
centres in tr.ese slums. The local Dais have also been trained. The women mwe m en
given skills training to improve household income. The management oi cnwienm. ..ml
->iui. in /a in '.luni Imamus is being slowly taken over by CDSs. Part-time Medic.J Officers
have been recruited to provide facilities of treatment of minor ailments and easily
accessible regular health checkups. Encouraged by the success of the programme in
reaching the Slum Bastees, the City Municipal Commissioner has i.given the USAID
family welfare programme for planning and implementatin in Kanpur City to UBS deptt.
entrusted them with responsibility of pre paring and implementing a development plan
icr Valmiki Bastees in Kanpur, iii. Even in Non-slum Areas, the UBSP deptt. has been
asked to help in formation of community groups for management of environmental
sanitation.
11.2 Bhopal: The CDSs formed in squatter settlements of Bhopal by UBSP nave been
instrumental in improving the provision of drinking water in slums^y installation of India
Mark II handpumps and Weiler tanks. The low cost sanitation scheme for constructing
oouoie pit latrines is being implemented by 'Sulabh' in Bhopal and CDSs have been
playing active role in motivation of residents. Other activities like immunisation ana
preschool education are being promoted. The CDSs provide the route for health Deptt.
to improve immunization coverage in these scattered squattered settlements.
11.3 Jaipur: Benchmark surveys done by UBSP provided the data indicating low
immunization coverage in the slums of city of Jaipur and other cities of Rajasthan. Arter
initial hesitation Health deptt has accepted the fact and now immunization camps are
Luing organized in the slums jointly by health department and UBSP department. UBSP
is not only providing the vital support of motivation at community level but the gap in
provision of medical personnels etc. are also filled in by the medical officer attached with
me department. The presence of a Medical Officer in the UBSP cell of State Government
rias facilitated the convergence with the health department.
..
11 ■ ■ ■ .....limit The Residont Community Volunteers and Dais are bum-j tramc-d i t. .
Icc.t. . .C.Cs and trfercby the health messages are reaching to every fioasc-itold’in the
s! •- ui Clu.-.ahati and nearly townships. The CDSs members have
luiea n.
tv i. .....
wooden pavements in a slum bastee located in marshy kind. Lov. cc t
co.i:y toilers have been constructed.
11.5 Sniiong: The RCVs have oeen trained in Diarrhoea management in scattered and
OLii,.,ig lum arcus of Shillong city. This knowledge has proved vital in prevention of
dumi.s m.mng outbreaks of gastroentitius
11.6
Pulse Polio in Delhi and Ranchi
Inspite of almost 70% coverage of UIP, the city of Delhi had continued to report
now
. of polio in recent pasjt. Inspired by the success of 'Pulse Pciio Strategy’ in
iimr.ii.g Latin America a Polio free region, the newly elected Government or NCT ot Delhi
oc-c.aed to try this strategy in Delhi. Perhaps for the 1st time in thw?nstory of the city, a
learn of about 50 Doctors launched a programme of direct maH contact' yn the
ro_.ucr.ti of the city to build up a campaign. They went around contacting the Ml.As. the
NGOs and social organizations, local resident Associations, Schools etc to (^c
orie. .union on the campaign. The UBS department of Delhi Governent with its network
in Delhi JJ Clusters provided the vital linkage to reach the slum households. Another
important initative was taken by National Institute of Urban Affairs and a group of MGC'S
to press upon.the idea of Zonal Planning for Pulse Polio. The Co-ordinating officer of
pulse poiio in south zone set down with NGOs, resdents associations, CEOs and
Government Doctors to divide responsibilities on area Basis in the entiie Zone. This
excic.se was found very useful in proper implementation, motivation and avoiding
unnecessary duplication and confusion. It is estimted that on 2nd October and 4th Dec.
S0% coverage of Children with polio vacine was achieved.
Inspired by the response to this programme other states and cities have also
shown keen interest. The most interesting features was the voluntary ciicrt undertaken
by ir,Bastee Vikas Manch of Flanchi. Watching the advertisement c/iwievision, the
leaders of this Manch which had been formed under UBSP programme in Ranchi dec,; - .i
to ur. . snake pulse polio programme in all the slum bastees of Ranchi ha. ir.g a populate,i
of ..or..,.-. 2 lakhs. Since the Manch has its network in all the slum Bastees, it incurred.
expci.d.ture on the programme. The vaccine was provided by the hernia department
Ti,L i.-, one extreme exchange of a true ‘UBSP effort’ by community puit.cipmic.i mi:
convergence.
11.7
Giner efforts in Delhi
in |..ust epidemic phase of 1938, the Area volunteers of UBSP programme
undertook the gigantic effort of building a campaign for prevention of diarchcea deaths
in JJ clusters of Delhi (population 2 million) by health education and provision of c.— .ins
tablets and ORS packets. They have also been instrumental in impioveme.it or
immunization coverage and monitoring of Environmental sanitation or JJ clusters. At
present in 11 JJ clusters the CDSs have been formed and efforts are nri : mad--aoopt a Oily level approach for JJ clusters in collaboration with IPP-VIII
Train: ■
in working with Community has been given to Medical Officers and ANMu of 1PP Vli">
Deli,, by NIUA.
Efforts are being made tn promote., the- idea of mini oj-.n "i
k'v'< community luvd at Bustoc- level and' Area Plan ..u the‘level r't
dun,.., J Dene instead of pie-sent centralised planning for one crore pcpuim.cri. ~ *
CHAPTER 12 - OPERATIONALISATION ISSUES
12.1 Urban Information:
12.1 1.
Iln.- fuel II i. it ui bun n ilon nution base are virtually non exist m it ii i our coui ,tr\
is a symptom of a morphous nature of our current urban planning practice including ui uno
hc-.alth planning. It is important to realize that this specific and syi'^oimtic
'ie:i_or
urimii—hi aith planning process must come before an information base can be
atea.
It is not possible to create an integrated information system which can help to make uroa.i
health planning systematic. Data or observation which comprise an information system
do not exist in vaccum, they are purpose specific. They have to be gathered with
reference to a view point, a specific frame of mind-paradigm. Information for urban health
planning, therefore can only be obtained when this framework is defined, that is act of
planning is made explicit and each task of planning process identified.
Good basic health information should be seen as a resource for health and not as
unnecessary expense. A shared agenda needs to be developed between public and
health workers based on real information and raising of public awareness with the help
of mass media educational institutions and cultural and social centres.
Information about diseases, health and quality of life can be major driving force for
change. The little information currently available is often not used effectively to fuel the
dialogue that should take place between politicians managers, health care professions';
and public about most appropriate services and their location. There is a need to?
appropriate local level epidemiology and the aggregation of information to different levels
for different purposes.
12.1.2.
Intracity differentials
Health problems of urban poor have a complex etiology but the^ are icoteu
poverty itself. Relevant information that would make it possible to assess the extant at
various problems and take adequate remedial measures is not available in most cases.
Data concerning urban poor are either omitted from official statistics or aggregateed with
data from more affluent areas. The use of city wide statistical average often hides
enormous variations between different neighbourhoods. More local intracity compans.T1. .s
should be developed to enable interventions to be more effectively targeted.
12.1.3.
Disaggregation of disadvantaged people
There is need for positive and selective identification of vulnerable
individuals and families. There is a wide heterogeneity of disadvantaged groups. Not all
of the urban poor live in slums and not all who live in slums and shanty towns are poor.
Information should be specifically built up for the following disadvantaged groups.
Part IV
Operationalization issues for total coverage
i)
ii)
iii)
iv)
v)
vi)
12.1.4.
a.
b.
c.
d.
e.
f.
g.
low paid and unskilled workers
unemployed and underemployed
multichild families v
Orphaned families
chronically sick and elderly persons
mentally or physically handicapped
v
Relevant issues Regarding Monitoring of Summit Goals
Most developing countries do not possess inbuilt monitoring systems. Large
surveys at periodic inten/els are hence unavoidable. Cost etfectivity of these
surveys, quality and sample selection are important issues which require attention.
Adequate political and administrative will is required to absorb truth and impute
remedial action.
When such surveys are planned, there is generally a mixing up of process
indicators (coverage) and outcome indicators like I MR and nutritional status which
requiie a time lag to improve.
In order to monitor progress, concrete markers to define *** change are urgently
requested.
It is difficult to monitor all indicators in all countries. Prioritisation should be
considered institution specific manner.
In the context of community participation, the alterntive approaches need to be
searched for Monitoring and evaluation.
Averages mark the true picture and needs of most disadvantaged groups.
Disaggregation of information is important. Separate micro sample needs to be
drawn for *** disadvantaged group in surveys.
12.2. Role of Health Centres
For health centres to fulfill their commitment to catchment area and population
coverage, it is essential that they should be based in accessible places which are
appropriately networked to both community activists and other salient community facilities.
Well located facilities are well used by local populations. However, cultural acceptability
is also an important aspert of this question and participation of local population in Health
centre construction and development should ensure optimum cultui ^lelevanc^ tnd
population involvement and coverage. Health centres should have criteria suC.-as
travelling time by foot or by motorized transport - and should be concerned with reaching
out to population as much population being able to reach them.
i
ii.
iii.
health centres should be at the heart of equitable health development for their
catchment populations in the context of district and national health system.
they should have medical and health staff who are adequately prepared and
motivated for leadership and community focussed health development, and should
be centres for multiprofessional training
they should involve community/users as equal partners in planning, management,
resource use and decision making (co-management)
iv.
v.
vi.
vii.
viii
ix.
xi.
they should provide high quality service from a judicious mix of national and local
priorities established in dialogue between the health system and community,'users
they should receive priority financing from all available sources with public funds
directed at addressing problems affecting equity
they should be able to attract and retain local resources, including community/user
financing
They should manage an appropriate information system which allows regular
feedback and monitoring sessions with community/users and be a priority location
for research into service performance, disease/problem surveillance and household
health behavious based on a set of specific indicators
N
they should promote Jnvolvement and actions of other sectors in health
improvement
they should be supported by district level teams endowed with sufficient skills ano
resources and by an enabling and legal framework
they should evolve towards addressing broader social and environmental |).n
as the local epidemology changes and as resources allow.
Link Worker: Three options are available
i)
CHW paid (just as in urban revamping scheme & IPP
pcjecs)
ii)
ICDS teacher
iii)
The NHC formed by a group of Resident Community Volunteers, •«». ithout
prejudice to the virtue of any of the above, it must be said that from the point of view of
community participation the NHC approach appears to be the best bargain. An
experience with CHW has brought out their following limitations:
i)
isolated from the community, propagate the point of view of meaicai establishment
ii)
press for more curative work
iii)
the honorarium does not satisfy and demand more,
iv)
get bog down in record keeping.
12.3
Though at the initial stages these community health workers may be used, but om;
temporarily,"since most of their responsibilities can be taken over by the NHC easily.
ICDS teachers have the same limitations in this respect. So the NHC approach can be
the only bargain in the long run. The time and effort spent in community to stimulate the^
process is worth the output.
12.4
Municipal Level
a)
b)
c)
It is important that Municipal system is involved especially at ZHO level/sanitation
linkage.
City level/Zone leave/ward level plans should be prepared.
Involvement of citizen’s committees, all the citizens of the city is sought in the
health efforts.
(The pulse polio efforts has proved that it was possible).
,
12.5
Distt. Level
The sectoral deptts. should make the necessary efforts for convergence
A Distt. Plan for urban population should be prepared
disaggregated data base for Distt. level should be prepared.
12.
Operationalization for total coverage of urban poor
12.1
Intersectoral coordination - central state and distt. level
MOHFW (esp.)
Urban revamping scheme
All India Hospital Post Partum Programme
Urban Family Welfare Centres
India Population project (V & VIII)
MOUD (esp.)
UBSP programme, Slum Improvement projects)
MHRD (esp.)
Primary education
Non-formal education
Adult education
*3
Department of women & child
ICDS in urban areas
12.2
Municipal Level
Sensitization on Mid decade goals. Z HOs and Sanitary Inspectors to play more
active role in working with communities. EIUS - engineering deptts to involve
community
Primary teachers: Parent Teachers Associations
Formation of citizen's groups at ward, zone and city level on the issues ot women
and child
12.3
Community Level
a)
UBSP functionaries to sensitize other field functionaries (ANMs, ICDS
teacher, sanitary inspectors, primary teachers, Jr. engineers) on we. in.
with the community.
b)
other field functionaries to provide technical support in UE3SP areas
(orientation of RCVs by Doctors, Teachers, engineers, anganwadi teachers)
c)
Sectoral Depth at Distt. level to ensure supplies (Immunization, Dai kits,
OHS packets, oral and conventional contraceptives, blackboards & S'.aik,
ironfolic acid tablets, vit A, weighing machines)
d)
specific messages and concrete tasks with reference to each rniddecad?
goal to be defined at community level and responsibilities assigned
e)
involve NGOs, PMPs, social activists and non-poor citizens of the city.
"X
Community level . ’) Implementation activities
Health Education/
V La
—■ y
|
Other specific tasks /
1. Neonatal Tetanus
Awareness of Neotanal Tetanus
in community
availability of sterlised blase
and thread with each pregnant
woman, training or TBAs
2. Immunization
Measles
Pcliornylitis
Stress on total coverage in
community for the immunization
to be effective esp. for
poliomyeltitis
- follow up visits alter
immunization
- distribution of Crocin
tor fever
- Care of
abcess etc.
3. Vit A
locally available cheap sources
of Vit A
availability of Vit A solution in
community
4. Use of ORT
ORT as preventive of
dehydration use of home made
fluids appropriate refessal
availability otQpS packet
community
5. Baby friendly Hospitals
Need for continuing breast
feeding as long as possible
breast milk doncrs(?) in
community creches at work
site
6. Malnutrition
stress on nutrition of adolecent
girl, pregnant mother
locally available weaning foods
availability of weighing scales
and regular growth
monitoringriron folic acid
7. Family planning
counselling on use of specific
spacing methods
community based distribution
of contraceptives
8. Em. Obst. Care
awareness of high risk conditions
antenatal, natal & post natal);
where to go in emergency
common fund for transport in
case of obstetric emergency
9. ARI
Identification of Pneumonia in
children
availability of sept, an taolets at
community level
_]
■
Part V
Recommendations
12.4
12.5
Information
a)
Rapid assessment methods to be used for collection of disaggregated
information in the city (slum and non-slum areas) and intra-city differentials
to be highlighted for advocacy of the poor
'L-
b)
Quantitative and quantitative information to be used for micro and meso
planning
Training and Communication
a)
All sectoral functionaries to be specially oriented on the situation, special
needs and perspectives of the urban poor so that planning is done on that
basis e.g.
location and timing of facilities
emphasis on nonformal education
choice of contraceptive by urban poor women
12.6
b)
Messages to take the perspective of urban poor women in account
c)
The emphasis on theatre, role play and mass action techniques to restoi e
the self image of oppressed urban poor women, break the silence and
restore self expression
Resources
a)
Restructure the patterns of expenditure tertiary ca^fe to primary career rick
and mortar to nonformal methods in education
b)
mobilization of community resources (labour, time, place)
14.
References:
1.
l-tichards P.J. and I homson A.M; Basic Needs and (ho Uibun Pooi : The pioci: mn
cf communal services 1984, ILO.,
2.
Ministry of I lealth and Family Welfare GOI Annual Report 1990-91.
3.
Interregional Meeting on the Role of Health Centres in District Health System
Surabaya, Indonesia 1994 - Draft Report.
4.
National Plan of Action - A commitment to child GOI department of Women and
Child 1992.
5.
Urbanisation in Developing Countries
Basic Services and community participation edited by Bidyut Mohanty - Institute
of Social Sciences, New Delhi - 1993.
6.
Community based programmes of Urban Poverty alleviation in India - Dinesh
Mehta, NIUA-1994.
7.
Family Welfare Project for Urban Slums India - World Bank document.
x
8.
>
Alma Ala-1978 Primary Health Care WHO-UNICEF.
9.
National Plan of Action: A commitment to the Child GOI Dcptt. of Women and
Child Development.
10.
Indicators for Monitoring Health Gouls of the Woild summit tor children - Di. UPS
Sachdev
Current concepts in pediatric - 1994.
ana uie Level
ul
W/(-Ji Not Reported/Not Available.
TABLE 15 INDIA: REVENUE RECTnPTS/EXPENDIIURE CP MUNICIPAL BODIES (NON-PLAN), 1986-87*
States
Total
Receipts
Expenditure
Per Capita
» Distribution of Receipts
( ■000 Rs.)
Internal
Sources
External Sources
Taxes
Ncn-taxes
Grantsin-aid
Shared
Taxes
Receipts
(Rs.)
Expenditure
Others
Andhra Pradesh
Assam
Bihar
Gujarat
Goa
674084
6134
12390
750948
10376
585193
8447
21560
721832
5998
26.29
29.49
30.48
64.41
21.95
23.63
61.84
16.59
10.54
21.05
26.50
5.20
38.86
13.98
38.45
11.23
2.64
NR
4.35
NR
12.34
0.78
14.09
6.62
18.56
134.38
11.12
19.56
256.83
211.79
116.66
15.31
34.04
246.87
122.43
Haryana
Himachal Pradesh
Jarrmu & Kasimir
Karnataka
Kerala
125877
36835
105991
421526
130655
109593
32075
66383
482331
170992
49.89
31.56
33.59
54.81
63.42
20.70
29.79
7.29
19.76
20.20
21.98
10.86
58.55
2.84
5.82
0.67
NR
NR
7.75
10.56
6.75
27.79
0.57
14.83
NR
115.46
450.91
121.74
123.62
66.07
100.52
392.65
76.25
141.45
86.47
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Nagaland
134591
1914041
1144
9667
NR
175387
1677297
NR
9576
507
42.05
59.54
2.79
29.67
NR
14.41
7.42
76.33
11.18
NR
22.87
15.80
NR
52.54
NR
2.00
4.91
20.87
NR
NR
18.67
12.33
NR
6.62
NR
102.39
335.63
5.59
77.54
NR
133.43
294.12
NR
76.81
11.17
Orissa
Punjab
Rajasthan
Tamil Nadu
Tripura
176566
544499
243013
304951
30946
149450
486574
213006
345095
27807
56.57
78.54
74.61
25.29
2.69
8.14
13.08
11.33
34.71
2.42
24.06
2.79
7.03
9.24
79.21
0.47
NR
0.15
28.67
NR
10.76
5.59
6.88
2.09
15.69
154.72
208.20
81.82
105.70
198.33
130.96
186.05
71.72
119.61
178.22
Uttar Pradesh
West Bengal
533653
51478
583956
35469
52.57
33.09
9.37
3.74
28.25
34.11
0.91
29.06
8.90
NR
82.33
49.94
90.09
34.41
Total
6219365
5908529
54.29
13.45
16.72
5.81
9.73
150.68
143.14
Source : NIUA, Upgrading Municipal Services 2
Norms and Financial Implications, 1989.
*
Data Relate to 157 Class I Municipal Bodies.
NR - Not Reported/Not Available.
Cv
P
r
TXBLE
States
18 INDIA;
PATTERN OP REVENUE EXPENDITURE Di MUNICIPAL BODIES (NCN-PLAN), 1986-87*
% Distribution of Expenditure
Total
(’000 Rs.)
General
Altai nistration
i Collection
cf Revenue
Miscellaneous
Public
Health
Public
Safety
Public
Works
Education
Recreational
Activities
3.89
1.68
12.62
11.82
4.93
11.87
22.64
10.75
6.87
45.76
21.71
0.96
NR
18.19
NR
1.10
0.49
5.03
2.62
NR
8.61
NR
6.93
14.41
NR
Andhra Pradesh
Assam
Bihar
Gujarat
Goa
585193
8447
21560
721832
5998
11.30
33.60
7.04
19.24
NR
41.53
40.63
57.63
26.84
49.31
Haryana
Himachal Pradesh
Jammu & Kashmir
Karnataka
Kerala
109593
32075
66383
482331
170992
16.27
12.61
47.18
9.05
16.15
48.67
44.06
36.19
54.23
41.22
6.26
NR
4.39
4.44
14.17
8.38
6.93
8.53
14.23
17.78
0.23
0.31
NR
0.11
2.47
3.54
NR
1.49
2.07
4.68
16.65
36.09
2.21
15.87
3.52
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Nagaland
175387
1677297
NR
9576
507
10.48
12.26
I®
22.32
NR
28.59
33.49
NR
65.07
100.00
4.23
4.42
NR
0.70
NR
12.19
12.41
NR
10.78
t®
3.88
16.01
NR
NR
NR
1.49
1.82
NR
t®
NR
39.15
19.60
NR
1.13
NR
Orissa
Punjab
Rajasthan
Tamil Nadu
Tripura
149450
486574
213006
345095
27807
9.62
5.02
25.51
8.55
15.96
32.71
43.53
30.33
40.37
42.15
5.10
4.53
8.75
9.54
4.19
23.87
20.32
16.65
6.27
30.01
10.53
0.03
0.43
16.43
NR
0.41
2.37
2.85
5.10
0.08
17.77
24.20
15.48
13.74
7.61
Uttar Pradesh
West Bengal
583956
35469
9.68
27.20
47.41
55.40
5.45
4.38
22.63
8.62
1.31
2.58
1.21
NR
12.30
1.83
Total
5908529
12.75
38.43
6.16
13.67
10.51
2.12
16.36
Source : NIUA: Upgrading Municipal Services; Norms and Financial Implications, 1989.
*
Data Relate to 157 Class I Municipal Bodies.
NR - Not Reported/Not Available.
Dev
TARTJT. 9
INDIA : ESTIMATED URBAN POPULATION AM) SLUM POPULATION,
1990
(Persons in Lakhs)
Identified
Sim
Population
1981
Estimated
Urban
Population
1990
Estimated
Sim
Population
1990
279.14
2,415.44
512.28
124.88
20.47
87.19
106.02
28.27
28.58
1.24
32.70
15.32
2.74
190.37
33.14
137.72
155.05
45.86
38.07
6.63
32.70
31.01
9.17
Himachal Pradesh
Janrnu & Kashmir
Karnataka
Kerala
Madhya Pradesh
3.26
12.60
107.30
47.71
105.86
0.76
6.27
5.74
4.10
10.75
4.58
19.44
165.62
68.16
168.81
0.92
6.27
33.15
13.63
33.76
Maharashtra
Manipur
Meghalaya
Nagaland
Orissa
219.94
3.75
2.41
1.20
31.10
43.15
0.17
0.66
—
2.82
312.55
9.61
3.99
2.75
53.02
62.51
1.92
0.80
0.55
10.60
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
46.48
72.11
0.51
159.52
2.26
11.67
10.25
0.02
26.76
0.18
68.93
115.69
1.29
213.78
3.24
13.79
23.14
0.26
42.76
0.65
Uttar Pradesh
West Bengal
198.99
144.47
25.80
30.28
326.54
198.57
65.31
49.64
Union Territories
Andaman & Nicobar
Islands
Arunachal Pradesh
Chandigarh
Dadra & hfegar Haveli
Delhi
0.49
0.41
4.23
0.07
57.68
N.A.
N.A.
N.A.
N.A.
18.00
0.93
0.93
i 7.65
—
92.84
0.19
0.19
1.53
—
38.25
Goa, Deman & Diu
Lakshadweep
Mizoram
Pondicherry
3.52
0.19
1.22
3.16
0.24
N.A.
N.A.
0.94
5.45
—
3.80
5.13
1.09
—
0.76
1.03
States/
Union Territories
Urban
Population
1981
DOLA
States
Andhra Pradesh
Assam
Bihar
Gujarat
Haryana
1,597.27
.
■
Source : A Ccmpendim on Indian Slims, Tom and Country Planning Organisation,
1985.
29
s-3j
MAJOR GOAL 9:
URBAN CHILO
ALL SECTORAL GOALS \'O BE ACHIEVED W URBAN AREAS Mill Si
CN SLUM POPULATION
iN NOTIFIED SLUMS. UNAUTHG.. ti
AH.-AS. hi CLASSIFIED I\1UNIC1/'AL AREAS AND MORE SPEEDICAl: :
MSK" URBAN CHILDREN
A
SRLCfElC GOAL !): URBAN CHILD
i
All sectoral goals to be achieved in urban areas with special emphasis on sL.m , . gelation h.'. h, m
notified slums, unauthorised slums, hinge areas, reclassified municipal areas.
ii.
Special attention to be paid to urban "al risk"groups. "At risk" children to include children bum Km
(a)
economically disadvantaged "at risk" groups, viz. slum dwellers, pavement dwellers, street
children, migrant groups and construction workers.
(b)
economically advantaged "at risk" groups, viz. children under the pi assure of stress srd
competitive stress, children at risk for drug abuse/child abuse, children losing their childhood
pleasures due to lack of recreational & play facilities and relaxation.
i
8.
PRESENT SITUATION:
'o
9
Karnataka has an urban population of 13.85 million spread over 254 cities and towns. lhe S.at. r.m.\s
filth in the degree ot urbanisation and accounts for 6.3% of the total urban population in the country. There .ire
17 Classi towns with a population of more than one lakh each and accounts loi
M the t.it.i' mean
population in the State. 4.91 million of the urban population lives in 237 towns with a population ot less than
one lakh. The rate of growth of urban population in Class I and Class // towns was 42% and 47% respm twety
during the 1981-91 decade. The rate o! growth and migration to the metropolitan city .mJ ether maim tow is
is creating acute problems of housing, trgffic and transportation. It has to be recognized that by 2011 A.U. more
than 50\ of India's population, and specially child population would be living in the urban areas
Children in urban areas suiter from multiple disadvantages in the areas oi nutrition, health, sumtatmn
and access to facilities and services appropriate for their requirements of balanced growth, which problems ere
further compounded by the existing soda! inequities. It is evident that the prtssmes or urh.mization n.i.e
such that the urban children have gradually lost their rights to food, shelter, education, health and other services
It is estimated that at least 25% of the urban children belong to the economically disadvantaged "at r:.k‘
groups, and are situated in dispersed urban pockets, and any strategies planned to reach the disadvantage^^ dd
should take such dispersal into accour,:.
C.
MAJOR STRATEGIES:
The main long term strategy fur urban development in Karnataka is to focus un aiterriuic
,
by providing for planned growth of the peripheral and suburban areas adjoining tut- meiiopidl ■ < , :
where the problem is most acute, through locating employment generation activities, me t.jjs
investments for urban development in small and medium towns, as well as incm.tires and ms.,.
.s
such as taxation measures of subsidies etc. Current strategies also include priority attention to hCei
and environmental improvements, specially for slum and pavement dwellers, th..ugh sites, services amt
housing etc., as well as improvements to the lighting, water, sanitation, latn.i.s, drainage m. ■.
86
Implementation of these strategies requires to be re examined especially in views of the socio cultural
and political realities, to ensure community participation and access to these services on an equity basis.
This would also require a greater a., J of co ordination and convergence among the various departments
of the Government under different programmes with the people being given a role or power in planning
for their development.
There is a pressing need for immediate implementation of minimum services for delivery to every
disadvantaged urban child. The minimum services should include health care, pre school education and
primary education, non-farmal education, programme for school drop out, health & nutrition education
services for mothers, supplementary nutrition progiamme for children 16 months ■ 6 years of age)
expectant and nursing mothers, and community awareness programme to involve community cadre for
implementation and monitoring
The on going programmes for implementation of various activities are Urban Basic Services for the poor
fUBSP), IPP-VIII, ICDS urban based programme, h/GOs efforts and other government schemes.
The components of these programmes require special attention towards (raining for the government
personnel implementing the programme, through capacity budding, awareness amongst the Community,
space for multipurpose center, and complementing the effort with mobile programmes.
UBSP could be identified as the approach through which all schemes of the government can converge
with community involvement.
'There is need for preparation ol an overall "City Action Plan" to focus attention on the poorest of the
poor in urban areas, laying emphasis to the following aspects.
Identification and mapping o! locations and areas where the poorest population groups are found,
including slum and pavement dwellers, street children and rag pickers. This ought to be done by the
ward committees of the local urban bodies.
i
Assessment of the status of children and women living m these areas in terms of health, nutrition and
education and access to basic facilities such as shelter, dunking water and sanitation for the family,
and opportunities for human resource development of the child.
Targetting available basic services and programme coverage to those most crtica/lly in need, and ensuring
access to health, nutrition and education facilities.
Preparation of city/town action plans by the ward committees of the municipalities in consultation w th
NGOs to focus on vulnerable groups far the achievement of sectoral goals through convergence of
existing programme and services specifically with respect to the fallowing elements:
87
Health And Nutrition:
(e)
Birth and Death registers to be maintained at the ward committee level
Establishment of a health identity card system on a mandatory basis for the disadvantaged group which
should have the same serial numbers as ration cards.
Providing outreach services for families "at risk" under IPP VIII or other such programmes.
Undertaking periodic training and skill upgradation programme for all municipal health officers undeCSSM Programme.
Creating awareness about use of OPS. Providing adequate supplies of OPS packets tor urban "at risk"
families through IPP- VIII, /CDS, UBSP and commercial channels.
Addressing household food security needs through better targetting of the PDS system to reach urban
"at risk" children.
,
Ensuring proper provision of ration cards and access to fair price shops to urban ‘at risk' groups and
maintenance of records of the same at the wards committee level and location of fair price shops within
the areas where the poorest population groups are found.
Making available iodised salt through fair price shops at affordable prices
To recognize the role of stress on emotional and psychological development of the urban child and to
identify and provide counselling and support services for the same within the identified areas.
(f)
Education:
Undertaking school mapping with community support to ensure access to education by all the "at risk"
children by the Education Department.
Initiating systematic Non-Formal Education activities for school drop-outs.
•
I
to set targets through text books, where content matter is relevant,
through teaching methods that are child-centered and culturally familiar to the child,
*
to introduce a modular system of teaching and learning,
•
to deetoaso numbet of hours bitoeatioi),
*
to do away with age wise admissions for each level, and
*
to increase resources to this system.
88
Establishing linkages between Anganwadi and other Non-formal pre school centers to the primary schools
to ensure that children from argmrwadi centres enter and complete the stage of primiry education.
To ensure evnhmtiun of children's performance for identified Minimal Levels of learning for each
year/stage of education. This is relevant both for the forma! and the non formal methodi ot education.
For purposes of admission declaration of age by the parents should be enough for (a) school purposes,
as well as (b) the municipal authorities for issue of birth certificates.
To encourage schools, community halls and other available government and community luildmgs to be
utilized for non-forma! education, before and after school hours, as well as National Literacy Mission
activities through voluntary organizations.
To encourage child to child programme for teaching of primary education skills lor the urban
disadvantaged child, by secondary school children under the National Literacy Mission ant other parallel
programmes.
To make available recreation and playground facilities for all children.
Mobilising community support for improving school facilities, including buddings, water and toilet
facilities, and basic teaching equipment /including play equipments) as well as voluntary teachers
To insist upon the private schools to allow their school buildings and playground facilities to be used
(by NGOs with prior tie ups) for non-forma!education and adult education, etc. after their regular school
hours.
To provide career data banks of employment opportunities for each level of completed education, for
school drop-outs and for those going through the non-forma! system of education.
To improve community facilities to school, centers, and child safety in and around schools /monitor
availability of drugs, road accidents, sexual abuse, etc.,)
Water Supply:
Ensuring the achievement of the urban norm of one drinking water source for 100 persons /20 families)
through development of alternate systems /like handpumps and wherever possible by providing additional
storage capacity)
Land and Housing: ■
The rights and requirements of the disadvantaged urban child should be recognised allowing the family
to have access to land or. nhich they are living or a house on ownership basis, with secenty of tenure
and proper civic facilities.
The pavement dwellers,'slum dwellers should be provided with land and/or shelter m proximity to their
employment areas.
Planning and decision making on providing shelter, land showing provision of proper community spaces
like parks, play areas etc. should be dune with community participation keeping the requirements and
rights of the urban child in view.
(i)
Environmental Sanitation
Covering all urban poor, with special facilities for pavement dwellers under the existing programme of
Low Cost Sanitation (LCS) and Environmental Improvement of Urban Slums (EIUS)
Developing community maintenance systems lor water, sanitation, drainage and solid waste collection
in UBSP project areas.
Providing space for smaller community latrine units lor better access to ‘at risk' communities under Slum
Clearance and Slum Upgradatmn Schemes with provision made for their maintenance.
Developing special designs for group community latrines to meet the basic needs of women and children.
fn urban slums there is no sanitation or proper disposal of solid waste Community education and proper
disposal of waste with the help of municipal bodies requires to be taken up urgently.
(j)
Communications And Media:
Preparation of programmes that use audio visuals, mass media, folk media, puppetry, street theatre, etc.
Preparation of data banks that are accessible to NGOs for planning.
i
~E.
i
PROCESS INDICATORS:
~
#
Preparation and operationalisation of town plans at ward committee level.
■
Coverage levels of health, education, water and sanitation in urban areas (quantity/
|
Formal and non-formai centers tor education (number)
;
Number of health cards issued
!
j
I
MAJOR GOAL 10:
CHILDHOOD DISABILITY
PREVENTION. EARLY DETECTION. INTERVENTION AND COMMUNITY BASED
REHABILITATION OF DISABLED CHILDREN BY 2000 A.D.
STATE LEVEL WORKSHOP OF "HEALTH OF THE URBAN POOR"; 26-28th May , 1995
PARTICIPANTS LIST
1»
Fr.Micheal Kumminivi1
Coordinator & Manager.
Slum Apostolate,
Deepti Bhavan, Nehru Nagar,
P.B.No.42,
Mandya - 571 401.
10.
Sr.Ceilia
Women's Desk,
Archbishop's House,
18, Mi 11 er's Road,
Bangalore
560 046.
2-
Guana Chitra
Project Coordinator,
Dept, of Community Health.
Bangalore Baptist Hospital.
Bell ary Road.
Bangalore - 560 032.
11.
Mr.Joy Maliekal
Project Director,
Rural Literacy ?< Health Programme,
170, Gayatripuram II Stage,
Udayagir i P.O.,
Mysore - 571 019.
Ms. Brunda,
12.
Ms.Lima Rai (MSW)
Medical Social Worker,
St.Martha's Hospital,
Bangalore - 560 009.
13.
Ms.Serta Menezes
Social Worker,
YMCA, C.I.C,
66, Infantry Road,
Bangalore - 560 001.
14.
Dr.Sunitha Singh
B.B.Sona Gardens,
18,Alexander Street,
Richmond Town,
Bangalore - 560 025.
15.
Mr-Hanumantha Raju
City Municipal Council,
Hospet,
Bellary.
16.
Mr.V.Moses
Secre tar y ,
Gulbarga Integrated Rural Lead Society,
Gulbarga.
17.
Mr.Ramesh M. Pattedar
Asst. Project Officer.
UBSP Corporation,
Gulbarga .
18.
Dr.Sr.Li 11ian
Mariagiri Health Center,
Kuppepadar P.O.,
Mangalore - 574 162.
Coordinator (Health),
The Association of the Physically
Handicapped.
Hennur Road, Lingarajapuram,
^an galore.
4t
Dr.E.Susan Gangan
Medical Officer,
Community Health Dept.,
St.Martha's Hospital.
Bangalore - 560 009.
5. Ms.Celestine
Social Worker,
YMCA, C.I.C,
66, Infantry Road,
Bangalore - 560 001.
6
Dr.K.I.Alexander
Dy. Area Manager,
CMAI ,
H.V.S.Court, 3rd Fl
|21 , Cunningham Road ,
Bangalore - 560 052
7. Mr.Gurulingaiah
Dist. Extension Officer,
Office of the Medical Officer,
Health & Family Welfare,
Bangalore City Corporation,
Bangalore - 560 009.
8 f^Dr.Vasundhara
No.145, 12th Cross,
J.P.Nagar II Phase,
Bangalore - 560 078.
9. Rev.Fr.Ierence Franz
.
Advisor to the Charitable Catholic
Nurses Guide,
Archdiocese of Bangalore,
Archbishop's House,
18.Miller's Road, Bangalore - 560 046.
19.
Dr . Sr. Vi si tatiori
C/o MCB Bhavan,
Sagar Road. Shifcoga
- 577 201,
Shimoga
7 7 201.
Mr.Varghese K. Navi
Asst. Area Manager,
CMAI ,
H.V.S.Court, III Floor,
21, Cunningham Road,
Bangalore - 560 052.
33.
Sr.Mary Peter - FDM
Nurse, 7he Shimoga Multipurpose Social
Service Society,
Sacred Heart Cathedral Compund,
Shimoga - 577 201.
Mr.Veeresh Javali
Public Relations Officer,
Rotary Club 3160,
Hospet,
Bel 1 ary.
34.
Sr.Sabeen
CHAI Board Member,
Nirmalagiri,
Kengeri Post,
Bangalore.
Sr.J ac intha,
Secretary,CHAI-Ka,
Bangalore.
35.
Sr.Mary Kripa
CHAI Bangalore Diocese,
15,
Bangalore - 560 027.
rSr. Mercy Abraham
President,CHAI-Ka,
St.Martha's Hospital,
Bangalore - 560 009.
36.
Mr.Gopal Krishna
Community Health Dept.,
CHAI ,
Hyderabad.
Dr.Mala Ramachandran
Medical Officer,
Health & Family Welfare,
Bangalore City Corporation,
Bangalore - 560 009.
37.
Dr-. Dara Amar
Prof. & HOD, Dept, of Community Health
St.John's Medical College,
Bangalore - 560 034.
Mr. David Raj,
Coordinator,
Shimoga NSSS,
S.H. Cathedral Campus,
Shimoga — 577 201.
38.
Dr. Mani Kai Hath,
Head - Community Health Dept.,
Catholic Hospital Association of
P.B. No.2126, 157/6 Staff Road,
Gunrock Enclave,
Secunderabad - 500 003.
Mr. Srinivas,
Community Health Department,
Catholic Hospital Association of
P.B.No.2126, 157/6 Staff Road,
Gun rock. Enclave,
Secunderabad - 500 003.
39.
India,
Dr. C.M. Francis,
Community Health Cell,
367 "Srinivasa Nilaya"
Jakkasandra First Main,
First Block, Koramangala,
Bangalore - 560 034.
Ms. Philo Michael,
Ms. Philomena Joy,
Ms. Sumithra,
Rural Literacy & Health Programme,
170, Gayathri Puram II Stage,
Udayagiri Post, Mysore-571 019.
Dr. Sr. Veeda,
Er.Muller's Hospital,
Kankanady,
Mangalore.
Mr. Udaya Kumar,
Mr. V. Venkatanathan,
Samaj Vikas Kendra,
No.227, 4th Main,
Srinagar,
Bangalore - 560 050.
Sr. Lillian,
St. Philomena's Hospital,
Bangalore - 560 047>.
Dr. Bobby Joseph,
Department of Community Health,
St.John's Medical College,
John Nagara,
Sanaalore - 560 034.
i
Dr. Preethi Kudesia,
327, 3rdc Cross, 3rd Stage,
2nd Block, Basaveshwaranagar,
Bangalore - 560 079.
India
4'3. Mr.
James J
NG Tutor,
St.Philomena's Hospital,
Bangalore - 560 047.
52.
44.
Dr. V. Keerthi Shekar,
Facu1ty,
Administrative Training Institute,
Lalitha Mahal Road,
Mysore - 11.
53. y/zDr.
Dr. M. Jayachandra Rao,
Additional Health Officer,
Bangalore City Corporation,
Bangalore - 560 009.
54,
Dr. V. Benjamin,
Community Health Cell,
No.367, 'Srinivasa Nilaya'
Jakkasandra First Main,
First Block, Koramangala,
Bangalore - 560 034.
Ms. Mary
/ N. Baby,
47, Y. M . C . A,
Pulikeshi Naqar,
Bangalore — 560 005.
55.
Dr. Veda Zachariah,
Deena Seva Sangha - Seva Ashram,
Sri rampuram,
Bangalore - 560 021.
4g,
Sr. Seena,
Gnana Jyothi ,
Aneka 1 ,
Bangalore District.
56.
Prof. N. Krishnaswamy,
Gandhi Bhavan,
Bangalore - 560 002.
49,
Dr. P. N. Halagi,
Additional Director
IPP IX (K > ,
Bangalore.
57.
Ms. M. Pankaja,
Technical Officer,
UBSP,
Directorate of Municipal Administration
Bangalore.
45,
46,
pl ,cfi
(Project),
Ms. Salma Sadikha,
58.
Technical Officer,
UBSP,
Directorate of Municipal Administration,
Banga1 ore.
51 .
Arun Serrao
KROSS,
P.B. No.4626
No.5, Nandidurga Road,
Bangalore — 560 046.
Fr. Joseph Kulathunqal,
Gulabl Sadana,
R.M. Hally P.O. - 571 455,
Mandya.
Susheela Shekar,
Superintendent,
Bangalore City Corporation , l-'i '■ '
H.Siddaiah Road,
Bangalore - 560 027.
1
Mr. Verghese G.M.
KROSS
P.B. No.4626,
No.5, Nandidurga Road,
Bangalore - 560 046.
gg
Dr. Stephen Jeanatti,
Health Centre (physically handicapped)
St.Thomas Town,
Bangalore - 560 084.
60.
Dr. Sarojini Fernando,
Action Aid,
No.3, Rest House Road,
Bangalore - 560 001.
Gunan Chaturvedi,
Sector Specialist Health,
Action Aid (India),
3, Rest House Road,
Bangalore - 560 001.
61.
ME CATHOLIC HOSPITAL ASSOCIATION OF INDIA
(CHAIKA) Karnataka.
Date
Workshop
on
Health of the Urban Poor
26 - 28 - May, 1995
Organised by
The Catholic Hospital Association of India, Karnataka Region
in Collaboration with
Govt, of India, UNICEF and other Voluntary Organisations
Venue: Indian Social Institute
24, Benson Road
Bangalore - 560 O46
8.30 A.M.
=
Registration
9.00 A.M.
=
Inauguration
10.00 A.M.
=
Tea
10.30 A.M.
=
Key note Address
Dr. C.M. Francis
Special Advisor - CHAI
11.10 A.M.
=
Workshop Dynamics
Dr. Mani Kaliath
Head - Community Health Department
CHAI
11.20 A.M.
=
Situational Analysis - I
Dr. Vasundhara M K Former Prof and
Head of Dept of Community Medicine - B.M.C.
11.55 A.M.
=
Situational Analysis - II
Dr. Halagi - Additional Director (Projects)
and Ex-officio, Additional Secretary
to Govt, of India
12.25 P.M.
=
Vote of thanks - Mr. Chandar - C.H.C. Moderator: Dr. Daramar - Vice-Principal &
Head of Community Health Dept.
St. John's Medical College
12.30 P.M.
=
Lunch
01.45 P.M.
=
Group discussion
THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA
(CHAIKA) Karnataka.
Ret. No ;
Date
2 -
Case Study - I
Dr. Mala Ramachandran - Medical Officer
incharge, Health & Family Welfare &
M.C.H. Bangalore City Corporation
3.45 P.M.
4.00 P.M.
=
Tea
4.30 P.M.
—
Case Study II
Dr. Maya Abreu
Community Health Department
St. John's Medical College
Bangalore
8.30 a.m.
10.00 A.M.
10.30 A.M.
-
Pleanary Session
Tea
Case study - III
Ms. Pankaja and Ms. Selma
Directorate of Municipal Administration
Karnataka
11.00 A.M.
=
11.30 A.M.
12.30 P.M.
=
=
01.30 P.M.
02.30 P.M.
4.00 P.M.
4.30 P.M. - 6.00 P.M.
=
27-05-1995
Day-II
28-5-1995 - Day III
8.30 A.M.
9.30 A.M.
9-45 a.m.
10.00 A.M.
11.30 A.M.
12.30 A.M.
01.30 P.M.
3.30 P.M.
4.30 P.M.
5.00 P.M.
—
=
=
=
=
=
=
=
=
=
Case study - IV
Mr. Joy Mai i ekal & Ms. Philomena
R.L.H.P. Mysore
Group discussion
Lunch
Plenary Session
Panel discussion
Tea
Group discussion
Plenary Session
Summary of Previous two days Proceedings
Tea
Plan of Action - Group discussion
Plenary Session
Lunch
Statement - Action Plan
Valedictory Function
Tea
Departure
I
Foreign panorama
PEV-3-3q
How Bangkok is tackling
its slums problem
By Philip Smucker
N the banks of a contami
nated channel boards of
pressed wood are piled preca
riously one on top of the other,
searching for support.
O
On these half-rotted gangplanks
that connect houses to each other, old
people and the unemployed are
to^batting, selling fried chicken heads
More than a million slum
dwellers in Bangkok refuse to
“make way" for development.
Together with social organisa
tions and community workers
they fight against eviction for the
right to shelter and a little piece
of their own urban land.
and other tidbits of Thai cuisine.
Small children run barefoot, dodging
rusty nails and splinters, on this net
work of homemade bridges that ex
tends over the stagnant water, where
rats and bacteria multiply among trash
and human excrement. On hot days,
boys go swimming in the channel.
Most men and many women spend
most of the day away from this sordid
place, laying bricks or mopping floors
for a daily wage that is rarely enough
to feed the average family of five or
Respite the horrifying conditions in
’
Wnch they live, the residents of
’‘Bangkok slums refuse to move from
tl? centre of the city to less congested
'7as on the outskirts. “Last year I
decided to move because the landlord
promised me 7,000 bahts (US $ 350)
if I would leave, but to this day, I’ve
yet to see a cent,” said one woman
who left the slum only to return.
“He lied to me, and besides, I
couldn’t stay (when I went). It was a
barren field. There was no work.
There was only more poverty,” added
the disillusioned slum tenant.
The population of metropolitan
Bangkok, now standing at 6 million,
will reach an estimated 12 million by
the year 2000. In an effort -to reduce
the number of slum-dwellers from the
current 1.2 million to a more mana
geable size, authorities are doing eve
rything possible to convince them to
leave.
But while the battle between mu
nicipal officials and slum-dwellers
continues, some innovative ideas are
emerging about how to provide them
with shelter, acceding to an expert in
human settlements from the United
Nations Economic and Social Com
mission for Asia and the Pacific
^CAP).
h^ngkek with unequalled housing
Probknu thanks to the slums that run
?On.B
contaminated channels, is
having some success with the twopolicy of slum improvement
distribution.
Through the land distribution
programme, squatters who live in the
slums turn over a portion of the land
to its legal owner, who then perma
nently rents a plot to them at a
reasonable price.
“We have seen that people prefer to
improve their own homes instead of
moving into housing provided by the
Government,” said the ESCAP re
presentative. Based on this assump
tion, ESCAP has put into action a
scries of self-help housing programmes
throughout Asia, offering an alterna
tive to subsidised programmes on the
western model.
In Thailand, only 17,000 houses had
been constructed by public entities by
1973. The National Housing Author
ity (NHA), founded that year, added
fewer than 50,000 units in the subse
quent 10 years — filling but a small
portion of the city’s housing needs.
NHA functionaries admit that
seme of its programmes were over
ambitious and that they were not
prepared to accommodate the lifestyle
of Thai slum-dwellers. NHA Govern
ment Suchct Sitthichaikasem said that
until recently some NHA housing
units went unsold for lack of water and
access to public transportation.
Other officials point out that poor
slum-dwellers often sell their new
homes to better off middle-class fa
milies and return with their earnings
to where they came from.
Nevertheless, the population of
Bangkok’s slums has been dropping in
relative terms — from 25 per cent of
the city’s population in 1974 to 20 per
cent in 1984.
The most significant advances in
the housing situation have been rea
lised through improvements in exist
ing slums, where field workers make
sure that people are prepared to make
an investment and improve their hou
ses — provided they will not be
threatened with eviction.
Initiatives undertaken by the resi
dents themselves, combined with a
strong organisation and negotiating
capacity, have proved to be the most
meaningful for these people. “There is
no reason why slum-dwellers can’t stay
where they are in the majority of
cases,” said one expert.
But since 1980, housing opportuni
ties have diminished for the poor of
Bangkok. The growing privatisation of
entrepreneurial activity has allowed
large companies and developers to
penetrate deeply into real estate
markets. Land in downtown areas is
being purchased by commercial firms,
forcing low-income employees to live
in neighbourhoods 30 kilometres from
their workplace, according to ESCAP
reports.
One ESCAP proposal points out
that slum-dwellers have to organise
themselves to improve their power to
negotiate and enable them to confront
the challenge of real estate developers
and speculators.
The Government rarely furnishes
information about how to deal with
eviction orders or get money together
to fight them. It is non-Govemmental
organisations (NGOs) that take on the
task of organising urban communities
and providing them with a platform so
that the poor can air their grievances.
ESCAP estimates that these forums,
can fill the communication gap bet
ween the Government • planning ma
chine and the people.
Despite these steps forward, Bang
kok slum-dwellers often remain at the
mercy of landlords determined to re
gain control of their land for com
mercial use. Landowners have won
several lawsuits recently over real es
tate occupied by marginal housing.
However, there exists a small but
determined oppositoin to the landlords
and developers. “Every human being
has the right to a place to live. It is a^
necessary condition for existence and.
pre-empts all laws,” pointed out1
Duang Prateep, whose work in def
ence of the human rights of Bangkok’s
poor is funded by Thailand’s ‘ royal
family.
— Third World Network Features.
Commuting problems the world over
LONDON:
T can take longer to cross
modern London by car
than it did by horse carriage a
century ago. Some New York
commuters are spending 200
dollars a month on fares and
six hours each day travelling.
Japan is offering long distance
“Bullet Train” commuters a
tax break on their fares.
I
The inability of some modem cities
to provide adequate transport for the
millions who work in them poses an
economic challenge for the 1990s.
“Without action now, London risks
losing its pre-eminence as the financial
and business centre of Europe,” says
John Banham, Chairman of the Con
federation of British Industry.
Worldwide, huge sums will be spent
on transport. Firms may have to spend
money moving outside city centres,
subsidising fares or buying more
computers so that people can work at
home. Or they may just go to places
like Paris or Frankfurt. which can
apparently handle their transport pro
blems.
Reuter correspondents around the
world took a look at the plight of
commuters:
In New York, where nearly 3.5
million people stream daily into Man
hattan, some have dreamed up new
ways of avoiding the crowds. Wealthy
executives from neighbouring New
Jersey formed a helicopter-pool to fly
in. A ferry company, Direct Line, last
year proposed to moor floating parking
lots on the Hudson River. New Jersey
commuters could drive onto these lots,
park and then take a ferry to work.
Housing close to Manhattan has be
come so expensive that many face a
three-hour bus ride to get to work.
In London, the world’s oldest un
derground rail network is groaning
under the daily strain of three million
commuters, while traffic jams last
more than half the working day. “We
are now a first world city with Third
World standards,” said Professor
Peter Hall of Reading University.
Many professionals have moved out
to smaller cities where they earn less
but enjoy a better quality of life.
Tokyo commuters endure some of
the most crowded trains and longest
rides of any. And a dramatic rise in
land values has forced people to travel
further and spend more on commut
ing. A one-day train fare of more than
eight dollars is common, while the
Transport Ministry reckons that some
100,000 people commute from places
more than 100 kms away. The gov
ernment and big firms are now en
couraging people to live way outside
Tokyo and commute by Shinkansen
“Bullet Train.”
Zurich shares some of London’s
worries. A survey of banks, insurance
and financial firms revealed several
problems over the next few years
because of parking space. Sixty per
cent of employees commute to work
from outside the city, many by car.
Some firms have moved to less
crowded areas, which may risk Zu
rich’s expansion as a financial centre.
Paris, however, looks set to enter
the 1990s with a big advantage. A fast,
efficient transport system is led by the
RER, suburban express railway,
which carries 600,000 people a day.
“Not many other European capitals
have such developed public transport
systems as Paris, said Roger Dubreuil,
traffic consultant for the police. Traf
fic has grown over the lit 20 years
but one-way systems and ring-roads
have helped keep it flowing.
Some 300,000 people commute to
Frankfurt, a city of 600,000, travelling
up to 60 kms. Plans to erect high-rise
office blocks promise more jobs but
two new local rail lines are already
planned to cope with higher demand >
and should be ready by 1994.
In Hong Kong commuters often
spend an hour-and-a-half travelling in.
An average journey from the outlying
new towns, built in the early 197O-,
can cost about a US dollar each way.
Tire Mass Transit Railway, Hong |
Kong’s underground, carries 80,000
pwple an hour in one direction during 1
the morning rush. Some go three stops
the wrong way just to be able to get
on.
,
— PTI Feature. Ij
^^wataki^kolageri :iJVA3I<iA!iA_d‘'5u2YUKTHA sakgataijas _ (33
■COarSNTS
(Ov .
—
1.
Simple Introduction
1.1
Housing situation in Urban Karnataka — I
1.2
Slum situation in Karnataka
I
3
—
1.2.1
An overview of slums in Karnataka -3
1.3
Slums in Bangalore
1.4
Slum Clearance and Improvement Programmes
1.4.1
Slum Clearance Board of Karnataka. —
- 5
II.
formation and Growth of KKN.SS
2.1
Emergence and Growth of KKNSS
G
- %
2.21
Operation demolition of 1985
to I
2.3X Chronology of events
-- u
KKN5S1S re sponses.
111
4.1
.
I
Participative Process'of An Urban Social Movement
"
i
- 2.C?
4.1.2
KKNSS and the working class
4.3
Urban Planning as a social process:
V.
Summary of our experiences and conclusion.
References.
— 2_G
—
KKNSS's view — 2.3
-
2-4-
.ATAKA KOLAGERI N1VAS1GALA SAMYUKTHA SAHGATANME (KARNATAKA
SLUM DWELLERS FEDERATION)
" ^TORY OF STRUGGLE TO 3JHV1VS"
"for the poor and pauperising overwhelming mass
of citizens, the Rulers have left no option
within the framework of evolving social order
they are erecting, except to perish or revolt.
the poor, including urban poor, will not perish
but will resist.
The struggle of the slumdwellers,
who number in millions, is not at present fighting for
better amenities but for mere survival.
They have
to struggle if they want even to survive".
(AR Desai, 1986)
KARNATAKA KOLAGERI NIVA3IGALA SAMYUKTHA SANGHATANE (KKNS3)
is the 'Voice of the slumdwellers of Karnataka 1, representing
the marginalised, alienated and trie dispossessed majority
in our country, who toil with their blood and sweat to uphold
the urban economy,
KKNS5 is a people-based movement.represene
ting the genuine aspirations of all slumdwellers, and provides
a platform for them to express themselves, their struggles and
hopes; it also serves as a means to formulate strategies for
their "struggle to survive" in this society.
1.1
Housing Situation in Urban Karnataka
The number of houseless persons in urban areas has increased
from 13 thousands in 1961 to 43 thousand in 1931 inspite of
significant increase in housing stock from 891 thousand units
to 1,723 thousands units during the(kame period.
In percentage
terras, the houseless population hajj increased from 0.24 in
1961 to 0.40 of the total population in 1931.
It is worthwhile
to take note of an observation by the study conducted by the
Population Research Centre which states that "....*houseless
population is under-enumerated to a large extent in censuses
because of their root-lessness and the apathy of the census
enumerators themselves
Thus, even the available data
2
is not that accurate for safe conclusions.
•
As against 1,817 thousand households recorded in 1981 census,
the number of residential houses returned was only 1,723 thousand.
The excess of households over residential houses indicates
that dwelling units are often shared.
It is noticed that 66
thousand dwelling units were-shared in 1961 and this number
rose to 94 thousand in 1981.
This shows an increasing shortage'
of dwelling units in urban areas of the State.
This is, in
addition, to the houseless population who do not have even a
shelter to share with others.
Of the 1,723 thousand dwelling units recorded in 1981- 1,620
thousand units were used wholly as residence.
The rest were
used partly as residence and partly as workshop or for commercial
purposes.
What is worse is that the proportion of dwelling units
used exclusively as residence has dropped from 97.3 percent in
1961 to 94 percent in 1981.
There is an unmistable sign that
the housing situation in urban Karnataka has deteriorated with
every passing year.
The rapid increase in population in the
urban area itself, the exodus of landless people from an indignant
countryside to towns and cities in search of jobs, the lack of
repair and maintenance of the existing housing stock have all
exacerbated the situation.
On the quality of dwelling units in urban Karnataka no reliable
data is available.
The House Listing Operations of the 1971
Census revealed that 12 percent of the dwelling units in Urban
Karnataka have both walls and roofs made of flimsy materials
such as grass, thatch, mud etc.
Another 37 percent of the
dwelling units had either wall or roof made of materials which
are not durable for more than a year or so.
further, as many
as 5 persons live in a single room dwelling unit; in two room
dwelling units on an average 3 persons live.
One can easily
..3/
3
imagine tne extent of overcrowding and lack of.privacy in
such houses.
The tenure of Land for households by and large is "temporary"
This is true
and always at the mercy of the State Government.
of even new layouts which had unfortunately been built up on
revenue sites (land not to be used for purposes other than
agriculture);
these houses stand to be demolished in the event
of the Government deciding to enforce the available legislations.
A recent study states that only 19 percent of the nouses in the
city of Bangalore have good tenuridl rights.
30
This means about
percent of the dwelling units do not have good title deed.
This is in fact the crux of the problem in the State.
1.2
Slum Situation in Karnataka
In Karnataka we see three distinct patterns of slum settlements
via.,
(1)
this settlement is characterised by ,the emergency of
spsawling "industrial slums" located in and around major indus
trial areas such as Dinny Mills, Yeshwantpur in Bangalore;
KGF in Kolar.
(2)
"Service slums" located in and around 'resi
dential areas' which is inhabited by domestic servants, house
keepers, peddlars etc; in Bangalore this category of slums are
found near Ja/anagar, Jayamahal Extension etc.
slums"
(3) "commercial
which abound near and around Commercial complexes or
office complexes like Shivajinagar in Bangalore, people from
these slums rely mainly on informal sector for their income.
These classifications are mutually contributeve and in no way
strictly regulated by our definitions.
f
1.2.1
An overview of slums in Karnataka
The recent survey conducted by the Slum Clearance Board of -
Karnataka (SOB) in 1984 identified 976 slums in the state.
corresponding figure in 1977 was 792.
The
Of the 976 slums identifiec
590 are so far declared officially as "authorised"
under the
..4/
4
provisions of the 31um Clearance & Improvement Act.
Whereas
the distribution of all identified slums over various towns
in the year 1977 is available such a distribution data is not
available for the 1934 survey except in case of Bangalore.
Between
1977 and 1984 the slum population has increased from
800,000 to 922,000.
The 590 slums had about 547,000 persons.
About 50 percent of the slums were located in class I cities
of the State.,
(i.e,cities with population more than 100,000)
and Bangalore alone accounted for 23 percent of the slums and
45 percent of the slum population (1977).
But in 1984 tne Class I
cities alone accounted for almost 70 percent of all slums and
80 perceno of slum population in the State.
The proportion
of slums and slum population in Bangalore increased within the
span of seven years to 41 percent of all slums and about 54
percent of slum population in the State.
It should be noted that although in terms of absolute numbers
the slum population in small towns is not considerable, the
percentage of slum population is comparable to that of large
cities.
In fact, after the metropolitan city of Bangalore, the
next largest proportion of plum population is found in towns
of less than 50,000 population.
This suggests that the rural
migrants prefer centres of largest opportunity and also centres
of proximate opportunity.
Thus, moving to far-off places is
Kept only as a last resort when all options are closed.
It is
also observed that the largest proportion of slum population is
concentrated in those cities that are multifunctional with
industrial base, rather than those that specialise only in
industrial base.
Thus, it is clear that industrialisation alone
do not contribute to the proliferation of slums.
Among the locational characteristics of slums within a city,
tne 1977 survey observed that the largest number of encroachments
..5/
5
were in private lands and the preference for private land
increased in Bangalore, where the growth rate of slums on
private lands was 151 percent between 1972 and 1982.
Also, an
overwhelmingly large proportion are interspersed with residential
areas.
Almost 98 percent of the slum areas in Bangalore are
interspersed with the residential areas and in other Class I
cities of the State,
oince 1980 many slums have also emerged
on the peripheral parts of the aity on revenue land and on land
earmarked for future urban development.
1.3
plums in Bangalore
As the data pertaining to the city is easily available and
as KKNSS
has established a strong base in the city we could
qualitatively and quantitatively -assess the slums in Bangalore
City.
VL Prakasa Rao and VK Tiwari ir. their study titled:
"structural Analysis of a Metropolis - Bangalore"
(1979)
r
state that the Bangalore City Corporation contained 159 slums
in 1971-72 with a population of about 1.3 lakhs accounting for
about 10 per cent of the city population; whereas the average
slum population in cities with a population of over a million
is estimated to be about 17 percent (KfS3, 1980).
The number
of ’declared slums' in Bangalore increased from 159 in 1972 to
287 in 1982 i.e. an increase of about 85 percent and identified
slums (including undeclared ones) are estimated to be 420
in 1984.
These studies also estimate that the average population size
of a slum was little ovex’ 800 persons.
However, the range in
size was between 34 to 9,000 persons - the most frequent size
being 300-600.
According to NS8 (1980) study slums in Bangalore occupy an area
of 3,451 acres which is about 11 percent of the corporation’s
..6/
6
total area.
Slum areas in the city centre occupy less space-
mostly single room residences; whereas slums in the periphery
occupy more space being of recent origin (since 1980 or so).
But security of tenure-wise City core slums have better standing
than that of periphery, i.e. risk of demolition, eviction etc.
are more in the periphery than in the city centre (this hypothesis
of ours in general proved to be wrong during 1985 demolitions
carried out by the State Government; however, theoretically still
tnis holds good!).
About 9 percent of the slum area in bangalore containing 42
percent of the city slum population was reported to be waterlogged
during monsoon.
In the case of other Class I cities the corres
ponding figures are 47 percent of the area and 51 percent of the
population.
Thus, slum population in the State is also suspecti-
ble to floods, -water logging etc. for a period of 15 weeks
in a year.
Vinod Vyasulu (1936) in his paper on "Urban facilities in
Karnataka" states that education, sanitation, drinking water
facilities and medical are lacking to an extent varying from
40 percent to 80 percent of the total urban population in the
various Class I cities of Karnataka.
1.4
Slum Clearance and Improvement Programmes
In view of tneir location three State agencies are involved
in the clearance improvement of slums viz., Bangalore development
Authority, City Corporation of Bangalore and Slum Clearance Board
of Karnataka.
Since the responsibility of housing slumdwellers
rests with three agencies this has given ample scope for the
complete ineffectiveness of their carrying out any meaningful
developmental programmes in any of the slums.
Many (gt times
these agencies do pass on their responsibility to the other
with the result no one desire to look at the immediate work
..3/
7
to be carried out in order to at least maintain the facilities
provided, if any.
Interestingly, all the three agencies do not necessarily recog
nise the "authorisation" of the slum by other two agencies to
provide facilities and amenities.
This completely brings in a
double burden on the slumdwellers to prove their tenure to each
of thdse agencies in order to receive facilities from them.
Also, cluttering of responsibilities has led to claims and counter
claims by each of these agencies.
1.4.1
Slum Clearance Board of Karnataka
In order to understand the roles and functions of each of the
three agencies, a simple analysis of SCB is sufficient.
The
Slum Clearance Board of Karnataka was established in 1975 with
the following major objectives:a.
take up projects to improve environmental conditions in
slums;
b.
protect the bonafide slumdwellers from eviction by the
landowners;
c.
construct tenements for slumdwellers and
d.
clear unauthorised-huts and prevent emergence of new slums.
In view of the high costs involved in the clearance of slums and
resource availabilities achieving all the objectives laid in
the said Aat became virtually impossible.
Even a cnaritable evaluation of the functioning and role of the
SCB indicates tnat the Board had taken a role of a
"disbursement
agency" of available funds for slum improvement projects.
Basic
issue relating to slums or a long term perspective or a plan of
action are not included in its functions.
There is provision for
maintaining the facilities that are provided.
Many a times
authorities do not know who has to maintain water supply, sewerage,
..8/
8
toilets eta. biiilt by SCB.
Further, due to anomalies in the
existing legislations SCB has no direct access to land for
building tenements or for relocating slums demolished or
evicted - it has to approach either the Revenue Department or
BDA for this purpose.
What is said about SCB is true for other
f
two agencies too.
Interestingly, the prevailing confusion on the role and
functions of the SCB, BDA and Corporation had led to situations
like where a slum was demolished after improvement schemes have
been implemented at substantial expenditure!
2.1
emergence and growth of KKT.SS
A brief background about Karnataka ^olageri Nivasigala Samyuktha
Sanghatane, and the struggles it undertook since its formation
is necessary here.
2.1.1
Around the end of 1982, when the previous Government
led by Mr. Gundu Rao,
then representing Congress (I), was the
Chief Minister he proclaimed that all slums were "eyesores"
and are to be got rid of, and that therefore all slumdwellers
should be shifted out from the core and intermediary zones of
the city to be settled in the peripherial areas in four different
directions.
fhis was something short of a la Antulay's plan
to shift pavement dwellers from Bombay to be deported to their
respective States from where they originally came from.
However, before Mr. Gundu Rao could initiate any action on his
proclamation, elections to the State Assembly was held and in
early 1933 the present Janata Party came to power.
But from
November 1982 itself the fear of possible evictions began to
float around the city.
In order to mobilise them under a singl
banner and to educate them on their rights - if and when evicti
• •9/
9
occur - KKNSS
was formed at the convention which was held for
this purpose attended by various activists and slumdwellers.
KKNSS, the participants felt
,ould provide the much needed
singular platform to voice their grievances and demands.
It was
resolved tt the convention that a charter of demands be
presented to the newly formed Government.
Among the main demands
were the provision of secure land tenure (patta), ownership
rights, housing and provision of basic amenities to all slums,
and re-enumeration and recognition of all existing slums etc.
A mass procession of slumdwellers was organised by the Sanghatane
in February 1983 and a Charter of Demands was submitted to
the Government.
The hanging threats of possible evictions of November/December
1982 and the subsequent convention realised the need for a
networking federation of all slumdwellers in the State of
Karnataka to provide much needed strength and vitality in their
"struggle and fight for survival".
That was the beginning of
their growing political consciousness at one side; 'whereas
on -the otherhand they were continued to be exploited, margina
lised and made to,live in dehumanising living conditions.
In
order to give a meaning to this growing consciousness and to
fight marginalisation and exploitation KKN3S was born in
December 12, 1932.
Since then KKi'JSS has been regularly campaigning for slum
dwellers rights’ from various platforms, forums etc.
Objectives of KKNSS can be briefly stated as follows:-
'
It aims to:a.
a platform to voice out their grievances and 'working
towards changing the policies of the State for the benefit
of slumdwellers in the State
of Karnataka;
..10/
10
b.
act as an umbrella organisation for the local people's
0
associations which are primarily meant to tackle local
issues;
c.
to undertake, execute and assist formation of local
associations for the promotion of social awareness and
equitable justice;
d.
to create a sustainable process — a process of self—aware
ness by which a community could raise itself to a more
human and equitable way of life;
e.
to encourage and develop leadership qualities among
slumdwellers, specially among women and youth, and
motivate them to work for the benefit of the community;
f.
to undertake, execute and assist programmes for the creation
of local resources for the benefit of slumdwellers;
g.
to work towards the unity and solidarity of all slumdwellers
irrespective of caste, language, creed, religion etc;
h.
to organise regular seminars, workshops, lectures, demonstra
tions etc. to hignlight the problems of slumdwellers;
i.
to raise public opinion on the issues to pertaining to
slums and slumdwellers;
j.
to impart legal aid and legal knowledge to slumdwellers;
k.
to collect, collate and disseminate information, data perta
ining to slums and slumdwellers.
2.1.2.
On March 4, 1933
KKNSS conducted a Dharna in front
of the Assembly Hall in Bangalore in order to press slumdwellers
charter of demands presented to the Chief Minister after the
February 1933 convention.
The attitude of the State Government
was unsympathetic and 'indifferent.
2.1.3
Curing 1983 the State Government carried out demolitions
in at least 3 places.
KKNSS protested and staged demonstrations
after each of the demolitions.
This in a way helped the affeqted
people to get at least "some" compensation when the Government
..11/
11
allotted land at a place 15 kms. away from the city.
Both
KK14SS and the dwellers refused to accept the proposal and offer.
2.1.4
On June 22, 1934 several huts located on a Government
undertaxing *s property (Xarnataka State Road Transport Corporation•t
property located near the main bus stand) was demolished.
It
was argued by KSRTC that the huts were unauthorised and illegal.
It was day of crowbars, bulldozers, lathis only.
Ironically,
these nuts were inhabited by construction workers who built the
Main Bus Stand, Over-bridge etc. by the side of which these huts
existed.
KSRTC too in a statement admitted tnat all the slum
dwellers were construction workers in their project.
KKNSS witn the active support of the State Construction Workers'
Union condemned the demolitions, conducted dharnas, mobilised
public opinion etc.
These protests led to an angry editorial
from the State's leading daily "Deccan Herald" to comment"....
it is ironical that those people who built the entire bus stand,
over bridge are today deprived of a roof over their heads and
are thrown in the street....."
The relentless functioning of KKN3S and Construction Workers'
Union got the affected people alternative sites.
About 46 families
were provided witn sites whereas others either returned to the
same bus stand or took abode in places nearby.
2.2
Operation Demolition of 1985
It all began with a "padayatra" of the Chief Minister Mr. RK Hegde
in the cantonment area during May 1985.
Walking along one of
the elite shopping area he found the meagre belongings of a few
pavement dwellers scattered all around their 'homes'.
Instead of
realising the callousness of the society he decided that it was
essential to "Bring Beauty Back to Bangalore".
And the only
way to do this was to evict all slumdwellers.
..12/
- 12
2.2.1
"Operation demolition" began on May 6th 1985 when the
Chief ‘-.inister Mr. Hegde was away vacationing in Kodaikanal,
and many of his ministerial colleagues were "out of station".
The demolitions were arbitrary and no one knew to which direction
trie demolition squad would move next! The entire operation was
planned and executed in a systematic way.
2.2.2
KKNSS started lodging protests to various agencies and
replies were evasive and contradictory.
CM claimed that slums
which were in existence prior to 15 years would not be demolished;
the City Corporation authorities said that they would not touch
slums older than 10 years; and the Slum Clearance Board was
claiming 1980 as the cut-off year.
While these puzzling claims
and counter claims were taking place the reality was that even
slums in existence since pre-independence days were demolished.
And not all the demolished slums were located on Government lands;
many of them were on private lands, church and rauzrai lands,
along railway tracks etc.
The actions
were so arbitrary that even lands officially allotted
by Government agencies were also not spared.
For example,
Mr. ?. Thangavelu, a veteran freedom fighter was allotted a site
by 8CC in 1954 to set up a bunk shop so that he could earn some
money and support his family.
His site was cleared.
This in
a way violates the Government's own allotments made in the past.
2.2.3
Between May 6th and July 5th 1935 around 65 slums were
demolished all over the city rendering about 25,000 people
homeless.
Only 11 slums' evicted people were provided with an
alternative site at Laggeri, 10 kms. away from the city; but
again in Jane 1985 the Government claimed that even the alternative
sites provided to these 11 slums were only temporary and they
will be re-evicted soon to a so-called "better" place.
13/
13
2.2.4
Throughout the demolition period the entire State
machinery and the police force were functioning with an unpre
cedented efficiency and effectiveness, something rarely seen
at other times.
The Police and Demolition Squad members many a
times outnumbered the number of persons evicted.
Helpless cries
of the children and the aged, women and men alike fell on.deaf
ears.
Ruthlessly the huts were razed to the ground, their meagre
belongings thrownout, or in some cases, carried away by the
demolition squads.
2.2.5
Initially KKNSS made many representations to the Urban
Development Minister under whose jurisdiction slums came.
He
pleaded "helplessness" saying that the Municipal Corporation
had had undertaken the demolitions.
Discussions with the concerned
Municipal authorities and the Mayor yielded no results as they
said that were only obeying the orders of a high level committee
of which the CM was the main person.
2.2.6
In view of different claims KKNSS launched a telegram
campaign and over 1,000 telegrams were sent to the CM who was
then vacationing in Xodiikanal.
2.2.7
On 27th May 1985 a mass rally was organised in which
over 50,000 slumdwellers marched to Vidhana Soudha, picketed
its portals and stormed the seat of power, before meeting the
CM with a memorandum demanding the stopping of all demolitions,
and provision of patta, housing and basic amenities to all
slumdwellers in Karnataka.
Empty promises were made and the
demolitions continued without respite.
I
2.2.8
The Chief Minister replied to the memorandum of KKNSS
presented on 27th May stating that "
.... slums create environ
mental pollution and are a health hazard to their surrounding
neighbourhood....."
..14/
14
2.2.9
This blatant reply from the Chief Minister led to
another delegation to the Urban Development Minister.
This
delegation was led a 60 years old women who all through her life
has lived in various slums of the city.
Her questions summed up
the complete view of KKNSS which runs as follows:
"is it not
we, slumdwellers who keep the entire city clean? who beautifies
the streets?
who construct the very structures that house the
Government and the rich?
how then the city could survive without
them?
The Urban Development Minister very sheepishly replied that the
city lacked infrastructural facilities
but the uneven and
inequal distribution of the resources, which is the real issue,
was overlooked by him.
KKNSS also questioned that if slums are
considered to be unauthorised constructions, then very clearly,
there are thousands of other skyscrapers, apartments and such
otner structures which do not adhere to all construction or
building by-laws, and therefore become "unauthorised" too?
Why then are those building not being razed to the ground?
The Minister had no answer.
2.2.10
On June 15th 1985 continuing struggles against demoli
tions 17 members from the Sanghatane went to Yercaud in Tamilnadu
wnere an All India Janata Party National Study camp was being
held.
A memorandum was given to the All India Janata Party
President Mr. Chandrasekhar, and discussions were held with
various leaders both from the State and.National level.
The
Sanghatane members soon realised that many of the National leaders
who opposed the demolition issue were hoodwinked into believing
that all tne evicted victims were given alternate accommodation.
The Sanghatane members soon impressed upon them that this was
a false notion, and that actually thousands of people are still
languishing in the streets without a roof over their head.
However, the false claims of the State Janata Party leaders
prevailed upon the delegates.
..15/
- 15 -
While the struggles
3.1
continued in the form of dharnas,
morchas, meetings etc. and organisations were mobilised,
Women's «zoice, a
women's group working among slum women in
the unorganised and informal sector in Bangalore filed a Writ
Petition in the High Court of Bangalore seeking a Stay on
the demolitions.
The court admitted the petition but no
hearing was given and demolitions continued.
The matter
came up for hearing on June 14, 1985, but though notice was
issued, no stay order was passed nor any other order restricting
demolitions.
3.1.1
On July 13, 1985, the KKNSS and others filed a Writ
petition in the Supreme Court against the State of Karnataka,
the Slum Clearance Board, the Commissioner of the Corporation
and the BDA which argues that the provisions of Section 11,
12
and 13 of the Karnataka Slum Areas Act of 1973, on which
the demolitions are based, are violative of Articles 14 and
21 of the Constitution (i.e. right to equality and the right
to life).
The argument goes that a person deprived of a place
to reside in the vicinity of her/his place of work, under .
conditions of abject poverty is deprived of the right to life.
It is also argued that the right to reside must be available
to all citizens and not only to those who have means to acquire
property.
A stay order was issued on July 13, 1985.
Bx parte
interim injunction was granted and appeals and counter-appeals
are going on.
3.1.2
The final hearing is due any time now.
Despite this stay order the Government carried on
demolitions in a novel way during December 1985/January 1986.
The system was simple.
BDA issues a form to the head of the
household which states that the family accepts to shift to a
new place and that would accept alternate provided by BDA
in an area where land is available.
agreement
Because of the mutual
between parties concerned this is not violative
of law, it was contended.
KKNSS conducted a thorough enquiry
and found that the signatories were unaware of the contents
..16/
16
of agreement and that the BDA was forcing them to sign.
KXNSS
mobilised the people through its local associations
not to sign such agreements and BDA was forced to stop this
campaign.
3.2
In order to step up their campaign KKNSS organised a
National Seminar on Housing the Urban Poor on October 22-24
1985 with Justice Krishna Iyer, Indira Jaisingh, Keerthi Shah
and other prominent defenders of the slumdwellers cause.
The
statement of the seminar made clear that slum and pavement
dwellers are overwhelmingly rural migrants, mostly belonging
to scheduled castes and scheduled tribes and other weaker
sections of the society.
They are exploited as cheap labour
as well as politically used as vote banks and at the same time
ostracised as "anaroachers", ’'squatters11 and "criminal elements".
In actual fact they are the construction workers who have
constructed the city, not being allowed to erect houses for
themselves-
they are the load-carriers who are branded as a
burden on society, they are the domestic labourers who enable
middle class housewives to go out for work, being deprived of
the right to run their own household.
The statement also pointed
out that the crucial issue of "the right to use land" has as
yet been entirely unresolved in the ongoing struggles in which
the poor are constantly on the defensive.
The enormous commer
cialisation and speculation in land has marginalised Vast
sections of the population and has made rational planning
processes virtually impossible.
Urban planning is meaningless
without the participation of the marginalised masses
who are
at the centre of the city’s economy but whose exploitation
is so abysmal that the middle classes and the State see the
need to make them entirely invisible.
The recent (1985) remark
of the Commissioner of &DA is indicative of the process the
seminar noted viz., "why do you get worked up?
them, people will simply vanish into thin air".
if we evict
17
3.2.1
In the statement of the National Seminar (1985)
and in its subsequent demands KKNSS contends that it is
necessary to question the "public purposes" for which slum
evictions are curried out.
KKNS3 also reiterated its belief
that vast stretches of prime land are held by public and private
charitable institutions for private purposes, and that such
land could be used for housing the urban poor.
3.3
KKNSS's short-term demands include: stop all demolitions;
constitute a larger bench to review the Slum and Pavement
Dwellers' case in the supreme Court; Right to Housing be declared
a constitutional right;
provide alternative housing in the
same place or in the vicinity for evicted slumdwellers in the
past and provide sufficient compensation to those rendered
homeless; enumerate and recognise all slums; issue patta and
'
ownersnip- rights to all urban poor; bar land occupied by urban
poor from commercial transactions, both private and public,
stop all urban land trading; provide, improve and maintain basic
amenities for the urban poor; do away with cut-off dates; appoint
a study team consisting of professionals, government officials,
NGOs and concerned citizens to look into various aspects of
housing for the urban poor and develop alternatives; stop police
harassment; enact separate slum dwellers' central legislation
to protect their rights.
3.3.1
KKNSS's long term demands include:
comprehensive
revamping of legislation affecting slumdwellers and the use of
urban land; redefinition of objectives, priorities, and finan
cial allocations of agencies like Housing Board, HUDCO, HDFC,.
Slum Clearance Board, Development Authorities; people's parti
cipation in this process of redefinition is an essential
pre-requisite; review of acts on land use by charitable institu
tions; reformulation and checks bn implementation of urban
..18/
- 18 -
planning; integration of rural and urban planning to reverse
migration trends; right to information and public participation
in planning; introduction of "self-building programmes" for urban
poor; obligation on industries to provide housing for workers;
reservation of one-third of extension areas for housing the
urban poor.
3.3.2
KKNSS is absolutely aware of the fact that seeking
recourse or relief through legal justice or presenting memorandum
to the State or its agencies does not solve the problem in its
overall perspective - however, it does help in (i) giving time to
strengthen our struggle;
(ii) suggest alternative solutions;
(iii) create a deeper awareness and understanding; and (iv) such
recourse-seeking functions as an educational process for the
poor to understand the structures and systems in the State.
Participative process of an urban social movement;
4.1
Urban problems and political processes ; a reflection
Urban problems are increasingly becoming political issues
for two basic reasons
1,
the process of consumption in an obviously
unequal
society and the role of the State (and its agencies)
as a powerful intervening force through its
REGULATORY powers;
2.
the spread of an urban ideology emanating from the rich
(elite!) sections of the urban milieu having close links
with the State which views slums in such terms as
"eye-sores", "health hazards" etc.
4.1.1
In Karnataka, the current interest and debate on
urban problems, and popular struggles/initiatives is due to
diffusion of a dominant policies of the State which is inherently
anti-people.
These policies became apparent during Mr. Gundu
Rao’s regime in 1981-82.
These anti-slumdwellers policies gave
rise to a wide range of protests generated by KKNSS.
Since
..19/
19
1982
played a pivotal role in the emergence of two kinds
of protest movements among the urban poor of Karnataka though ,
independent of the policy bases and effects.
a.
They are:-
a form of ECONOMIC DEMAND (protests) primarily to meet
immediate needs related to living conditions of the habitat
such as drinking water supply, sewerage etc.
This
type of protests are now part of KKNSS's organisation
and have a strong internal coherence, also mest prevalent
type of urban social movement in many cities and is similar
to what we may call "socialisation and collective consum
ption" of amenities and facilities.
b.
a form of protest which demands for the right to live
and livelihood as enshrined by the Constitution of India
based on the social fabric of the slums.
as POLITICAL DEMAND.
This we term
This type of protests or demands
highlight State's oppression by various means through
ius regulatory and welfare polices; equitable distribution
of resources like land, housing materials at nominal
prices; subsidy for housing, representations of slum
dwellers in the concerned boards and demanding room for
their participation.
This can be termed as an intermedia
ry level of our mobilisation.
This mobilisation has got
a strong protest base and consistently question the
structures and systems in urban areas, land policies
legislations, schemes etc. which are deterimental to
the very life and livelihood of slumdwellers.
•
This form of protests also help us in clarifying our percept
ions, conceptual frame work aims etc. on a continuous basis.
This promotes our mobilisation aspect as part of our movement
in an objective level.
..20/
20
4.1.2
<C;SS and the Working Class
Economy of ths cities in Karnataka has two basic sectors viz.,
a.
formal, non-agricultural economy covering manufacturing,
commerce, administration service etc.
This sector has
access to the resources of the State and other facilities.
b.
informal, non-agricultural economy mostly covering that of
service sector.
They have no access to resources of any
The most important is of course their wage rates
kind.
are significantly lower and fluctuating.
Because of the low wage rates and unstable economic conditions
people depending upon this sector live in appallingly poor
living conditions; majority of them, obviously, reside in slums,
pavements etc.
In such a situation an organisational ike KKNSS
cannot ignore strengthening and linking of sectoral organisations
like Construction Workers, Domestic Servants, Hawkers, Women,
Youth etc.
This makes possible the integration of formerly
passive, popular urban informal sectors with the crucial
In
political battle initiated by the working class movement.
this sense, we can look forward to an urban social movement
as people are mobilised around crucial issues affecting their
livelihood take active part in the political process in the
direction of a change in social relationships and processes.
4.1.3
In order to strengthen this aspect where it is essential
KKNSS functions through the respective Trade Unions or target
groups.
For example, when KSRTC
demolished the hutments of
those workers who built the Bus Station it was the State
Construction Workers Union which took the initiative with the
active support of KKNSS in organising protests, dharnas etc.
It was Mrs. Balamma, a 85 years old woman, who led the proaessrcw;
in May 1985 highlighting the double oppression suffered by
women in the slums viz.,
(i) as any other women in the docile
,.21/
21
Indian milieu which is inherently pro-men; and (ii) as a slum
dwellers who is neglected and pusned around by the State.
It was children who led the procession on October 2, 1985 (Mahatma
Gandhi's birtnday)
to focus attention on their under-nourished,
unschooled status, unhealthy living conditions devoid of even
minimum facilities.
4.2
KKNSS believes that even a reasonable social transformation
of the urban structures and systems are impossible without an
alliance with the organised -working class -with the unorganised
and unconscious working class who all face the same crisis in one
form or the other.
We have established relationships with trade
unions of the informal sector and their leaders time and again
addressed slumdwellers on matters pertaining to housing, amenities
etc.
KKNSS also urges established Trade Unions to include housing
as one of the demands in their charter.
Thus, the unity and
motivation of the slumdwellers' did survive any possible polarisa
tion of the political opposition which exist in other areas.
What is true of our relationship with the Trade Unions is also
true of political parties in the State.
Many leaders from various
political parties despite their agreement with the State on the
policy of demolition in the name of rehabilitation
of “congested
slums" had offered their assistance in condemning evictions,
demolitions; they have also addressed to slumdwellers from various
plat-forms seminars etc. in defence of them, their rights etc..
Thus, we were able to neutralise any direct, possible opposition
from political parties to our demands.
4.3
Urban Planning as a Social Process:
KKMSS's view
The increasing complexity of the urban problems has led to
a more "human" urban planning which appears as a political saviour
to the crises felt by the citizens in their daily life.
very high expectations are placed upon planning.
Thus,
KKNSS in relation
to its past experiences views planning as a deliberate State
. . .22 /
22
process with only limited, defined objectives like regulation;
institutional intervention; readjustment of the economic and
social problems vis-a-vis social interests.
To us "urban
planning" is the creation of dominant interests in collaboration
with the State which views slums as an "administrative problem".
Thus, planning|?rocess in our view emerges to be a "net work
of vested social interests" deterimental to the slumdwellers
and poor in general.
To substantiate our view and analysis a recent example is
sufficient.
Real Estate Developers (RED) have mushroomed in
the Bangalore City since 1980 and have "developed" many layouts
in and around the city.
Recently it was found that these
layouts were built on revenue lands, not eligible for residential
use.
The house owners (hailing mostly from middle class or
neo-rich sections) along with the REDs formed an association
styled "Revenue land House Owners’ Association" to get the
matter "settled"
with the Government.
In some cases, it was
learnt, the Government has imposed a nominal sum as "fine" for
the mistake done for using revenue land for residential purposes
and let off.
consideration.
Other requests for such exemption are under
Government has also promised to provide basic
amenities at the .earliest.
Thus, mobilisation of people and the quick decisions of the
,*•4 *
Government did not occur in a social vaccum; on the contrary
social base of the REDs and the House owners played a definite
role in "settling" the issue.
It is in this context that
KKNSS demands participation of slumdwellers in the Urban planning
process so that they can voice their needs in proper forums
despite the limitations.
4.4
Did these struggles, protests and initiatives of KKNSS
maxe any visible socio-cultural-economic impact and lead to
..23/
- 23 people's movements which the third phase of our organisational
work?
It would be false co claim that people's movements have taken
place. But definitively such a trend has taken roots and
growing, fk closer scrutiny will reveal that a numerous number
of small, day-to-day protests against the state's policies are
taking place.
Local associations, which have strong functional
links with \-xKNS3z are asserting their rights in a specific
way and the slumdwellers are now quite sensitive to their living
conditions than in the past.\ To us, such a position is conducive
for the growth of a political movement since in course of time.
people would realise that the "Small" problems they face are
the side effects of bigger policy decisions of the State.
Very
fruitful and effective struggles can develop, and are developing,
according to the conjuncture and to the classes through ideo
logical motivation.
This implies that we believe people move
from general immediate day to day demands (thinking'also)to
a mere radical, political and ideological protests aimed at
the transformation of social relations if sustained efforts
are carried out«y
5.1
The spread and level of progress of KKNSS as a people's
forum cannot be separated from the general level of consciousness
in the society which progressively growing.
But this is only
a contributive factor that hastened their participation in our
struggles and strengthened our-educational activities.
5.2
Our experiences and analyses can be theorised
and summarised as follows
a.
a sustained urban movement can be an instrument of
social integration which goes beyond religious, linguistic,
regional, cultural barriers;
..24/
24
b.
the difficulty of fighting against the various mecnanisrns
of the State and "elitist" policies of the State prove to
be a good political education in course of time as people
realise the limitations of the "democratic processes and
structures".
c.
a movement like KKU'SS can definitely differentiate to people
between ’immediate demands* and ’long term demands' and the
stages of preparation are simultaneous.
d.
a movement like ours can also destroy the social relationships
created and developed by the State, say for example, distri
bution of urban land for real estate developers - by claiming
these lands for housing the poor.
e.
the so called "militants" of the slum (a mild term for
'goondas' and ’slumlords’) have progressively lost their
traditional base with the people.
Earlier these militant
leaders used to collect annual rents, conduct slum panchayats
to settle most of the personal and locality matters etc.
KKNSS and the local associations formed have now been exposed
these militant inherent vested interests
with the exploitative structures.
hUeir links with
This also happened when
militants failed to generate rnucn interest to work for the
slumdwellers.
During hours of crisis, such as evictions,
tnese militants revealed their limitations.
With the progre
ssive alienation of these militants people's associations
asserted their supermacy.
Conclusion;
6.
The struggles of slumdwellers not only in Karnataka
but all over India have assumed a greater importance by
their increased levels of consciousness, demanding that
they need a better deal instead of arbitary decision of
the Government to demolish their houses, in the pretext
of "beautification drive" development of cities.
.
..25/
25 lhe time has come that the slum dwellers have realized that
Housing is a Fundamental right to all citizens and they too have
a due share in urban cities.
The time lias gome to bring the
vast masses of urban poor within the frame work of national policy
and planning to treat them as equal and deserving citizens and
to make serious efforts to bring about improvement in their
quality of their lives.
APPENDIX I
In section 3.1.2 we referred to a letter distributed among
slumdwellers for applying alternative house sites.
The English
translation of this letter is as under:-
"Addressed to the Commissioner
Bangalore Development Authority
Bangalore
Sir,
In pursuance of letter given dated 28th December 1985, request
ing rehabilitation, you have provided a house site numbering
on Survey No
in
area, provided with all facilities,
water, electricity, drainage and street lights.
I am voluntarily vacating ray present unauthorised possession
from HAL 2nd stage located on survey No.
there are no basic facilities available there.
since
Viewing this
rehabilitation provided to me, I will not complain to any authority
or go to Court of law.
Therefore, I surrender ray previous posse
ssion and my right to the old dwelling and I am giving this in
writing to you.
Thanking you,
Yours faithfully.
Signature of head of household".
..26/
26 Note:
To make matters worse, the allotted land under thia
scheme is under dispute since a private party is claiming
its ownership and has been granted a stay by the court in
regard to that particular land!
£
1.
a EMCEE s
We have drawn substantial material from various papers
presented at the National Seminar on Housing the Urban Poor
conducted at Bangalore in October 1985, and newspaper clipp»
ings over the period 1982-1936 of Karnataka Kolageri Kivasi
gala Samyuktha Sanghatanae.
2.
Vinod Vyasulu in “State of Karnataka's environment" 1986.
The chapter on urban development in Karnataka is referred
here.
3.
H. Rarachandra in "Slumming the metropolis"
(1986)
in Essays on Bangalore published by Karnataka State Council
for Science and Technology.
4.
Survey results
of the Bangalore City slums, 1980,
4
1
National Sample Survey Organisation:
5.
Shivalingapppa, 1979, in IIPA's
journal "Administering
slums and slum problems in a city".
6.
Gabriele Dietrich in Economic and Political Weekly, March 1,
1986 "Housing the Urban Poor" - a commentary on the
struggles and initiatives of KKNSS.
3.
Samuel Johnson’s article on Housing in Karnataka presented
at the ISEL Seminar, Bangalore.
$
WORKSHOP
ON
URBAN
NOTE'
BACKGROUND
Against the
POVERTY
'aesthetic approach1
The official perception of the phenomenon of urban poverty
’has been by and large conditioned by simplified notions
about differentiation of urban poor.
Urban poor have been
treated, in terms of methodology of policy and planning,
as a homogenous entity.
And generally urban poor are
equated with slum dwellers.
In the area of official action
the emphasis is generally laid on shifting slums to some
God forsaken outskirts of a city.
In other words, the
problem of slum dwellers has been increasingly treated as
an 'aesthetic'
city.
one which is related to the beauty of a
We feel that such official actions signify outmodel
understanding of urban poverty.
On some beleifs of official perception
In this background, we feel that there is a deepfelt
necessity to initiate a comprehensive discussion on
urban poverty in terms of evolving an alternative
strategy to tackle the above said problems
Essentially,
this means a concrete re-examination of the current
beliefs and theoritical models of urbanisation trends in
India.
One such belief is that urban growth in India is
un
balanced because it is oriented to metropolitan cities
and the small and middle size cities are very slow in
growing.
The belief still persists that metropolitan
communities are experiencing very high growth rates
because of a heavy stream of migration from the
country side.
- 2 It is further necessary to draw attention to the fact
that during the decade the rate of metropolitan growth
is lower as compared to growth of regional towns.
The above said belief results in a bias towards a big
cities in allocation of resources at the cost of
smaller towns and cities.
The problem of urban poor
is not just confined to big metropolitan centres.
Even in terms of slum population, for example in
Karnataka, small cities like Raichur, Shimoga, Bellary,
Tumkur, Harihar have reported the existence of 12%,
7%,
7%,
10%, 16%
of slum dwellers respectively,
And it has registered a definite increasing trend.
2
Another widely held misconception is that official
policy in regard to urban poor should concentrate
mainly on spheres of service and reproduction.
Schemes
like ICDS, Basic services approach, Mid-day Meal scheme
for the' school children essentially reflect this 'service
oriented'
approach in spheres of production, And in the
spheres of employment urban poor are left at the mercy
of 'informal sector'.
Foor citizens in urban areas are
forced to fend for their livelihood and income by resorting
to a proliferating insecure, lowly paid relatively non
growing, more exploitative and humiliating 'bazaar' and
' informal sector' and also live in a increasingly deteriorating urban situation.
1.
S.C. Jain .and Kirtee Shah, A disscussion on the__Urban
poor, Ahmedabad - this paper "draws our"attention to"”'
the widely held beliefs behind official perception.
(1987. P.8 a document for private circulation)
2.
Source: Urbanisation in Karnataka - Seminar papers,
technical se'etion TV 'P'.4 institution of Engineers
Bangalore - 1985.
Desai A.R.
' Urbanisation and proliferation of .slums
and Pavement dwellers, paper presented at the seminar
on law, urt>an development and planning, organised
by Lawyers collective, Bombay, 1982
3.
3
- 3 Now the task is to achieve a synthesis of'services
oriented approach' and a fundamental approach towards
the problems of production and distributive JUstice,
The present workshop intends to provide a forum for
this d'bate.
These are just few of the problems that we would like
to highlight in the workshop.
Hence, we have planned
it as a congregation of social scientists, policy
makers and activists.
i
NATIONAL COMMISSION ON UftbAiMI SAT1UN
A discussion note on the Urban Poor and Soma suygoations
for action for ths Commission
by
Or. S C Jain
Mr. Kirtee Shah
Ahtnedabad Study Action
Group (ASAu)
i»o
JlUaUjuwlJiaoxMs
1,1
Ths m@nugeme.nt of grrawfch of ths Citias
especially the
metropolitan enrf other big cities ■= in a manner that would
•naura (a) an acceptable quality of environment and
raasonauju standard of living to their inhabitants,
and
(b) result in reduction of inqualitiea is ana of the
formidable challenges before the planners, administrators
and paopla of thia country.
A number of complex forces,
operating simultaneously and often pulling in conflicting
directions, constitute a stern teat to our planning
ability, institutional ingenuity and administrative
capacity,
A great vision and high degree of creativity
are going to be needed in assessing problems, determining
priorities,
formulating solutions,
finding resources and
effecting durable changes,
<J.2
The most demanding of the urban challangns, unquestionably,
is the challange posed by urban poverty: tha challange of
reducing exploitation, relieving misery andr c
ating
r.-~~ f-1^
more humane conditions for working, living and
f the
■■
- 2 -
di s adv an tag ad sections of the urban population: the taek of
adequately fovdinn. educating, housing end employing a large
and rapidly growing number of malnourished, illiterate or
semi-lltarata, un-or aemi^ski llsd, un-or under-employed and
impoverished city dwellers struggling to make a living from
low paying occupations,, enterprises and jobs and surviving
on pavements and in poorly serviced chaiyls, overcrowded
and unhygoinic slwras, i Hogel squatters and other forms
of degraded and inadegunta urban ssttlEmsnts.
If tiia present trends persist it is cartain that in coming
decades, as fijui,
the urban landscape will continue to
mirror, probably more glaringly, the contradictions and
ills of the Indian Society: economic disparities, social
inequalities, culture! alienation end increasing depriaetlon
for a large number of its people.
Chore mill be more
sky scrappers and in them more spacious and luxurious
apartments for a previleged fstu.
At the same time the
number of those wno "squat in squalor and drink from the
dreom” will also increase.
The poor and the unskilled
from the rural ureas will continue to flock to big cities
in the hope of employment and better life only to add to
tho growing number of unemploy nd and further deterioration
in the quality of city life.
1,4
There is considerable evidence to suggest that tna growth
path selected by us has not led ths poorest sectors of
3
population to bettor living standards nor hag it led to
reduction of inequalities in any visible manner.
The share
of the poorest 30 per cent in tho consumer expenditure
has remained nearly stagnant during 1950-70.
It mas 13.2
per otint in 1958=59 and 13.6 per cent in 1977=70.
The
percentage uf population below poverty line had only a
marginal decline from 41 par cent to 40.3 per cont during
Ths percentage of population suffering From
1959 = 1979.
calorio or protein d&ficiensy was as high as 32.60 which
is higher as compared to the Figure of 28 ®8 per cent for
rural urea®.
Since the population has expanded from a
mere 300 million in 1951 to 683 million in 19810 the
reduction in percentage does not mean reduction in absolute
numbers.
In fact the urban population below poverty line
might have gone up from 32 million to 58 million.
It ia
paradoxical that this should have happened despite the
annual average rise of income by 3.5 per cent.
Justice
Iyer described this phenomenon sarcastically as a double
process of growth of GNP, namely growth of Grose National
Product and growth of Gross National Poverty at the
same timel
Since the accent of planning process in India,
as in several other developing countries, is on improvement
of living standards of the poorest groups in society and
reduction of inequalities in asset distribution, the urban
development policies must be viewed in this light
4
1,5
The official response to tho phenomenon of urban poverty and
the situation of urban poor - which has so decisively altered
the visual landscape, social fabric and overall character
of the Indian cities - in form of policies, strategiea, and
programmes has bean generally unimaginative, inadequate,
half-haapt«d and sectoral.
with the slum dweller.
Tho urban poor is usually equated
Housing is perceived to be the slum
dwellers* main problem.
Till recently providing a pucca house
was perceived to be its solution (until running out of money
and realising that in the numbers game it stood no chance of
winning).
Recent new responses like tha Sitae and Services,
Slum Improvement, the Urban Community Development Projects
(UCD), the Integrated Child Development Services (I CDS),
The basic Services approach, the Mid-Day Heal Schema for
U
the school children and the Small and Medium) Town’s Develop
ment Programme represent a better assessment of situation,
more realistic attitude to resource constraints,
a broader
frameworkyand probably a naw awareness of the responsibility.
However, most of them are at their early experimental stags;
are not reaching even a small fraction of the people thay
are meant to cover, reach and benifit; are often floundering
on implementation frontj and some of them are already showing
5
signs of malfunctioning,
The^e approaches, programmes and
projects are certainly hopeful signs and therefore deserve
a proper try, careful monitoring and evaluation, redesign,
strengthening and a fresh commitment.
The fact, however,
5
remains that considering the scale, complexity, and gravity
of the poverty situation and the threat it poses to the
social fabric and economic wall being^of the city and its
citizens, the response is woefully inadequate.
1.6
H comprehensive and well articulated policy for urban poor
is yet to emerge.
While alums undoubtedly house ths urban
poor, it w>>uld bs wrong to conclude that slum improvement
and urban poverty eradication are synonymous.
according
to the Sixth Plan document about one» fifth of ths total
urban population may ba currently living in slums.
by 1905,
such population is estimated to be about 33.0 million.
However,
tho population below poverty line was estimated
to be 38 per cetnt of the total population in 1976.
If this
rate persists, the urban population below poverty line
would be 62.9 million as against 33.0 million living in
slum areas*
1.7
In ths fifties and early Sixties it used to be a fashion
to use the terme 'slums'
and 'squatter colonies' to
denote extremely chaotic and dilapidated 'houses' end the
highly deprived and unhealthy character of the residential
environment in such areas.
The illegal occupation of the
land on which the shacks, hut or enclosueres mads of cheap
and cast-away materials had been constructed was a standing
challenge to the institutions of law and order.
The slums
were considered to be a blemish on the fair name of the
6
city, a blot on its social life and a parasito on its physical
body.
Slums and squatter settlements were viewed as dens of
criminals and thieves, of pimps and prostitutes, of lepers and
beggars, of bootleggers and smugglers, of the toughs and
The city commissioners frowned on any proposal for
the thugs.
investing municipal incoms on the amelioration of the conditions
in the nlumeio
According to them, it mas misplaced humanitarianism
which amounted to punishing tho law-abiding and innocent
citizens.
Further it constituted an open invitation to more
lawlessness.
Instead, they argued, they would ask the
fraternity of social workers to co-operate with them to evict
the illegal occupants and persuade them to ba on the side
of the enforcement forces of law and order and help surveillance
organisations which were to be strengthened to prevent illegal
occupation of lands.
There were even suggestions to cordon-off
the cities against infil t ^ration of unwanted elements.
1.8
Thess attitudes still persist.
However, a change is visible.
The compelling logic of numbers could not but assert itself
in a ay stem of politics where numbers matter in gaining political
power,
If such a large number of persons were arrayed against
the society, no police would be able to succeed in restoring
law and order.
The squatter settlements were seen as receiving
pockets yf in-migrants who had been pushed out by the rigours
of deprivation and bleak prospects in rural communities,
especially during the disastrous periods of famine, floods,
etc.
Those people had been lured to the cities by prospects
7
of batter incomas and wars exploring their chances with tha
help of friemds and rolatives.
The slum -pmiket was a
balancing mechanism for level ling-up rural*-urban disparties
which had bean generated by^uncontrolied forgets of planned
development and natural adveraitieso
The slum reflected
I'- t
fc- <
the poverty of’means of, in-migrants and/transitional
character of’ their involuament.
Poverty and struggle,,
however, are neither illegal nor immoral.
Un the contrary,
stronger social snd moral fabric than
the poor
the affluent -©aura claim to possess.
the theories of ’cordoning0
Such explanations dismiss
the cities (as practised in
some socialist and military dictatorships) to keep the
intruders at bay.
It maanjf freezing inequalities and
injustices perpetrated by an oppressive political system.
It considers all talks of 'removal’ as cruel.
1.9
A theoretical analysis,
as represented by urbanologist
Turner, classifies slums into slums of hope and slums of
despair} the latter are reception pockets of those who had
met bad luck,
failed or fell out.
The former, peopled by
the n«ui frontiersmen, represent rising hopes.
As the
pioneers berthed into an economic opportunity and gat
integrated with the economic and social structure, they
could stabilise their incomes and social relations and could
attend to the problems of housing and residential environ
ment.
Tha strategy was, therefore, of gradualist incremen
talism J
providing access to the basic resources and
- 3 ‘I
structures o f^resi dential environment to begin with and hopsv^
Cit -fi-Cm J <zk
that the suprastructure and details would eoasyaa the
transients improved their incomes and started consolidating
and giving social expression to their economic gains*
Tho present ’Site and Service Scheme’ derives its rationale,—
not in a^sfiiall ineasurep- from this view of squatter
s e 11L tsm an tn®
1.10
Thia position raprasants a marked deviation from the earlier
position based on the legality or otherwise of the existence
of slum so tt lem un ts«
It io dynamic, functional and humans.
It views man and settlements changing over a period of time,
in incomes,, social connections and maturity.
it views slums
as an essential part of city’s social and economic life. .
A slum dweller is not a parasite, hanger-on or peripherial
individual on the economic margin.
The services provided
by him are essential to the very survival of the city as
an economic entity.
Besides, it views slums as people and
not Just places with human sensitivities, responsiveness,
empathWcabi lities and capacity for collective action.
V
1.11
The strategy of in-sitbf development and upgradation,
especially where a slum had been in existence for over
10 years, was an Important departure from the earlier
policy of slum removal and mass relocation.
The legislative
tools are still inadequate to enable a public authority to
earmark and doclare an area for upgradation, carry out
- 9 -
necessary improvement projects and collect the cost through
a suitable levy,
Ag a result, the 'in«situ»improvement of
slums* is confined to municipal lands alone; this has a
very limited ocope.
78.1
It may be of interest to know that
per oent of the slums in Ahmedabad have bean built
on private land; 6.4 per cent on Government land and only
10.4
par cent are on municipal land.
The unspecified *no
man’s land* cietegory is applicable to only 5.1 par oent.
1.12
Lven if the legislative tools and implementation machinery
are str engthanedp the 8 transitional settlement’
does not get to the root of the problem.
approach
It has no answer.
to the problem of how the cities should cope with continuing
flows of in«=mlgrant3 at an ever increasing rate with a
progressive reduction in the availability of developable
land, rigid tax base and increasing difficulties in
recycling of invested resources.
1.13
The transitional settlement^ approach does not spell out
the nature of intervention to guide the process of population
movement.
Although wage levels in the city are undoubtedly
high at compared to rural areas, the industrial production
•/ > * e 2L<
activities are likely to
under the influence
of current restrictive legislations and incentive polices for
developing industries in backward areas.
It would be a bold
city government which can plan for the full employment of
its own population which it adds every year.
What is the
10
point of investing and freezing the migrants with slum
gcl -C
J
improvement and Sites and Services ^pproaoh if the future
prospects of expansion of economic activities of the city
■_&>/ not•
iV
hand,
I- V
their full scale absorption?
On the other
ths naw centres of industrial di spersal^ providing
economic opportunity^ suffer for want of skilled labour
■4
because houalng^ so ci al service® and/resident! al environ-*
mentj haws not been aimultaneounly developed.
of growth dispersal,
A planned policy
accompanied by planning of infrastruc
ture for conservation and development of human resources
and ttyuchroni eatlon of information and communication services
can make the process of movement much more meaningful than
unguided migratory movements into the cities1.14
A planned policy of population distribution supported by
appropriate implementing powers, resources and organisation
can rationalise the flow to a considerable extent, although
it cannot stop migration from far off districts^ other states
and foreign countries in so &r as it is sheltered by local
relatives and friends of in-migrants.
Metropolitan sluio5
AV«L
rather- a national problem.
Even in a cosmopolitan city like Ahmedabad 60 par cant of
the in-migrant householders in slums belonged either to
the district to which the city belongi# or to the neigh
bouring districts.
In smaller cities, the proportion of
population coming from the adjoining region 1s likely to be
much larger.
The area approach has, therefore, considerable
potential for restraining the process of unguided migration.
- 11
1.15
Thera is / strong evidence that tha growth of low incoms
settlements is much hi ghat Js compared—the population
growth of the city as a whole.
The slum population of Ahmcdabad is estimated to have risen
from L1.87 lakh in 1961 to 4.15 lakhs in 1976.
Part of the
rise no doubt due to a higher.#^®-®# birth rate but ths
l=*ueg«» part"n^- rise ie^attributed to in-migration. y>§tor^.j
rC
of Bombay, Kanpur and other cities
not much difforont.
The in-migration rate in slums is about twice that of tha
city «is a whois.
1.16
Or. S P Ktmhyap of the Sardar Patal institute of Social
and Loonomlc Ha sear ch, in analy sts/Ahmedabad riftfcfi. (19 76 - 77),
found that as compared to the per capita monthly income
of slums (Rs. 51.29) that of chauls was Rs. 121.71 and that
of non-poor settlements was Rs. 378.49, excluding super
rich families.
These dlsparatlas did not necessarily
reflect differences in productivity but the manner of
organisation of production process and appropriation of
surplus.
The expanding proportion of slum population,
therefore, reflects growth of impoverished masses of
population.
In the regional cities the per capita
income of slum dwellers is smaller as compared to metro
politan city of Ahmedabad.
low Income settlements,
The growing population in
therefore, aggravates the misery.
12
1.17
The social composition of alum population in Ahmedabad
showed that 21.0 per cent of the households belonged to
scheduled castes, 12.2 per cent to scheduled tribes and
14.8 pay cant Muslims.
In Baroda the percentage of
scheduled tribes and Baxi Pan ch population was 47.64
per cent in the slums as per 1976 enumeration.
These
percentages are much higher aa compared to overall city
porcentage for
same groups.
If ths present trends continue we may find a higher
pornwntags of low income households and scheduled
population groups inhabiting ths city.
The social and
economic character of the city io accordingly bound to
change.
1.18
The facto of life in the so called slum settlements
as they are known to us today lead us to view them as
unplanned low income settlements rather than as transitional
settlements.
A large number of settlements have existed
for more than 25 years.
The following table provides data
about ths ages of 1205 slum settlements identified in the
seven major cities of Gujarat.
tin ysdrs)
Lose than 5
5-10
11*25
26-50
Over 50
N, A
Ng. gf Settlements
LsttuaiiLaaa
24
63
168
6 09
326
15
1.99
5.23
13.94
50.54
20.05
1.25
13
Over three-fourth of the total settlements are more than
23 years wide
Only 2 par cant of tha settlament a which
are 1.ciao than 3 years old would come in the transitional
category «a they are likely to ba peopled largely by
newly srrivad iftpnigrants,asafound inlaid slums alMU
However^ ths oworwhoAmong majority still belong^ to old
settlers.
In Ahmedabad,
for ®xarapl0c 61.3 per cent of the
hoMQ@hsld@ were staying in slum® bsfore 1963.
If tha
chawla aso includ0do sama of which are raore than 10Q years
©Adp th® p®rc@ntag@ wauld incr®aa® sharply.
It la thus'
clear that w© ®r® dealing her® not with transient migrants
but with ®0ttled people who have decided to make tha city
their home.
A ssttlomsnt thus comprises parsons at
different levels of economic and social integration: of
those: with permanent intention to stay; of transient
explorers and eeasonals} of failures and cast-outs.
The
.(o
facita brought out by t-ha-author1 s studies in baroda and
supported by other studies is that a larga majority of
the dwellers who have an economic base in the city have
succeeded in reaching tha social nexus end are determined
to stay in tha city for the rest of thair life*
Tha
undecided ones either lack economic and social locus in
the city or hava improved their Incomes and social status
so considerably »i to afford a movement to a new araa
belter life.
14
1.19
The urban poverty line haa bean defined as Re. 75 per capita
par month expenditure level, corresponding to caloric
-■tT
requirement £h 1977-78 prices. based on thia the total
urban population falling below poverty line expenditure
level Lu a a estimated to be 38.1 per cent in the country
For policy imple-
(Gujarat figure was 29.02 per cent).
raentati0nD
further differentiation is necessary so a» to
distinguish between the marginally poor and the very poor
households.
If income is taken as proxy for expenditure
level, the Ahmadabad slum picture would be composed as
shown in ths following tablas
Income supplamentation needad
Monthly
1 nciima
par capita
(1976-77)
Percentage
of
households
Below 25
2 5-50
11 .50
4 5.74
22.7
52.3
Hi 319
fa 3828
39.1
35.9
fa 219
fa 2628
50-75
35.63
69.2
fa
fa
Above 75
7.13
87.5
5.8
-
100.00
51.29
26.6
fa 136
Average
Gap
yearly
monthly
35
420
am
fa 1632
Considering the data about families below poverty line gap
varied from Rs. 8.5 per capita per month to Rs. 52.3 per
capita par month.
per month.
The average gap was Rs. 26.6 per capita
If we take the average family size as 5.11 an
income supplementation of the order of Rs. 136 per month
or Re. 1632 annually is required to bring most of the
15
famlllea above poverty line.
However, it has to ba of the
order of R*. 3828 for vary poor families and only He. 420
for mmrgin«Ily poor families.
Raising the poverty line to Rs. 85 par capita per month
for his 1980 study (Planning Commission figure Re. 83)
Picholia estimated the average gap to be Rs. 27 per capita
per month which is vary class to tha data cited above.
His percentage of marginally poor is smaller but tha
percentage of the very poor is quite close.
1.20
The most readily available means to raise incomes io the
productive ubs of under-utilised manpower.
The urban
situation in thia respect seem to have worsened during
the period 1972-77 for which N.S.S. data have bean analysed
Tha following table presents data on unemployment rates.
Urban Unemployment
Rates
Rural Unemployment
Ratea
Years
Dally
Status
Weekly
Status
Daily
Status
Weekly
Statua
1972 - 73
9.00
6.55
8.21
3.89
1977 - 78
10.34
7.86
7.70
3.79
While tha rural unemployment rate was attoiiin during thia
period under reference both on daily status as well as
weekly status basis, the urban unemployment rata had gone
up by about 15 per cent on dally basis and 20 per cant on
weekly baaie.
15.A
idsaggrogated figures are not available on unomploytaant
rates amongst urban poor houaaholds on a nation-uilda or
statewide study scale,
bicholla9 however* In his case
study of a ward in Ahmedabad reports the following
figures about unemployment on usual status basis.
Sea tho following tabla;
Category o f
HougstoA ds
Paruantuga of
Unamployod once
curation jf
Unemployment
Tc popu*’ To Labour Moro thai i
1atlon
fo rcu
on<* year
Total
1-2
y our©
Mora than
2 years
>Joo r
11.29
20,81
54.0b
2 0 • 73
24.39
100
.:ion-poor
2.44
3.55
45.45
36.36
18.19
100
overall
7.91
13.21
53.76
22.53
23.66
The contrast© ar© clear.
The poor housanalcs have
relatively a much higher rate of unoinployeci labour power
as compared to non-poor houoaholda.
even in poorer
households* incidence of unemployment wub found significantly
higher in scheduled caste and scheduled tribe groups*
furthers the severity is indicated by the period of
unemployment.
Nearly one-fourth of the unemployed were
in that status tor more than 2 years*
uomparud to the
non-poor* the poor householos hao a longer waiting period*
Un 7 fa rtunatsly * data are not available* on urban under*
employment rates in poorer suctions*
uisarla has analysed
that under-employment rate amongst casual labourers is
- 15.b -
higher an CQ.npurud to other earner categories.
.>« casual
labour forma a Large proportion of labour force in alums <■
(about l/3 of the total), the undor-onploymunt rate in low
incume aroaa io llkaly to ba much highur as compered to
the ganaral city rates.
Incqrno '>roupL
Nq. q_f Harngra
0-1u0
2047
10.15
100-200
7411
47.25
200-300
34 59
22.05
300-500
il? .£_££,1L
1044
to © i/ 7
500-700
14
□ .09
’'i • S •
061
5.49
15605
100.03
iiot only the hijh rate of labour unuer^itilioutrun but
also tha low rate of returns accounts for tnu poverty
of nri overwhelmingly largo numbur of house-holds Ln Low
income aattlomenta.
The barada data throws lijht on
the distribution of earners according to thulr monthly
income (.'Survey year 1976).
The typo of occupations in which thia labour force wee
dietributad wan found aa under:
15. C
F requsney
Percentage
of workers
ngriculturo end Animal husbandry
340
2.22
UomoMtloa and ©arvants
507
3.23
Casual labour
5450
54.34
wockura in lnduatryB Cavernrasnfc end Private 3ost©!?
5217
33.24
Patty business
1735
11.38
Technical
453
2.89
Retired
as
0.34
Otho® a
1839
11.72
15606
100.00
Occupational category
Mats From pthor studies shows that domestic oarvanta and
casual workars occupy ths bottom of the oarnlnj seals.
Thkilr monthly income saldom uxcuadad Rg. 200*
In most
of ths oases it was below Rs* 100 per month.
Next Gone
temporary workers*
Their carnlnga came botuincn Ha* 100 •
Ro* 300 in a largo majority of cases.
A few had a monthly
income of over Rs* 300 but no one had more than Rs. 500.
A majority of permanent workers enjoyed incomus upward
of H»* 250 per month*
The self-employed persons wars
engaged in petty trade or small buslnuss. houauhold crafts
and services (tailor, laundry, barber* carpentry, pottery.
leather work, blackgmithy* etc.), and transport services
(auto rikshaw) pedal rikehaw. hand-cart pulling).
- 15.0 -
A large majority of craftsmen had lasg th^i poverty level
incomes*
Under transport category* the modern sector
worker© (Auto-rikshaw drivers) oroseed thu poverty line
while othsB’s were having low income*
Petty traders with
low investment had telow poverty level inaomii0.
Tha Jala* therefore* suggest that regular!a-tion of
employment (its da-casuali@atl0n0 ©^ttlud Locus or
de-tamporalRation)* its modernisation (high onsrgy appli
cation to produce mors usrk) and collectivisation (through
unions* associations* tar cho@&@r@) appear to be intimately
usaoolated with higher s®turn®9
while highoz? productivity (aspoclally in aalf-iMployed
sector) is aanooiatert with higher returns* ji;cg In the
manufacturing astabllshmnnto in tho informal sector are
about half of those in the organiaud sector* though
labour productivity between them does not Ulf far markedly*
Ths unregulated hours of work and wage nnrmo coupled
with deprivation of statutory banafits account for their
law wega rates*
1*21
While analysis of employment and income data may throw
some light on the currant state of the urban poor, we have
to probe further to assess the future prospects of
regenerations
Lducation is one of the steps that confers
a title on a successful graduate to participate in relatively
bettor paids regular and non-=hazardous jobs.
Despite
groat stridss taksn by th® stats to univerealise primary
education, tho high rates of illiteracy continue to stalk
tha areas of poverty*
Ths literacy percentage of alum
dweller® in Ahmedabad urns worked out to be 10o9 per cent
according to the AoM.C. Census survey (1976)*
The figure
wag 16 075 per cent for males and 4*24 per cent for females*
This can be seen against the city’s literacy percentage
□ f 59*02 par cant attained five years later*
6 fl. < v"
Ths heavy drop-out/from school is partly due to problems
of Mccaasj
language background, slow progress caused by
low level of mental and physical abilities, behavioural
truancy and alien teaching environment*
But it is mainly
Ai-t
due to^withdrawal of students beouase of poverty and help
needed in domestic work*
1*22
Public health services of low income sectors of the oity
has certainly improved lately*
Malaria staff visits and
small pox vaccination services are now universal*
However
the family planning services do not show a strong presence*
According to the Ahmedabad study cited, proportion of poor
- 17 -
families having mare than 3 children under 14 years wag
nearly one-third of the total while the corresponding
percentage was only 3 per cent amongst the non-poor.
Child and mother mortality index has not been separately
document ad An these studios, but it is certainly much
higher than tha city’s average.
1.23
The hwuwing and environmental conditions of low income
settlements have boary subject of dstailad enquiry in
most t»f the city survays.
mAnar variaticnso
Ths story Ab th® oame with
An ovarwheAmingly lerg® number of them
have walla made of raud, wooden planks, bamboos, gunny
bags or burnt bricks laid in mud mortar;
roof>
4^
n (/
moetly^caet-away tinsheets, broken asbaatosgjy-cement
eheetss wood, grass or bamboo.
Tilao and 8.C.C. roofs
account for lees thm 5 per cent of the structures.
5
Domestic electric connection, private water supply connec
tion; or ooparata family lavatory unite are very rare.
1.24
There io another force which deepens the incidence of
the already existing poverty of slum household^- It is
the higher birth rate, coupled with early incapacity or
death of earning members.
The percentage of Juvenile
population (below 14 years) was as high as 43 per cant.
Those who were returned aa working members were only
25.0 per cent of the total population.
Picholla presents
demographic contrasts between 8PL (below Poverty Line)
and APL (Above Poverty LlnaQ families of ths same ward
in Ahmadabad city.
18
Age group
Below Poverty Line
Per cant
Above Poverty Line
Per oent
0-4 years
11.6
5.1
5-14 years
29.2
17.8
15-59 years
54.3
68.9
60 A over
4.9
8.2
Ths abovs-powarty line families carry only about 60 par
cant of the Juvonila dependency load and have about 14 par cent
higher population in working age group,
Urban living does
not account for a significant ris® in the adoption of
family planning practices in slum ajsag.
If the birth
rata in the slum areas can be brought at par with the rest
of the city it would result in reducing poverty by about
This does not require enormous investment of
b<,u
rhsourcoo^ only oducation* co-operation* and co-ordination
18
points.
of supplier,
1,25
Since incremental housing programmes depend on the future
savings assumptions about ths householders* it is necessary
to analyse the data on savings and indebtedness.
Kashyap
reports a savings-earning ratio □ f«□ .29$ for registered
workers households in chawls.
It is of interest to note
k-
that^savings ratio is much higher in non-poor localities
seen within ths same incoma group when it is compared to
savings ratio of chawl dwellore.
Further* contrary to
the general belief it goes down as pur capita income
increases*
- 19 -
These are enigmatic findlnga.
Although, in view of the inaecur
employment conditions and income fluctuations a high propansity
to save is a reasonable explanation, yet all the other factors,
namely asset bass, earner-dependency ratio, consumption
compulsives, economics of bulk purchasing, etc* militate
against high savings potential.
The indebtedness picture
is not cigar from Kashyap8s data*
Plcholiu provides a
more detailed picture about indsbtsdnesso
Whan other legitimate modes of adjustment to poor incomes
Ilka cutting dotan consumption @s purchasing of inferior
quality and cheaper good® Fail, tha low income households
resartto bagrowing.
slight advantage.
Haro tha non°migrant families have a
Because of thair long residence and
experience they succeed as more acceptable barrowers as
compared to newly arrived migrant families.
The data on the amount of borrowing by low-income households,
especially on account of deficit, is not available for
any recent year.
Picholia found that 35 out of 106 houso-
ho Ido/bolie poverty line; that is, about one-third of ths
houaetwlds wore deficit households.
The expenditure in
these cases was found to be in excess of their current
income.
Soma JO of these households (B6 per cent) resorted
to borrowing to meet tha deficit.
The rest drew upon their
past savings to meet the deficit.
Soo the following Tabla!
20
Per capita
per month
Par cant
Income
of BPL
group
house
holds
Par cent
of indeb Per cent
of
ted house
deficit
holds
househo Ido
(Hs.)
Average
annual
borrowing
of deficit
borrowing
households
(Hs.)
Avurago
debt per
indebted
family
Upto Ha. 30
8.5
4.9
3.7(44.4)
1100
500.0
31-50
32.6
16.4
15.1(48.5)
2547
900.0
51=5)4
5@o9
31.1
14.2(23.4)
4208
1125.0
100.0
52.4
33.0
3461
1037.0
Th© data ahews that 52 .4 psr cant of 8PL household® were
indebted.
1’he avsrago dsbt par feral ly was Re. 3461.
It
is to bo observed that while the p@r cant of deficit
household end deficit borrowing went down progress!vely
with increase in per capita incomsp the average debt per
family incroaged with increased income.
This was partly
due to the fact that the bank loan assistance for buying
produotlve assets was flowing mostly to the marginally
poor sections.
About 6 per cant of the OPL household
reported such loan assistance.
Even if allowance^. is
made for such productive borrowing, the fact remains that
contingency borrowing, social borrowing, and deficit
borrowing accounts for a very large share of total debt.
Local authorities have been content to play only an
Indlreut role in relation to income
and employment develop
ment, social security and social welfare, especially amongst
21
the poorer suctions of tha population*
Thai; major pre-
occupation has boon local works, public utilities, public
health, primary 4»duodtionp revonuas and housukeuping
functions*
welfare aervlooH arc being bettur funded now,
Harljon employee© malfurso woman @nd child uuifure
41*
< C* tWH tf**\ 0
progi'wuse, etu*^ Urban planning and housing departments,
howeverp Barry mainly land-utaa exaroiaus*
Thuy have
hardly any gaols expressed in term© of incoruo or employ-*
went dwvaloprasnt or social Integration and eg ci al security*
Tho alignment of municipal functioning with ths basic
planning goals of th© country and th® aspirations ©F the
poor r»qulEOQ that a naw orientation la accepted by th©
local aufehoritloa and that thay er® given an opportunity
tc participate in the rr«B development proirammoo focussed
around anti^pevsrty and employment promotion goals*
-Eh*_
Uujarat State he© already constituted District Planning
boards in which civic corporations are rapresented by
their Mayor and commission®?*
Korneva?, unlike a Zills
Uanchayat, District Hural Development Agency,
frlbsl
Sub-plan Authority* Hural Development Corporations, eta*
which nxcluslvely look eftur low Incom a famillue, there
Is nothing camparebla in the cities*
Tha Urban Community
Development Service has yet to grow in stature and
capabilities to daal with the income and employment espeate
Its role Is recognised but its contribution has been
22 •
peripheral to a fam training oouraas and minor loan
faci 11 tationo
Its usorklng i@ oriantad to development
of soma common atnenitiasa
Household and cluator approechag
and raspuskg dovalopaant axeralaae hevo not bean tried by it
ao yato
-|oy
-ic
The tlrao hag ©gras ij.'fetea. feha tec©l outhorltiee^lnvolve^
thamaolwaa more deeply &sd helping th® tew incoraa gottlero*
poly® thsir psablera© ©(? tetu ins9ta.Q0 unstable amployraent
and unhealthy snvlroRsaent and mdq tho fund® and focllitia*
avall@bla to ths® mora Fully for thio purposeo
Ths State
oon ha psrsuadod to aaraark altesatlons to^OlstrlGt
Planning Saardjfox* boing applied to th® assistance
programmes® For th® urban poor end provision of their
batslw ttfl&tecttva n®ada Ilka alt© and BervlGO®.
23 •
2*Q
Isouee I
2<i
fadaarmiM-a.f.?mtfiU M. .taUiilM 1
\vo c.,
' f
k'lUia development policies essentially are part
of nation »i dswulopoent policies In which baalc
lolulluna &s» to too sought for problems at rural and
urban development together*
l¥ the national policies
sues»©d An p9pt4A®sA©Ang family planning end creating
substantial income ©nd employment generation activities
for rwssA poor®
pressures of ©&ty®ward migration
would tee ©onelderably reduced An their intensity.
lhe cities and town© sen find the problems of urban a&
development within their coping o opacity*
A
perspective pAen which ensures full absorption of
new addAfeiun® to Aaoows force An rural areas io
heeeQaasyo
A plen with a built-in potential for heavy
urb<^ taigratiun As Inconsistent with the control of
urban ward migration*
The present oeoographlc projection
ft-JL
shows a 4 par cent rate of growth in iabour force in
urban areas which io noro than double the projected
growth rate*
It will also require policies for the rationalleation
of income* wag as ano prices with a view to reduce
differentials between urban and rural areas and
intro-urban sectors oapaoially when such differentials
are not based on productivity differences*
A close
- 24 -
cou ruination uf housing anu industrial development polioiae
ario requiring tns industry tu shara thu cost of uuveloping
siiuitur unu social durviuuu fur its low paid employeae
r ■'
uusud an nuiiunax norma will nova to form port ufpollciuu
of, pl ano ad dovolupmun t*
Z\
Ina policiua royarding num of land usa, iJrtt.ir—development*
rucycling of reauuictiti mill have to us raaliuticully recast
in too light; u f / pur spoG tlvc/for the nast 15-25 yours*
A
ts-7 framework uf pravontivo pulicioa nsotja tu be evol vod
ano thw pro aunt from-a warn to oo examined from ths at.,nd
point of conui atuncy with this frarao-work.
2* 2
Amallor uti ve Mallei wa J
Ine iMiiullurotlua policies waarace a wide variety of isauas t
(aj
Pupuliitlon control
otudluu olwm that oirtn and niortallty rates are higher
in pockets of urban poverty*
Thai reduction of infant
mortality may temporarily upset tne balance but in the
long run may have beneficial effect on tiw aiz*roJ
kuruan poor to restrict the family airs*
The organi
sation el efforts' for family planning adoption' however
nvud not wait*
efforts on successful concentration of
foully planning will hove immediate affect on the
reduction of inueateun..so ana anhancumunt of saving
- 25 •
potential*
in tns long run it will roducu Bicsut supply
of labour end bulla up capital for Investment which will
raise returns from lauour*
concentration of family planning
ano Child rand Maternal Care efforts will thus fora ssusntial
ingredisnfctj of smell oration work against urban poverty*
(bj
PuolAc supply of oaeontial goods at yuarenteal©ffordable prices)
Th® pwblAs supply oyotssa needs to eoyog1 ® broader ©poctrua
of eaasnti®! gooas to hgusQtaida afe subsidised safco@0 IF
nossasasyo go that the ugban p©®i? ean haws ps©toetAon
•gainst th® erosion of purchasing poassro
fcdltol© ©Alp charge
Gletho kerosene* pulaaE0 raAAh0 onion© end potatoes ©era bo
adoou to tha ©kA©ting list of Food grain® eno sthos Atsaoo
The content* rot© ana tnou@ of subaAuAaation of aaentlal
goo as unuer Public uistrAbutlon Astern channel® of supply
aru major issues*
Thu dual pries oyotom may bo necessary
tu ensure that Pua supplies are not mlauseu*
(c)
Affordable shelter anu larger ehare of public utilities for poorl
whatsver perspective of income la taken of urban poor* ths
shelter at the minlraua norms of subsistence will become
un affordable
present market rates which srs showing
>
r■'■'J *
tendencies O0 affiarp
Public supply of affordable shelter
is inevitably*
Hssourca mobilisation ana increased allocation
of land and service resources of local authorities for urban
poor would become necessary*
The employers of the workers
•ust share responsibility as principal beneficiaries*
Thought
and reflection is necessary Jo^t\T
vapportionaent o< reeponaibilltie*
for contribution or resources*
26
(dj
useasu*lisatiun; social security l
In * oevalopiny ucunoray, a number of entrepreneur initiative*
for now ent tie* snu now trial* are oxpuctud to ulojaom*
To
yuaruntsa permanency in ouch vetting la unrealistic*
Hi*k
ano uncertainty are part# of the ywntura*
might* therefore* be non»peruenent«
A number of Job*
bucial security backing
A
ia necessary if the worker la not to suffer ha^ohipa*
aw©ht©ntl«1 extension of coverage sf social security benefit*
■for/low income nouaenwlu* « sic ug« ps®i&At»n0 unemployment
benefit** maternity ai«a0 slakneae insurance* ate* can relieve
Vvx C\
criei*'borrQu4ny@ and titua hwAp An rodu&fei^&r®^ debt burden**
ie-l-t. 3 j
Io)
Lowaging ecnool
teupple®anCary ^fetrition 1
The coquiuition of proouetiv© skills requires a literacy
'Cm
mc’gv
bdrop-out/aeatroy 0 the very base on which th*
isausm skill structure ia aullto
higher retention r*t* i*»
therefor®o a naaassary condition for advanced **111
acquisition ^*dt04r anu use spa from/poverty -trap eventually*
K.?
1
nlony/with other method* mi d- a ay me ale might improv* pretention
rate*
The extension of food echoiorehip^ to children from
poor urban familie* ie worth con*ideration*
( fJ
haalr^utign of uonaumptiun and davln^a I
Survey* enow th«t * large part of income of urban poor ie
o>
•pent on alchonolic drink* end other conounwCiun good* harmful
C Jv\K
to hwalth*
It deutroya saving potential and tauHUe/aocial
ten*ionl-
h*thoc* for r*du^ft£= consumption to the *qtt£si£k»*
Ww4rt.v\C\
MV good* for human nutrition* education and health ie a
neoeeeary part of uroon poverty all aviation.
0
27
<*n Important question associated with the irapl«uaentation
o' Melioration policiue is that of the agency to promote
auvolupraent of trie Aum»incaraa urban houeeriolaa,
kaj
bhoula fchw Urban community development <UoU) agency
b« expsncad An coverage*
jeq
riented ana retooled or
a naw agency As ntcaescry 'i
(bj
uincu hwalthj houaxng &iii ada«ution&x servlco© have
lot of o&apAasfc'nt&sAtles end linkages* usnor® should
tho urban poverty alleviation agency bo located to
socur® ©s®Bp ©ration u ©^ihfi. gop ar taunt© ©apply Any
k-c
fehaas sarvlcac 7 Ohoula At bo municipal ©@Ep®i?atlon»
a naw ayeney uf otat® uov©rnment( an aload voluntary
ayanoy ml th a ouuntil typ© atruotura on mhich various
other Uodlaa ar® roprasont®d 7
\o>
should
Hutu should oanoflolury institutions ba involved*
there ba consul tail ve co-ordination co rami t toe of workers*,
okx4/w
/neiyhbaurnoua volunteer© 7
2’4
Technvloax lypnofer, ^tlll dayelcpiai^nt* pyoduot|y^ Mfeet
ftft8MA*LU,HfU c,F«s4<t
»E »
There ere technological development© in the field of
epprupriate technology which cun inoreeao productivity*
ruduoe monotony and avert health rioke*
Theas it erne mill
have to be identified by a national project on "Technology
mid Urban Poor",
buch iteraa should be identified* demon•i
8 Italian prujauls shuuXa uo sal up la Ibum I Baton e9 sklii
• 2a
development outlays and arrangements should t>» in stalled
and the infrastructure* consultancy end marketing Units
nesseaary to utilise the skills should be laid out*
The
fr-e.
productivity of/ non -formal sector varies from operatar
to oporatose
Tho te&nnology transfer* skill development
and productive asset acquisition wuuld help in upgrading the
operator* getting Asm returns from their worko
Thv productive asset ©sqiaAsAtAan will hove to be accompanied
by^appropriate 14ne<»up sf srodit asrengsasntB for purchasing
a^ fiasO asset© ©nd a-squArlng morning cspltal*
T^e priority
aostor will* therefore* inGlud® srodAfe fl@uHtot*»*WS| lin«5
i'( <•
to be ©p@n@d for/urban p@s&o
2*5
Improvoaant of labour market mochtfilma 8
uaupite fsas earvicee of oraployasent QMbhangasj the rate of
clearance As very low which shows cither sluggishness in growth
<i/<
or imperfection of/market-mechanism.
Apart from gathering
at a central piece in tho city* there io hardly an alternative
aeonaniam to bring tho openings fur temporary and casual Jobs
to the attention of those who subsist on daily wage basis*
U><
There are several isethoos to improve labour market mechanism.
however* the recognition of their limitationo ie necosssry*
Market information can secure batter adjustment of supply
and demand and provide indications for price* supply* end
demand adjustments in the long run but it cannot correct
distortions inuuced by historical inequalities and policy
biases*
- 29
Afrm rat, Aha AamlaaXan «
.swianaUanB an Aha
In order to
(a)
clarify perceptions
(b)
remove projudleae and misconceptions
(c)
raise awareness and Uslld up natlensl consciousness
(dj
devolop approprlat® pollsl0@o strategies* opprosohsst
programs®® ©nd projecte
(q)
design suitable sgancl®® for pfenning and implamentation,
and
(f)
organise sffoctivs action
which wsauld h®lp dealing (affectively with the phenomenon
of urban psworty and the situation created by it in th®
Indlcn urban eantrooo it io suggested that ths Nation®!
Commission on urbanisation und0rtak®o undar its eu apices*
ths following activities J
l-l
J.1
fl situational *nglyala an urban pavbttY of Indian QlUgs»
baaed on secondary and if necessary primary data
covering various categorios of cities and representing
different regions*
To make ths picture more realistic*
graphic and paople»besed* caee*>etudiea( interviews and
anecdotes may be included*
Ths Situational Analysis besides presenting a factual
picture of urban poverty should be designed to ploy
a rold similar to thst played by Danderkar-Haths*s
study on Indian Poverty*
Ths effort should ba directed
towards raising public awareness and building nstlonsl
- JO -
consciousness of the dimenpione and gravity of ths problem
and addrase all 1 ovals in tha appropriate forma*
3 *2
H docuiocnfe presenting
analysing pereoptionsE) vi«we0
bsliof§$ images* ©pinions and attifeudan of g ©r©oQ«=©e@tion
of Indian society with rsgard to tha urban poor => thoir
level of aaAot^neci end r©&@ in sseAsfey and w©ys to deal
with thaAj? psobloaao
Thia aKOrcis® should aita at bringing into f@cuo th©
perception® and intoroots of popple soncoining th© poor
and poverty*
Taking thia up along with th© fact-baaed
Situational Analyalo will help both way© “ seeing peoples*
perceptions in the content of reality and understanding
the role percept Iona play in shaping reality*
The exercise may be so designed as to obtain views and
opinions of people at different levels and playing
different roles in ths urban framework*
It should cover
the highest end the lowest in ths land*
3.J
Performance evaluation and impact analysis of polioies*
programmes* projects and agencies designed to tackle
poverty situations and improve the lot of the urban poori
Thu following programmos/proJects/agencies are suggested
for this purpose t
31
(a)
Ths Sits* and Servicae Approachee
(b)
(he Environment Improvomont and Shatter Upgrading
Approaches
(c)
The Urban Community Development Project
(d)
Tha Integrated Child Dovslopmant Scheae
(®)
The tUdraday Mani Scheme for School Children
(?)
Tha Basis Services Approach
(g)
Tha Urban Land Celling Acto
All those projects hayo boon da®Lgn©d to r®ach v®rlou®
urben soitwIsqs ® hou01ngj> nutrition^ sducotl®n0 community
organisation, otc® ra to specif!© target groups among tha
urban poor and hava baun operating for some years now®
Question© lite©8 Do they roach tha really needy?
benefit the Intended beneficiaries?
Do they
Are they cost effective? and
Hom can their ©overage be extended?, are to be examined*
3.4
d paaltlan-RaBej; .sn-PXQvontlv^ eng r^dUl atrotoalM
nslMdXciQ ft .tan year pwraqegtivg plan dBVotaitad with
Lfr.ii
q la RagnOl.tin,«
In doing thia* the assistance of interested and competent
public and private agencies • professional, educational,
resseroh, voluntary, etc. -can be obtained*
A note
outlining the Terms of Pafsrenoe could bo prepared to
solicit participation and work out time schedule, cost
estimates and other detaifck.
The process of doing this exercise itself can become a
useful moans of building up a subject constituency*
Stage set for new
policy
By JAGPREET LUTHRA
Urban
Development
Corporation
IX months
the National
rom after
the Planning
Com- (HUDCO), another positive aspec
Commission
Urbanisa
Thc
Ministry
held
discussions
but has
has on
to wait
for the the commission’s findings has e
with submitted
State UrbanitsMinisters
and two
tion
final report
to that urbanisation can be; a. sett
States
— Tamil
Nadu
and Maha
the
Government,
the
Urban
De sustaining process and need not always
tted the
recommendation
rashtra
—
have
already
formulated
velopment Ministry is feverishly depend on state funding. The com
and sent their
responses to
the Centre.
engaged
in follow-up
action
both mission has suggested involving he
According
to. The
the
Secretary
in private sector in funding urbanisation
Government
has
at
the policy
and Joint
practical
levels.
S
the Urban Development Ministry, Mr. and encouraging joint sector projects
The Ministry is working in dose
P.S. Sundaram,
hasCombeen
witlrthe
theresponse
Planning
positive. The other States, he said, had in the field.
tnsure that the report’s
GEMs
also favourably
the
report
at
Eighth
due
tionreceived
of Plan
a hikeis
ingiven
the Plan
the Urban >m
Ministers
conference
in
The most impressive aspect of the
4 per’ cent
to 8 per
New Delhi last month but the Centre commission’s study, according to Mr.
is awaiting a detailed written response Sundaram, is the list of 329 generators
from them to act on the report.
of economic momentum (GEMs)
Mr. Sundaram explained that it was suggested by the commission. The list
very necessary to seek the individual
is not a definitive one but as an
■esponse of every State as the report
illustrative one, he observed, it was a
was basically a national document
major breakthrough. The commission
vhich must be tested for adaptability
has identified these GEMs based on
needs of every State. The
the guidelines that State capitals de
L“s0 organising State-level
and discussions for the nc- serve the same attention as the na
?.try' feedback on the report in tional capital and that five-year plans
■consultation with Unicef. “It is basi- should provide support to large indu
■cally going to be a learning exercise to strial cities, port cities and other
■assess local needs before we give the industry-specific cities to expand and
■States any guidelines on the subject,” consolidate their economic bases.
■ie said. The seminars will be. held over Most of these centres, according to the
report, have high rates of population
■ he next two months.
growth.
GUIDELINES
The recommendations regarding
H According to Mr. Sundaram, the GEMs, said Mr. Sundaram, would not
■ commission's recommendations are only supplant the urban location stra
■ based on well-researched facts of In- tegy for such centres but also the
■ dian urban life and provide the Gov- industrial location strategy.
■ emment, for the first time, extensive
While pointing out that the urban
■guidelines for a national policy on housing chapter of the report matched
■urbanisation. The report, he was con- well with the National Housing Policy
Mldent, would effectively replace the finalised last summer, he said the
^Kurrcnt ad hoc and panic approach to commission, had, however, not pro
^■the country’s urban problem.
vided a definite solution to the diffi
One of the most radical aspects of cult problem of urban squatters.
■ the approach, observed Mr. SundaThe commission, according to him,
■ ram, was that it considers growing
P urbanisation a vital input in the growth has also been vague in its recommen
dation
about the 4 per cent hike for
I of the economy, thereby convincingly
I refuting the growing school of thought urbanisation in the Eighth Plan allo
I that advocates discouraging urbanisa- cation. The suggestion, he said, was
I tion and views cities as parasites on the very broad and the Ministry was
Fi national economy. Instead of recom seeking the help of research bodies to
break up the suggested hike into
mending that urbanisation be stifled,
specific heads for a better realisation
the commission, he said, had shown
of resources. The Ministry, he said,
I ways to cope with it.
<-h^rCOrdin® t0 Mr' H1C Yadav> was hopeful of formulating specific
Cnref Special Projects, Housing and policy decisions on the major recom
mendations by the middle of this year.
According to Mr. Yadav, if the
report is followed in right earnest,
beginning with the Eighth Plan next
year, there should be a perceptible
change in the urban situation in the
country by the end of the Plan. One
would have to wait until the end of the
Ninth Plan, 10 years from now, for a
more definite improvement, he added.
He was confident that the Eighth
Plan would mark a new stage in the
policy on urbanisation. The Planning
Commission, he noted, could not af
ford to ignore the need for correcting
the urban situation in view of the
political will that prompted the setting
up of the commission.
S
E
1
((JO 1i A>(ri
Maternity Health Care for the Urban Poor in Bangalore
A Report Card
Sita Sekhar
Executive Summary
Background
Bangalore Mahanagara Palike's (BMP) maternity homes represent the only
decentralised set of health facilities in Bangalore that are accessed by
relatively low-income women and children. A network of outreach centres
has now been created through IPP 8 to expand and further strengthen the
services of the maternity homes. While this expansion and upgradation of the
health facilities for tire poor needs to be applauded, it is important that careful
thought is given to their proper utilisation, maintenance and effectiveness.
This comparative study on Maternity Homes, Urban Family Welfare Centres
and IPP Health Centres, discusses tire system's maladies, concerns about tire
future of these facilities and presents some thoughts on how to address them.
A total of 500 patients and 77 staff of these facilities were interviewed in two
phases. The major findings were as follows:
• The overall satisfaction of patients was the lowest with the services of the
maternity homes. Only a third rated them as good while 71% and 60%
considered IPP centres and UFWCs respectively as good.
o Only 39% of the patients of the maternity homes claimed that they
received all medicines free as opposed to 63% in IPP centres and 61% in
UFWCs. Maternity homes also lead in taking payments for injections. But
the staff says that medicines are given free to all patients.
• Cleanliness of toilets is an indication of tire standards of hygiene and
sanitation. Here, patients rated maternity homes the lowest (43%) in
contrast to IPP centres (83%) and UFWCs (61%).
• Maternity homes were rated the lowest also in terms of staff behaviour
towards patients. But the gap between them and IPP was much smaller in
this case.
• The most distressing finding concerns the prevalence of corruption. While
none of the facilities seems corruption free, maternity homes stand out in
terms of the severity of the problem Payments are demanded or expected
by staff for almost all services, but most of all, for delivery and seeing the
baby. The proportions of people paying bribes vary from one service to
another. On the whole 90% of the respondents reported paying bribes for
one service or the other at maternity homes at an average of Rs 700 per
head. Nearly 70% pay for seeing their own babies! One out of two pay for
delivery.
1
e If a poor woman paid for all services, it would have cost her over Rs. 1000
for a delivery. It is reported that a nursing home might give her hassle
free and better quality service for Rs. 2000. A rough estimate of the bribes
being paid in all these facilities may be between Rs one and two crores
annually. A similar estimate based on the finding that 90% of the women
pay an average of about Rs 700 at the Maternity Homes would put the
total amount of bribes paid at about Rs 1. 6 crores. The annual
emoluments o the staff at the 30 maternity homes also amount to about Rs
2 crores.
• Most of the staff denies the practice of corruption. They do complain about
the constraint of facilities, and shortage of staff, supplies and resources.
Doctors emphasized the need to improve the awareness of patients,
especially with respect to the need to be regular in their visits
The evidence presented above clearly points to the need to lU'gently reform
the municipal health care facilities for the poor in Bangalore. At the core of
the problem is the highly unsatisfactory state of the services of the maternity
homes. If the present conditions continue, the newly created IPP centres will
also deteriorate and become part of the pool of corruption and low quality
that characterise the system It will be a great pity if the fresh investments
being made for these centres are rendered unproductive by continued apathy
while paying lip service to die upliftment of the poor. On the brighter side,
reforming the maternity homes should be a manageable task given their
relatively small size and the compact population they serve. The Chief
Minister's concern for good governance and control of corruption offers a
window of opportunity for BMP to design and carry out an agenda of
reform If promptly done, reforms will have a strong demonstration effect.
3
Maternity Health Care for the Urban Poor in Bangalore
A Report Card
Sita Sekhar
Backgrotmd/Introdnction
The provision of good maternity care to poor women and primary health care
to children should be one of the primary concerns of any government in a
country. Since poor women do not have access to quality care in the private
sector due mainly to the prohibitive costs, it becomes all the more important
that the authorities ensure that proper care is made available to these women.
In the city of Bangalore, it is the City Corporation that provides a major share
of these services to the poor women. This is done through a network of three
kinds of health care institutions. There are around 30 Maternity Homes and
Urban Family Welfare Centres, and 55 India Population Project run Health
Centres.
The present exercise began with a round of discussions among NGOs
working with the urban poor and officials from the IPP, following reports of
poor service and widespread corruption in the provision of these services1.
The group met to strategize for working towards an improvement in tire
maternity care provided to poor women. Public Affairs Centre was assigned
the task of conducting a Report card study on the services provided by these
three kinds of maternity health care providers run by the Municipal
Corporation of Bangalore, since it would be unfair to draw any conclusions
without a systematic investigation. It was decided to get feedback from poor
women who have used these facilities on the quality of care provided, the
level of cleanliness, accessibility, and extent of corruption in them The
purpose of the study was to get corroborative evidence on the poor quality of
services provided, and the widespread corruption in the maternity homes to
strengthen the advocacy work.
The rest of the paper is divided in to 3 sections. Section I describes in detail
the methodology followed for this study. Findings from the surveys are
presented in Section II. Section HI presents the conclusions and
recommendations of the study.
1 This includes an earlier Report Card study on public hospitals which brought out the inefficiencies in
the running of maternity homes and also the highlighted the prevalence of level of corruption in them.
Section I
Methodology
This survey was carried out in two phases. The first phase involved getting
feedback from slum dwellers that had accessed the services of the Maternity
homes,. Urban Family Welfare Centres (UFWC) and India Population Project
(IPP) Health Centres run by the Corporation of Bangalore. The Report Card
methodology was used to collect the feedback. The sample was selected using
multi-stage-sampling technique.
Phase I
Twelve maternity homes, and UFWCs were selected and 20 IPP Health
Centres were selected based on relevant criteria such as size of the facility,
number of patients visiting the facility and the size of the population served
by the facility. Geographic representation was also ensured. Respondents
were selected by visiting slums that are served by the selected maternity
homes and health centres. 150 patients (women) each for Maternity Homes,
and UFWCs and 200 women for IPP Health Centres were selected for the
sample. These women gave feedback on the services provided by the three
kinds of providers. This led to a sample size of 500.
Phase II
This was a survey of the three kinds of staff - doctors, nurses, and other staff from Maternity homes, UFWCs and IPP Health centres. Six Maternity Homes,
6 UFWcs and 10 IPP Health Centres were selected from among those that
were covered in the first phase ie the survey. One doctor from each facility,
one nurse form each UFWC or IPP Health Centre and two nurses from each
Maternity home were interviewed. One other staff member from each facility
was also interviewed. This yielded responses from 22 doctors, 44 nurses and
22 other staff on various issues related to maternity health care for the poor.
The sample size therefore was 77 staff members.
5
Section II
Major Findings
2.1
Overall Satisfaction with Services
The overall rating of services provided by Maternity Homes, UFWCs and IPP
Health centres by people who visited them is given in Chart 1 below.
Chart 1: Overall Rating of Services
OveraHI Rafting of Services
a Good
□ Average
□ Poor
Service Provider
71 % of the users of IPP Health Centres have rated their services as good,
while 26% have rated them average. 60% of women who went to UFWCs
have rated their services as good while 39% have rated them as average. 33%
of the patients of Maternity homes consider the services provided by them as
good while 58% say they are average.
IPP health Centres are on the whole rated better than the UFWCs and
Maternity Homes. For similar services provided by all three the rating is the
highest for IPP Health Centres and lowestfor Maternity Homes.
2.2
Feedback on Service Delivery
A.
On free supply of medicines
More of the patients that went to UFWCs (73%) and IPP Health Centres (71%)
are aware that medicines are to be given free than those who have gone to
maternity homes (63%).
6
While only 39% of the patients were given the medicine free of cost at the
maternity homes, 61% and 63% were supplied the medicines free at the
UFWCs and IPP Health Centres.
Money was demanded for the medicines from 11% of the women at the
maternity homes while only 4 and 3 % reported being asked to pay money for
medicines at UFWCs and IPP Health Centres.
The average amount paid for medicines was higher at Rs 94 at maternity
homes than Rs. 30 paid at UFWCs. But the least amount was paid at IPP
Health Centres (Rs. 15)
Table 1:
Information related to free supply of medicines
Tablets related aspects
Percentage
of
respondents saying
yes at maternity
home
Whether advised to take
tablets
Whether
aware
medicines are to be
given free
Whether
medicines
given
All
Some
None
How many of medicines
given free
All
Some
Whether
money
demanded
for
medicines
Average amount paid
Whether asked to buy
medicines from private
shops
84
Percentage of Percentage of
respondents
respondents
saying yes at saying yes at
UFWC
IPP Health
Centre
94
90
63
76
71
36
54
10
55
39
6
60
32
8
39
61
11
61
39
4
63
37
3
Rs. 94
84
30
75
15
80
> All doctors, nurses and other staff at all three types of facilities say free
medicines are given to all patients all the time.
7
B. Feedback on tests done at Maternity homes
Feedback on tests done at Maternity Homes
Percentage
of
respondents
saying
Status
yes/Rs.
Scan
Blood Urine
test
test
Whether done
8
71
65
Whether informed of result
85
70
76
Whether paid
38
13
7
Average amount paid
176
21
21
Table 2 :
A large proportion of the women had urine and blood tests done at the
maternity homes. Scan was done for a smaller 8% of them. Most of them said
they were informed of the results in all the cases. Though these tests are
supposed to be free of charge , 38% of those who got a scan done, 13% of
those who had a blood test done and 7% of those who had a urine test done
paid for the test. An average amount of Rs. 21 was paid for the tests and Rs.
176 for the scan.
The data indicates the practice of collecting fixed relatively smaller sums for
blood tests and urine tests and larger sums for scans a t the maternity homes.
s
C.
Feedback on Hygiene Related Issues
Table 3:
Feedback on Hygiene related Issues
Percentage of respondents saying yes
Injection related aspects
Maternity Homes
UFWCs
IPPs
Whether given injections
Use of disposable syringe
Payment for injections
Average amount paid
84
52
12
Rs. 16
93
70
07
Rs. 16
93
70
06
Rs. 14
Hospital facilities related aspects
Percentage of respondents saying yes
Availability of drinking water
Clean & Usable toilets
Maternity Homes
83
46
UFWCs
89
61
EPPs
95
83
Many of the women (84%) who visited maternity homes and 93% of those who went to UFWCs and IPP Health Centres were given
injections. Of these 11% paid for the injection at maternity Homes, 7% at UFWcs and 6% at IPP Health Centres. An average of RS 16
was paid for the injection at Maternity Homes and UFWCs, and Rs 14 at IPP Health Centres.
As in the case of tests a certain sum has been collected for the injection though it is to be given free of charge at all three places.
9
Despite use of disposable syringes being mandatory, half the women who
went to Maternity homes reported non-usage of disposable syringes. Usage
of disposable syringes is more prevalent at IPP Health Centres and UFWCs
at 70%.
> The patients for the Maternity homes corroborate the information given
by the staff regarding usage of disposable syringes.
> In UFWCs 40% of the doctors and 60% of the nurses reported using
disposable syringes - zvhich contrasts with what patients have said.
> In the case of IPP Health Centres 92% of the doctors and 33% of the
nurses said they used disposable syringes. This varies significantly from
what is reported by patients.
> However the staff do point out that even if disposable syringes are not
used they do use autoclaves to sterilize the injections.
It is to be noted that in the times of the fear of AIDS and other communicable
diseases, there is an alarming level of unawareness among the patients on the
issue. They have not realised that the syringes used for them are being
sterilised and they are not disposable ones. That is what explains the
contrast in what the patients reported and what the staff said. In fact, most
UFWCs and IPP Health Centres use autoclaves to sterilise the syringes and
rarely use disposable syringes.
Availability of drinking water is reasonably good at all the three facilities
but the IPP tops with 95% patients saying they do have drinking water. But
when it comes to clean and usable toilets maternity homes are clearly not as
good as IPP Health Centres with 46% and 83% women respectively rating the
toilets always clean and usable. The UFWCs are only marginally better than
Maternity homes at 61%.
> All the staff at all three facilities have said there is drinking water
available and that toilets are kept clean and usable.
*A
10
Satisfaction with behaviour of staff
D.
Ratings on Behaviour of staff
Table 4:
Percentage of respondents always satisfied with
behaviour of
Doctors
Nurses
Other
staff
Maternity Homes
73
73
73
UFWC
83
76
86
IPP Health Centre
95
81
92
Patients are generally quite satisfied with the behaviour of the staff at all the
facilities (with 73% of the women reporting being always satisfied and the rest
either never or sometimes satisfied). The satisfaction is however significantly
greater with the staff of IPP Health Centres. While users of Maternity homes
rate all three kinds of staff equally on behaviour, patients at IPP Health
Centres and UFWCs find doctors and other staff better behaved than nurses.
Behaviour of staff does not figure as an issue for the respondents. Staff at the
IPP Health centre is rated the best behaved by the patients.
E.
Waiting time at the facility
Table 4:
Time taken to attend to patients
Maternity home
UFWC
IPP Health Centr e
35 minutes
28 minutes
23 minutes
Patients at the maternity homes have to wait for about 35 minutes to be
attended to. The waiting is marginally less at UFWCs at 28 minutes. The wait
at the IPP Health centre is the least at 23 minutes.
The data on waiting time indicate a certain amount of crowding at the
facilities. For a centre that serves a geographically smaller area, the waiting
time at the IPP health centres could certainly be brought down.
Doctors, nurses and other staff at all the three kinds of places have quoted
not more than five to ten minutes as the waiting period for patients.
11
2.3
Extent of Corruption
Many of the patients have reported instances where they have paid a bribe for
some purpose or another. The various purposes for which they have paid
bribes are tabulated below. In general however, it can be said that there is
corruption in various forms in Maternity homes. There is evidence of
corruption in UFWCs and IPP health Centres as well but not to as great an
extent as in Maternity homes.
Table 5: Extent of Corruption
Purpose for payment
Percentage
respondents
paid
of Average amount
who paid
Maternity Homes
For medicines
11
94
For scan
38
176
For blood test
13
21
For urine test
7
21
For delivery
48
361
For seeing the baby
69
277
For immunization of mother
13
18
For immunization of child
10
10
For family planning
10
95*
For injections
11
16
**
Other reasons
32
Total
1089
UFWCs@
For medicines
4
30
For injections
7
16
For immunization for child
0
0
Other reasons
2
1
Total
47
IPP Health Centres
For medicines
3
15
For injections
6
16
For immunization for child
2
13
Other reasons
0
0
Total
44
* This is those who went to a maternity home for Family planning. Some who
were referred from UFWCs for sterilisation to Maternity Homes have paid as
much as Rs 150/-.
** Average not worked out
12
@ there are people who have reported having paid for sterilization but are not
included here as sterilization are done only at MHs.
The level of corruption at Maternity Homes is much higher than that at
UFWCs and 1PP Health Centres. One of the reasons for this could be that
UFWCs and IPP Health Centres do not involve admission. The reason for
zohich bribes are paid by tnost patients are for seeing the baby (69%) and for
the delivery itself (48%). Other services like injections, family planning
medicines etc are also provided for payment of bribe but the extent is not so
large. As far as the average amounts paid are concerned they are quite large
for seeing the baby and for the delivery (Rs.361 and Rs. 277 respectively)
zohile other bribes are smaller in value.
There certainly is corruption at both UFWCs and at IPPHealth Centres, and
nominally more at UFWCs for most reasons. Hozoever the fact that even
services such as provision of free medicines, injections, immunization and
family planning are not provided free as they should be even if for some
patients is disturbing.
At maternity homes even small things like providing hot water, giving an
enema, cleaning the room or the patient are not done for as many as 32% of
the patients without money changing hands.
> When asked how patients express their appreciation almost all the staff
at all three kinds of places said they "say thanks".
> When asked if there is a practice of receiving gifts or money they mostly
said no (with the exception of one doctor and a few other staff)
> When asked if they were aware of anyone demanding money for services
they all said no!(again with afezv exceptions)
2.4
Usage of the Services of Maternity Homes, Urban Family Welfare
Centres (UFWC) and India Population Project Health Centres (IPP
Health Centre)
Table 6:
Purposes for the visit
Facility
Maternity Home
Main purpose of
visits
UFWC
IPP Health Centre
Antenatal care
79%
Immunization for 55%
child
Delivery
94%
67%
62%
73%
79%
13
.Among the patients who had visited maternity homes, 94% had gone there for
their delivery and 79% for antenatal care. Among those who had visited the
UFWCs, 67% had gone for antenatal care and 62% for immunization for the
child. Of the women who visited IPP Health Centres, 79% went for
immunization for the child and 73% for antenatal care.
The above findings show that maternity homes are more popular among
women for antenatal care than the other two providers. This indicates either
a lack of awareness among the patients of the availability of these facilities
nearer their residences at the IPP Health centres or a reluctance to go to a
new place. In either case there is a need to educate the women on the
advantages of using the IPP Health Centre.
2.4.1 Referral to Maternity homes by UFWCs and IPP Health Centres
Patients who had been to Maternity homes were asked who referred them
there. The response shows that most of them came there on their own (68%),
some were recommended by friends and relatives (8%) while 20% had been
referred by IPP Health Centres and 4% by UFWCs.
Among patients who visited UFWCs and IPP Health Centres, 63% and 64%
said they were referred to maternity homes for delivery. Of these 81% and 67
% went for their delivery to maternity homes from UFWCs and IPP Health
Centres respectively.
Chart 2: Use of sources of reference
Use of sources of reference
14
This shows that while a reasonably large proportion of those who visit
UFWCs and IPP Health Centres are referred to maternity homes for
deliveries, there are still many women who come there on their own. One
probable cause could be their familiarity with the maternity homes and
therefore the confidence in them. This calls for intensive awareness and
motivational campaigns by the IPP staff among slum dwellers.
The question as to why, when 64% of the patients are being referred to
maternity homes from IPP Health Centres, only 67% of them have actually
been to maternity homes for delivery is also raised. Is there a block at the
maternity homes or are they wary of going there out offear that they would
not get proper treatment?
Other Interesting Findings
2.5
> Most users of maternity homes went for delivery(95%)
> the main purpose for visit at UFWCs was Antenatal care and child
immunization.
> The main purpose for visit at IPP HCs was child immunization and
antenatal care
> most patients visiting MHs went on own(68%)
> Relatives and friends are chief motivators for visits to UFWCs
> Link workers bring 29% of patients to IPP HCs
> 7% persons refused admission at MHs
> Immunization programs users say they benefit from - mainly pulse polio
(over 95%)
GIVING A FACE TO THE NUMBERS!! -2 case studies
< "'•<
x
' r
'
<<'
' '
< Jcxx
xxx
'>•«’ x
<:<:< x x’jixx ,<<'
ir. » i x x < x
t'xs <>
> xxxxxkxx < r
Nagamma had a harrowing time at a young age of 19. She went for a
delivery to a maternity home expecting to. bring home a baby in joy. It
turned into a nightmare. Upon arrival in labor the doctor refused her
attention unless she was given money. The husband in a panic went and
mortgaged her jewelry , and paid the doctor Rs. 1000. The rudeness of the
doctor added to their misery. Once the money was paid, the doctor
conducted the delivery but it was too late. The baby had died.
The nightmare did riot end there. The staff would not show the dead baby
to the aggrieved parents till some more money was paid. Can Nagamma be
blamed if she vowed never to go to a BMP Maternity Home again?
On the brighter side, at another Maternity Home one patient was badgered
in to paying a large sum for a delivery. Her family and friends got together
under the guidance of an NGQ and sat in dhama till the Doctor returned
the money! Here's to hoping there are more and more incidents like this in
the future!
15
Section III
Conclusions and Recommendations
It is for the BMP to decide how to deal with the problems brought out by the
above findings. To assist in the process, PAC and several other experts and
NGOs working with the urban poor held a discussion to think about the
options that might be considered by BMP. What follows are the major
conclusions drawn and the recommendations that came out of these
deliberations.
3.1
Conclusions
> The study very clearly brings out the distinct differences in service quality
between Maternity Homes and IPP Health Centres. While Maternity
homes do not score that well on cleanliness and hygiene, IPP health
Centres do. Basic medicines that are to be given free me not being given to
a large proportion of poor patients at Maternity homes, while at IPP HCs
most people get free medicines.
> Ihe differences in quality of service are also indicative of poor discipline
and responsiveness among the staff at Maternity homes.
> The practice of corruption is far more entrenched in Maternity Homes
than in IPP Health Centres. Bribes are being demanded and paid for
almost every service being provided at Maternity Homes.
> The staff are not ready to accept the prevalence of corruption leave alone
trying to tackle it.
3.2
Recommendations
> A more effective oversight mechanism should be created to monitor the
activities of the maternity homes. A board of visitors consisting of 5-7
persons could play this role through quarterly meetings to review the
operations, needs and plans of each maternity home. A board can also
check and eliminate unnecessary overlaps between the maternity homes
and the outreach centres. The board should include 4-5 independent
experts and activists concerned about tire urban poor and health. A
corporator and another official could also be nominated to the board. If a
board for each home is impractical, perhaps, a board could cover about 4
homes located in contiguous wards. These boards should report to the
Commissioner or his deputy.
> A patients' charter should be created for the maternity homes. It should
publicise the services offered, time deadlines and terms of service, fees,
16
remedies in case of problems, patients' rights and duties. This could be the
first service of BMP for which a charter could be designed on an
experimental basis. Staff should participate in this process and be trained
and motivated to implement it.
> Though the services are free, the reality is that the poor women are made
to pay for them in a majority of cases. They pay, but have no assurance of
quality or rights. Why not move to a system of contributions to a health
fund by the women ( some are allergic to the concept of user charges)? Tire
idea is not to recover the full costs of the services, but to let patients share
the costs (hence contribution) so that they have a right to receive the
services. Norms for the contributions could be published. Delivery is a
predictable event and not an emergency. They can save for this event and
pay rather than be faced with extortion when in distress.
> Hie fund thus created should be used for the maintenance and
improvement of the facility where it is collected. It will be an incentive for
the doctors and staff if the money can be used to improve their facility.
Whether a part of the fund could be used to pay a bonus to the staff is a
matter for further consideration. Public hospitals in MP are already
working on similar lines.
> In the case of the IPP centres, it is imperative that provision be made for
the diversification of their management and control. When they revert to
BMP, the issue is whether interested NGOs, foundations, teaching
hospitals, etc., could be brought in to operate the services with a
maintenance grant from BMP. IPP centres have the potential to become
community service centres as their infrastructure could be used after office
hours for meetings, teaching and even private practice and other services
beneficial to the community. If this approach is adopted, the maintenance
costs and BMP's burden can be reduced as additional income will be
generated by the centres through the use of their facilities. Good NGOs
may have an incentive to work along these lines as it will help further their
own mission.
> Even if all these actions are taken, there is a need to empower tire poor
women to demand their rights and to stand up against abuse. The only
way to do this is by creating support groups of women in different slums.
Some NGOs have already agreed that they will play this role in their areas
of work. They have also expressed interest in operating help desks in the
maternity homes for patients. Support groups could prepare and brief
pregnant women and accompany them on visits to maternity homes. This
function properly belongs to the voluntary sector. IPP centres could be
used as a base for organising the support group activities.
17
3.3
Follow-up to the Report Card
As a follow-up to the study, the findings were presented to the Officials of the
BMP and the response has been very encouraging. Steps have already been
taken to implement the recommendations made in this report. For more
information in this regard, refer the paper by S. Manjunath that describes the
complete initiative in detail.
y&M' 3-
/■> A 1W LI A rin THE COMMONWEALTH association for mental handicap
IlrtJLJ O
AND DEVELOPMENT DISABUfTTES
(SUPPORTED BY THE COMMONWEALTH FOUNDATION)
Background Document of CAMHADD One-DayWorkshop on
Citizens & Governance Programme
The Trisector Dialogue (Government, Private and Civil Society) in Health
Preventive Health Care with Special Reference to Urban Poor(Bangalore)
Sponsored by
Bangalore Mahanagar Palike(Corporation)
In Partnership with
Rajiv Gandhi University of Health Sciences Bangalore
Sri Jayadeva Institute of Cardiology Bangalore
Supported by
The Commonwealth Foundation London
Venue: Sri Jayadva Institute of Cardiology
Date: 11 January 2003
Prepared by
The Commonwealth Association for Mental Handicap and Developmental Disabilities
Sri Jayadeva Institute of Cardiology, Bangalore
Urban Health Research and Training Institute, Bangalore Mahanagar Palike
Contact Person :
Dr V.R.Pandurangi-Founder,Emeritus Secretary General
and International Co-ordinator CAMHADD
36A, Osberton Place, Sheffield(UK) S11 8XL
E.mail: camhadd@hotmail.com
CAMHADD Secretariat:“ Shashi-Arvind Nilay” 871-872, 18th Main Road, 5lh Block
Rajajinagar, Bangalore(lndia) -560 010
1
Preface
|camhadd|
CAMHADD - A Professional Association and A Pan Commonwealth NGO Supported by
the Commonwealth Foundation London was established in January 1983. Its main
objectives are prevention (primary and secondary) of mental handicap and to strengthen
health professional links between and among developed and developing countries.
CAMHADD has arranged 27 regional workshop including 8 Pan Commonwealth
workshops from 1985 to 2002 involving 1387 (Male 714 Female 673) invited participants
professionals from 45 Commonwealth countries and 17 Non Commonwealth countries.
CAMHADD is in official Relations with WHO since 1990 for collaborative programmes,
CAMHADD in collaboration with WHO has developed and implemented priority
initiatives for the prevention of brain damage due to birth asphyxia (lack of oxygen either
before or immediately after birth) a major non-communicable cause of death and
disability in newborn to prevent mental, neurological and sensory handicaps as integral
component of safe motherhood and child survival. CAMHADD is a long-standing partner
of WHO in a number of technical areas, in particular mental health, disability prevention,
maternal and newborn health, reproductive health, prevention of injuries, prevention of
childhood blindness and Unity Towards Health to Achieve Social Accountability. WHO
has co-sponsored 13 CAMHADD Regional workshops.
CAMHADD is granted observer status by the Commonwealth Health Ministers to attend
their meetings.
CAMHADD was accredited as Pan Commonwealth NGOs to represent at the
Commonwealth Heads of Governments Meetings (CHOGM) at Edinburgh (UK) in
October 1997, Durban (South Africa) in November 1999 and Brisbane (Australia) in
February 2002.
Citizens and Governance Programme arose directly from out of the Commonwealth
Foundation's “ Civil Society in the New Millennium" project
Citizens and Governance Programme : The Tri-Sector Dialogues
Governance as distinct from government is interpreted by most to mean having an
inclusive approach to policy and decision-making, and to sharing responsibility for any or
all of decisions, actions, provisions among the three main social actors -the government,
private sector and civil society.
The Commonwealth Foundation(CF) organised a workshop in Australia in 2001. It
highlighted the importance of examining the appropriateness and impact of tri-sector
approaches in concrete situations in diverse of parts of the Commonwealth, Following
this discussion Commonwealth Foundation decided to initiate a series of dialogue in up
to 12 diverse localities in the Commonwealth in collaboration with Ford Foundation.
One-Day Workshop on Trisector Dialogue in Health at Bangalore (India) Is one
in the series.
2
The topic of the workshop is : Trisector Dialogue in Health : Preventive Health
Care for Urban Poor (Bangalore)
This background paper is prepared following a series of meetings, workshops, and
individual views. Involving government, private sector, and civil society. Details are
enclosed in Annexure. [1-6]
On behalf of CAMH ADD, I would like to express our sincere thanks and gratitude
to :
Mr Colin Bal,Director of the Commonwealth Foundation London for supporting One Day
Trisector Dialogue in Health.
Dr Rajesh Tandon -President PRIA (Participatory Research
his guidance
in Asia), New Delhi ,for
Mr M.R.Srinivasa Murthy, Commissioner, Bangalore Mahanagar Palike(Corporation) for
sponsoring and supporting the workshop
Professor S.Chandrashekar Shetty-Former Vice Chancellor, Rajiv Gandhi University
of Health Sciences, Bangalore for his guidance
Dr Chandrashekara, Vice Chancelleor, Rajiv Gandhi University of Health Sciences,
Bangalore for supporting partnership programme
Dr A.R.Prabhudev, Director, Sri Jayadeva Institute of Cardiology Bangalore for his co
operation,cpllaboration and support
Dr Mala Ramachandran and Dr M.Jayachandra Rao of the Health Department of
Bangalore Mahanagar Palike for arranging pre-workshop meetings and consultations
Dr S.Pruthvish and Staff Members and Post Graduate Students of the Departmnt of
Community Medicine, Ramaiah Medical College Bangalore for their active involvement
V.R.Pandurangi
Founder, Emeritus Secretary General
and International Co-ordinator CAMHADD
3
Consultants of the workshop
Dr. V. R. Pandurangi- Founder, Emeritus Secretary General
And International Co-ordinator CAMHADD
Dr. S. Chandrashekar Shetty-Former Vice Chancellor
Rajiv Gandhi University of Health Sciences (RGUHS) Karnataka Bangalore
WHO Representative
Dr. Roberta Ritson-External Officer
Government and Private Sector, WHO Headquarters Geneva
Facilitators
Dr. D. K. Srinivas-Rajiv Gandhi University of Health Sciences Bangalore
Ms. Shagun Mehrotra -PRIA (Participatory Research in Asia) Hyderabad
Dr Mala Ramachandran-Director, Urban Health Research & Training Institute
Bangalore Mahanagar Palike Bangalore
Dr. M. T. Hemareddy - Former Director of Health Sciences and Family Planning
Government of Karnataka, Bangalore
Rapporteurs
Dr Roberta Ritson (WHO Co-coordinator)
Dr Ganesh Supramaniam-CAMHADD
Dr S. Pruthvish-Community Medicine and Public Health, Ramaiah Medical College
Bangalore
Resource Persons
Dr A. R. Prabhudev-Director, Sri Jayadeva Institute of Cardiology Bangalore
Dr Rajesh Tandon - President PRIA, 42 Tughalakabad Institutional Area
New Delhi -110 062
Dr K. V. Ramani-lndian Institute of Management, Ahmedabad-360 015
Dr. M. Jayachandra Rao - Health Officer (East) and Project Co-ordinator, India
Population Project-VIII Bangalore Mahanagara Palike, Bangalore.
4
Background to the Trisector Dialogue
[The Civil Society Initiative]
1. The Commonwealth Secretariat(COMSEC)
2. The Commonwealth Foundation (CF) London
3. The World Health Organization (WHO)
"Civil Society can be defined as what people and their organisations do to improve their
societies.
|The Commonwealth Secretariat and Civil Society]
Commonwealth Heads of Government Meetlng(CHOGM) Durban(South Africa)
November 1999 : The Durban Communique : Para 42 - Civil Society
“Heads of Government declared that people-centred development implied that people
must be directly involved in the decision making process and in the implementation of
development plans and programmes through their own organizations. They noted the
significance of civil society in empowering people to benefit from globalisation, in
contributing towards the goals of poverty elimination, equal opportunity and fair
distribution resources and in helping to deal more effectively with ethnic,racial and
religious conflicts. They acknowledged the need to enable capacity-building efforts of
local and regional non-governmental organizations. They noted the report of the
Commonwealth Foundation on Citizens and Governance and the Communique of the
Third Commonwealth NGO Forum and asked Senior Officials, at their next meeting, to
study the issue of the Forum presenting its views to the next CHOGM.
[The Commonwealth Foundation and Civil Society]
The Commonwealth Foundation and The Civil Society Commonwealth Foundation is an
intergovernmental organisation of the Commonwealth, was founded in 1966, and is
based in London. The Foundation is one of three inter-governmental Commonwealth
Organisations. It works along side and in co-operation the Commonwealth Secretariat
and the Commonwealth of learning. Its mission is two fold: Civil Society and the
People’s Commonwealth.
[The Civil Society]
The Commonwealth Foundation initiated a Civil Society Project in the New Millennium to
strengthen the ability of citizens and civil society organisations to work together and
with government and the private sector, towards the achievement of fundamental
Commonwealth purposes and values, and especially those relating to good governance,
people-centred and especially those relating to good governance, people-centred and
sustainable development, and poverty eradication.
5
[The World Health Organization (WHO)|
WHO established the Civil Society Initiative (CSI) in June 2001. The civil society is
defined as what people and their organisations do to improve their societies. The CSI
main objective is to promote more effective collaboration information exchange and
dialogue with CSOs on global, regional, national and local health issues and to develop
partnership to achieve its objectives.
[The Citizens and Governance Programme)
The Citizens and Governance Programme is a significant new initiative born of a major
research and consultation study mounted by the Commonwealth Foundation in the Civil
Society in the New Millennium Project. The citizens and Governance Programme is
about responsible citizenship and responsive, participatory democracy. The two are
mutually reinforcing and supportive; strong, aware, responsible, active, and engaged
citizens along with strong, caring, inclusive, listening, open and responsive democratic
governments.
This is the basis on which a good society in which needs is met, association constructed
and connections established can be built. It is the connection between citizens and
governance that prepares the ground to address the myriad challenges that face our
societies. Poverty, marginalisation, and discrimination can only be overcome through
responsive governance and active citizenship.
|The Citizens and Governance Programme: The Trlsector Dialogue)
Governance as distinct from government is interpreted by most to mean having an
inclusive approach to policy and decision-making, and to sharing responsibility for any or
all of decisions, actions, provisions among the three main social actors -the government,
private sector and civil society.
The key question is: who does what? What roles are appropriate for the state, what for
the business sector (and the market more generally and what roles are most appropriate
for civil society (including citizens themselves as individuals as well as their voluntary
associations and more institutionalised civil society organisations)?
A second question is: What difference does it make? What impact is made on a
society’s ability to meet people’s basic needs - such as the need for human security,
shelter, health, and livelihood-by new tri-sector distributions of power and
responsibilities? What changes to existing relationship are needed in order to increase
impact?
A Preliminary discussion of these questions was held at a workshop organised by the
Commonwealth Foundation (CF) in Australia in 2001. It highlighted the importance of
examining the appropriateness and impact of tri-sector approaches in concrete situations
in diverse of parts of the Commonwealth, Following this discussion Commonwealth
Foundation decided to initiate a series of dialogue in up to 12 diverse localities in the
Commonwealth in collaboration with Ford Foundation.
6
One-Day Workshop on Trisector Dialogue in Health at Bangalore (India)
The Bangalore one day workshop “ Citizens and Governance programme: The
Trlsector Dialogue in Health Is one of the series of dialogue on 11 January 2003.
The topic of the dialogue will be “ Preventive Health Care with special reference to
Urban Poor (Bangalore) and venue will be Sri Jayadeva Institute of Cardiology.
The Workshop will highlight some specific health Issues for prevention of
diseases and disabilities and also promotion of health after listening to the voices
of the poor so as to achieve good health as the greatest asset of the poor.
(The objectives of the workshop]
•
•
•
•
To promote Commonwealth Foundation’s Project "Citizens and Governance
Programme: Trisector Dialogue in Health
The Role and responsibilities of trisectors: government, private and civil society in
social development to achieve social accountability
Strategies to develop trisect or collaboration for the benefit of citizens
Reduction of Poverty through Health Promotion
To develop strategy for preventive Health care to urban poor (Bangalore) in collaboration
with trisectors: government, private sector and civil society.
|Preventive Health Care with special reference to Urban Poor Bangalore]
Health : Health has long been recognised as one of the human fundamental right and is
reflected in the universal declaration of human rights Yet huge disparities exist in health
between rich and poor within developing countries.
Health is not mere absence of disease or infirmary but is a state of well being at the
physical, Mental and Social(as well as spiritual) levels : WHO
III health is not simply a consequence of poverty, it is an aspect of it Better health
contributes directly to diminishing poverty by improving quality of life expanding
opportunities and safe guarding livelihoods
Limited health budget and growing health needs forcing developing country
governments to make strategic decisions on the use of both domestic and foreign funds
Within the health sector, ministries should preferentially allocate resources to primary
and secondary care rather than to tertian/ care.
When public sector fails to meet the health care needs of the poor out of pocket
expenditure rapidly exceeds public expenditure. Payments for private health care can
be considerable up to 90% of house hold expenditure on health in India are in the private
sector with the poor paying proportionately more than the rich.
7
The pattern of disease also varies significantly between rich and poor with disease of
category l(communicable disease, maternal, perinatal and nutrition related conditions)
dominate among poor and which accounts 59% of death and 64% Dalys lost among
them. This does not mean that poor do not suffer from non-communicable disease
they do. But they are not the principal cause of excessive morbidity and mortality.
To achieve the objectives of the workshop and to promote Commonwealth
Foundation project on “ Citizens and Governance Programme” CAMHADD will
initiate partnership with Sri Jaydeva Instlttue of Cardiology and Bangalore
Mahanagara Palike (Corporation) to develop this programme as Commonwealth
Model.
Bangalore
Bangalore is the Capital City of Karnataka State in South India with a population of 65.02
Lakhs according to 2001 Census + Flaoting Population of 10 Lakhs ccovering an area of
226 Kms. 12 % of the population live in slum area and 30% of the population is Urban
Poor.
The Bangalore Mahanagara Palike(Corporation)
The Bangalore Mahanagar Palike has 28 Maternity Homes, 6 Referral Hospitals,
19 UFWC’s and 55 Health Centres, which provide Family Welfare/Maternal Child Health
and Reproductive Child Health services to the urban poor of Bangalore Metropolitan
area. Five maternity homes are added under the IPP VIII during the year 2001.
The Bangalore Mahanagar Palike has developed programme for control of
Communicaable Diseases.
These facilities provide a range of services from day care to in patient facilities for
women and children. The scope extends from preventive to promotive to curative Health
Care, and are spatially distributed all over the city and are invariably located in or near
the urban poor localities.
Besides this, The Bangalore Mahanagar Palike provides such services as sanitation,
mosquito control, Prevention of
Food Adultaration, stray dog,cattle and monkey
managenet and Nirmala Bangalore Toilets.
The Bangalore Mahanagar Palike has also initiated Swacha(Clean) Bangalore concept
which involves door to door collection,push carts and lorry synchronisation,source
segregation and citizens participation.!
The Bangalore Mahanagara Palike has now a mandate to improve the governance in
these facilities and provide quality care with a view to enhance customer perception and
satisfaction in obtaining health care from the Bangalore Mahanagara Palike facilities.
8
twi? -\
fl
Workshop for the Health Professionals of the Bangalore Mahanagara
Palike on 26th December 2002 at the Urban Health Research and
Training Institute, to prioritise the Health needs of the Urban Poor
The workshop was attended by Health Officers, Superintendent of Referral
Hospital, Doctors of Maternity Homes, Urban Family Welfare Centres, Health
Centres, Health Inspectors, Pharmacist, Staff Nurses, LHVs and ANMs of Health
institutions of BMP, totaling 25 participants.
W
Dr. M Jayachandra Rao, Health Officer East welcomed the participants and spoke about
the Objectives of the Workshop.
Dr. Pandurangi, explained the CAMHADD initiative and the Trisector Dialogue for
preventive Health care in Bangalore.
Dr. Mala Ramachandran conducted a Brainstorming Session of the Health needs of the
community and there after evolved the priorities by the consensus of the group.
The brain storming session listed out the following needs of the urban poor from the
health professionals perspective.
Lack of a link between the facility and the community, and inter and intra sectoral
coordination.
2. Access to cost effective treatment and investigations relating to Primary Health
Care, including specialist services, and referral linkages.
3. Toilets, under ground Drainage and safe drinking water and problems of Gastro
enteritis and Cholera. Sanitation and solid waste management
4. Housing
5. Health education, counselling, sex education, with focussed attention on child
marriages and male participation
6. Education for all, Enrollment of Dropouts, Adult literacy, Child Labour.
7. Pollution both environmental and household
8. Nutritional problems, Food adulteration and Public Distribution System
9. Communicable Diseases
10. Non communicable diseases, Cardio vascular diseases, Cancers,
11. Blindness and cataract
12. Substance abuse
13. Problems of elderly and care in chronic illness
14. Care of disabled
15. Accidents and Trauma Care, Disaster management and availability of ambulances
16. Violence, Crime, safety and security, Legal assistance, Beggary destitution,
Prostitution, Gambling and street children
17. STD/HIV/AIDS
18. Mental illness,
19. Adolescent Health
20. Income generation and poverty alleviation
1.
•
The group then prioritised these issues by consensus
1st Priority- Access to cost effective treatment and investigations relating to Primary
Health Care, including specialist services, and referral linkages.
2nd Priority- Toilets, Under Ground Drainage and Safe Drinking Water and problems
of Gastro enteritis and Cholera. Sanitation and solid waste management
3rd priority- Housing
4th priority- Health education, counselling, sex education, with focussed attention on
child marriages and male participation
5th priority- Nutritional problems, Food adulteration and Public Distribution System
6th Priority- Education for all, Enrollment of Dropouts, Adult literacy, Child Labour.
7th Priority- STD/HIV/AIDS
8th Priority- Accidents and Trauma Care, Disaster management and availability of
ambulances
Violence, Crime, safety and security, Legal assistance, Beggary
destitution, Prostitution, Gambling and street children
STD/HIV/AIDS
Mental illness,
Adolescent Health
9th Priority- Non communicable diseases, Cardio vascular diseases, Cancers,
10th Priority- Problems of elderly and care in chronic illness
Dr. Prithvish and Dr. Pandurangi summed up the discussions
AnnexeWorkshop for the Opinion Leaders at the Nandini Layout Slum of the
Bangalore Mahanagara Palike on 27th December 2002 at the Nandini Layout
Health Centre, to prioritise the Health needs of the Urban Poor
The workshop was attended by the local leaders, women’s groups, Community
Based Organisations, women who worked as link workers in the IPP-VIII and
Health Staff of the Health Centre, totaling 35 participants.
The Lady Medical Officer of the Nandini Layout Health Centre welcomed the participants
Dr. M Jayachandra Rao, Health Officer East spoke about the Objectives of the
Workshop.
Dr. Mala Ramachandran and the medical officer of the health centre conducted a
Brainstorming Session of the Health needs of the community and there after evolved the
priorities by the consensus of the group.
The brain storming session listed out the following needs of the urban poor from the
health professionals perspective.
Issues at Nandini Layout
1. Accidents
2. Primary Health care and Referral
3. Pollution
4. Toilets and Underground Drainage
5. Safe drinking water
6. Blindness control
7. Alcoholism
8. Old age problems
9. Crime and Dowry
10. Unemployment and Poverty alleviation
11. Education/ adult education and school Drop outs
12. Street children
13. Housing
14. Non Communicable Diseases
15. Handicapped
16. Mosquito Menace
17. Child marriage
18. Transport facility
19. Physical education center
The group then prioritised these issues by consensus
1st Priority- Safe Drinking Water
2nd Priority- Toilets, Under Ground Drainage and Gastro enteritis and Cholera.
3rd priority- Accidents and Trauma Care
4th priority- Primary Health Care and Referral
5th priority- Education for all, Enrollment of Dropouts, Adult literacy, Child Labour.
6th Priority-Handicapped
7th Priority- Alcoholism
8th Priority- Transport
9lh Priority- Violence, Crime, Dowry
10th Priority- Non communicable diseases, Cardio vascular diseases, Cancers,
Dr. Pandurangi, explained the CAMHADD initiative and the role the community
should play to act as a pressure group to ensure their health priorities are met.
Dr. Prithvish summed up the discussions and proposed the vote of thanks
Workshop for the Opinion Leaders at the Murphy Town Slum of the
Bangalore Mahanagara Palike on 27th December 2002 at the Murphy Town
Health Centre, to prioritise the Health needs of the Urban Poor
The workshop was attended by the local leaders, women’s groups, Community
Based Organisations, women who worked as linkworkers in the IPP-VIII and
Health Staff of the Health Centre, totaling 52 participants.
The Lady Medical Officer of the Murphy Town Health Centre welcomed the participants
Dr. M Jayachandra Rao, Health Officer East spoke about the Objectives of the
Workshop.
Dr. Mala Ramachandran and the medical officer of the health centre conducted a
Brainstorming Session of the Health needs of the community and there after evolved the
priorities by the consensus of the group.
The brain storming session listed out the following needs of the urban poor from
the community perspective.
1.
2.
3.
4.
5.
6.
Alcoholism
Housing
Sanitation and Garbage removal
Dowry
Toilets, Under Ground Drainage problems of Gastro enteritis and Cholera.
Reproductive and Child Health
1$
7. Unemployment
8. Problems of elderly and care in chronic illness
9. Youth and Street children
10. Communicable Diseases
11. Non communicable diseases, Cardio vascular diseases, Cancers,
12. Education Adult literacy and Dropout
13. Inter caste Marriages
14. Substance abuse
15. Blindness and cataract
16. Violence in women
17. Early Marriage
18. Pre Marital Sex
19. Health Care for men
20. Child Labour
21. HIV/AIDS/STD
22. Awareness
23. Child Abuse
24. Primary Health Care
The group then prioritised these Issues by consensus
1st Priority- Alcoholism
2nd Priority- Sanitation and Garbage removal
3rd priority- Toilets, Under Ground Drainage and Safe Drinking Water and problems
of Gastro enteritis and Cholera
4B1 priority -Substance abuse
S’" priority- Primary Health Care
6th Priority- Education for all, Enrollment of Dropouts, Adult literacy,
7th Priority -Unemployment
8'h Priority - Child Labour.
9th Priority - Housing
IO01 Priority-Violence, against women
11th Priority - Child Abuse
12lh Priority Awareness
Dr. Pandurangi, explained the CAMHADD Initiative and the role the community
should play to act as a pressure group to ensure their health priorities are met.
Dr. Gopinath summed up the discussions and proposed the vote of thanks
k*
Annexe'3
Workshop for the Non governmental Organisations working in
the slums of Bangalore on 28th December 2002 at the Urban
Health Research and Training Institute, to prioritise the Health
needs of the Urban Poor
The workshop was attended by 25 representatives of NGOs working In the slums
of Bangalore.
Dr. M Jayachandra Rao, Health Officer East welcomed the participants and spoke about
the Objectives of the Workshop.
Dr. M.T. Hema Reddy, explained the CAMHADD initiative and the Trisector Dialogue for
preventive Health care in Bangalore.
Dr. Mala Ramachandran conducted a Brainstorming Session of the Health needs of the
community and there after evolved the priorities by the consensus of the group.
The brain storming session listed out the following needs of the urban poor from
the health professionals’ perspective.
1.
Awareness of General issues of importance like legal issues, health issues,
availability of services etc.
2. Primary Health, Mobile services, referral services, availability of treatment for
communicable and non-communicable diseases.
3. Safe Drinking Water, Sanitation, Solid Waste Management, Toilet and Under
Ground Drainage, nuisance of stray animals
4. Access to cost effective services/ Lack of accountability /Corruption/Lack of
information about services/Health Insurance/Lack of awareness about the rights
of the community/Community ownership/ Empowerment
5. Child Marriage
6. Street children
7. Alcohol and substance abuse
8. Migrants and settlers
9. Violence against women, Sex related violence, Sex abuse
10. Child Labour
11. HIV/AIDS/STD
12. Polygamy, Multiple Partners
13. Male Participation/ Lack of gender sensitivity
14. Housing and electricity
15. Exploitation
16. Unemployment/ Poverty
17. Education-Adult and Drop outs
18. Adolescent Problems/Sex Education /Pre marital Sex
19. Malnutrition
20. Disability and Accessibility issues
21. Recreation
Accidents and Trauma Care
Area Dynamics in Government
Inter and intra sectoral coordination
Crime/Safety and security Trafficking in women, suicides and Dowry harassment
Nutrition problems/PDS/Food adulteration
Lack of City plan, lack of sensitivity among citizenry to slum problems, lack of
media attention
28. Care of old
29. Pollution
22.
23.
24.
25.
26.
27.
The group then prioritised these Issues by consensus
1st Priority- Awareness of General issues of importance like legal issues, health
issues, availability of services etc..
2nd Priority- Safe Drinking Water, Sanitation, Solid Waste Management, Toilet and
Under Ground Drainage, nuisance of stray animals
3rd priority- Primary Health, Mobile services, referral services, availability of treatment
for communicable and non-communicable diseases.
4th priority- Access to cost effective services/ Lack of accountability /Corruption/Lack
of information about services/Health Insurance/Lack of awareness about the rights of
the community/Community ownership/ Empowerment
5th priority- HIV/AIDS/STD
6th Priority- Alcohol and substance abuse
7th Priority- Adolescent Problems/Sex Education /Pre marital Sex
8th Priority- Malnutrition
9th Priority- Disability and Accessibility issues
Violence against women Sex related violence, Sex abuse
10th Priority- Accidents and Trauma Care
Pollution
Dr. Prithvish summed up the discussions
iS
Annexe-^
Workshop for the Health Professionals of the Bangalore
Mahanagara Palike on 30th December 2002 at the Urban Health
Research and Training Institute, to prioritise the Health needs of
the Urban Poor
The workshop was attended by Deputy Health Officers, Medical Officers i/c of
Sanitation in ranges, Doctors of Urban Family Welfare Centres, Health Centres,
Health Inspectors, LHVs and ANMs of Health institutions of BMP, totaling 21
participants.
Dr. Mala Ramachandran welcomed the participants and spoke about the Objectives of
the Workshop.
Dr. Pandurangi, explained the CAMHADD initiative and the Trisector Dialogue for
preventive Health care in Bangalore.
Dr. Mala Ramachandran conducted a Brainstorming Session of the Health needs of the
community and there after evolved the priorities by the consensus of the group.
The brain storming session listed out the following needs of the urban poor from
the health professionals perspective.
1. Lack of Knowledge on general and health issues, legal issues their rights
2. Solid Waste Management
3. Toilets, Under Ground Drainage, surface drains and Safe Drinking Water.
Sanitation
4. Communicable Diseases
5. Playground and Recreation
6. Access to cost effective treatment and investigations relating to Primary Health
Care, including specialist services, and referral linkages.
7. Education for all, Enrollment of Dropouts, Adult literacy, Literacy for women
8. Apathy and lack of planning their lives
9. Problems of elderly
10. Accidents and Trauma Care,
11. Insurance
12. Disaster management
13. Stray animal nuisance
14. Non communicable diseases, Cardio vascular diseases, Cancers,
15. Care of disabled
16. Food Vendors, Street vendors, unhygienic open air food preparation, food
adulteration
17. Juvenile delinquency
18. Local Dynamics
19. Child Labour
20. Debts
21. Quackery
22. Accessibility to roads
23. Alcoholism and substance abuse
24. Women empowerment
25. Housing and electricity
26. Unemployment and vocational training
27. Violence, Crime, safety andseeurity
28. Malnutrition
29. Child Marriages/Taboos/Superstition
30. Pollution both environmental andhouoahold-AIr and Noise
The group then prioritised these Issues by coneensus
1st Priority- Lack of Knowledge on general and hasitt issues, legal issues their rights
2nd Priority- Solid Waste Management
3rt priority- Alcoholism and substance abuse
4” priority- Communicable Diseases
5th priority- Food Vendors, Street vendors, unhygienic open air food preparation, food
adulteration
6*’ Priority- Juvenile delinquency
7m Priority- Women empowerment
8” Priority- Housing and electricity
91” Priority- Problems of elderly
10th Priority- Local Dynamics
Dr. Hema Reddy summed up the discussion
Dr. Pandurangl proposed the vote o< thanks.
20
2k
ANNEXE- 5
Workshop for the Representatives of the media on 3rd January 2003 at the
Urban Health Research and Training Institute to prioritise the Health needs
of the Urban Poor.
Dr. Mala Ramachandran welcomed the participants and spoke about the
objectives of the Workshop.
Dr. Prithvish, explained the CAMHADD initiative and the Trisector Dialogue for
preventive Health care in Bangalore.
Dr. Mala Ramachandran conducted a Brainstorming Session of the Health needs
of the community and there after evolved the priorities by the consensus of the
group.
The brain storming session listed out the following needs of the urban poor from the
media perspective.
1. Education - enrolment and education for women
2.
Lack of employment opportunities/occupational problems
3.
Lack of awareness on general issues and awareness for change
4. Lack of basic medicines/lack of accessibility to services including health
services
5.
Lack of transport facilities.
6. Child labour
7. Problems of children of convicted parents
8. Lack of toilets, drains, lack of sanitation/safe drinking water
9. Strengthen community based organisations/empowerment of women.
10. Violence in Women
11. Exploitation
12. Education regarding rights and availability of services
13. Lack of recreational facilities like library, playground
14. Nutritional problem including anemia, vitamin deficiencies
15. Develop linkage through community workers
16. Electricity/Housing
17. Replicating successes in preventive health interventions to other areas.
18. Lack of counseling centers
19. Lack of career guidance facilities
20. No land ownership
21. Lack of access to amenities like provision stores and telephone facilities.
22.
Blindness/Cataract interventions
23. Problems of old age
24. Problems of migrant workers
25.
Lack of availability of creches
26.
Bridging the gap between rich/poor- amongst children
27.
Sustainability of changes, motivation
28. Gender discrimination
29.
Female feticide
30. Lack of family ties
Provisional Programme
The Tri-Sector Dialogue Workshop on: Preventive Health Care with Special
Reference to Urban Poor (Bangalore)
Venue: Sri Jayadeva Institute of cardiology, Jayanagar 9th Block
Bannerghatta Road, Bangalore-560 069
Telephone: (080) 6534466
08.30
Session I
Registration
Chairperson
Professor S.Chandrashekar Shetty
Former Vice Chancellor
Rajiv Gandhi University of Health Sciences Bangalore
And Consultant to Trisector Dialogue in Health
09.00
Welcome
Dr A.N.Prabhudev
Director
Sri Jayadeva Institute of Cardiology
09.10
Self Introduction of Participants
09.20
Purposes of the Workshop and Presentation
Of Background Paper
Dr V.R.Pandurangi (CAMHADD)
Consultant to Trisector Dialogue in Health
09.30
Keynote Address
Dr Rajesh Tandon
President
PRIA (participatory Research in Asia)
New Delhi
10.15
Tea/Coffee Break
Session II
GROUP discussion: Three Groups
Theme: Who does what?
10.30
Government Sector
Private Sector
Civil Socciety
Facilitator
Rapporteur
Facilitator
Rapporteur
Facilitator
Rapporteur
(Three Sectoral groups: Participants will discuss their sectors current and /future roles
and responsibilities)
•
•
•
What is it what the sector is best placed to do?
How does this compare with the current role of the sector?
What expectations are there of the roles that are best taken on by the
other sectors (or where it is in appropriate for other sectors to be
involved)?
Session III
Plenary Session: Presentation of group reports
11.30
Chairperson:
Rapporteur: Dr Ganesh Supramaniam
Lunch
12.45
Session IV
Group Discussion “ What should the Future look like”
13.30
Government Sector
Private Sector
Civil Society
Facilitator
Rapporteur
Facilitator
Rapporteur
Facilitator
Rapporteur
Each Sector discusses
•
Who should do what in relation to the identified need/issue?
•
How does this differ from the present tri-sector distributions of power and
responsibility?
Programme
CAMHADD One-Day Workshop on
The Tri-Sector Dialogue: Preventive Health Care with Special Reference
to Urban Poor (Bangalore)
Venue: Sri Jayadeva Institute of cardiology, Jayanagar 9th Block
Bannerghatta Road, Bangalore-560 069
Telephone: (080) 6534466
Date: 11th January 2003 Time: 0830-1730
08.30
Session I
Registration
Chairperson
Professor S. Chandrashekar Shetty
Former Vice Chancellor
Rajiv Gandhi University of Health Sciences Bangalore
And Consultant to Trisector Dialogue in Health
09.00
Welcome
Dr. A. N. Prabhudev
Director
Sri Jayadeva Institute of Cardiology
09.10
Self Introduction of Participants
09.20
Purpose of the Workshop and Presentation
Of Background Paper
Dr. V. R. Pandurangi (CAMHADD)
Consultant to Trisector Dialogue in Health
09.30
Keynote Address
Dr. Rajesh Tandon
President
PRIA (participatory Research in Asia)
New Delhi
10.15
Tea/Coffee Break
1
Session II
10.30
GROUP discussion: Three Groups
Theme: Who does what?
Guidelines for group discussion and plenary session
Dr. D. K. Srinivas-Director, Curriculum Development
Rajiv Gandhi University of Health Sciences Bangalore
Government Sector
Facilitator
Private Sector
Facilitator
Civil Society
Facilitator
Prof. Chandrashekar Shetty
Dr. K. V. Ramani
Ms. Shagun Mehrotra
Rapporteur
Rapporteur
Rapporteur
Dr. Ganesh Supramaniam
Dr. Roberta Ritson
Ms. Nalini Sampat
Dr. Pruthvish
(Three Sectoral groups: Participants will discuss their sectors current and /future roles
and responsibilities)
Dr. Mala Ramachandran
•
•
•
What is it what the sector is best placed to do?
How does this compare with the current role of the sector?
What expectations are there of the roles that are best taken on by the other
sectors (or where it is in appropriate for other sectors to be involved)?
Session III
11.30
Plenary Session: Presentation of group reports
Chairperson: Dr Roberta Ritson
Rapporteur:
Dr Ganesh Supramaniam
Ms Nalini Sampat
12.45
Lunch
Session IV
13.30
Group Discussion “ What should the Future look like”
Government Sector
Private Sector
Civil Society
Facilitator
Facilitator
Facilitator
Prof. Chandrashekar Shetty
DrK.V. Ramani
Ms Shagun Mehrotra
Rapporteur
Rapporteur
Rapporteur
Dr Mala Ramachandran
Dr Ganesh Supramaniam
Ms Nalini Sampat
Dr Roberta Ritson
Dr Pruthvish
Each Sector discusses
•
•
Who should do what in relation to the identified need/issue?
How does this differ from the present tri-sector distributions of power and
responsibility?
2
Session V
14.30
Plenary Session: Presentation of Group Reports
Chairperson: Dr A. N. Prabhudev
Rapporteur: Dr Ganesh Supramaniam
Ms Nalini Sampat
Tea/Coffee Break
15.30
Session VI
15.45
Group Discussion: Three Groups
Theme: “What we need to play our part"
Government Sector
Private Sector
Civil Society
Facilitator
Facilitator
Facilitator
Prof. Chandrashekar Shetty
DrK. V. Ramani
Dr Francis
Rapporteur
Rapporteur
Dr Mala Ramchandran
Dr Ganesh Supramaniam
Ms Nalini Sampat
Rapporteur
Dr Pruthvish
Each Sector discusses
•
•
16.45
Their role in the identified issues
Identifies obstacles and what is needed to overcome them
including support, resources, capacity building needs etc.
Plenary Presentation of 3 Groups
Chairperson: : Dr Rajesh Tandon
Rapporteur:
Dr Roberta Ritson
Ms Nalini Sampat
17.30
Closing Session
Chairperson
Mr M. R. Srinivasa Murthy
Commissioner
Bangalore Mahanagara Palike
Co-Chairperson
Dr. D. K. Srinivas
Rajiv Gandhi University of
Health Sciences Bangalore
Recommendations
Dr Roberta Ritson
WHO/HQ/Geneva
Plan of Action
Dr Ganesh Supramaniam (CAMHADD)
Chairperson’s Remarks
Vote of thanks
DrV. R. Pandurangi (CAMHADD)
3
Citizens and Governance Program: The Tri-Sector Dialogue Workshop on
Preventive Health Care with Special Reference to Bangalore Urban Poor
11 January 2003
Guidelines for Group Discussion and Plenary Session
1.
Participants will form three sectoral groups. The three groups will hold discussion
simultaneously in separate places.
2. The participants will discuss their sector’s current and/or future roles and
responsibilities in addressing the identified need/issue focusing on during: the group
discussion
I Group Discussion - Theme: "Who does what?”
Discussion Points:
i. What is that the sector is best placed to do.
ii. How does this compare with the current role of the sector?
iii. What expectations are there of the roles that are best taken on by the other
sectors (or where it is inappropriate for other sectors to be involved)?
II Group Discussion - Theme: “What should the future look like?"
Discussion Points
i.
ii.
Who should do what in relation to the identified need/issue?
How does this differ from the present tri-sector distributions of power and
Responsibility?
Ill Group Discussion - Theme: “What do we need to play our part?”
Discussion Points
i. What is needed to enable the sector to play its role effectively in the future
Identified in the previous session?
ii what obstacles/constraints are anticipated?
iii. What is needed to overcome them including support, resource, capacity building
needs etc.
Since the dialogue is only for a day, keeping the time constraint in view, the groups are
requested to focus on the issues raised in discussion points
3. Plenary Sessions
During each of the three plenary sessions, the three sector group reports are shared.
Overlapping experiences, expectations, points of agreements and areas of
disagreement are identified and further discussed. If necessary, plenary could break into
‘buzz’ groups - small cross- sectoral or sectoral to workout solutions to dispute areas so
that a final recommendation on each theme is ready at the end of each plenary session.
In the third and final plenary, the entire group discusses next steps including any related
to workshop report and the 2003 international workshop.
4.
Group Reports
Each sectoral group report should be brief, precise, and specific and action oriented.
The organisers appreciate your cooperation.
Happy Dialogue!
4
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Page 1 of 8
JANASAHAYOG
- a Resource Group for People Living in Slums
A proposal to facilitate people to make the Karnataka Slum Act 1973 into a pro-people Act
A campaign
to facilitate people
across the State of Karnataka
to undertake a 6-month process
of awareness, education, consultation and advocacy
leading to the amendment of
the Karnataka Slum Act, 1973,
into a pro-people act
. JANA SAHAYOG
- a Resource Group for People Living in Slums
Pag' 2 of 8
A proposal to facilitate people to make the Karnataka Slum Act 1973 into a pro-people Act
KARNATAKA SLUM ACT 1973
X The Karnataka Slum Act, 1973, is in the process of being amended.
X The Karnataka Slum Clearance Board, which serves as both the regulatory and implementing
agency for the Act, has proposed 19 major amendments to this Act.
X The Law Dept has cleared 4 amendments for approval by the Legislative Assembly.
X Consultations with people, which are part of the process of amendment, were not undertaken.
X Activists came to know of these amendments only during the last session when the papers to
approve 4 amendments were circulated to MLAs, and the information entered the public
domain.
X Jana Sahayog's review of these amendments shows that these will further empower the
beaurocracy, while making it even more difficult for people to uring about changes to improve
their lives.
X Because of time constraints, the bill to approve these amendments was not taken up at this
session - but will now be taken up in the winter session.
X Jana Sahayog believes that this 6-month delay provides a window of opportunity to introduce
further amendments in the interests of the people.
X Jana Sahayog has undertaken a brief review of the Act. This is enclosed.
Jana Sahayog believes that a prop-people Act can be advocated if all urban activists, human rights
groups, mass organisations and organisations committed to good governance come together under a
State-wide campaign forum to
1) undertake an awareness programme amongst people living in slums, elected representatives, media, Bar
Associations, and stakeholder organisations
2) formation of campaign units in each of the 27 district centres. These campaign centres will cover all
habitations under tire town panchayats, town municipalities, city municipal councils and city
corporations in their districts.
a) these campaign centres will facilitate the formation of consultative groups, and will facilitate thee
people's groups to study and understand the Act as it stands, and to recommend amendments to
protect their rights and interests.
b) these campaign centres will then coordinate people's groups in their districts to
i) meet elected representatives of local bodies, and to submit memorandums to these local bodies.
ii) meet and submit memorandums to their Deputy Commissioners for forwarding to the Chief
Minister and the Minister for Housing;
iii) meet and submit copies of the memorandum to their MLA, MLCs and MPs, with a request to
support the amendments on the Floor of tire House;
iv) meet and submit copies of the memorandum to districts of all political parties asking them to
formally asking the parties to endorse these amendments and support it in the Assembly.
v) meet and submit copies of the memorandum to district heads of all progressive and human
rights organisations, with a request to act in solidarity with this people's campaign.
c) These campaign centres will also act as a resource centre for media in the district. The media will be
enrolled to report on the campaign, create public awareness, and bring pressure on the government.
d) These campaign centres will meet with their bar associations and request them to endorse the
amendments, act as resource persons to the people's groups, and to influence the legislative ad
administrative bodies.
3) form a state campaign forum based at Bangalore to undertake the above actions at a State level.
4) form a campaign secretariat to support and coordinate district and state initiatives of the campaign
forums.
JANA SAHAYOG
' - a Resource Group for People Living in Slums
Page 3 of 8
A proposal to facilitate people to make the Karnataka Slum Act 1973 into a pro-people Act
INADEQUACIES & LIMITATIONS OF
THE KARNATAKA SLUM (Clearance and Improvement) ACT 1973,
The Karnataka Slum (Clearance and Improvement) Act became operational in 1975. A review of
the Act highlighted the following:
Two third of the sections (provisions) are against slum people; only one third of it is pro
poor. Many of these provisions have not been enforced.
2. One third of unreported High Court judgements are against Article 21 Right to Life and
Livelihood.
3. Procedures and formalities for declaration of slums are complicated.
4. The different Acts governing reople living in slums - BDA/UDA Act, Regularization of
Un-authorised Occupation Act and Prevention of Public Premises (Un-authorised
Occupation) Act including Corporation and Municipalities Acts - overlap and are often
contradictory, making implementation open to the interpretation ofdifferent officials.
5. The Slum Act does not specify the time limit for identification and declaration of slums so
as to bring them under the purview of the Act.
6. Discretionary power delegated to the prescribed authority leads to people's opinion and
participation being seen as unnecessary by officials in the exercise of their discretionary
powers.
7. Misinterpretation and misuse of Sec. 11 dealing with re-location resulting in non
consultation of the affected people has resulted in major human rights violations in the
name of slum clearance and redevelopment.
8. Section 58 prohibiting the sale of arrack in slums has not been implemented by the Board
despite representation by people living in slums.
9. Procedural delays and inaction has resulted in many slums which come under the purview
of the Act not being declared, and thus being vulnerable to continual threats of slum
demolition and encroachment
10. There is no Police force within the Board to protect slums declared under the Act, and lands
under the jurisdiction of the Slum Board from encroachment/encroachers, and to prevent
forcible occupation of Slum Board constructed houses by outsiders.
11. No time limit has been fixed for issue of ID cards after the declaration of slums.
12. There is no scope for representation of slum CBOs, SCs and women in Slum Board. There
is no prescribed norm for nomination of members to the Board.
13. There is no scope for people's participation while planning and executing development
schemes in their respective slums.
14. Absolute power of the state government to overrule the decisions of the Board in respect of
notification and de-notification of slum land and declaration is a major cause of confusion
and undermining of Slum board autonomy and democratic functioning.
15. The prescribed rules have lot of in-built confusions, contradictions.
1.
JANA SAHAYOG
- a Resource Group for People Living in Slums
Page 4 of 8
A proposal to facilitate people to make the Karnataka Slum Act 1973 into a pro-people Act
EXISTING CONDITION AND SHAPE OF SLUM BOARD
- as reported by STEM
The following are the observations on the functioning of KSCB by STEM
1. Lack of coordination between ULBs (Urban Local Bodies) & other departments.
2 . Absence of in-built monitoring system
3 . Restricted allocation of Funds for programmes
4 . No provisions for maintenance of amenities provided
5. No effort made to recover the loan from beneficiaries
6. Absence of community participation (Slum people)
7 . Inadequate and untrained KSCB staff
8 . Inadequate and incompatible data on slums
9. Non existence of community Development wing
10. No scope for participation ofNGOs
11. Absence of feedback mechanism
12. Highly centralized decision making system
JANA SAHAYOG
■ Resource Group for People Living in Slums
Page 5 Of 8
A proposal to facilitate people to make the Karnataka Slum Act 1973 into a pro-people Act
PROFILE OF SLUMS IN KARNATKA
General Information:
1.
2.
3.
4.
5.
6.
7.
216 cities and towns in Karnataka are governed by the elected Urban Local Bodies
(ULBs). Of these: 6 are Municipal Corporations, 40 City Municipal Councils, 82 Town
Municipal Councils, 82 Town Municipal Councils, while the remaining 88 are Town
Panchayats
It is estimated that there are over 4500 slums in Karnataka. However, all slums have not
come under the purview of the Slum Act
It is important to note that slums in 52 towns have not come under the purview of the
Slum Board - even after the completion of 25 years of Board's existence.
As per the Slum Board list only 40% of the slums (1977 slums) have been identified &
listed by the Slum Board remaining have to be brought to the books but all of them are
not declared.
Undeclared slums especially on Railway, Defense and Forest and Private land are more
vulnerable in Bangalore
More than 26 % of the total population of cities and towns in the state live in slums
Bangalore city has the highest number of slums in the state with 778 slums with a
population of 18.5 lakhs
JANA SAHAYOG
- a Resource Group for People Living in Slums
A proposal to facilitate people to make the Karnataka Slum Act 1973 into a pro-people Act
MAJOR OUTLINES OF ISSUES
FACING PEOPLE LIVING IN SLUMS IN KARNATAKA
8
8
8
8
8
8
Land related
Basic Amenities
Education
Employment
Violation of Constitutional and legislative provisions
Misuse and misappropriation of Government schemes
Page 6 of 8
Page 7 of 8
JANA SAHAYOG
- a Resource Group for People Living in Slums
A proposal to facilitate people to make the Karnataka Slum Act 1973 into a pro-people Act
Profile of 21 Class I cities in Karnataka
(proposed to be covered under SUDP programme)
Coverage
□
□
□
□
□
Total number of slums in 21 cities
Total number of house holds
Total slum population
Percentage to the total population
Literacy' rate
985
2,76,769
14,97,366
23.2
27.8
Highest Percentage of the Population and Number of slums
Cities
% to total
population
□
□
□
□
49.20
47.60
45.40
40.60
Hospet
Raichur
Bijapur
Bellary
No of slums
59
56
55
77
Land ownership
□
□
□
□
Public/ Govt, land
Private land
Declared so far
To be declared
761 slums
224 slums
389 slums
596 slums
77.3%
22.7%
39.5%
60.5%
Slums liable for inundation & land ownership
□
□
Public land
Private land
Total
343
70
413
slums
slums
slums
42%
70%
30%
681 Slums
304 Slums
33.7%
66.3%
332 Slums
653 Slums
33%
66.8%
327 Slums
658 Slums
20.8%
41.9%
37.9%
205 Slums
407 Slums
373 Slums
BASIC AMENITIES
Water supply
□ Access to water supply
□ No access to water supply
Toilet facilities
□
□
Access to Community toilets
No access to Community toilets
Underground drainage
□
□
Covered by UGD
To be covered by UGD
Drainage facilities
□
□
□
Provided
Particle provided
Not Provided
JANASAHAYOG
- a Resource Group for People Living in Slums
Page 8 Of 8
A proposal to facilitate people to make the Karnataka Slum Act 1973 into a pro-people Act
Condition of roads
Bad Condition
Fair Condition
Good Condition
□
□
□
54.5%
40.1%
5.4%
537 Slums
395 Slums
53 Slums
36.4%
63.6%
359 Slums
626 Slums
29.5%
705%
291 Slums
794 Slums
Street lighting facility
□
□
Sufficient
Inefficient
Garbage disposal
□
□
Satisfactory
Unsatisfactory
SOCIAL AMENITIES
Primary Schools within a kilometer distance
□
□
Schools available
Schools not available
65.1%
34.9%
618 Slums
330 Slums
Accessibility to PHC/Health Centre within a kilometer distance
□
□
Accessible
Inaccessible
24.6%
75.4%
242 Slums
743 Slums
74.5%
25.5%
732 Slums
251 Slums
21.8%
78.2%
207 Slums
741 Slums
65.8 %
34.2%
630 Slums
328 Slums
52.2%
48.8%
494 Slums
452 Slums
Ration shops
□
□
Available
Not Available
Community Hall in slums
□
□
Existing
Not existing
Anganawadi/ Balawadi centers in Slums
□
□
Available
Not Available
Local associations and societies in slums
□
□
Existing
Not Existing
KARNATAKA SLUM AREAS (IMPROVEMENT AND
CLEARANCE ) ACT, 1973
SALIENT FEATURES, STRENGHTS & LIMITATIONS
THE DEFINITION OF SLUM
I.
Any area that is DECLARED by the Government as such under Section 3(1)
1. Area that is likely to be a source
2. building are not fit for human habitation
of danger to health I safety / convenience
because the area is
1. Low lying
IMPORTANT FEATURES OF THE ACT
II.
1.
2.
3.
4.
5.
6.
7.
8.
2. insanitary or over crowded
DECLARATION OF SLUMS
PREVET GROWTH OF SLUMS
PROHIBIT UNAUTHORISED CONSTRUCTIONS
IMPROVEMENT OF SLUMS
SLUM CLEARANCE AND DEVELOPMENT
ACQISITION OF LAND
PROTECTION OF TENANTS
SLUM CLEARANCE BOARD
IH.
PURPOSE OF THE ACT
1. IMPROVEMENT
2. LAND ACQUISITION
3. SLUM CLEARANCE
BECAUSE:
•
•
•
•
•
Slums are increasing and are a source of danger to public health
To check the increase, eliminate congestion
Provide basic needs (streets, water, and drainage)
To clear slums that are not fir for habitation
To remove unhygienic conditions
TO PROVIDE BETTER ACCOMODATION For slum dwellers
• Acquiring land
• Improving, developing, clearance
• improve public health
IV.
PROCEDURES
SECTION
CONTENT
AUTHORITY
TIME
3(1) Notification, declaring area to
to be slum area
Government “prescribed authority”
no time limit
4(1) Registration. Occupier/owner of
building must register it if
prescribed
“prescribed authority”
4(2) When the prescribed authority is
satisfied, he shall issue registrat
ion certificate
“prescribed AutoRoute”
time limit to
fixed by the
prescribed
authority
no time limit
fixed
V.
5(1) “prescribed authority” may dire“prescribed authority”
ct that no building can be constr
ucted without prior written permission
expires at
the end of
2 years
5(4) The “prescribed authority can grant “prescribed authority”
or refuse permission but an opportu
nity must be given to the applicantto show why permission shouldn’t
be refused
no time FIXED
PREVENTION OF UNAUTHORISED CONSTRUCTION
5B(I)(a)
(b)
Once slum comes under this chapter, no
CONSTRUCTION OR RECONSTRU
CTION can be done until permission
is received
licensing authority
no time
no rent etc can be collected from such
building
5B(b) if done without permission, then Govt.
can impose punishment of upto 3 years
or fine of Rs.5000/=
Slum clearance board
5C(1)
Board can order demolition of such
building or prevent further construction
Slum Clearance Board
(2)
Board has to give the owner/occupier/
builder copy of the order of demolition
and notice to show cause.
Slum Clearance Board
Reasonable
time
(3)
If no cause is shown, then Board shall
make order binding and can take any
measure for giving effect to the order
and recover expanses from the owner
(4)
If the Board feels that immediate action
should be taken it only has to give a
minimum of 24 hours notice
Slum Clearance Board
24 hours
2.
VI.
IMPROVEMENT OF SLUM AREAS
6
If the prescribed authority feels that at
a “reasonable” expense, slum may be
improved ; it can serve notice to carry
out those works of improvement
Prescribed authority
60 days
notice
7
The expenses of the improvement done
by the prescribed authority may be reco
vered from the owner/ person who has
interest in that land with interest
Prescribed authority
no time
limit
9
prescribed authority can order demol
ition of building that it deems unfit
after show cause notice
Prescribed authority
local authority
State housing Board
time that
prescribed
authority
specify
VII. SLUM CLEARANCE AND REDEVELOPMENT
11
Government can, on a report of KSCB
or other Authority that the most satis
factory way of dealing with conditions
in an area is clearance and demolition,
it may, by notification declare it to be
a slum clearance area
(2)
Must show cause
12
If it is declared under S-l 1, there is an
obligation to demolish the buildings
within a specified time
13
If not demolished, the Prescribed
Authority can enter the area and
demolish the buildings and sell the
materials
Prescribed Authority
15
The prescribed authority also has
the power to re-develop a slum
clearance area. Must show cause.
Specified time to owner to develop
& can recover expenses from owner
Prescribed authority
VIII. ACQUISITION OF LAND
17
Government has the power to
acquire land for improvement/
re development or rehabilitating
slum dwellers it can do so after
notice in official Gazette ,
must show cause
Government
Prescribed time
Specific time
IX.
X.
PROTECTION OF TENANT FROM EVICTION
28(1)
No person can evict a tenant from any Prescribed authority
building or land in a slum area except
with prior permission of the prescribed
authority
(5)
When granting or refusing permission Prescribed authority
the prescribed authority must consider
whether alternative accommodation will
be available to the tenant, whether
eviction is in the interest of the slum
improvement/clearance and other factors
CONCLUSION AND RECOMMENDATIONS
1. As far as the purpose of the Act is concerned , slum improvement, providing better
accommodation for shim dwellers and providing basic needs are all part of the intention of
the Act. This is an important part of any act “ legislative intention” and can be used to the
advantage of people in a litigation. However, it is not sufficient by itself. It needs to be
backed up by specific provisions within the Act. Secondly, if the intention of the legislation
is divided into its 3 main parts ( improvement, clearance and land acquisition), only 1/3 rd is
pro people.
2.
DECLARATION as a” slum area” is a two edged sword. On the one hand, only if an area is
declared to be a “ slum area” can slum dwellers even claim any rights to basic needs (water,
sanitation, electricity, housing) . Therefore it becomes essential for a notification under 3(1).
On the other hand, notification also opens the floodgates for exercise of discretionary power
of the Authority for clearance and acquisition of the land. What might be better would be to
have two different procedures. Any area that has (a) existed for a certain time (b) a certain
specific number of dwellers be automatically declared a slum area which cannot be cleared.
What should follow this is the basic procedure for accessing basic needs. Other areas can be
open to clearance and acquisition as long as alternative accommodation is provided to the
dwellers of those areas.
3.
What is evident throughout the Act is that everytime people have to respond to the prescribed
authority a time limit is fixed either by the Act itself or by the prescribed Authority.
However, when the Government / Prescribed authority has to act, there is no time limit
imposed on them.
4.
Although the Act has many provisions that can be considered as “ pro-people” the long
procedure, the non-existence of any time limit, the discretionary power of the Authorities
and the power to clear/demolish slums almost defeats the effect of these provisions.
5.
It seems that the Act requires many amendments. But for this political will is required and to
change that would be a long drawn out (if at all) process.
6.
If a public interest litigation is to be filed, there are certain requirements
/
/
r
i
KARNATAKA SLUM AREAS (IMPROVEMENT AND CLEARANCE) AND
CERTAIN OTHER LAW (AMENDMENT) BELL,2001
A Bill further to amend the Karnataka Slum Area$ (Improvement and
Clearance)Act, 1973 and the Karnataka Public Premi3es(Eviotion of Unauthorised
OccupantsJAct, 1974.
Whereas it is expedient further to amend the Karnataka Slum
Areas(Improvement and clearance) Act, 1973 (Karnataka Act 33 of 1974) and the
Karnataka Public Premises (Eviction of Unauthorised Occupants) Act, 1974
(Karnataka Act 32 of 1974) for the purpose^ appeared hereinafter.
■'
Be it enacted by the Karnataka State Legislature in the fifty second year of
the Republic of Indiaj 'as follows, naroely:-
1. Short title and commencement.- (1) This Act may be called the
Karnataka Slum- Area^ (Improvement and Clearance) and Certain Other Law
(Amendment) Act, 2001.
(2) It shall come into,force at once.
2. Amendment of Karnataka Act 33 of 1974.-In the Karnataka Slum
Areas (Improvement and Clearance) Act, 1973 (Karnataka Act 33 of 1974),-
(1) in section 27,in the heading^ after the words ‘land acquired' the words ‘or land
transfered by the Government or the local authority’ shall be inserted;
(ii) after sub-section(2), the following shall be inserted, namely:-
"(3) Where any slum area is located on the land belonging to the
A-u/6ovemment or any local authority ^the Government or the local authority may
subject to such restrictions and conditiojins as it may impose^ transfer to and vest
in the Board such lanc&free of cost for the purpose of undertaking such measures
as may be necessary for improvement, development, clearance or redevelopment ■
of the land or the errection of building or buildings thereon".
3u
-qSj^fter section 27, the following sections shall be inserted, namely:"27A.Carryingout the development and allotment of «ite* etc., (1)
Subject to section 27, the Board shall fprm layout on the lands transfered to and
vested in it under sub-section(2)(^)<oFsection 27 by realigning the internal roads
for the easy and convenient movement of the slum dwellers and for improving the
hygenic conditions. The. Board may undertake all measures necessary for
improvement clearance development or redevelopment of such land and errection
of building thereon..
I
.■
■
? l
and the persona affected by such demolition shall, as far as, may be
accommodated within the same slum area and if it is not possible therdf shall be
accommodated in the area’vailable in the adjacent slum area or any other area
meant for rehabilitation of slum dwellers.
. .
(3) Subject to such restrictions aad conditipns and limitations as may be
prescribed,the Board, shall have power to leasc^-self-or otherwise transfer the sites
formed in the layotft^under sub-section(l) or dwelling unit of any building
constructed in such layout.,.
27B. Recovery of sums due to the Board.-(1) All cost damages, penalities,
charges, rent contribution or any other sum which under this Act or any rule
made thereunder, are due by any person, to the Board may be reeev^e^oy -the
prescribed authority by issuing a notice of demand to such person and indicating
therein the liability ^ncurred in default of payment, and may be recovered jn the
prescribed mannerjwithin one month from the date of service of The notice such
person does not make payment to the Board <gr;
(2) Any person disputing the demand made in the notice issued under subsection(l) may prefer an appeal under section 59, within thirty days from the date
of service of the notice and the provisions of that section shall mutatis mutandia^p
apply?
,
;_ S-da, boob
jSj-fbr: §ub^sections(l) and (2),^ following shall be substituted,namely:
"(1) The Board shall consist of a Chairman and other Officialiand non
official members as specified in sub-section(2);
(2) The Board shall consist of,-
(a) A Chairiman, who shall be appointed by the Government;
(b) the Commissioner of the Board shall be the Member-Secretary;
(c) A representative of the Finance Department, Government of Karnataka,
not below the rank of a Deputy Secretary to Government;
(d) A representative of the Housing Department, Government of Karnataka,
not below the rank of a Deputy Secretary to Government;
(e) The Director of Town Planning Department, Government of Karnataka;
(f) A representative of Health and Family Welfare Services Department,
Government of Karnataka, not below the rank of^Joint Director;
A
(g) A representative of the Bangalore Mahanagara Palike not below the rank
of a Deputy Commissioner;
(h) A representative of the directorate of Social Welfare Department,
Government of Karnataka, not below the rank of lloint Director,
_
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yz v - 3
Report of
CAMHADD One-Day Workshop on
The Tri-Sector Dialogue
For Preventive Healthcare with Special Reference to Bangalore Urban Poor
at Sri Jayadeva Institute of Cardiology,
Jayanagar 9th Block, Bannerghatta Road, Bangalore-560 069. INDIA.
held on 11th January 2003
Sponsored by
The Bangalore Mahanagara Palike (BMP)
In partnership with
Rajiv Gandhi University of Health Sciences, Karnataka
and
Sri Jayadeva Institute of Cardiology (SJIC)
Supported by
The Commonwealth Foundation, London
Prepared by
The Commonwealth Association for Mental Handicap
and Developmental Disabilities (CAMHADD)
and
Urban Health Research and
Training Institute
Bangalore Mahanagara Palike
A view of the SJIC
- one of the largest Cardiac institutes in Asia
Kempegowda Tower
- a symbolic landmark of the city's municipality - BMP
Inauguration oj
the Tri-Sector Dialogue Workshop
L to R . Dr. V. R. Pandurangi, CAMHADD
Mr. Sreenivasa Murthy, Commissioner, BMP
Dr. Maalaka Raddy, Honble Minister for Medical Education. Karnataka
Dr. Roberta Ritson, WHO, Geneva
Mr. C. M. Nagaraj, Worshipful Mayor, BMP and
4
Dr. A. N Prabhudeva, Director SJIC
Acknowledgements
CAMHADD would like to express its sincere thanks and gratitude to Mr Colin Ball, Director, The Commonwealth Foundation
London for supporting Bangalore One day Workshop on “Trisector Dialogues in Health."
CAMHADD would also like to express its sincere thanks to Mr M.R.Srinivasa Murthy, Commissioner Bangalore Mahanagara
Palike for sponsoring and supporting the workshop.
CAMHADD is grateful to Dr A.N.Prabhudev, Director, Sri Jayadeva Institute of Cardiology for providing facilities to
organise the workshop.
This report is the result of co-operation between many people. CAMHADD would like to thank
Dr Chandrashekar Shetty, Dr
Prabhudev.Dr D.K.Srinivas, Dr Roberta Ritson and Professor David Harvey and
Dr Ganesh Supramaniam and also all those who have contributed in any way to its preparation, in particular chairpersons,
facilitators and rapporteurs.
CAMHADD would also like to acknowledge the comments and advice given for preparation of the background paper.
I would like to express my sincere thanks to Dr R.M.Varma,Founder President CAMHADD, Dr Mala Ramachandran,
Dr Jayachandra Rao, Chief Medical Officer Bangalore Mahanagara Palike, Dr Hemareddy, Former Director of Health
services, Government of Karnataka and Dr Pruthivsh Secretary(Academic) CAMHADD Indian Chapter.
Our special thanks to Professor David Harvey for editing the report, Dr Prabhudev for organising the workshop at
Sri Jayadeva Institute of cardiology, Dr Rajesh Tandon. President PRIA for delivering Keynote Address, Mr I.S.N.Prasad,
Special Commissioner Bangalore Mahanagara Palike and Ms Shagun Mehrotra, Manager PRIA A.P Office
CAMHADD would also like to thank all invited participants for their participation at plenary and Group discussion with
their contribution.
CAMHADD would
also like to thank Mr Virupakshayya, Commissioner Slum Clearance
Board,
Ms Nalini Sampat, CAMHADD Indian Chapter Co-ordinating Secretary and all the Partners and co-ordinators for their
commitment to the proposed Preventive Health Care Programme for Bangalore Urban Poor
V. R. Pandurangi
Consultant to Trisector Dialogue in Health
Bangalore One Day Workshop
21 January 2003
- 1 -
Background to the Workshop
CAMHADD : One of the Commonwealth Professional Associations and A Pan Commonwealth NGO supported
by the Commonwealth Foundation, London was established in January 1983.
Its main objectives are prevention
(primary and secondary) of mental handicap and to strengthen health professional links between and among developed
and developing countries.
CAMHADD has organised 27 regional workshops, including 8 Pan Commonwealth workshops from 1985 to 2002
involving 1387 (Male 714 Female 673) invited participants/professionals from 45 Commonwealth countries and 17
Non-Commonwealth countries.
CAMHADD is in Official Relations with WHO since 1990 for collaborative programmes and is a long-standing partner
of WHO in a number of technical areas, in particular mental health, disability prevention, maternal and newborn
health, reproductive health, prevention of injuries, prevention of childhood blindness and Unity Towards Health to
Achieve Social Accountability. WHO has co-sponsored 13 CAMHADD Regional workshops.
CAMHADD in collaboration with WHO has developed and implemented priority initiatives for the prevention of brain
damage due to birth asphyxia (lack of oxygen either before or immediately after birth) a major non-communicable
cause of death and disability in newborn to prevent mental, neurological and sensory handicaps as integral component
of safe motherhood and child survival.
CAMHADD is granted observer status by the Commonwealth Health Ministers to attend their meetings. CAMHADD
was accredited as Pan Commonwealth NGO to represent at the Commonwealth Heads of Governments Meetings
(CHOGM) at Edinburgh (UK) in October 1997, Durban (South Africa) in November 1999 and Brisbane (Australia) in
February 2002.
One of CAMHADD programme activities for the New Millennium is to promote better public understanding of
the Commonwealth and the issues that concern its people and also to promote Citizens and Governance
Programme that arose directly from out of the Commonwealth Foundation’s Civil Society Project in the New
Millennium.
The Need for the Tri-Sector Dialogues
Governance as distinct from government is interpreted by most to mean having an inclusive approach to policy
and decision-making, and to sharing responsibility for any or all decisions, actions, provisions among the three main
social actors -the government, private sector and civil society.
The key question is: who does what?What roles are appropriate for the state, the business sector (and the market
more generally and what roles are most appropriate for civil society (including citizens themselves as individuals as
well as their voluntary associations and more institutionalised civil society organisations)?
A second question is: What difference does it make?\Nhat impact is made on a society’s ability to meet people’s
basic needs - such as the need for human security, shelter, health, and livelihood-by new tri-sector distributions of
power and responsibilities? What changes to existing relationships are needed in order to increase impact?
A Preliminary discussion of these questions was held at a workshop organised by the Commonwealth Foundation
(CF) in Australia in 2001. It highlighted the importance of examining the appropriateness and impact of tri-sector
approaches in concrete situations in diverse parts of the Commonwealth. Following this discussion Commonwealth
Foundation decided to initiate a series of dialogues in up to 12 different localities in the Commonwealth in collaboration
with Ford Foundation.
-2-
The bangalore Trisector Dialogues Workshop on Preventive Health Care for Urban Poor is one of the 12
workshops supported by the Commonwealth Foundation.
The objectives of the workshop
•
To promote Commonwealth Foundation’s Project: "Citizens and Governance Programme: Trisector Dialogues
in Health
o
The Role and responsibilities of trisectors: government, private and civil society in social development to
achieve social accountability.
•
Strategies to develop trisector collaboration for the benefit of citizens.
•
Reduction of poverty through health promotion.
Expected Outcome
To develop a strategy to provide preventive health care to the urban poor in Bangalore, in collaboration with trisectors:
government, private, and civil society.
The workshop arranged by CAMHADD was sponsored by Bangalore Mahanagara Palike in Partnership with Rajiv
Gandhi University of Health Sciences Karnataka and Sri Jayadeva Institute of Cardiology Bangalore.
Bangalore “ The capital City of Karnataka in South India”
The modern world is experiencing a rapid increase in urbanization leading to more urban poverty in developing
countries. Most of the growth is likely to be in Asia and rapid urbanisation will stretch the already scarce resources to
the maximum. Urban life offers diverse forms of employment and cannot be contained. Therefore the challenge is to
evolve appropriate and sustainable ways to manage the urbanisation process rather than prevent it.
Bangalore with an area spread over 225 sq kms. and a Population of 6.5 million, consisting 30% urban poor and
9% slum dwellers is the capital city of Karnataka in South India. Bangalore as the Information Technology (IT) centre
is one of the fastest growing cities in Asia and urbanisation is one of the major problems the city will face in the coming
decade.
Health Infrastructure of Bangalore : 250 large Hospitals and nursing homes and 5000 family practitioners.
Health facilities run by Bangalore Mahanagara Palike : 68 Urban Family Welfare Centres/Health Centres,
6 referral hospitals, and 24 Maternity Homes.
Tertiary Care Hospitals
•
National Institute of Mental Health and Neuro Sciences.
•
Jayadeva Institute of Cardiology.
•
Kidwai Memorial Institute of Oncology.
Road network: of around 4000 km, catering to about 17 lakh (1.7 million) vehicles, of which nearly 70 percent are
two-wheelers. The existing road network has to be upgraded by adding flyovers, grade separators, subways, broad
good surfaced roads, development of multi-storeyed car parks.
Naturally, the growing needs of the city and the ever increasing demands of the people, trade and industry, particularly
the information technology sector, make it imperative to plan and provide top-class infrastructure facilities like sidewalks
and parks besides ensuring all basic civic amenities to the satisfaction of citizens and attract tourism not only from
other parts of the country but also from abroad.
-3-
The Bangalore Mahanagara Palike a local self Government that is responsible for the civic governance of Bangalore
has been making concerted efforts over the years for the development of the city’s infrastructure through a series of
ambitious projects aimed at improving the existing facilities and providing new ones to meet future requirements.
It plans to unveil a series of new initiatives, to be implemented over the coming months at an estimated cost of 17
Million Rupees(170 crores) funded with financial assistance from State Government, Karnataka Urban Infrastructure
Development & Finance Corporation (KUIDFC) and Housing & Urban Development Corporation (HUDCO).
These projects are not only need -based to reduce traffic congestion but also designed to enhance Bangalore's
beauty, as a growing metropolis.
Recognising the urgent need to address this problems : CAMHADD, the Bangalore Mahanagara Palike, and Sri
Jayadeva Institute of Cardiology have come together to identify key areas for intervention in order to develop a city
plan for preventive health with special focus on the urban poor. An endeavour of this magnitude will require partnerships
to be developed between the Government, Private Sector and Civil Society.
Sri Jayadeva Institute of Cardiology(SJIC) was founded in 1972 by a generous donation by a philanthropist, the
late Sri. Ambali Channabasappa to establish a heart care centre. The SJIC has a motto “ To provide the very poor
and needy with access to expensive cardiac medical care and cardiac surgery" free of cost in deserving cases.
The Institute is to provide excellent service for patients suffering from heart ailments, maintenance of high standards
in cardiac medical and cardiac surgical treatment, high achievements in academic and research activities, in the fields
of cardiology and cardiac surgery.
Concessional treatment for all patients below poverty level and holders of green ration card is available. The Institute
provides for post graduate and super speciality training in cardiology and cardiac surgery.
The pre workshop process
1.
The first step in the process was a series of meetings with the Municipal Commissioner of Bangalore in which the
representatives of the Health Department of the Bangalore City Corporation, CAMHADD representatives, Director
of the Manipal Institute of Neurological Sciences, Ramaiah Medical College, Director of Jayadeva Institute of
Cardiology, Representative of Rajiv Gandhi University of Health Sciences were present. The key decisions at the
first two interactions was the willingness of the Bangalore Corporation to be the main nucleus to develop preventive
health care for Bangalore urban poor along with the other partners, from slum clearance board, Banks, Institutes
and NGOs. These meetings also approved the formation of a Technical Committee consisting off representatives
from the Bangalore City Corporation, Sri Jayadeva Institute of Cardiology, Community Medicine Department of
MS Ramaiah Medical College, Rajiv Gandhi University of Health Sciences, and CAMHADD.
It was also decided at these meetings to invite the Honourable Minister of Medical Education to preside over the
Inaugural Session of the workshop and the Municipal Commissioner to give keynote address. The minutes of
these meetings are enclosed at Appendix 1
2.
The next step was to prioritise the health problems of the urban poor, by organising a series of stakeholder's pre
workshops dialogues to obtain their perspective. Pre-Workshop dialogues were held for key health personnel:
health administrators, medical officers, health inspectors, health visitors, and auxiliary nurse midwives, opinion
leaders in the slums, community based organisations and link workers,.NGOs working in the slums, and media
personnel.
-4-
These pre-workshops were conducted as brainstorming sessions and a consensus on the priorities was evolved
through a scientific process. One of the pointers in these workshops was that although the set of about 30 issues
identified each of the groups were in general similar, the priorities as seen by the opinion leaders were different
from those seen by health professionals which in turn varied from the perspective of the NGOs or the media.
From these interactions evolved a set of ten priorities.
«
Air pollution
•
Accidents and trauma
•
Violence against senior citizens
•
Violence against women
•
Cardiovascular diseases
•
‘‘Toilets, underground drainage systems, solid waste management
•
Substance abuse
•
Child labour
•
HIV/A1DS
•
Primary Health Care
The minutes of the pre-workshops are enclosed at Appendix 2
3.
The consultants of the workshop and the organiser of the pre-workshop then decided to examine the seriousness
of the problem for each of the issues identified by the information available or from the web sites. Government
Departments and NGOs working in the various areas were contacted and available data was gathered. All
information gathered was processed and for each of the ten issues the extent of the problem was listed out.
4.
The Committee then explored the likely interventions that were necessary. Some interventions were either in place
or required strengthening. Some of the interventions need to be looked at differently or required policy changes or
re-addressing by the law. It was decided that the problem and the suggested interventions would form a part of
the Bangalore Charter Declaration. The Bangalore Charter Declaration is enclosed at Appendix 3.
5.
The workshop was structured broadly as per the suggested format of the Commonwealth Foundation and was
modified to suit local circumstances and was planned in two major sessions-The Inaugural and Workshop Sessions.
The programme is enclosed at “Appendix 4.
The topic of the dialogues was "Preventive Health Care with special reference to the urban poor in Bangalore.
The "workshop was expected to highlight some specific health issues for prevention of diseases and disabilities and
also promotion of health after listening to the voices of the poor and other stake holders, so as to achieve the fundamental
rights of good health as the greatest asset to the urban poor.
Preventive Health Care with special reference to Bangalore Urban Poor
Health has long been recognised as one of the human fundamental rights and is reflected in the universal declaration
of human rights, yet huge disparities exist in health between rich and poor within developing countries.
Health is not mere absence of disease or infirmity but is a state of well being at
(as well as spiritual) levels: WHO
-5-
the physical, mental, and social
Limited health budget and growing health needs are forcing developing country
governments to make strategic
decisions on the use of both domestic and foreign funds. Within the health sector, ministries
should preferentially
allocate resources to primary and secondary care rather than to tertiary care.
When public sector fails to meet the health care needs of the poor out of pocket expenditure rapidly exceeds public
expenditure. Payments for private health care can be considerable up to 90% of household expenditure on health in
India as in the private sector with the poor paying proportionately more than the rich.
The pattern of
disease also varies significantly between rich and poor with disease of category I (communicable
disease, maternal, perinatal and nutrition related conditions) dominating amongst the poor and which accounts for
59% of death and 64% Disability against life years lost among them. This does not mean that the poor do not suffer
from non-communicable disease because all studies show they do. But they are not the principal cause of excessive
morbidity and mortality.
A poor man may not have enough to eat, being underfed, his health may be physically weak, his working
capacity is low, which means that he is poor, which in turn means that he will not have enough to eat-he
will not be healthy and his family will be a sick family who have inadequate access to basic health care
inspite of Bangalore having a good health infrastructure.
The workshop was attended by 51 invited participants from Government and Private Sector and also from
Civil Society.
The opening session of the workshop was chaired by Dr. S. Chandrashekar Shetty Former Vice Chancellor of Rajiv
Gandhi University of Health Sciences, Karnataka Bangalore and Consultant to Tri-Sector Dialogues
Dr. A. N. Prabhudev - Director of Sri Jayadeva Institute of Cardiology Bangalore welcomed the participants.
Dr. V. R. Pandurangi (CAMHADD) - Consultant Trisector Dialogue Workshop presented background paper and the
purpose of the workshop.
Dr. Rajesh Tandon - President PRIA (Participatory Research in Asia) New Delhi (India) delivered the keynote address.
Dr. D. K. Srinivas, Director Curriculum Development Rajiv Gandhi University of Health Sciences Karnataka, Bangalore
explained the participants guidelines for group discussion and plenary sessions.
Dr. Roberta Ritson(WHO/HQ/Geneva), Dr. Mala Ramachandran, Ms. Nalini Sampath Dr.Ganesh
Supramaniam(CAMHADD) and Dr. S. Pruthvish were Rapportears for the workshop
The Inaugural Session, on 10th January 2003
Included a Keynote address by the Municipal Commissioner, an address by the Mayor of Bangalore City and the
Release of the Bangalore Charter Declaration by the Minister for Medical Education. The WHO representative also
spoke in this session..
The workshop session was held for a whole day on 11 January 2003.
The Government Sector represented by the Municipal Corporation Health and Education Departments, the Slum
Development Department, Police Department, Doctors in Health facilities, Government Dental College, Health University,
and All India Radio.
The Private sector was represented by the corporate sector, banking sector, medical colleges, management institutes,
and corporate hospitals.
-6-
The Civil society was represented by the Bangalore Agenda Task Force, which is a citizen corporate, and Government
initiative for improved governance in Bangalore.
Others included NGOs working in different areas like women in distress and community involvement, child labour.
This session began with a brief description of the purpose of the workshop and the presentation of the
background. This was followed by a keynote address by Dr Rajesh Tandon, the President-PRIA who
represented the civil society.
The participants were then divided into three groups depending on their affiliations.
The groups discussed
Who does what?
What the sector is best placed to do?
How does this compare with the current role of the sector?
What should the future look like?
Who should do what in relation to the need /issue identified?
How does this differ from the present tri sector distributions of power and responsibility?
What expectations are there of the roles best taken on by other sectors?
Where is it appropriate for other sectors to be involved?
Where is it inappropriate for other sectors to be involved?
The groups’ common views
Air pollution : The interventions suggested in the background papers were accepted. The groups felt the main player
was the Government. In addition some interventions were suggested. The participants felt that the urban poor had
poor housing facilities and the lack of ventilation and use of outdated cooking methods caused smoke filled homes.
The slum clearance department said they had a programme of providing housing for the poor and could help in this
intervention. The Education Department stated that both teachers and students, should be given awareness in schools,
through innovative methods on issues of pollution and hazards as part of a regular curriculum.
Another cause of pollution was by indiscriminate burning of leaves, plastics and other waste material. The intervention
discussed was the municipal body should levy heavy fines.
Waste indiscriminately thrown can generate methane and other gases, which cause pollution, and can be avoided by
the municipality developing scientific landfills.
Regional transport office and the Food and civil supplies department should initiate action against adulterated
fuel sale.
Encourage grass on pavements to prevent dust pollution
Accidents and Trauma : The interventions suggested in the background papers were accepted. The groups felt the
main player was the Government. In addition some interventions were suggested :
Training of all the staff of the corporation health facilities in trauma care.
Rationalise the use of the existing ambulances for transporting accident cases and develop referral mapping.
Barricading of dangerous strategic points by the Corporation.
-7-
The police department could coordinate school education programmes on traffic and road safety.
Enforcement of law regulating movement of heavy traffic vehicles inside the city.
The police department to standardize speed breakers.
The groups felt that the private sector and the civil society could help in procuring and upgrading ambulances. Also the
private sector medical institutions could handle the accident cases. The Indian Medical Association could use its
advocacy to ensure that the private medical establishments treat accident cases.
Violence against senior citizens : The interventions suggested in the background papers were accepted. The
groups felt the main player was the Government. In addition some interventions were suggested. It was agreed that
most of the interventions were by the police department or the local body. The existing help lines needed to be widely
publicized.
The intervention of providing security for the senior citizens by a paying guest system for students enlisted with the
local police.
The private sector can play a major role in managing old age homes and day care facilities.
The health insurance companies could examine the possibility of providing group insurance schemes for the elderly
citizens.
Violence against women : The interventions suggested in the background papers were accepted. The groups felt
the main player was the Government. In addition some interventions were suggested. Wide publicity regarding healthy
life styles and alternatives like setting up of gyms in slums.
NGOs could play a major role in running counselling centres and provide local immediate assistance to the women in
distress.
Cardio vascular diseases : The interventions suggested were accepted and the government was the principal
player
Toilets, Underground Drainage System, Solid Waste Management: The interventions suggested in the background
papers were accepted. The slum clearance board was in a position to construct toilets through the Sulabh International
and maintained by them for 30 years. The group felt that unless awareness was created on importance of use of
toilets and the problems of indiscriminate open-air defecation the toilets would not be fully used. Awareness of the
community by the health workers and through the school children was advocated. In Bangalore the experience of
public participation through the private sector that constructed and managed the toilets in the city needs to be expanded.
Substance Abuse : The interventions suggested in the background papers were accepted. In addition it was felt that
disused and abandoned buildings and land needed to be identified by the police and periodic beats daily would be a
necessary intervention. The private sector and NGOS could play a role in development of attractive messages against
substance abuse, which would be communicated through celebrities.
Child labour : The interventions suggested in the background papers were accepted. In addition, the Chinnara
Angala Programme **(?) a bridge course for dropouts needed to be expanded to cover all the urban poor localities.
Further the rescue service through a help line of the police department had to widely publicized. The private sector
was involved in the practice of engaging child labour. The group felt that the industries, which followed labour laws,
could function as advocacy groups to ensure child labour is discouraged The Federation of Chamber of Commerce
and Industries could as a professional body take stringent actions against industries, which violated labour laws.
- 8 -
HIV/AIDS : The interventions proposed had to be mainly done with the private and the civil society taking a major role
with the Government only playing a minor part. Care and support to HIV positive persons and management of counselling
centres was seen as a major point of intervention where the NGO sector plays a leading role.
Primary Health Care : The groups felt that the role of all the three sectors was very important if Primary Health Care
was to reach the urban poor. NGOs and the private sector including medical colleges could completely take over
running some of the Health facilities. This would enable building in better referral linkages and also provide additional
facilities.
Concluding Session
Mr. M. R. Srinivasa Murthy Commissioner Bangalore Mahanagara Palike chaired the closing session along with
Dr. D. K. Srinivas as co-chairperson.
Dr. Roberta Ritson representative of WHO/HQ/Geneva presented recommendations of the workshop and Dr. Ganesh
Supramaniam Secretary General CAMHADD outline the plan of action. Dr Rajesh Tandon, President PRIA delivered
Valedictory Address. Dr. V. R. Pandurangi gave the vote of thanks.
Outcome of the Workshop
To develop a joint pilot project on preventive health care for Bangalore urban poor as
a Commonwealth Model in
collaboration with various partners in six divisions of Bangalore Mahanagara Palike covering an area of a total
population of two hundred thousands. An agreement among CAMHADD, Sri Jayadeva Institute of Cardiology
and Bangalore Mahanagara Palike has been signed on 12 February 2003 to launch the project by using the
existing three Corporation run Health Centre/Urban Family Welfare Centres and one 24 bedded Maternity Home The
Urban Health Research and Training Institute to be the nodal centre for the pilot project.
-9-
Facilitators Observations.
The local committee had invested a significant amount of effort in the research into local health needs and priorities
of the urban poor of Bangalore in preparation for this one-day workshop, as well as a major planning exercise. This
advance preparation was very evident during the conduct of the workshop, as was the motivation, professional
expertise and commitment of the participants.
The committee consisted of eleven members drawn from both health professional and non-health professional
backgrounds, ensuring a mix of government, private sector and civil society backgrounds, in keeping with the emphasis
on partnerships and intersectoral action for health.
The outcome of the discussions and dialogues between the
different partners during these preparatory meetings are incorporated into the Bangalore Charter Declaration.
The Bangalore Charter described the profile of the city of Bangalore, its population and its health infrastructure,
before outlining the process by which the ten priority areas for action to improve the health of the urban poor were
identified as follows, together with appropriate interventions:
Air pollution in Bangalore City; accidents and trauma care; violence against senior citizens; violence against women;
cardiovascular diseases; toilets, underground drainage system and solid waste management; substance abuse;
child labour; HIV/AIDS; and access to primary health care. These covered environmental problems, urban health
services and social issues, as well as practical and implementable interventions to address these ten areas for
action, leading to improvements in the level of health care and access to health care services for the urban poor.
The keynote address at the workshop, which outlined the Trisector Dialogue approach for a healthy community, was
delivered by the Commissioner of the Bangalore Mahanagara Palike (Bangalore City Corporation), Sri M.R. Sreenivasa
Murthy. The Commissioner emphasized the rapid escalation in urbanization of the city and its resulting increase in
the numbers of urban poor living in the city, as well as the burden imposed on the city's community services.
He
welcomed the initiative of the Commonwealth Foundation and the Commonwealth Association for Mental Handicap
and Development Disabilities (CAMHADD), together with the Sri Jayadeva Institute of Cardiology, in launching this
initiative for preventive health care in the city. He was also pleased to note the interest of the World Health Organization
in the initiative.
A particular feature of the workshop was the involvement of representatives of not only the public sector, but also
private enterprise and civil society, all committed to work in partnership towards the common goal of improving the
health of the poorest of the city.
The vision of a good society was described in his address by Dr Rajesh Tandon,
president of a local centre for the promotion of learning and democratic governance. A good society was defined as
one where all citizens enjoyed economic, social and physical security: basic human needs which global society
recognized as more relevant today than ever before, particularly in the aftermath of 11 September 2001. The Trisector
Dialogues launched by the Commonwealth Foundation were aimed at promoting good governance and a good
society, as well as the involvement of multiple sectors and partners in the achievement of this vision.
Throughout the workshop, there was lively and controversial discussion on tackling priority issues in preventive
health care, and appropriate and practical interventions were identified. Following a review in plenary of the issues
raised in all discussion groups, it was decided that priorities for action were cardiovascular disease, oral health,
blindness, diabetes, trauma care and environmental issues. The key outcome for the workshop was the identification
of a model project in preventive health care for the urban poor of the city, focused on these priority areas. It involved
coordinated action by stakeholders from the different sectors who were already committed to the project.
The local committee would follow-up on the recommendations of the workshop and ensure the implementation of the
preventive health care initiative. A series of meetings would follow to collect the epidemiological data needed as a
basis for a strategy for action. The workshop closed on a positive and optimistic note.
-10-
Appendix 1 :
Two Meetings were held with Commissioner Bangalore Mahanagara Palike prior to the workshop and was
attended by representatives of Bangalore Mahanagara Palike and CAMHADD
1.
First Meeting was held on 20 November at 2.30PM at the chamber of the Commissioner, Bangalore Mahanagara
Palike and was chaired by Mr M.R. Sreenivasa Murthy, Commissioner Bangalore Mahanagar Palike
2.
Second Meeting was held on 18 December 2002 at Atria Hotel and was chaired by Mr. M. R. Sreenivasa Murthy
Commissioner, Bangalore Mahanagara Palike.
These meetings took the following decisions after detail discussion of various issues.
1.
BMP to host the one day workshop on “Trisector dialogue in Health” which is the first of its kind on health for
urban poor with some financial support and also to develop collaboration with the CAMHADD/Commonwealth
Foundation/Health Division Commonwealth Secretariat/WHO/Sri Jayadeva Institute of Cardiology for on-going
programme to make this programme as a Commonwealth Model. Such dialogue in Bangalore is first of its kind
in preventive health for Bangalore urban poor.
2.
To make use of existing health infrastructure of BMP for preventive,promotive, curative and rehabilitation programme
in collaboration with other partners mentioned in appendix 5
3.
The Urban Health Research and Training Institute of the Bangalore Mahanagara Palike to be used for training of
health workers at all levels.
4.
The Yeshwanthpur, Mathikere and Kodandramapura area to be selected for health care project including accident
and emergency cases by using existing Health units in the area.
5.
A Technical working group to be constituted from amongst the members to design a format for survey for
establishing benchmark and to launch health project for urban poor.
6.
To arrange a meeting with Commonwealth and relevant programme Divisions WHO in May 2003 during World
Health Assembly to initiate discussion to develop collaboration
.7.
Dr Jayachandra Rao and Dr Mala Ramachandran to be co-ordinator and the Nodal Executive with BMP/
CAMHADD/Commonwealth/WHO.
Third Meeting : Post workshop Meeting was held on 13 January 2003 at the chamber of the Commissioner Bangalore
Mahanagara Palike(BMP) and was chaired by Mr M.R. Sreenivasa
considered the follow up actions.
Murthy, Commissioner BMP. This meeting
Participants: Representatives of BMP, CAMHADD and WHO
This meeting took the following decisions after detail discussion of various issues.
1. To focus on development of a health care project for urban poor in Yeshwanthpur-Mathikere- Kodandarampuram
area on the basis of ten priorities identified for improving the health as mentioned in Bangalore Declaration.
2.
To develop the project in two stages. First stage as “Pre-Pilot Project” for one year and second stage as “Health
Project.” The period of the project is to be decided by the Committee.
3.
To submit the project proposal on behalf of the Commonwealth Association for Mental Handicap and Developmental
Disabilities (CAMHADD) and will later develop collaboration with the Commonwealth Foundation, Commonwealth
Secretariat, WHO and Health Related Organisations of United Nations for Bangalore Model project
4.
Various Partners and their Commitments(Please see Appendix 5)
5.
Time Schedule
®
Baseline Survey: 20-31 January 2003
a
Submission of project proposal by CAMHADD : 5 February 2003
o
Meeting of Project Launching Committee with Commissioner BMP : 17 February
o
Launching of the project : Mid March 2003
6.
Bangalore Mahanagara Palike to meet the cost to prepare project proposal.
7.
To establish a centre for prevention and management of high risk pregnancy integrated with training at all levels
- 11 -
Appendix 2 :
Two Pre Workshop Consultative Meetings held prior Io one Jay triseclor dialogue wo'kshop 'n^eakh : Preventive
health care for Bangalore urban poor on 11 January 2003 to gel inlormat.on fo prepare background paper
prioritise health related issues.
,
onm onH <«/=>« attpnded bv the consultants, facilitators and
First Consultative Meeting was held on 10 November 2003 and was attenoea oy me
rapporteurs of the workshop
The objectives of this first meeting
Listing problems related to urban poor
Listing existing health facilities and other services
To prepare guidelines for group discussion for the workshop on 11 January 2003
This initial meeting identified the following important problems of Bangalore urban poor
•
Drinking water, sanitation, and communicable diseases
♦
Non-communicable diseases, malnutrition and disability
•
HIV/AIDS and sexually transmitted diseases
•
Reproductive, adolescent, perinatal and newborn health- inadequate health facilities
•
Lack of facilities to treat accident cases in slum area
•
Substance abuse
•
Violence and crime
•
Community safety and security
•
Child labour and street children
•
Lack of education and transport facilities
•■
Housing
Second Consultative Meeting was held on 28 November at Department of Community Medicine, M.S.Ramaiah
Medical College and focused on the urban poor and was attended by 20 invited participants from different
disciplines representing health,police,NGOs. The significance of this meeting was bringing together many
people from different sectors to share their common concerns regarding health issues in urban impoverished
areas.
Participants presented the experience in their area particularly problems faced by them, intervention strategies, gaps
in the programme including lack of unity in health and social accountability
The following issues were discussed
•
The basic needs of the people who live in slums.
.
To increase the health centres and creating awareness of the facilities provided by the government.
•
To work on areas like Waste management, HIV Aids prevention
•
Common needs of people, such as access to eloan
, ■
provided.
access to clean and safe drinking water, sanitation, drainage should be
•
Necessary measures to prevent accidents and deaths
.
Identification of the hospitals and nursing homes on the highways.
-12-
Coordination with insurance agencies as well as police would ensure that there will be
no delay in the treatment
of accident victims.
Creating awareness among the people who are in slums about pregnant women birth
rates, nutrition. Family
planning, and health education.
The following Five Workshops were arranged prior to the one day trisector dialogue
workshop in health : Preventive Health Care for Bangalore urban poor on 11 January 2003 to qet
information to prepare background paper and to prioritise health related issues.
1.
Workshop for the Health professionals of the Bangalore Mahanagara Palike on 26“ December 2002 at
the Urban Health Research and Training Institute to prioritise the Health Needs of the Urban Poor
2A. Workshop for the Opinion Leaders at the Nandini Layout Slum of the Bangalore Mahanagara Palike on
27“ December 2002 at the Nandini Layout Health Centre, to prioritise the Health needs of the Urban Poor
The workshop was attended by the local leaders, women’s groups, Community Based Organisations, women
Q
who worked as link workers in the IPP-VIII and Health Staff of the Health Centre, totalling
35 participants.
2B Workshop for the Opinion Leaders at the Murphy Town Slum of the Bangalore Mahanagara Palike on 27“
December 2002 at the Murphy Town Health Centre, to prioritise the Health needs of the Urban Poor
The workshop was attended by the local leaders, women’s groups, Community Based Organisations, women
who worked as link workers in the IPP(lndia Population Project)-VIII and Health Staff of the Health Centre,
totalling 52 participants.
3.
Workshop for the Non governmental Organisations working in the slums of Bangalore on 28“ December
2002 at the Urban Health Research and Training Institute, to prioritise the Health needs of the Urban Poor
The workshop was attended by 25 representatives of NGOs working in the slums of Bangalore.
4.
Workshop for the Health Professionals of the Bangalore Mahanagara Palike on
30“ December 2002 at the Urban Health Research and Training Institute, to prioritise the Health needs of
the Urban Poor
0
The workshop was attended by Deputy Health Officers, Medical Officers i/c of Sanitation in ranges, Doctors of
Urban Family Welfare Centres, Health Centres, Health Inspectors, LHVs and ANMs of Health institutions of BMP,
totalling 21 participants.
5.
Workshop for the Representatives of the media on 3rd January 2003 at the Urban
Health Research and Training Institute to prioritise the Health needs of the Urban Poor.
Health, Environment and social Issues Prioritisedlb,Uhe participants
at consultative meetings and workshops
Health Issues
•
Safe Drinking Water, sanitation and garbage removal
•
Toilets, Under Ground Drainage, Gastroenteritis and Cholera.
-13-
Accidents an'.’ Trauma Care
•
Primary Health Care and Referral
•
Handicapped
•
Non communicable diseases, Cardio vascular diseases, Cancers,
.
HIV/AIDS
•
Substance abuse
•
Access to cost-effective treatment and investigations relating to Primary Health Care including specialists
and referral services
Environmental issues
•
Air pollution
Social issues
•
Raising awareness of general issues of importance like legal and health issues
•
And availability of services
•
Violence against women and senior citizen, Crime and Dowry
•
Education for all, Enrolment of Dropouts, Adult literacy, Child Labour and street children.
•
Housing and Transport
Appendix 3 :
Bangalore Charter Declaration
The consultants of the workshop established a committee to collect information through Pre workshop consultative
meetings and workshops. The problems and the suggested interventions form the part of the Bangalore Charter
Declaration. The details are available in the publication of “ A Tri-sector Dialogue for A Healthy Community: Bangalore
Charter Declaration
-14-
Appendix 4 :
Workshop Programme
CAMHADD One-Day Workshop on The Tri-Sector Dialogue: Preventive Health Care with
Special Reference to Urban Poor (Bangalore)
Venue: Sri Jayadeva Institute of Cardiology, Jayanagar 9’” Block
Bannerghatta Road, Bangalore-560 069, Telephone: (080) 6534466
Date: 11lh January 2003 Time: 0830-1730
08.30
Registration
Session I
Chairperson
Professor S. Chandrashekar Shetty
Former Vice Chancellor
Rajiv Gandhi University of Health Sciences Bangalore
And Consultant to Tri-sector Dialogue in Health
09.00
Welcome
Dr. A. N. Prabhudeva - Director
Sri Jayadeva Institute of Cardiology
09.10
Self Introduction of Participants
09.20
Purpose of the Workshop and Presentation
of Background Paper
Dr. V. R. Pandurangi (CAMHADD)
Consultant to Trisector Dialogue in Health
09.30
Keynote Address
Dr. Rajesh Tandon-President
PRIA (Participatory Research in Asia)
New Delhi
10.15
Tea/Coffee Break
Session II
10.30
GROUP discussion: Three Groups
Theme: Who does what?
Guidelines for group discussion and plenary session
Dr. D. K. Srinivas-Director, Curriculum Development
Rajiv Gandhi University of Health Sciences Bangalore
Government Sector
Private Sector
Civil Society
Facilitator
Prof. Chandrashekar Shetty
Facilitator
Dr. K. V. Ramani
Facilitator
Ms. Shagun Mehrotra
Rapporteur
Dr. Mala Ramachandran
Rapporteur
Dr. Ganesh Supramaniam
Ms. Nalini Sampat
Rapporteur
Dr. Roberta Ritson
Dr. Pruthvish
(Three Sectoral groups: Participants will discuss their sectors current and /future roles and responsibilities)
•
What is it that the sector is best placed to do?
•
How does this compare with the current role of the sector?
•
What expectations are there of the roles that are best taken on by the other sectors (or where it is in
appropriate for other sectors to be involved)?
-15-
Session III
11.30
Plenary Session
Chairperson
Rapporteur
12.45
: Presentation of group reports
: Dr Roberta Ritson
: Dr Ganesh Supramaniam
Ms Nalini Sampat
Lunch
Session IV
Group Discussion “ What should the Future look like"
13.30
Government Sector
Private Sector
Civil Society
Facilitator
Prof. Chandrashekar Shetty
Facilitator
Dr K. V. Ramani
Facilitator
Ms Shagun Mehrotra
Rapporteur
Dr Mala Ramachandran
Rapporteur
Dr Ganesh Supramaniam
Ms Nalini Sampat
Rapporteur
Dr Roberta Ritson
Dr Pruthvish
Each Sector discusses
•
•
Who should do what in relation to the identified need/issue?
How does this differ from the present tri-sector distributions of power and responsibility?
Session V
14.30
Plenary Session
Chairperson
Rapporteur
15.30
Tea/Coffee Break
Presentation of Group Reports
Dr A. N. Prabhudeva
Dr Ganesh Supramaniam and Ms Nalini Sampat
Session VI
Group Discussion: Three Groups
Theme: “What we need to play our part"
15.45
Government Sector
Private Sector
Civil Society
Facilitator
Prof. Chandrashekar Shetty
Facilitator
Dr K. V. Ramani
Facilitator
Dr Francis
Rapporteur
Dr Mala Ramchandran
Rapporteur
Dr Ganesh Supramaniam
Rapporteur
Dr Pruthvish
Ms Nalini Sampat
Each Sector discusses
•
•
16.45
17.30
Their role in the identified issues
Identifies obstacles and what is needed to overcome them including support, resources, capacity building
needs etc.
Plenary Presentation of 3 Groups
Chairperson
Dr Francis(Community Health Cell)
Rapporteur
Dr Roberta Ritson, Ms Nalini Sampat
Closing Session
Chairperson
Plan of Action
Mr M. R. Srinivasa Murthy
Commissioner
Bangalore Mahanagara Palike
Dr Ganesh Supramaniam (CAMHADD)
Valedictory Address
Co-Chairperson
Dr. D. K. Srinivas
Rajiv Gandhi University of Health
Sciences Bangalore
Dr Rajesh Tandon
President PRIA
Chairperson’s Remarks
Vote of thanks
Dr v R Pandurangj (CAMHADD)
Recommendations
Dr Roberta Ritson
WHO/HQ/Geneva
- 16 -
Citizens and Governance Program: The Tri-Sector Dialogue Workshop on Preventive
Health Care with Special Reference to Bangalore Urban Poor
Guidelines for Group Discussion and Plenary Session
1.
Participants will form three sectoral groups. The three groups will hold discussions simultaneously in separate places.
2.
The participants will discuss their sector’s current and/or future roles and responsibilities in addressing the identified
need/issue focusing on during: the group discussion
I Group Discussion - Theme: "Who does what?"
Discussion Points:
i.
What is that the sector is best placed to do.
ii.
How does this compare with the current role of the sector?
iii.
What expectations are there of the roles that are best taken on by the other sectors (or where it is inappropriate for
other sectors to be involved)?
II Group Discussion - Theme: "What should the future look like?"
Discussion Points
i.
Who should do what in relation to the identified need/issue?
ii.
How does this differ from the present tri-sector distributions of power and responsibility?
Ill Group Discussion - Theme: "What do we need to play our part?"
Discussion Points
i.
What is needed to enable the sector to play its role effectively in the future Identified in the previous session?
ii
What obstacles/constraints are anticipated?
iii.
What is needed to overcome them including support, resource, capacity building
needs etc.
Since the dialogue is only for a day, keeping the time constraint in view, the groups are requested to focus on the issues
raised in discussion points
3.
Plenary Sessions
During each of the three plenary sessions, the three sector group reports are shared. Overlapping experiences, expectations,
points of agreements and areas of disagreement are identified and further discussed. If necessary, plenary could break
into ’buzz’ groups - small cross- sectoral or sectoral to workout solutions to dispute areas so that a final recommendation
on each theme is ready at the end of each plenary session.
In the third and final plenary, the entire group discusses next steps including any related to workshop report and the 2003
international workshop.
4.
Group Reports
Each sectoral group report should be brief, precise, specific and action oriented.
The organisers appreciate your cooperation.
Happy Dialogue!
- 17-
Appendix 5 :
Various Partners and their Commitments
Sri Jayadeva Institute of Cardiology : .
To provide free diagnostic and treatment facilities for the beneficiaries.
The Government Dental College and R. V. Dental College to:
Provide free oral health care services through the health facilities in the project area on a regular basis, and
develop a referral protocol. They also agreed to take the responsibility to conduct the survey in the project area to
know the burden of disease to enable planning of services, through their interns and postgraduates.
Lions Clubs International Sight First Programme
To provide eye care services through District Blindness Control Society Bangalore (Urban).
Comprehensive Trauma Consortium to provide training to the medical officers and Para medical staff of the
corporation facilities in first aid and trauma care, including emergency care management.
MS Ramaiah Medical College
- Community Medicine Department agreed to conduct the survey in the
Project area through their interns and post graduates.
Diabetic Club Bangalore Region
To provide free screening, treatment and follow up of diabetic patients
initially for a period of one year.
Samraksha-An NGO working for counselling,care and support in reproductive and sexual health.
Global Trust Bank Bangalore assured support in selected programmes
Slum Clearance Board
Assured constructing 100 houses and toilets for free distribution to slum dwellers
Karunashraya (NGO)
Offer free home care and if needed hospital care to terminal cancer patients.
Sumangali Seva Ashram(NGO)
Offer to run the day care centre for senior citizens in a building provided by BMP
- 18 -
List of Participants
Ms. G. Anusuyya Bai
No.46, Mumswamy Road
Tasker Town
Bangalore-560051
Dr. Anant Bhan
Consultant
Community Health Cell
367, Srinivasa Nilay,
Jakkasandra
1“ mam, 1“ Block,
Koramangala
Bangalore - 560 034
Dr. Ajit C. Mehta
6-A. 2"“ Dadyseth Road
Babulnath
Mumbai - 400 007
Dr. Bharathi
Assistant Surgeon
Nandini Layout Health Center
Bangalore Mahanagara Palike
Bangalore
Prof. Chandrashekar Shetty
Former Vice-Chancellor
Rajiv Gandhi University of
Health Sciences Karnataka
4" T Block, Jayanagar
Bangalore 560 041
drcshetty @ hotmail.com
Mr. Deepak Menon
Voices
165,9" cross, Indiranagar
1“ stage, 1” Floor
Bangalore -560038
Dr. C. M. Francis
Consultant
Community Health Cell
Chalissery House
1” Main. 4“ Cross,
Venkafoshwara Layout
Siddagunte Palya
Bangalore - 560 029
Prof. D. Gopinath
Dept of Community Medicine
M. S. Ramaiah Medical College
Bangalore - 560 054
Dr. A. Harikiran
R. V. Dental College
CA 37.24"' Main,
J. P. Nagar, 1!l Phase,
Bangalore - 560 078
Dr. B. H. Govinda Raju
"Kshema"
Karnataka State Health Education
And Medical Academy
No 2,4“' Cross,
Dr. Rajkumar Road
N.G. R.Layout
Rupena Aghrahara,
Bangalore - 560 068
Dr. M. T. Hemareddy
Director - Student Welfare
Rajiv Gandhi University of
Health Sciences Karnataka
4" T Block, Jayanagar
Bangalore - 560 041
Dr. M. Jayachandra Rao
Health Officer (East Division)
and Project Co-ordinator
India Population Project-VIII
Bangalore Mahanagara Palike
Bangalore - 560 020
Dr. G. Lokesh
Health Officer
Bangalore Mahanagara Palike
Bangalore
Dr. Mala Ramachandran
Director
Urban Health Research
And Training Institute
16" Cross, Malleswaram
Bangalore-560 003
Mrs. Manjula N. Rao
Bangfore Agenda Task Force
19/1, Neptune, Alexandria Street
Richmond Town,
Bangalore - 560 025
Dr. P.P. Maiya
Paediatrician
Dept, of Pediatrics
Ramaiah Medical College
Bangalore - 560 054
Mrs Nagamani S. Rao
215,‘Shreyas'’
4" Main Road
Chamaraj Pet
Bangalore-560 018
Mr. Narasimha Murthy
Paraspara Trust
No. 17/2, T Cross,
Bonduppapalya
Yeshwanthpur
Bangalore - 560 027
Dr. Nirmala Kesaree
Director
Bapuji Child Health &
Research Centre
Davanagere - 577 002
Dr. K. S. Nagesh
Principal
R. V. Dental College
CA 37,24=’Main,
J. P. Nagar, 1st Phase,
Bangalore - 560 078
Ms. Nalini Sampath
Training Co-ordinator
CBR Network (South Asia)
134,1“ Block, 6” Main
3” Phase, Banashankari
3rd Stage, Bangalore - 560 085
Dr A. N. Prabhudev
Director
Sri Jayadeva Institute
of Cardiology
Jayanagar 9* Block
Bannerghatta Road
Bangalore-560 069
Dr. K. M. Prasanna Kumar
Prof. Of Epidemiology
M. S. Ramaiah Medical College
M. S. R. Nagar
Bangalore - 560 054
Mr. A. Manjunath
Vice President
Global Trust Bank
M. G. Road,
Bangalore - 560 001
Dr. S. Pruthvish
Associate Professor
Community Medicine Department
M.S. Ramaiah Medical College
MSR Nagar
Bangalore - 560 054
Dr. Mangala S.
Vaidehi Medical College
Dept, of Community Medicine
Mr. S. D. Rajendran
Community Health Cell
Chalissery House, 1a Main, 4‘" Cross,
Bangalore.
Venkateshwara Layout
Siddagunte Palya. Bangalore - 560 029
- 19-
Dr. Rajesh Tandon
President
PRIA
42, Tughlakabad Institutional Area
New Delhi - 110 062
Mr. M. R. Sreenivasa Murthy IAS
Commissioner
Bangalore Mahanagara Palike
N. R. Square,
Bangalore - 560 002
Dr. Ramananda Shetty
Director
Govt. Dental College
Victoria Hospital Complex
Bangalore - 560 002
Ms. Sushelamma
Sumangali Sevashrama
Bangalore.
Dr. S. Rajanna
Joint Director, Slum Clearance Board
Bangalore
Dr. Rama Murthy Bingi
Sri Jayadeva Institute
of Cardiology
Jayanagar 9” Block, Bannerghatta Road
Bangalore - 560 069
Prof. K. V. Ramani
Professor, Computer
And Information Systems
Indian Institute of Management
Ahmedabad-380015
Dr. Rajan Babu
Chief Medical Officer
TVS Motor Company Limited
PB No.4.4 Harita Hosur-635 109
Tamil Nadu
Mr. D. Ravi
Manager-Community Development
Sundaram-Clayton Limited
Corporate Office, 8 Haddows Road
Chennai-600 006
Dr D. K. Srinivas
Director, Curriculum Development
Rajiv Gandhi University
of Health Sciences, Karnataka
4" T Block. Jayanagar
Bangalore-560 041
Ms. Shagun Mehrotra
Manager AP Office PRIA
S-2, Rangaswamy Mansion,
3-6-532/1, Street No. 7,
Himayathnagar
Hyderabad - 500 029
Dr. Shivaswmay N. G.
Consultant Cardiologist
Sri Jayadeva Institute of Cardiology
Jayanagar 9” Block,
Bannerghatta Road
Bangalore - 560 069
Dr. Sunitha
Assistant Surgeon
Murphy Town Health Centre
Bangalore Mahanagara Palike
Bangalore
Ms. Sheena T. K.
Project Co-ordinator
Bangalore Agenda Task Force
Bangalore
Dr. Suman
Post Graduate Student
Dept, of Community Medicine
M. S. Ramaiah Medical College
Bangalore - 560 054
Dr. Sathish
Post Graduate Student
Dept, of Community Medicine
M. S. Ramaiah Medical College
Bangalore - 560 054
-20-
Mr. S. M. Shantha Raju
Deputy Director (Edn.)
Bangalore Mahanagara Palike
Bangalore.
Dr. T. M. Shantaram
Deputy Health Officer (North)
Bangalore Mahanagara Palike
Bangalore.
Dr. P. S. Thandava Murthy
Health Officer (South)
Bangalore Mahanagara Palike
Bangalore.
Dr. N. K Venkataramana
Director
Manipal Institute for
Neurological Disorders
A Unit of Manipal Hospital
Airport Road. Bangalore - 560 017
Ms. Veena Harish
Sumangali Seva Ashram
Bangalore.
Dr V. R. Pandurangi
Founder, Emeritus Secretary General
& International Co-ordinator CAMHADD
36-A, Osberton Place
Sheffield (UK) S11 8XL
United Kingdom
Dr Ganesh Supramaniam
Consultant Paediatrician
And Secretary General CAMHADD
Watford General Hospital
Watford (UK) Herts, WD1 8HB
United Kingdom
Dr Roberta Ritson
External Relations Officer
External Co-operation and Partnerships
World Health Organization (WHO)
20, Avenue Appia CH -1211,
Geneva 27, Switzerland
Distinguished
Resource
Persons
Dr. A. N. Prabhudeva, Director Stic
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Dr. S. Chandrashekar Shetty, Former Vice Chancellor,
Rajiv Gandhi University of Health Science, Karnataka
Dr Ganesh Supramaniam, Secretary General camhadd
Some Snippets...
Participants at Tri-Sector Dialogue
Invitees at the Inaugural Session
Group Discussion in progress
CAMHADD and WHO Representatives with the
Commissioner, Bangalore Mahanagara Paiike
Drinking water, education are
priority areas for urban poor
By Our Special Correspondent
bangalore, JAN. 3. Safe drinking water, toilets, un
derground drainage, trauma care, education,
prevention of alcoholism, and empowerment of
women to resist violence. These are some of the
priority needs spelt out by the urban poor in Ban
galore.
The slum dwellers of Nandini Layout were
consulted as a prelude to the “Trisector dialogue
on preventive healthcare for urban poor of Ban
galore*. to be held here on January' 10 and 11. The
Government and NGOs are among participants
in the exercise being organised by the Common
wealth Association for Mental Handicap and De
velopment
Disabilities
(CAMHADD)
in
association with the Commonwealth Founda
tion, Bangalore Mahanagara Palike, Rajiv Gandhi
University of Health Sciences, and Sri Jayadeva
Institute of Cardiology.
Almost similar priorities were spelt out by
mediapersons who were consulted on Friday.
Emphasis should be given to education, many
presspersons felt.
That would mean better jobs, motivation for
better living conditions, awareness of preventive
healthcare, and income to purchase nutritious
food and medicine.
What does the BMP have to say? The bulk of its
healthcare budget goes for solid waste manage
ment and salaries of the staff at the dispensaries
and hospitals.
This is despite the infrastructure of 28 materni
ty homes, six referral hospitals, 55 health centres,
and 19 family welfare clinics.
Barely sufficient for slum dwellers, who form
12 per cent of the five million residents of the
City. Those termed "urban poor” comprise 30 per
cent of the citizens.
While the civic body has a good track record in
population control measures through the India
Population Project, it has severe handicaps when
it comes to day-to-day health care. There just are
not enough essential drugs to be given to the
poor. Most of them cannot afford to purchase
them on their own. Communicable diseases,,
which Include TB, gastro-enteritis, hepatitis, skin
diseases, and even malaria and filaria, continue
to prevail. Most of the time, major epidemics are
prevented but diseases continue to reduce work
ing days and bring down already meagre
incomes.
Thanks to the cooperation of voluntary orga
nisations such as tire Rotary, and by educating
the urban poor, Bangalore has had remarkable,
success in polio eradication.
next
Whether this can be replicated in the case /
other diseases, and how far can the sanitat
levels of slums be improved will become issu
/
be discussed next week.
/
_____ >
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January 4 2Q03
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■
Envisioning a healthier tomorrow
A Trisector
Dialogue
for a Healthy
Community
Keynote Address
delivered by
Sri. M. R. Sreenivasa Murthy, la.s.
Commissioner, Bangalore Mahanagara Palike
on 10th January 2003
BANGALORE
MAHANAGARA PALIKE
CAMHADD
JAYADEXfi Cardiology
Keynote address for the Trisector Dialogue
(Government, Private Sector and Civil Society)
for a Healthy Community
The modern world is experiencing a rapid escalation in urbanisation, especially in developing countries, leading to
an increase in urban poverty. To meet these challenges different civic agencies need to collaborate and pool their
strengths to provide a vehicle by which the vast majority of people living in poverty can improve their quality of life. By
2025 it is estimated that two thirds of the world’s population will live in cities and towns. Thus the world’s urban
population is expected to double within 25 years. Most of the growth is likely in Asia and this rapid urbanisation will
stretch the already scarce resources to the maximum. Urban life offers diverse forms of employment and cannot be
contained. Therefore the challenge is to evolve appropriate and sustainable ways to manage the urbanisation process
rather than prevent it. Bangalore as the IT capital is one of the fastest growing cities in Asia and urbanisation is one
of the major problems the city will face in the coming decade. Recognising the urgent need to address this problem
the Bangalore Mahanagara Palike, Jayadeva Institute of Cardiology and the Commonwealth Association for Mental
Handicap and Development Disabilities have come together to identify key areas for intervention in order to develop
a city planfor -preventive, health with specialfocus on the urbanpoor. An endeavour of this magnitude will
require partnerships to be developed between the Government, Private Sector and Civil Society.
General Profile of Bangalore City
>
Bangalore Metropolitan area has a population of 65.23 lakhs (Census 2001).
>
The Urban poor constitutes 30% of the population
>
It is estimated that nearly 10 lakh is the floating population.
>
Health infrastructure in Bangalore includes 250 large hospitals and nursing homes, 5000 family practitioners,
tertiary care hospitals, like NIMHANS, Jayadeva Institute of Cardiology & KIDWAI and five medical colleges.
The Bangalore City Corporation runs 68 UFWCs/Health Centres, 6 Referral Hospitals and 24 Maternity
Homes.
Background for prioritising health needs of the urban poor of Bangalore
>
A series of workshops were organised to obtain the perspective of all the stakeholders
>
A Workshop was held for key health professionals like health administrators, medical officers, health
inspectors, lady health visitors, and auxiliary nurse midwives.
>
Workshops involving the opinion leaders in the slums, community based organisations and link workers.
>
Workshop for NGOs working in the slums of Bangalore was arranged and their perspective of the
health needs of the urban poor was also taken.
>
Workshop for Media to obtain their perspective
>
From these inter actions evolved a set of ten priorities.
Air Pollution in Bangalore City
The problem
> Air pollution is mainly caused by automobiles and industrial emissions.
> Vehicles numbering 12 lakhs in Bangalore account for 60% to 80 % of the total air pollution.
>
>
>
Vehicles while waiting at traffic signals consume 5000 litres of fuel per day, leading to wastage of fuel and
excessive emissions.
Vehicles emit pollutants like Carbon monoxide, Hydro carbons, Nitrogen oxides, Sulphur dioxide, Lead
oxide, Suspended particulate matter, etc.
Cars and two wheelers in metropolitan cities account for 78% and 11 % of the pollution.
>
The KPCB has estimated in 1995-96 that SO2 produced by petrol vehicles is 1.4 tons per day and Diesel
vehicles is 6.4 tons per day.
>
>
SO2 causes acidification of air.
Carbon monoxide emitted by automobiles reduces the oxygen carrying capacity of blood to the tissues,
and affects the CNS and predisposes one towards heart attacks.
-1 -
>
About 0.25 tons of lead is added to the atmosphere of Bangalore every day. Lead poisoning affects production
of Red Blood Cells and causes brain damage. It causes gastro intestinal diseases, liver and kidney disorders,
and abnormalities in fertility and pregnancy. It causes impaired mental development in children. More than
40 % of the babies born in Bangalore in the millennium will have poorer cognitive functions and lower IQ due
to excessive lead in their blood. In adults headache nausea, loss of appetite, weight loss, muscle cramps
and nervous disorders occur
>
Oxides of Nitrogen are derived from effluents from industries using nitric acid and also automobile exhausts.
Exposure causes eye & nasal irritation and pulmonary discomfort. Nitrogen oxides promote the production
of atmospheric ozone and acidification of soil and water. Ozone can harm to huma lungs and other tissues.
>
Hot spots which are heavily polluted areas identified in Bangalore City, are Sirsi Circle, SBM Circle and
Yeshwanthpur Bus Station
Interventions
s
✓
s
✓
Consequently restructuring the public transport mechanism becomes a necessity. An investment
of Rs 100 crores has been made to provide 1000 state of the art buses, to encourage use of public
transport. There is an urgent need to put in place the mass rapid transport system
Providing grade separators and flyovers at congestion points to ease the traffic flow
Enhancing the vehicle registration fee is a measure, which will act as a deterrent to purchase of vehicles, as
seen from the Singapore experience. This will encourage commuters to use public transport
Air pollution from industrial emissions is the second largest contributing factor to air pollution. Widening of
the green belt around Bangalore and stopping the issue of licences for factories within a 60 Km belt around
the city through a legislation will reduce pollution levels
✓
Phasing out old vehicles including two wheelers
/
Synchronise traffic signals to prevent traffic congestion at traffic signals which causes pollution from idling
vehicles
Accidents and Trauma Care
The problem
>
Road traffic accidents are the leading causes of mortality and morbidity in Karnataka.
>
The percentage of head injury due to road traffic accidents in Bangalore is 62 %.
>
Head injury from all causes in Bangalore was found to be in the range of 120-160 per lakh with a
mortality of 14-20 per lakh population.
>
The NIMHANS study has cited 68 % of death due to head injuries in road accidents.
>
On an average 60-80 two-wheeler riders including pillion riders meet with head injuries every month,
out of which 6-8 succumb to death. It accounts for 48 % of road accidents resulting in head injuries.
>
Out of the head injury admissions nearly 10 % die during the hospital stay.
>
Death amongst those not wearing helmets is two times more as compared to those wearing helmets.
>
Severity of head injuries is higher and skull fracture is 1.2 times more among those without helmets
>
Use of helmets by riders of two wheelers would decrease head injuries by 30-50 %
Interventions to reduce the mortality and morbidity include
J
Establishing an effective golden hour management, through positioning well equipped ambulances
at high accident zones, as a critical intervention
Compulsory use of helmets
Ensuring pothole free roads
J
s
J Widening of roads
z
z
•s
z
z
-2-
Enforcing lane discipline
Restricting the movement of heavy traffic vehicles inside the city
Road safety education at school level
Examine the rationale of speed breakers
Enforcement of laws relating to mandatory treatment and administering first aid for accident victims by all
medical establishments.
s
police force sensitised to non harassment of the help providers and medical establishments
s Recognition of those persons who help accident victims and publicity of such acts
s Training police personnel in management and transportation of accident victims
Violence against Senior citizens
The problem
>
Forced suicides of the elderly for economic reasons, sexual, physical and psychological abuse is common
amongst the elderly.
>
The number of senior citizens i.e., people over the age of 60 years in India have increased from 12 million
in 1901 to 20 million in 1951 and 57 million in 1991.
>
Population projections made by the Registrar General India indicate that the number of senior citizens
would be 100 million by 2016 in India.
>
In Karnataka the number of senior citizens, which is currently 6.99 % of the population, is projected to
increase to 9.71 % of the population, by 2016.
>
Elderly men have the support of a companion, as they tend to remarry. Hence the proportion of elderly
widowed men is lesser than women.
>
Among the elderly men 56.67 % continue to work as against 18.14 % of women in urban areas. In rural
areas, 62.43 % of elderly men and 21.43 % of elderly women continue to work.
Interventions
K
s
K
s
Maintain a directory of senior citizens at the area police stations. Ensuring the security and safety of
senior citizens, by periodic contact by the local police.
Issue of senior citizens cards by the local body
Local bodies to create old age home facilities to be managed by NGOs in the community halls
Local bodies to create day care facilities with recreation and catering facilities to be managed by
NGOs in the community halls
K
Old age homes where peer group presence will reduce loneliness is an essential intervention.
K
Encourage formation of local committees of senior citizens, as a self help group
K
Care of the elderly in sickness and chronic ailments with a cost effective package
K
Enrolment of senior citizens as wardens in traffic control and other areas to be explored
K
Health corpus through the network of income tax, sales tax, commercial tax, excise duty to be explored.
Examine possibility of tax exemption for contribution to the corpus fund
K
Health insurance package with community or group premiums to be explored.
Violence against women
The problem
>
z-
>
>
>
>
>
Violence against women starts at the stage of conception where female foeticide is practiced in favour of
begetting a son.
Violence against women covers domestic violence, sexual violence, sexual harassment, rape and sexual
abuse, marital rape, forced prostitution, dowry related violence, abuse of children and neglect of widows
and elderly women.
A study by the International centre for Research in Women found that 45 % of women interviewed were
victims of domestic violence.
According to research conducted by RAHI, a support centre for women survivors of incest, 76 % of 600
women interviewed have been sexually abused in childhood or adolescence
80 % of rapes are perpetuated by relatives or men known to women, 24 % of rapes involve girls below
16 years.
Domestic torture constituted 30.4 % of total crimes against women in 1996 and rape formed 12.8 % of total
reported crimes against women in India.
A study by an NGO SAKSHI in 1996 revealed 72 % of women reported sexual harassment at the work
place.
-3-
Interventions
•/
J
J
Counselling centres with free legal aid facilities for women in distress to be established ward wise
by the local body.
Redressal through women police force, zone wise
Encourage community based womens’ groups with both Governmental and non government support.
Cardiovascular Diseases
The problem
>
Among all non-communicable diseases, Cardiovascular Diseases taken together are the leading cause of
morbidity and mortality.
>
There is a rising trend, of cardiovascular diseases, which is reaching epidemic proportions, propelled by a
shift in the population distribution of risk factors.
>
Cost of diagnostics and therapeutics is high with long term costs being involved. Hence it is prudent to
spend resources on preventive and primordial prevention avoiding or reducing modifying risk factors
associated with CVD.
Coronary Artery Disease (CAD)
>
Current estimates indicate that at least 50 million people are suffering from CAD in India.
>
A population survey suggests a prevalence rate in India of 10.9% in Urban and 5.5 % in rural males between
the age group of 35 to 64 years. The corresponding figures for females are 10.2 % and 6.4 % for urban and
rural populations.
>
Hypertension is a major cause of morbidity and mortality in India.
>
The prevalence rate varies from 1.24 to 11.59 % in urban and 0.52 to 7 % in rural areas.
>
Studies conducted by Diabetes Association of Karnataka in rural areas, involving age group of 20 to 85
years, gives a crude prevalence rate of 16.35 % and 18.12% for women and men respectively.
Hypertension
Rheumatic Heart Disease
>
A reliable estimate regarding prevalence of Rheumatic Fever and Rheumatic Heart Disease in school children
is 5.4/1000 and 6.4/1000 in urban and rural pupils respectively.
Interventions
s
s
Establishment of preventive cardiology centres with cardiovascular diseases made part of the public
health package delivered through the health worker.
Introduction of ECG facility at identified hospitals providing primary health care, and networking
with Tertiary care centres through Telemedicine facilities
Toilets, Underground Drainage System, Solid Waste Management
The problem
>
It is estimated that nearly 50 million people suffer from and 5 million die from
enteric related infections in developing countries.
>
WHO (1994-95) estimates only 85 % of people in India have access to safe drinking water and 29 % have
access to sanitary facilities
>
A survey by the Bangalore Mahanagara Palike, indicates that there are 675 toilets and 1050 urinals in
Bangalore
Intervention
K
-4-
Construction of toilets close to the slums
Identification and rectification of critical areas of sewage and drinking water mix due to leaks in
sewage pipes
z
Mapping of Sewage lines and water supply lines.
K
Strengthen the Epidemic task force.
J
J
Maintenance of toilets by generating funds through authorised advertisement hoardings on the toilets
z
Establishment of Mini sewage treatment plants for each extension and reuse of the water for afforestation
Establishment of scientific sewage treatment plants at strategic points
J
Periodic repair and maintenance of drains
z
Awareness generation amongst the citizens for waste segregation at source
J Establishment of transfer stations with segregation
J Monitoring through GIS mapping of Garbage trucks
J Transportation logistics through bulk carriers from transfer stations
J Establishment of sanitary land fills
J Recyclables to be segregated and reused
s Strict enforcement of Biomedical Waste Rules
•f Strengthen the Swaccha Bangalore programme
Substance Abuse
The problem - Tobacco consumption
>
There 25 diseases associated with tobacco use.
>
The chronic disabling diseases reduce the life span by as much as 15 years in long term users and result
in great suffering and economic loss.
>
Production, availability and role models in the community, lead to perpetuation and reinforcement of the
addiction.
>
Every 8 seconds a person dies of tobacco related diseases in the world.
>
With current smoking patterns, about 500 million people alive today world wide, will be killed by tobacco
related diseases, and half of these are now children and teenagers.
>
One million Indians die annually from tobacco related disorders.
>
Smokers have a 70 % higher mortality than non-smokers.
>
Tobacco consumption pattern in India is as follows: 50 % beedi, 30 % gutka, or chewed tobacco, and 20 %
cigarettes.
Alcohol and Health
>
Karnataka’s production capacity of alcohol has increased by 150 % and per capita consumption by 114 %
>
People are beginning to drink at an earlier age,(average age has dropped from 25 to 23 years), drink larger
quantities, and develop health problems (Mean age dropped from 35 to 29 years)
>
More than 50 % drinkers have problem drinking patterns and associated morbidity
>
Only 1.4% to 2.3 % of persons were asked by health providers for history of alcohol use and none were
advised against it
>
The Karnataka Government’s alcohol related health expenditure and alcohol related industrial losses are
Rs 975 crores.
Interventions
Perpetrators of Drugs to be severely punished with capital punishment through stricter legislation,
as is practised in Singapore
Z Awareness through campaign in schools
J
Z
Public campaign through attractive messages for propaganda
z
Establishment of deaddiction and counselling centres
z
Banning smoking in public places
z
Banning advertisement and sponsorship from tobacco or liquor companies
|z
-5-
Child Labour
>
Estimates state 11 crore children are involved in labour in India.
>
Karnataka has as estimated child work force of 10.5 lakhs.
>
In Bangalore about 18000 children have been estimated to be involved in labour.
>
Social issues concerned with child labour include sexual abuse, substance abuse, involvement in anti social
activities and drug peddling.
Interventions
■/
y
Stricter enforcement of Labour laws
Ensuring the safety of these children through establishment of shelters
v"
Organising literacy programmes, motivational programmes for improving the seif worth
✓
Health care by providing identity cards for free care and sensitising the health care providers to the problem
of this target group
>
Rate of sero positivity in sentinel surveillance at different antenatal clinics ranged from 0.5% -2 % (1999).
HIV/AIDS
>
Similar surveillance in STD clinics shows the sero positivity is 12% -22% (1999).
>
In one of the leading Medical College Hospitals in the City, 18/3800 deliveries (0.5%) were identified as HIV
positive in Maternity wards, wherein antiretroviral therapy was administered to 13 of these mothers and
infants (1999).
MS Ramaiah Medical College Hospital in the City reports 8-12 patients are HIV positive every month.
>
>
According to official reports of Karnataka State AIDS prevention society, Bangalore Urban District, 18033
cases of HIV positive upto December 2001, and 1354 AIDS cases, with reported deaths being 143.
Interventions
z
Prevention of HIV infection in high risk populations
• Targeted interventions
• STI care and condom programming
J
Prevention of HIV infection in low risk populations
• IEC and social mobilisation
• Blood safety and occupational exposure
• Counselling and voluntary testing and counselling centres
• Women and children as a target group
• Youth as a target group
J
Programme strengthening
• Surveillance
• Training
• Monitoring and evaluation
• Technical resource groups
• Operations research
• Programme management
-6-
J Capacity building for low cost community care
• Care and support
Intersectoral
• Workplace interventions
• Inter-ministerial links
In the context of Bangalore, the following are the special groups that the mapping has identified:
- Female Sex workers
- Male Sex workers
- Men who have sex with men
- Street Children
-Trans sexual population
- Truckers
- Migrants
- Intravenous Drug Users
- Prison inmates
The targeted intervention
•
Behaviour Change Communication
•
Condom Programming
•
STI Care and Management
•
Peer Education
•
Local Level Enabling Environment
Primary Health Care
>
Provision of cost effective and easily available primary health care is the right of every citizen.
>
This includes Reproductive Health Care, communicable and non communicable disease control.
>
Special focus needs to be given on maternal and infant mortality. The weak link that is seen in any
primary health care delivery is the weak referral linkage
>
Adolescent health care should be given a special thrust.
>
Access to health and related information is fast becoming the need of this group, to enable them to
make informed responsible decisions and prepare them for responsible parenthood.
>
India’s adolescent population is 21.8 % of the population i.e. 207 million in number and married
adolescent population is 20 /1000 population.
>
6% urban and 21 % rural women aged 15 to 19 years are married before the age of 15 years.
>
Adolescent fertility is estimated at 17%.
>
Unmarried adolescents constitute a sizeable population of the abortion seekers and their size
cannot be estimated.
>
STD/HIV and RTIs are problems that are common.
>
Other issues include sexual abuse, prostitution, street children, violence, suicides, substance abuse
and nutritional problems.
- 7 -
>
It has been found that in six major cities of India 15 % of prostitutes are below 15 years and 24 %
between 16 to 18 years of age.
>
Another area that needs to be critically looked at is the Disabilities.
>
It is estimated that there are 5 percent of persons with different disabilities in the developing world.
>
Current estimates put the number of disabled persons in India at 4.5 crores.
>
Childhood disabilities being more common , locomotor disabilities, communication disabilities ,
mental retardation, cerebral palsy and visual disabilities form the common disabled conditions .
>
3 percent of estimated 45 million people receive welfare measures of the Government in India.
Interventions in Primary Health Care
■s Cost effective, accessible, and user friendly primary health care services
z
Providing Safe Drinking Water as a primary measure for control of water borne disease
J Strengthening the existing Reproductive and Child Health Services
J Life style education at different levels in schools
J Retention in schools can delay the age at marriage and also empower women
• s Empowering adolescents with information and services
z
Making media responsible to promote values, not contrary to existing norms.
z
Service providers be equipped or trained to handle adolescent development particularly with inter
personal skills.
s Developing of clinical protocols
J
Referral mapping and referral protocols need to be established
J Energising the Disabilities Act of 1995
■/
Creating an environment friendly to the disabled, through improving accessibility measures, vocational
training linked with employment measures
z
Sensitising the health care provider to the emotional and psychological needs of the disabled
Family support systems need to be established
Building a community link concept to increase demand generation through community volunteers
I have in my keynote address attempted to kindle thoughts on the major issues that with intervention can produce a
tangible impact on urbanization and its attendant problems. Representatives from the various partners will be
deliberating on the issues and possible solutions. In the context of developing a city plan for Bangalore it would be
essential to keep the ongoing programmes, which are in place, in mind. This will enable the participants of this
workshop to also make recommendations as to which agency can take up a specific component. Bangalore has a
wide network of NGOs and Corporate sector who are already involved in various issues of governance. I would be
very happy if the roles and responsibilities of the corporate sector in terms of ensuring transparency, accountability
and resource mobilization can also be identified. All these aspects put together will help to develop a comprehensive
city plan that will be a forerunner to formation of a microplan at implementation stages. I wish the deliberations of the
workshop a great success.
-8-
BANGALORE MAHANAGARA PALIKE
Urban Health Research and Training Institute
16th Cross, Malleshwaram, Bangalore - 560 003.
Phone : 3365469 Email: mala150@hotmail.com
CAMHADD
871-872, 5th Block, 18th Main, Rajajinagar, Bangalore - 560 010
Email: camhadd@hotmail.com Mobile : 94480 53311
"J^^Cardiology
Bannerghatta Road, 9th Block, Bangalore - 560 069 ,
Phone : +91 80 - 6634600. E-mail: pdevsjic@bir.vsnl.net.in
ixivjcv’.,
i:“i«i'tciiVt t >»-•> o vioju ooivii vi i lAcii i icilcirxei t'OlOiiUt? OL
Oft ImG ZUtH? G»J Si
iU.UU r.i.Gi,
Dear Fnend.
The state ^fVorwHte.ka is a client of the World Rank and the ADB for a variety of
projects which have been under implementation in Karnataka since 1999. The state
has also combined these with a Reforms process both fiscal and administrative and an
annual document has been prepared and issued by Govt to inform the officials and the
civil society. These are known as the Medium term fiscal plan [MTFF] (2001-02, 0203.03-04-— url httn://www.kar.nic.in/statcbudect) and the Governance Sfratcev and
Action Plan [GSrlPj (2001-02, 02-03, 03-04 enclosed). In the FY 02-03 and 03-04 22
departmental Mirrs are now prepared annually which replaces the earlier
Performance budgets and these are available, for reference at CIVIC office.. With the
passing of a new legislation (Karnataka Local Fund Responsibility Act url
http://educanon.vsni.com'civic_bangalore/iocaliiscalresponsibility.html) it is now
incumbent on local authorities to formulate their own MTFPs and peoples
participation m budget preparation and finalisation lias become mandatory.
To understand the nature of these reforms and initiate a three sector dialogue with
Govt, civil society and World Bank as kev actors CIVIC Bangalore, the DPAR GoK
onthe NGO Task force on Good Governance held a first workshop, in Oct 2002.
The workshop had excellent presentations on the highways project (KSHIF) and
rxrimarv education IDPEP) protects by researchers and on the health sector bv CHC.
The inaugural address was on “Karnataka Reforms process: The way ahead", by Dr
A. Ravimlra (then Chief Secretary), and fiscal reforms were presented by Secy FD
(Bud and Resources) and Stephen Howse from World Bank.
In collaboration with other NGOs and consumer groups CIVIC is now initiating a
dialogue on a series of urban sector projects for which the GoK has approached the
WB fbr leans. The Karnataka Urban Sector Reform project (Bank Approval Mayl6
2004), The Kamaraka ‘urban Water and Sanitation Sector project (Bank Approval 20
Jan 2004). The Karnataka Health Systems project (Dec 2004) are under negotiation
and finalisation. The last one has seen a greater involvement from civil society and
NGO sector in the- formulation of rhe pro ject. In addition CIVIC proposes discussion
on the WB Urban Sector strategy (enclosed) and Urbanisation and Urban Transport
Policy would be important topics on the agenda. On governance reforms in an initial
discussion last month some concerns were raised a copy of which 1 will forward to
you shortly.
We now invite yon to a discussion on some of these issues on 20°* Feb
2004 from Ifi.fio io 12.30 p.m at the office
CIVIC Bangalore
1 .4
TV-J T7> A -
XT, juaxxix x AWA ,
4th mam road,
Vasanthanagar.
juuu^aiui v- uuu
Phone: 2226 4552,2238 6864
It will be a pleasure it you could come for the meeting and 1 nope y ou wil, pa,ficipate
and share your valuable suggestions.
Warmest regard®
Vmay Baindur
Ante'c2l_Pagel_o^IJ_ -
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2000/01-20Q5/C6 (September 2003)__
Future Reform Milestones
Govorr m er. t S tratcgy
Reform Milestones tc Cat :
' -2094/00__ ,ZL _ J005/06
2000/01 and 2001/02
2C02/03 and 2003/04
I. FISCAL REFORMS 4. PUBLIC EXPENDITURE MANAGEMENT: To strengthen the fiscal and financial aspects of goiemmenfs operations
Reform Area
AHrctf
Sistdn rK’/ty &
Tian-.ftiwcy
Otjeitive
Fiscal adjurtmntto
avoid a debt trap.
Fiscal transpaiency
to promote pubic
debate and
av.arc.ness.
Develop r, Mcdurn-Tarr. Fines'
Plan (FATI-P) to guide fiscal
:x|i.stment to achieve fiscal
targets (zero revenue delicti and
3% consdirtited tinea I defic .t b /
206'5/06).
Inst.tut.onalze tie Medium-Term
Fisc al Plan into the annual
budgetary process
Prsnda legslati/e backirg to tire
MTFP through a Fiscal
Her ponsMt/Act
Publicdkm of 2002/03 and 20H3/M
White Paper on State’s fiscal
Position issued and meiium-term MTFPs
fiscal targets announced
Pawage of Kan.atr ka Fiscal
2001X2 llecium-Terru Fiscal Flan Responsibiit;.’ Bill in the State
(MIFF) prtlished and
Legislature: effective April 1,2003.
.fcerrinsted.
First hiIf-yearty orogress report as per
■fa thl/monta.ng of
FRA.
consolidated fiscal position
htvduced.
n200!/02, consolidated
ion owing as pe’ target (Rs 6766
crore vs. target of Rs 6670 crore)
Mo.ra away from re liance on offbudget borrowing.
Art ere to contingent liability cap
and better manage contingent
liablitios.
Ceding on Government
Giaranteec Art (1999) caps
certimj and makec guarantiee
fees made mandatory.
Adaarencu to FRA defici rerkrctioii
targets
Reduction in off- budget burrowiig.
In 2002/03, consolidated borrowing
below target Rs 6428 crore vs. Rs
6764 crore (5.4% ofGSOP).For
2003/04, target of Rs 5,610 crore
J4J3%_rfGSt'P)______________
Continued adherence to ceiling on
guarantees in the Guarantees Act
Issuance of guidelines fir sector.'!
allicaiions of guarantee;.
Adherence to quantitative targets
in rhe Guarantees Act.
T20O4/IB MTFP and
half-yearly progi ess
repot.
Adierenca to FRA
deficit reduction target?
Frit her reduction in offbudget and
consolidated borrowing
as per TZTFP
State to obtain credit
rating.
Continued adherence
tncoiiiigcn
guarantee;, and
amend: neit to
Guarantees Act to
rermve KBJNL
exemption.
Improved risk analysis
fur guarantees, and
revised alloc; tion
gridelines
Mai e ns much fiscal i ifom ibcn
as posabe avalable to tire public
Development of
strategy to re duc e risk
exposure lo co
operative sector.
Introduction of Action Tfken Rep xt .on 7.rHtioual fisual
last year's budget.
irifoirartionoiitte Web
(e..p arrears)
Piiilicatiun of additional material on
Overview of Budget expanded to
include information on off-budget
bo,rowing, tax axpenditires and
tar arrears.
monthly fiscal accoirits on the wib.
Publication of monthly accounts
on the internet commenced.
Detailed six-monthly accounts
rebased (CMIR publication)
Full budget on the
Web.
Reduced tinm-lag in
tabling annual
accounts.
2005,06 MTFP and
htif-yearty progress
report
Artie,rance to fiscal
RrrsponsibiSt/
Legislation, incl.
elimination of revenue
deficit and liscal detail
to3%ofGSOP.
Filthier Reduction in
ccnsulidated borrowing
and off-budget
barcaing as per
MTFP.
Continued adherence
to ceiling on
guarantees, and
gifdelinns on their
allocation.
Irrplcmentr.tion of
strategy for reducing
risk exposure to co
operative sector.
As per 2004/05.
Performance
benchmarks
Fistel perlbimnca
AnrutJ deficit reduction target:
monthly monitoring of fiscal
position.
Car/) liability mamgiment
Nunber of day: of CAen'rait
witi RBI (target of zero);
Oft-bulgit homvmg: reduced
overtime and tfruinated in
2005/06.
CmtiigeTt llabiffy management
Compliance with Kamatake
Gating on Govxnment
Guarantees Cap; lav;
dewoli.tion of guarantees to
GoK.
Tnnspeieivy: Increased
volmie of fecal data in the
pdilic domah.
Reform Area
R Rev.MRMj
Objective
Policy and
administrative
reforms to raise
additional revenue,
improve efficiency',
and reduce
canpliaice costs,
based on
recommsndationt of
Karnataka Tax
Reforms
Cxrrmission.
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2000/01-2005/06 (September 2003)
Future Reform Miles tones
Guvorrm en t S trategy
__________R^ornn Milestones to Date
2002/03 and 2003/04
20C5/06
2004/00
200 JJC1 and 2001/02__
Indmct fcxexP.epiace sales tax,
entry tax and turnover tax by
Value-AdJed Tax based onseffassestmert and a functional
organization
Introduction of VAT.
Rationalized tax structures.
complete.
Roll-out of functional
reorganization.
Growth in tax revenue and
tax/GUDP ratio.
Finitiona! organization
pilot
Computerization of
seles tax check-posts.
Reduction in tax arrears
Sties tax concessions for tier
investnxnti abolished and ficor
rates for sal as tax introduced
Rationalization of sales tax regime
(reduction of entry tax, turnover tax);
abolition of infrnstruciurc cess.
Sales tax
computerization
VAT preparation initiated.
Adninistrative reforms to improve
canpliance and transparency.
Perfornrarce based
rotation of check-point
staff for transparency.
Often raxes: Overhaul stamps 4
registration (SSR), and motor
vehicle tax to dose loopholes,
boost buoyancy, as wall as to
improve sen ice to custanersrbxpayers. Strengthen enforcement
and cut rater in excise to redur e
evasion.
Imeleneatetiou of transport tax
reforms ish.fttj ad valorem
rates, ra!ior.ali:atfon of dabs,
reducdoi of exemptions).
Pilot, integrated
Stomp duty reduction frtm 13.5% to
9% Abolition of stamps. Ectat lislmort computerizexi check
of Central Valuation Ccmmitte a.
posts v.ith simplification
of busines s processes.
Foimntio.i of Beverage Corporation
arxl reduction in excise rates to reduce
evasions
Transport tax rnfoims to equalize
pitilic and private sector rates
Performance
lieficfirrtarlra__
Positive feedback from
taxpayers-.
Incieasei; in user charges end
hidier collection efficiency.
Roll-iiut of integrated
check-posts.
Excise computerization.
Coniphte Stamps and
Registration
ctmpuierizstion.
Preparation of integrated checkposts
(transport, excise, sales tax).
Improve cost-recovery for “non
merit" government services, such
as irrigation, tranqiort, higher r nd
tectnical education, hoqxte1
services, and water suppy.
Automatic indexation of bus feres inlrottaced. Bus charges increased by
30)6 shcelate 1999.
Adaption of new non
tax levenie strategy.
Inpltmr ntrition of non
tax revenue slratagy.
Power tariff: increased by 3416 since und-2C00.
Urban water changes foi Bangalore increased by 45% ri 2001.
Irr gat on charges doubled.
Higher education chu rgus incraa-red by 20%. will increase 10% annually
Regular revision of user charges, and improved
collection.
Retainer user chsirgns introdicedfor hospitals and rural wafer supply.
Mi re syi teinaf c tncn itoring of nun-tax revenues.
Greater incentives to Departments to exilect ncn-tax revenues.
C. Coirpastton of
Pvtiic Spending
Objectives
Reorient spending
towards identified
priority sectors,
control expenditure
risk areas; reduce
subsidies.
Control wage and pension t il
while rtafnnc-up in high-priority
areas (education, health, police-,
forestry).
Richitrrerr control strrrte'jy
Hocus a subsidies and bettetarget social transfers
Food sul ‘Siity capped at Rs 3C'O
errre.
esab ished intuiting hl^i level
coitri I proc edure
Hiring restraint continues. Increated hiring of teachers and medical percimnel, es|>ec;all/ In Wtge bill ard civil service size.
_ ruralr rens^Cgrtinuedcqntrd of irage_bill.
. - . ---------- Spiru’inci in priority sectors.
Pension forecasting study completed.
Undertake perarneldc arxl ctnictual pension
n
c
relijim,.
Power sector finanerg
requirement (monthly
Study if provident fund Implement
monitoring).
balances.
reccmmendationi; ot
Spinning on subsidies.
the study
Reduction in food subsidy.
Snveys/databar es of social welfare pensioners,
scholarship holders and hostels to improve
targeting.
^\>ttiec_13_Page 3of_ IJ_
Reform Area
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2600/0 1-2005/06 (September 2003)
Future Reform Milestones
Reform Milestones to Date
Government Strategy
___ 20'34/05
2005/36
2303/C 1 and 2001/02_____ 2602/03 and 2003/04
Stilt sperdng towards highpriority anear: (a) social sectors
(school education one health) and
base i-frestructure.
Compared to 195J3/O3 (base year), average spending in 2000/01-2002/03
foi priority sectors has increased as follows:
o
social secton>(schc ol education and I earth) up by 13%
o
bas c maintenar.ee (irrigation roar's, public biddings) up by
o
bas e capital spending (roads, rural water supply) up by 14%
Additional annual
increases in the
identified priority'
sectors.
Petfo.Tnarcc
benchmarks
Additional annual
increases in the
identified priority
sectors.
1534
D.Publi:
Eipexttue
Matti gent ni en-f
Fimcid
AmimttHBt/
Oijodhe
Improve Bprsnclnc
efficiency, and
rnprove Sn uncial
perfoirmince
measurement,
reporting., and
acsountr.bilty.
improve spending effiaerq:
Improve budgetary realism.
Improve screening of schemes
nnd capital projects p nor to
introduction. Improve control of
capital projects during
implementation. Prioritize payment
of arrears, maintenance, and
completion of ongoing projects
over new investment projects.
Reerieri budget ebng
ileperttveM fees to give
departments greater responsibility
and flexibility in the budgsting
process.
Expenditure Rjviuw Committee
etabished to review all
schemes.
Studios on budget estimation and
forecasting (fiscal
mirt: mn.nship) ccrnpdeded.
Fiscal Rtsponiirility Act introduced
requiring fiscal impact of new policies,
including supplementary budgets, to
be offset by countervailing rneassres.
Appenrix E (civil works) con puterizaiion for
better budget and inplemenlatitrn corirol
Reduction in supplementary budgets bared on
provisions of Fiscal Responsibility Act
New r.ysien i of taw monitoring
introduced.
Departmental budgeting introduced through realignment of demands for
gmnb: with Department's (zOO-VO^.
Publication of departmental MfF°s (DMTITk;) for 6 Departments in
2032103 pilot and 22 Depaitmonts in 2003/04 roll-out with milti year
budgets, and performance targets.
Reduction in the nin ibe’ of schemes from 3,(100 (200'1/02) to 2.500
(2003'04).
Reduction in tie nmbe.'of ctjectcodcs from 209 (2001/021 to 70
(2003/04).
New budgetan/ release order replacing spending controls on individual
tens by controls on agejegdo deparfrnental spuming (2903/01).
Coinpiteize and integrate bey
aamttiing functions to inprove
efficiency, controls, and
uccjuriing capability. Use
Treasury ccmpiterization
(Khajane) as. a platform for MS,
and as a ’single and cental
liayme.it stream (e g. LoC,
salaries, I’RI grants, employee
nccourts, pensions, etc).
Intrcduce new revenue foretasting method; to
inpiovn the realism of budget esli nates.
Computerization nf trea juries
initiated.
Completion of computerzaiion of
Treasuries; Budge tay control
introduced.
Computerization of capital works
cor trol (Appends E) initiated
Simplifythe budget by
introducing
departmental
programs.
Reduction in
scpplementary budgets
based on provisions of
FRA.
Further reduction in the
nimber of schemes
and object codes.
Continued production
of DMTFPs and public
reporting of
performance t gainst
targets.
Continued production
ofDMTFPs and public
reporting of
performance against
targets.
lute dune single payment stieamfor government
tran-iactioiis (by making I oC payme nls through
1reasury)
Ccn pliie ZP/TP accounting ccmputnrizalfon
(linked toirenscry).
Capital Works Control (Appendix E) cornpuleii ’.ecl
(inmajor capital works departments. Dompiteiize
pension payments (civil).
Pilot computerized payment of salaries at
Secretariat, followed by full payroll
ccmputeri.iaton.
iputenzationgrf DtlOt._______ __ _______
Reduced diipaiitii.s bebver.n
budget, revised arid ciclial
estimates.
Smaller volune of
sq.pfcmontuy budgets.
More timely finanriai
statements
Reduction inbrck’ogof
accounts and audits of local
bodies and I’SIJs.
More itnuly and complete
responses to audit efrse various
prepared and disclosed.
Reduction in un-rcconcilsd
items, and in magnitude of
Pirilic Account deposits
II. A
AG
Sta
LLTltLL
form Area
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2000/01-2005/(16 (September 2003)
Future Reform Milestones
Refoim Milestones tc Data
Government Strattjg;
2004/05
2005/06
2003/01 and 2001/02
2002/03 and 2003/04
Strngttnn sccour.Hi}.
Develop ncomiing c aprbilty.
Improve tmelimss and cisclosure
of financic.l repertrg.
I9h mute major distcdois (a.g
clean ip public accounts; and
ensure regular recant iilatior s.
Ina.-ntivizo cumplienco with baric
accounting raqiirane nts
Chics. cf Ccntrdkr (Accounts
Mrnagemeot) established.
General ban on ycar-end use of PDAs
involving GcK funds Further
measures to clean-up and reconcile
items in the Public Ar corn!
Improved timeliness of
monthly account,ng
data.
Continue clean up of
the Pultic Accounts.
Start reconciling
various account: at all
levels.
Incentb.izc cunpliance
v.tith accounting
requirements by linking
to fund transfers.
Local andpira-stelalborfe.-;
improve financial riccountabiit/
and modemiue financial
management
Estot'istirnmt of data base for
acroi rtr aid nudts.
*
Complete clean-up cf
the Public Account, and
ensure regular
reconciliation.
Revise/ modernize KFC
Code and other
manuals.
Strengthen IFAs role
and capabiSty.
Induction of
profession al
accountants in KSAD.
7.udit response
Audit reeponsos up to
database put on line;
drte.
fnrtt er measures to
jedice reiponselag.__
Reduction in backlog of accounts and
Eliminate backlog and maintain trrely accounts
and audits cf para-ctatalc (KGID, PStis, ott er
audits of para-i tatals (K'GID, PSl's
other Boards and AUlioritics) and local Boards and Authorities) and local governments.
Cm pkte -ollaii of FBAS at BMP, and accounting
governments.
ccmpuieri tefton at other IJLUs.
Financial audit of 6 CCs by Chartered
Accountants._______
Roil cut of pilot to other
Karnataka Loci Fund Aiihoriiiet
linplementation of
Local Fund Authorities: local □ofier;.
Fiscal Responcbilty Bill 2003 passed
f iscal Responsibility
byStf te Legislature to improve
Bilnn pile:bast.
financial accountabifty <nd
management of local goverrenants and
other author ties
Data-base created of audit responses,
and effettivemeasures taken to
reduce the back-log
improve euittnspmivt-ness.
Performance
benchmarks
MHNISTRATIVE REFORMS: To improve senice cefvery, increase government efficiency, and reduce corruption
atmmce
Articulate strategy for goremance
leformi
First end final Administrative
Rcforns Ccrrr is rion reports
published.
2031-02 Governance Sir^eg1/
and Action Plan (GSAP)
pubfrthei
2032-03 GSAP and 2003-C4 CSAF
piidished, with aclia-taken reports.
2001/05 GSAP
2005'06 GSAP.
Monitoring of action taken
against proposals in successive
GSAPs.
5_«£U_
y \nne.
Reform Arei
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2000/01-2005/06 (S^tember20p3}
Government Strategy
Reform Milestones tc Data
Future Reform Milestones
2004’05
J
2005/06
2005/01 and 2001/02
2002/03 and 2003/04
H Since DeAwry Improve sen ice s in a widening
nrrnber of agencies through
agency reform. using business
Oija:tha
reengineering, citizen charters,
hr. prove 1 service
and user surreys.
de every in services
wifi large public
interface
Mei.e sendee delivery m re
responsive by tringhg
government closer to the people
threugh urban and rural
decentralization
Service delivery reforms in the
fotovring agencies:
•
Transport Regional Offices
Service delivery reformsin the
folowing agencies, (in addition to onus
alroadymertioned):
*
Rural arkninistrative (talcta) officer.
.
BVJSSB
•
Stanp s and Registration
«
R rial IT kiosks
«
BDA
•
•
•
Laid records
Karnataka State Road Transpert
Corporation
Primary Health Centres, and other rural
healih cervices
•
Government hospitals
.
BCC
1 iicrna red publicity for charters.
.
PDS
E>dtm:i monitoring of the performance of the
reformed agendas, including user surveys.
Increase untied grant to rural
Gl>s.
Increase united gratis to rural GP.
Service delivery reforms in the following agencies
(in addition to ones already rnentjone-d):
Strengthen PRI Act by anendneit
Introduce greater progressivity and flodbiliy into
PRI grrntn.
La inch training procyam for PRI
elected roprosentetrves.
PRIc increasinc/y responsible for be neficiay
selection.
Enforce IIT1 at local level, inct through
notice boards.
Proper metering, failing aid payment
arrangements for rural writer supply.
Petformarce
benchmarks
try>ro rec! service delivery, as
measured by user surveys an!
recbcSon in trr.e to deliver
services.
Be'ter quality of and cost
recovery for local services, e.g.
drirkiug water supply and
saitiriion.
Reform property ba regmefor rural
local governments.
Reform property tax in Bangalore
C. Gwcm.-rerf
Efficiency
tractive
Rrfionaize
fuacbon , improve
internal efficiency,
make great er use of
IT, increase
trrnspaancy
Reduce and rafconalrz e transfers
of civil senrants through (i) a
monite’ing system. and (i) | titling
in place new instit.itic na
mechanisms.
Rod out newtax system to nearly all
Karnataka's cities and tewns.
Ccn.puierize urban local gwenmonts services,
starting v/ith Bangalore Cty Council
Increase delegation to urban
gcrrerimirtc.
Devalop service benclmr.rk;; for uban
gwominents
2001102 ban on general
transtert.
Transfers kept to 35,000 in 20'02,03
(5.6% of staff sbength).
Continued lotvvolune oftra rsfors
Mr nilorir.g system inlroiiuc ed
and placed on he irt emet.
Computerized counseling for transfers
ofteachers, the largest ryoup of civil
servants.
Crdre management authorities
esablist ed to regulate transfers.
Policy of rerbiuling b an fers to
no mi re th: n 5% of itaiT sfrer gth
int educed
Transfer; koptto 15,900 in
2001-32 (3% of staff strength)
Continued lew volume of transfers
Measures to lengthen tenure ol senior(Cla s A,
incliidhg IAS and KAS) officers.
Dnslit reduction in nurber of
transfers starting n 2001/02.
Increase in tenure for senior
civil servants.
Functional review
nyler nentaion.
Re tuition in file pendency.
Suxessful e-g ivemance
inilatire:;.
Allied! Page6o£li
Reform Area
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2000/01—2005/06 (September 2003)
Govemm en t S tratcgy
Reform Mileatonos to Data
____ Future Reform Milestones___
2000/01 and 2001/02
2002/03 and 2003/04
2004/05
I
2005/36
Increase transparency in
recruitment
Issuance of rales to reduce
weight given to interviews iris-a
vis exams.
Performance
benchmarks
Camion exam for teachers extended
to higlr-school teachers,
Introduce common exam for
candidate primary school
teachers to reduce dscretion
associated with individual cologo
tests.
Improve covurnment effectiveness
via a series of functional reviews
and rnptementrtion of their
reoxninendations.
Completion of functional reviews
for 1 3 major departments to
guide the process of rationalizing
government functions.
Speed up Government
adnn strive
transaionsi'dedsion-niaking time.
Stops to speed up decision
making and reduce the layers
through which files move: "desk
officer system" and "single- file
system" introduced.
Further rnplementetiotr of functional review acton
plans and recommendations. Extension of
functional reviews to new agencies.
Cimprehensivci action plans drawn up
for mirier nentalion tri functional
reviews by rill 13 Departments.
Introduction of ccmpriterzed file
monitoring system for Secretar iat
Introduction of tine Smits for Departmental file
clearances.
Introduction of levetjiirping system.
Introduction of, and atherence to, quantitative
targets fertile pendency.
Revision of Secretaria t Manual of Office
Procedures to reflect the new system.
Renew of departmental rules to
rationalize and simplify.
Improve government efficiency by
series of cross-departmental
reviews.
Expand ttie use of e-gcwernance
throughout government
Inlial implementation of funefond
review recommendations by 13
Departments.
Develop and mplement strategy for outsourcing
across Departments.
Review and increase in lielegation of
financial and administrative powers
across dopsriments.
E-govemance initiatives
underway in service agencies
treasuries.
Secretariat 1AI-I, computerized file
monitoring system, oifico attendance
system, computerized trearnrias
introduced.
Pulrlicafiun of E-govemance Strategy
Creation of potBon of Secretory, EGo/et nance.
Staffing up of e-governance cell
Introduction of paperless office (electronic files).
Introduction of Karnataka Portal (?)
Installation of Human Resource Database.
Wfcfo Area Network for the steto, with e-mail ids
provided to all heads of offices at State, district
and taluka levels.
Measures to improve office attendance.
Reduce the number of government
departments and agencies
Creation of Water Rcsouces
Department via merger of major
irrigation, minor irrigation and
ground vrater.
Reduction in budgetary demands to 28
fran 62 via Departmental grouping.
Frieze on creation of quasigtrrernmertal agencies, except in rare
cases which are adequately justified,
to prevent duplication and waste.
Review departmental divisions and merge
departments wherever possible
Nunber of positions made
reduniant
Reduction in arrears of pending
files.
Nuntier of e-gwemanco
projects fundicning.
j\>meKlt_Page 7_oj lJ
Reform Area
D. Antixunjplii'n
Objective
Reduced corruption
through increaser!
freedom of
inTomiafion and
more transparent
procurement
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 200(^01—2005/(16 (September 200$)
Govearriment Strategy
Re'oim Milestones to Data
Future Reform Milestones
_ 2D0M1 and 2001/02
___ 2C 02/03en<i_20p3/04__ ____ 2004(05
2005/36___
.Freadbm of.'.oft.rmaftn: Provide
legsla'jve basis to rig'it I)
information, andniptuncntdae
sane.
Pci’lic prccuen er: Legislate to
enforce transparency m
procurement.
Reform program to sb engthen
procuramant be nsitarenuy urri
efficiency.
Right to infnmatMi (RTI) Act
passed.
RTI Act made effective. Act publicized
ami information officers trained.
Increased internet placement of
Go/ernnentActsiRdes, arid GGs.
Transoa'encyinTenders and
Procirranetrt Law passed.
Estab istment of proruremert
policy cell.
Dcve'opment of Procurement
Reform Act on Plan
Catologng, indexilia
and computerizing of
government records.
Disclosure of
information as per sue
moto requirements of
RTI Act
Continued adherence to the
Adoption of standard
Transparency Act.
bide ng documents
across gorenment.
Rules to Transparency Act
amendment to cover consultancy
services, and other procurement types
previously outside its scope.
Launch of centralized verb-site- for
procurement
Appointment of Deputy Secretary
(Procurement).
Increased use made of Internet for
publishing of bid results and for e
procurement E-procuranent marie
mandatoryf or tenders above Rs --50
lakh.
Greater rise of third-part/ inspection:
for large contrails.
fiteps taken to make
bidding documents
more accessible.
Elimination of PSD
exemption from
Transparency Act
Greater use of tfiirdpat/ ir epoctions for
smaller contract:.
Overhaul of drug
procurement anl drug
reonioiinji
Evaluate functoning
arid impact of RTI las
to improve
effectiveness.
Pitlic kiosks
et tat list red at
Secretariat for the
piblic to obtain
infonnation on the
statu; of their papers in
Government
departments.
Review of the
Kunntalia
Transparency in
Procurement Act on
basis of experience;
implementation of
survey to gauge
effectiveness of
procurement reforms,
and adoption of revised
strategy on this bast:.
Performance
___ benchmarks__
Perception of rediced
corruption, asrnersuredby
surveys.
Increased public access to
rnfcmnatwn.
Wider availably of bid
documents; use of standard
bidding docrmint;.
Survey plannee! in 2005'06.
An'iecJf_:Page 8o£JJ_
KARNATAKA ECONOMIC RESTRUCTURING FROGFLAftiME: 2000/0 -2005/(i6 ISepte.Tioer 2003)
Govornm ent Strategy
Reform Mileatones to Data
_^utureRefom^Mil«.tonEs____
PetfoTOarce
200D/C1 and 2001/02
2(02/03 anti 2003/04
2004/05__ |
2005/06_________ benchmarks
OVATE SECTOR DEVELOPMENT: Fornprove the txisiness environment and lecuce movement of government in commercia) aciviHes
to Area
•jiiMjn
‘Vt'iz^Scn
■r»
rd busines s
merit; less
rati.:
tnee; more
■ivestment
her growth
Reforms to make it easier and
quicker to start a newburinosr in
Karnataka, and to rm a business.
Government approwi of ti e
Policy Riper on Eus'.neirs
Deregulation.
StrengitMiii ig of KUI-,1 tn make it a
mere effective one-slop shop for
business
Amalgamaton of 3teparste
single-window agencies.
Karnataka Industries Facilitation Bill
(KIFBj passed by th. State
Legislature to enable fait-tiacl.
clearances (through time-bour.d
clearances and self-certificaticn).
Returns/regstcrs oanp niosare
caret itiy required to
m;jnt3irrsubrntrodr.ee I from 24
to 4.
Infi od ict on of new inspection term a
based on random sampling and
transparent procedures.
Passage of Induslrial Township
Authorities Act to enable industries to
runtiiair own estates
Passage of Special Economic Zone
Act by Slate Legis labire
Tenure of trade licenses etc increased
(e.g. c rB year to five year).
Ag [cultural Lberali'ation
Amendment to At MCA st to
enable creation offirrt non
gc/einmert wholesale inaiket in
India.
Liters: lization of sandahr.ood sector.
Reno /al of select cam.odifes from
puviewrf APMC Act.
Amer men to Af MO Ad Io
rejface rnulS-p sin: by singl epont sess collection
Liberalization of other sectors.
Lfberr.lizitic n (fit e miring
sectors.
„
, ■
Revarnpngof 3DAto b.ni;more
land onto the make’.
Liberalization of public transport rector
by allowing private q-er tors to tin
st* rt-hail uiban and long-distance
rC(je!
increased flexitility ft r conversion of
agicuitui al to non acricultural land.
Implementation of
Karnataka Industries
Facilitation Act
introduction of deerned
clearances, use of
combined application
form, launch of new
handbook for
entropr enours;
dissemination ol new
rale:;.
Ir nplerr en ati on of
Industrial Township
Authorities Acts in
about b industrial
estates.
Development of special
economic zones
Conduct foliow-up
simy cn industry
deregulation.
On tie basis cf
feedback from
business, further
srnplfy business
establidmiint
procedures.
Implementation of
Indus tril l Township
Authorities Acts in
remaining industrial
estates
Fnther development of
special economic
zenes.
Outsourcing of
infection functions
Development ofne.v
Agricultural Mail: eting
Policy.
Liberalization of silk
st ctor. Privatisation of
site fi rms.
Amendment to APMC
Act to |:ro'.idi: legal
basis for contract
farming
In'ror.’uctiot. of
ccmfutrriz jd aw tiois
aid tendering at
AIW&
Consolidation of APMC
market;.
Firth er deregt ilatonof
aciriciltsral mrrkite
(e.g. irty by private
markets;.
Introduction of private
sector management
into water suppt/
manag ement on pilot
basis.
Further unity and land
deregulation.
Feedback from industry and
fanners via surveys (a.g.oti
nu.ibor of inspection:, tone to
set up a business].
Investment voh.mas In
Kanataka.
Annex It Page9of II
Reform Area
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2(.<)(i/01—2Q05J06 (Septeniaer 2003)
Government Strategy
Reform Milestones toDat;
Future Ref yen Vii .es tones
_ .200J/C 1_an dJ200i;02_ ___ 2C02/03 and 2003/04__ ____ 2004,l0fl____ ___ 2005/06___
flRistusture and Establish and implement policy
Pthttizs Public
framework and durable
Eitaprse:
institutional mechanism to support
Otjerthe
Vlllhclrar state front
commercial activi lies
to recuca
administrative aid
fiscal burden of
PSUr; increas:
efficiency of PSUs
re;na:ningvrith
Gverrriiert
PSU closnre'privatizalioi/
restructuring.
Public Sector Restru;tu ring
Ccmmission established.
Department of Disinvestment create 1
to acc eteratn PSU re.tndimg.
Pedey p; per on PSU Reform anti
Pnvafzationand related
proceduies, with 171’SUs
identified ar Phase I of i>rogram.
10 Phase I PSUs closed and
prirati »alion ongoing for 3.
High-Rower ed Comr.ittoe
esabished for implementstiai of
nev PSU policy.
Ascot valuations underway in closed
PS’Js through courtIiquida on.
4 PSUs closed by 2001.02
List of Ftase II PSUs idnitfiel fee
closure/privatizaticn.
Counselling sesions organized for
retrenched workers.
Phase I of PSU
restructuring
completed.
Cimplele Phase II.
Progress with Phase III.
Performance
_ _beric!tmarks
Nunbar of PSUs
soUfclaMd/resructued
8 PI rasa II enterpriies
to bo closed/privatirecf.
Phase ill of program for
rationalization/ consoli
dation of remaining
PSUs initiated.
New’/RS package offered
Social Safely Met ad 'iu.r
appointed.
Er.vir.rmertal sc.eeiing
completed for Phr.se I PSUs.
IV. POVERTY MONITORING AND STATISTICAL SIREN GTHENIN G: To make better use of data to inform policies end evaluate their poverty impact
A R ve .-ty an J
Humin
Duvslcym.'nt
Mznitoilnt SJrstonj
Oirjorthe
Aino-e pro poor
develop nerifotii.-y
mrikit ginale
possible by good
poveity-rekteidrrta
be ng made
available on a finely
basis
Establish Poverty and Hirrtm
DevelC'pment and Poverty
Monitoring System (PHDMS).
Inditutionaize the 1999 Hunan
Development Report •writ-, regular
tracking of and reporting on
poverty and social indicators.
Undertake special studies on
critical poverty-related issues.
Hunan Developer erf. Division
constiited. Advisory Group
appointed. Terns of reference- of
thi; prop rsed not itoring system
an t !i st c f ir die ate re in; Irz rd.
Production of rlist idler el
poverty i.-stinates based on
latest household i un ey
Poverty and Him: n Development
Monitoring chapter included in 200293 ami 2003-04 annual Economic
Saw/.
Study of rural drinking water aid
prinary education
Study on impact of dr ought
Introduction of qu arterly
economic bulletin; fcrtracl inj:
dirtrict-lcve- chanjet in
agrici itural wa jet. and |ric es.
Annual monitoring
chapter in Economic
Sunny, induing
asscsshg progress in
reducing regions,I
disparities and
improving social
iiiicat.es in backward
regonc.
Arrival monitoring
chapter in Economo
Cany out othe'specialpirpcse studies ns
needed.
Pifolicert on of
Krrn.ita!:a State
Development Report
runctioniig of IhePHDMS.
Use ofitr results ty policy
makers.
Poreriyifun an dead oprnent
target; to ju tgr- success of
awral progian (iuckidiig
aetilth acd education targets).
Studies on labor
markets, gender, and
irfcr-di strict outcome
disparities.
Iirtrcducticn of annual
monitoring of
absenteeism at public
fac8iies(c.g. schools,
prmary health centres.
Fair Price Shops)
fl Piogttn
Eivlnvton
Oijerthm
Mure and more
Malte line departments
lesjronsib'e forcommisobning
independent eviluaticns of their
programs (the "independent
Evaluation Irtetivo*)._______
Coder issuedroqiirirgal
department; to ccrrriisrtoi
regular program evatuaiiors f om
erenial agnneies
1D pihtdepart neito injtiab;___
70 evriluntions complete.
Regular sen es of ivorksl ops at which
evaluntions and action-taken reports
presented.
Evaluation of effectiveness
Continued roll out of eraliiation iriliative with
focus on action takun as n result of the
evaluations.
_
____
Nunbar nt evaluations
untied akon.
Quality aid rel.vanco oftho
1}_
Reform Area
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2 00 0/01-2 TO 5/66 (September 20W
Futurr; Reform HiiKtcnes
Govurr.m ent Strategy
__________Reform Milestones jcData__________
2004/05 __ |
2005/06
2003/01 and 2001/02
2602/03 aid 2003/04
external evaluations
of government
programs corn pl erect
and used to h prove
program design
Ensure that con ipfite .1 evaluation:
rue us xi io improve proiran
design
C. SM-itua/
SsreigtKt inj
Improve stat; output esbnaooi b;
improving data :oi rci.s md
proressing, rind by rnreisi igthe
demand for output esirn ie:.
Otjedh'e:To
develop statistics
capacity of ‘.he state
expand
disseminartion, make
estimates cf state
output and inflaticn
more finely and
accurate.
pn.gramevilu.itic ns.
Training provided and guidelries
Publication of t valuators end action
^3n refort5 0i1
issued.
Evaluation Coordination
Committee octabl shud to review
actior s taken in response to
evaluaticnreports.
Giver mrent CorrmJ'ee report
on improving stab; ix. itprt
esimticn.
Further training provided
Production of quarterly indtrslral
pre duction (IIP) serie;.
Computerization of the process of
production cf 2001/02 qiick esthatos.
Expansion cf the nnnualEconirnic
Steve/ to include GSDP figures <nd
analysis.
Performance
__herrchrr.arks
evaluations.
Use of the evaluations to
improve program design.
Tinleli.ie'.s cf output and
inflation csfmatBs.
F ub ic< tion of Ilf1 data
Frailer computirizitk n.
Gaps in GSDP estiinalicc tackled through sub
sector studies.
Quarterly tension of GSDP estimates.
Reduction in divergence
between earlier arid later
estimates of output jov.th and
inflation.
Mote use and malysis of state
output and irifletiori.
Lai inch of DES website.
Training of DES slalf in computers.
V. SECTORAL REFORMS: Tc address sectoral issues critical for achieving Karnataka’s strategic deveto,anient conk.
A Power Sector
Financial recovery
Objective: To
reduce the fiscal
burden if the povrer
sector, and to
rnprove power
sector snppy quality
ard access
Rertructurirxia'id private
par’ici) atm
Adoption of Financial
Restructuring Plan (FRP)First tariff increase (2002)
Corporatization ofKEB
(e: talrlishmenf of KPTCL)
Secondtariffincreasc (2003).
Reduction in financial loses.
Int eduction of purchaser-provider
model.
Balance sheet rostrxturing to reduca
delit overhang.
Unaui.dliig of ffP ’CI into four
distribution conpanies and on:
transrnisi.ioi; company (June 2002).
Reduction in power sector fiiancia! losses as per
FRF, and in erous-subsides
Fri/iti?ati>nofrne or
raon: ESCOMs.
D'.veop policy' to
promote open access
PiJulic atiun of privatization rtreteiy.
Icfficiericy irroreva neats.
Ar.ierdrrerrsto Electricity Act to
ini reuse the pisna Ities for the
theft i f electricity (Anti 1 heft Law
orATL)
Launch of universal meiering
canpaign.
Drive io regularize ilk ga'ciiste mrac
resulting in addiicnal 800,COO
customer s.
Provision of poke to electriciy
canpriny to enforce ATI
Crmplefion of
privatization.
Improv: collection
efficiency !o !>6%.
Cumpletion of universal
metering.
Vigcrous cnforcomsit
cf anti-ihel Act.
Maintain high level of
cdlection efficiency and
ar ti-theft activity.
Financial losses of the sector.
Customer satisfaction wth
power supply
Aim-ze B Pagz_llnf_ 11
Reform Area
KARNATAKA ECONOMIC RESTRUCTURING PROGRAMME: 2000/01-2305/06 (September 2003)
____________Reform Mile Hones JtcDat 3___________ ______ FutunrRef inT^Mliretoius______
Govorrm ent S trategy
Performance
_ 200WGland20jM/02_______2002/03_antl2g03/04___ _____ 2004f05___J_— _20C5M6____________ befichrr.ar ks____
8. Ecucefivi
ScJw
Objective: To
ensure quality
educcitfcn for alt
Develc pit g a strategy for
education reforms and improvs
capacity for policy 'onnu'ation and
planning.
Improve rccosc and cnnlln.en.
Publication of Edtivision Strategy
(February 2002)
Creation of Pokey and Planning Lhit
Strengthening of Pule/ aid Planning Unit by TA
and partnership wlh Azin; P«mjFoundation.
Nunbar of chikken enrolled.
t
Nunber of chit ten comptejr^
various levels cf education.
Devs:: to inpre ve enrollment.
No of out-of-school chihlre r falls from
1 niillim In 02'01 to 0.4 i nil lion in
02'03. Hiring of additlonrl teachers to
fill vacancies.
Extension of school me; I program to
the entire state
20)3-04 dedared as year for
rq ro’.inu lean inc aitccmns.
Program for univercali ting eletr.enlaiyeclucatom
espuciUty in the north eartem districts (funded
through SSA).
Edict tioa budget, especially
non-sala.y con po lent
Laum h c.f school meal [.rogran
in backward ne rth er st districts
Improve c.uaity
Ccmnior eiitrfnc j test
intoducridforreciiiment of
terchars.
Conputerizud counseling introduced
for tec char transfers.
Filo; to decer.tre.izc
decision-making and
funds to tf e tiightchc.ol level (iiigtischrol development
plans).
Etal.lislmentof
Srhosl Quality
Assurance
Oigaiiziticn.
Strengthening of Block.
and Cluster Resource
Centres (funded
through SSA).
Increase and rrior a'ize
expenJture on sctoo education.
Teach er management
r eform:; to reduce
_absentiieisni._____ _____________________
Furt.rer increases in school education budgrt c s
School education bu Igctincreased fran Rs 2541 crore in 1998/OC to Rs
per MTFP, eepecia ly for nor^salaiy component
30’6 crore in 2002/03 (r.e.j: increase of 20%.
Rationriiz rticn cf education spending by trrns'er
By transfer oflaai hers' positions from the south to he north savings of Rs of teachin j postions toward; benchmark
toacher/ct ild ratio and rat onali; atbn of school
14) cw: gene ral ad
size to reduce tie nrndoer of small hiijher primary
jnd hiehschqob._______________________
Document of
The Work! Bank
Report No. 24375
INDIA
o"S"*> W* kSirvA'irArrv
J *.A *A
■*_/ A K/W4JIS k?VV*V A
June 24,2092
Energy Sc Infiasti ucture Unit
South Asia Regional Office
Currency Equivalents
(as of May 26, 2002)
Currency Unit = Indian Rupee (Rs.)
US$1.00 = Rs.48.00
Abbreviations and Acronyms
ADB
ALM
at>
APUSP
BOT
C.AA
CAE
CBFI
CDF
CDFI
CDS
CIGF
CSr
DFID
EFC
DSW
Fl
FIRE
GDP
GIS
GOAP
GOT
GOTN
HDFC
TTUDCO
rppn
ICIP
IDA
IDFC
1L&FS
1NHAF
JBIG
LIL
M&E
MCH
MDF
MEiP
MIGA
MPC
NABARD
Asian Development Bank
Advanced Locality Management
Andhra Pradesh
Andhra Pradesh Urban Services Project
Build Operate Transfer
Constitution Amendment Act
Country Assistance Strategy
Country Assistance Evaluation
Community Based Financing Institution
Comprehensive Development Framework
Community Development Finance Institution
City Development Strategy'
Community Infrastructure Guarantee Facility
capital Investment Plans
Community Support Fund
Department for International Development
Eleventh Finance Commission
Economic Sector Work
Financial Institution
Financial Institutions Reform and Expansion Project
r!
— ovurvjuv a rvuuvr
orvOU
Geographic Information System
Government of Andhra Pradesh
Government of India
Government of Tamil Nadu
Housing Development Finance Corporation Ltd.
Housing and Urban Development Corporation
International Bank for Reconstruction and Development
India Community Infrastructure Project
International Development Association
Infrastructure Development Finance Company
Intemationul Finance Corporation
Infrastructure Leasing & Financial Services Ltd.
India Habitat Fontm
Japan Bank for International Cooperation
Learning and Innovation Loan
Monitoring and Evaluation
Municipal Corporation of Hyderabad
Municipal Development Fund
ivierropoiitan Environment improvement Program
Multilateral Investment Guarantee Agency
Metropolitan Planning Committee
National Bank for Agriculture and Rural Development
i
NGO
ODA
OECF
OFD
1’HED
PPiAh
PSP
RMK
SAFER
SEB1
SFC
syi
SIDBI
SWM
UK
inn
TT\ FT)
UlviCEr
UNEP
TTNCHS
UP
UPRS
USAID
U vVSS
WB1
Non-Govcmmcntal Organization
Overseas Development Agency (UK)
Overseas Economic Cooperation Fund (Japan)
Operations Evaluation Department
Public Health Engineering Department
Pubhc-Pnvate Infrastructure Advisory Facility
Private Sector Participation
Rashtriya Mahila Kosh
South Asia Forum for Infrastructure Regulation
Securities and Exchange Board of India
State Finance Commissions
Specialized Financial Intermediary
Small Industries Development Bank of India
Solid Waste Manaeement
Tcchmofll Assistance
Tamil Nadu Urban De velopment Fund
United Kingdom
I Trban I xieal Body
Urban Management Program
United Nations International Children s Emergency Fund
United Nations Environment Programme
United Nations Centre for Human Settlements
United Nations Development Programme
Uttar Pradesh
Urban Poverty Reduction Strategies
United States Agency for International Development
Urban Water Supply and Sanitation
World Bank Institute
Vice President:
Country Director:
Sector Director:
Task Team Leader:
Mieko Nishimrzu
Edwin R. Lim
Vincent Ctouame
Robert Maurer
Ivleera Mehta
K. Mukundan
INDIA
URBAN SECTOR STRATEGY
1.
Objectives of the Urban Sector Strategy
1
A.
iL o
. »>> WJ. X«-» A-Z >** I A O
» • A f-»>O C’*'T*o*p ry» • 4prr
rcro~r\i"oc 4-p o«sl* *»*■> <• e» 4-U o
K/ cat > Ks J
>W .J SO. M’kUCpJr Ivl lilUtU |Avj/Ud^O vUz VIUIVWJV << UCJ.<- ■
<■' O
support io the urban sector because it is critical to India's overall economic development and
particularly its poverty reduction urogram. This strategy note, and the dialogue held with GO1
«p/1
di’rmtj ils
provides ?. Iramework lor hyildwit? a program of urban
vpcrauozis and advisvij our vices duiitig TY 02-04. It updates die drall urban operational strategy
prepared in 1W/.
2.
The up dated urban sector strategy aims to contribute to India’s poverty reduction pro:
by suppoitiug die role of cities m economic development and seeks io improve die living
standards oi poor urban dwellers. Intermediary objectives are to:
a
support the deceiiualizxAtiOii process imtiuted under me 74^' constitutional amendment'
*
strengthen urban governance and management, to make the delivery of urban sendees
more efflcieul, sus tamable, and responsive (o users mcludmg (he noorj and
improve resource mobilization and fmancmg systems to help address investment
backlogs.
®
tu..
ovCiui' xfaCxigrOualu
3.
Over the past decade, the context of urban development has changed in India. The
countn^s focus on economic liberalization financial sector reform and a new enmhasis on
uUCeuualiZauvju Will ullcct ulbuH gxuVVih, the CCOuOuuC Ivie Ox CitiuS, aild the SCiviCe liCuds Ox
urban dwellers. Until very recently urban infrastructure was not considered a "core" economic
issue. National policy discussions focused more on rural development and rural poverty than on
the problems cf cities. This relative lack of policy attention, combined with flawed incentives
and insitinciuni revenues of most uiban service entities explains die dismal performance of die
sector. It has led to low quality, reliability and coverage of sendees, inadequate maintenance and
m*?f(bchve vp*?T?*hoii of tbo existing mfrasfr’.’.clure, a mounting backlog of investment
requiTumuiils and umespousive ucalmcnl or users, especially poor auu vulnerable groups.
4.
Urban Growth. India is still nrcdominantlv rural, but its urban population of 290 million
(estimate as the 2001 census cf India figures of urban population ore not available) exceeds the
ioud population of most cotmiiius m ihu world. A third of India's population resides in large
cities with more than a million people. The number of such cities is estimated to increase from
23 in 1991 lo shout 40 by 2001. Tn 1991, over 65 percent of the population was in the 277 ’’Class
I towns "with a popmaviGii Ox more dmn 0.1 mdlirm liter, iiumbcr is expected to mcrease to over
425 by 200i. ! urban growth is characterized by both rural to urban and a large proportion of
urban to urban migration. During the eighties, the rate of urbanization in India declined. ‘
National institute of urban Affairs (1998), Urban Hector Reforms tn India: issues and Suggestions.
Report prepared for the Asian .Development Bank, New Delhi, p. 1
2
As Rakesh Mohan (1996) in his paper on ‘Urbanization in India’ argues, this is a disturbing signal
as it may suggest that industrialization and urban infrastructure have failed to support urban growth. This is
•■Is?, evident from the fact
despite the
in share of agriculture in total GDP the share of urban
centers, wliere a large proportion of non-agricultural employment is mceij co be iooa^d, m me uOtal
population has not increased significantly.
4
De«nite Hm* deceleration m«nv analvsN have pointed OUt tJwt the Ul)n?*Cf of economic
huvc led to v* renewed growth of urbaix centers witli n grcutcr Uxip&ct on
larger cities.'
5.
Another feature of urbanization has been a large number of urban agglomerations that
mcludc a umiibci u* separate muiucipaf entities. Most or the urban centers with more man a
million people are 'mulu-ciues' that include many rural centers on the outskirts. They have
complex. ineffective service delivery arrangements and present considerable challenges for intra
.- . mJ ptvttwxxA k.o»i i». vC rcpncMtOw **o aiuvu. „c , c«opmozu is widcspAcad m India and
urban '•1 ■*.?*■
a possible 40 percent of the 500 districts could become predominantly urban by 2001. Even in
nrcdominantly urban districts, however the nature of urbanization across India is varied. It is
mois 2nrricultur2
12 states such cs Pmvfib to more industry-services led in "western states swh
ito Gujaiai and Maharashtra.
6.
Cowritbi/riorw to Economic Growth Recent studies indicate that the share of GDP
CxiXUXxOwLLlg XlOjLlX
CCxikCxO gxCv. aTOaX.1 CAAA estimated 50 percent dem*2 the otirly xxiixotics to o\ or
60 percent by the turn of die century/ Iviore than 90 percent of ail government revenues come
from the cities/ India's ciues would contribute even more to the country's economic growth and
IT! red«if,«iia
-a-rT\’ ’f* flijcrrr dtd r»r\f ciTrfcst- crorp
!*lfrsStniCtl3re bottlenecks SCW’C?
deftoxCiiCiCs, poor local govcrnuiicc and distortions iu laud and factor markets.
-7
/ .
tu.a....
vy
v_z»
Kj^r nvcu.
ti, _
... Ar r. +ka
j
xxxv uuvimout'u uvauuulv vxi tLtv w Wiagv tuxvx u^uu»Xa4.^ wx uiudu
services is iimired and its reliability is poor. Available data suggest that there have been
imorovements in access to water services. However "access" tends to be defined as being
f»fytwoz'-T4»<3 rzx o niMo nonvnrV r(Qcrz>«*riio<?c of how c^en
ectv'dly f^owrs
it or how safe
uiai water 13. Somiauou couimues to be iuaatx|uaic and neaiui statistics snow waierovine
diarrnea as one of the mam causes of morbidity and child mortality in India, lhe performance of
urban Transport systems has clearly deteriorated with the rapid growth of the vehicle fleet.
s.
Rising Service uemand and Shortfalls in Investments, me demand lor quality urban
services is increasing ranidlv with the growth in urban ponulation. incomes and competitive
businesses that can b? snsfamed only m an "efficient city" environment with reliable
mfrastrue tine and logistics. Even assuming efficient operation and maintenance, investment m
the sector falls far short of the amounts needed to cope with this demand. Low investment fevels
can largely be explained by service charges and local taxes that are set too low coupled with poor
collection. Financing has been largely through budgetary allocations and a limited access to
government controlled institutional finance. Urban areas would need to make large investments
to clear the huge backlog in expanding the provision of services while imnroving their quality.
Different estimates suggest that the quantum of required investment could be 3 to 10 times the
likely resource availability through traditional sources. Analysis m die India infrastructure
Report suggests that this level of investment is sustainable from a macro economic perspective “
though cities would need to tap market-based funds to achieve it. This has already started but
wider coverage v-dh -'-qmrn sharp Improvement in the creditworthiness of cities and in their
For exa.mple, Dinesh Mrhf» (1997) in his paper on ‘Urban Governance in India — Vision 2021’,
mfisrrorep *k«f k,r
1 tkvxr«11 krs QTtnr *70 21202 W**h 210X0 11122 2 21111102 p0Oplc. It Will be pCS21bl0 to
aSSCSS ulCSc dxfxCi'Mi^ cuialyScS Ox u’Ciids Ox ixiuoliiZatiOil Oiily ZLu€f tliC 2001 PopUl&uOxi CciiSuS uoul <Hc
available.
’
Based on Rational Institute ot Urban Affairs (1997) "Urbanization in India: Patterns and
Perspectives”, as Quoted in Asian Development Bank “India: Urban Sector Strategy”. 1996. p.3.
5
Rased on World Rank (1997) “India: Uihan Tnfrastnichire Services Review”, as quoted in Asian
r-Vo-.d----......
TT^nm
9
>00^ v 5
, ‘■--'“J
jZxpCi t Gx'Oup Oil COxxuixCiviaxiZauOii Ox LixidSulxCuxic Pi’OjcCiS (1997). ‘‘Tile xxxdiu IliuaSLX'uCuxx'e
Repon ", IvHnisiry of Finance, Government of India
5
cmwitv to hwow their expenditnre* efficientlv New possibilities of private sector iovestinents
in the lLl mCmI sector hove else, eii*crt,cd cuid veil! require improved Capacities to structure viable
transactions together wim a more predictable regulatory environment.
o
T’^rtMz^o .*M rOver tho
'^<vccidr* tv? th
increased ?hcrc
cuidiidiuig, jduiii
aic&, iiicfe ttab a decline m uiuati poverty noiii 38.2 percent in 1937-88 io
32.4 percent m 1993-94. During the same period, rural poverty declined only marginally irom
*O 1 to '3'7 ~ vtoeoonr '■
LTn'J'ox-or nrhnn n,v'OrTrr ir) T»V|-11O Jg loqc 'txr£»u p w rlpT-r
f-1 onmnorofl +q TTir°l
poverty. Constfamio Ou foinial acctoi employment liuve probably affected overall poverty
reduction adversely/ Besides income related poverty estimates, oilier man-income dimensions of
r»z»\/Mrix/ «« TMllw*lMrl ir»
fonznhoTiv> nrwir
fovynHIlCe OH SO'-’lttl ITsdlCHlOTS, ?Tld H lack of
opportunity xor die disadvantaged are also important1’1. These worsen vulnerability io disease and
the impact of tabor market iluctuations. domestic violence and natural disasters, such as flood.
eyelone or etsrfhquuket'. The'/ also result m im increased sense of mseeunly.
it;.
Hnorts at poverty' reduction are affected by inadequate urban services and worsening
urban environmental conditions. The noor arc much worse off in terms of access to a range of
urb™ services including housing, access tc water, sanitation and transport. They lack security of
tenure and die quality or dieu living exivxtomnem is poor. Then lack of spatial mobility also
affects their participation m the labor market. The participation of the poor in urban governance
i« minimal because iostitiitio.ns are unresponsive and the poor lack organization. In this record.
spCvia. tuiti'povcx ty pr. .pr.uiu ni m oan areas have oeeu very *ev*. A mle in recent years programs
have improved targering and their integration with improved iocai governance, their financial
sustainabihtv and sreater communitv control over them remain important concerns.
11.
Emerging Opportunities. Despite die poor performance of urban services in India, new
opportunities have emerged for the sector in the last few years. India's focus on decentralization
under the 74th Constitutional Amendment Act together with an emerging emphasis on improved
vv—rro
J
V. -x-
r»o«~» o*»*-
>xv-c
e» nafl " •« rv
r» **orv* r'**o*o'w ’**
o cao+or
xUi mw nv.fci*v ov^tur.
f"
cse^Urvx
factors include innovadons in private sector and community participation in service delivery and
new opportunities to mobilize investment resources from the financial markets. These changes
vtri-s-k o oynyx.,in.<? *n***reqt of* the Oovemment of Indi? ?nd some of the state governments m
dUUlCJSlug U1 L/Oli pOVcriy".
12.
m
While international assistance supports onlv a small proportion of investments in the sector
or<
ott»i-rvirr> ■fXv
rtnd access to successful experiences m other
"^3” sx2mj9c sss
1’
‘Oountry T*tmt-1 q*vc.-k I^.spcrt for Infirostmoture’, and DFID
(1999). IvCVxcW 01 PubxxC-Px'iVxuC-PttxuxcioxiipS ill Wdtcx' dxxd IZiiVxiOixxxiCixuix SciVxCCS xOx xiiditt , iiiiiiicO.
Oruciai information is based on consumption information of the National Sample Surveys (NSS)
and poverty estimates generated by the Planning Commission using the head-count index based on foodcacrgy method. The poverty line is based on a total household expenditure estimated as sufficient to
provide 2100 f.’«.!one« in "Than areas and some basic non-food items. (World Bank, 2000, ‘India: Policies to
Produce Po’.'ert'' end
For cXzuiiplc, Woild ocuik (2G0v, op. cil.) argues that “Growth hi the urbanized part of the economy
was iess signincantin reducing poverty across states, reflecting the capital intensive, import substituting
nature of India’s industrial development, its requirements for skilled rattier than unskilled labor, and labor
market regulations that limited the arowth of formal sector employment These factors limited the impact
of urban growth on labor demand and kept the proportion of urban population relatively small, so that its
prcpcrticnata impact was low.” This outlook howevar doss not match with ths high population growth
projections envisaged by many urban analysts during the nineties.
There is very iitiie systematic hiiorniation anti analysis on these aspects avaiiahie for urban areas.
6
Asttm Dcveluptnetit H.~.'.*.!< Elv Dapartment lor International Development (DFxD), United States
Agency lor mremanonai Development (USAID), the Japan Bank ior international C ooperation
(JBTCJ and the World Bank Groun.
13.
Trie nvnu Bank 3 Past Assistance.11 Bank operations in the urban sector in India started
twenty-five years ago. Since then, it has iinanced thirty projects with total commitments of over
US $ 3 billion. In the seventies and eighties, Bank projects focused on 'increasing the public
.and, sho.tox t*Ajd
sappr^,
, .ccs, and financing pac.<ugv.o con.>xotixxg c. olios and services, slim
upgrading, water supply and sanitation, and transportation of the poorer groups'. Waler supply
and sanitation projects 'sought to not onlv improve the level of urban services and shelter, but to
rko prolylprn<? of f>-FfirMg>r»r»y oy»rl effectiveness of ICSOIUC2 mobllizCtidL
olen
uiilizaiiou and streuguieniug of institutional frameworks'. During the nineties with growing
concern on me quality ana sustainability ol early projects me Bank's urban sector lending
declined
14.
In iviuicii-Aprii, zoom a review or the Bank’s assistance in die urban sector was carried out
as an mnut to a Country Assistance Evaluation (CAE) renew. It found the nerfcrmance ci most
,,T-koT, on<l >nk<m water or»rl conitfltion wpteefs xxroc ]esc than satisfactory and the project benefits
auu USSCio IxxxcuxOeu xavxivu iviig-tClUl ouSlaiuaOiiity.
xxic stuuy CXpiaiiied nils assessment as a
result o’ me complex namre ol projects in relation to local client capacities, lack of ownership of
reforms needed to make the projects sustainable, and chronic difficulties with land acouisition,
.ow
review pointed to important changes in the
Indian urban couiexi and emphasized Uiai lhe Bank's decreased involvement hi the urban sector
in India had led to missed opportunities.
ITC s sliulcgy lor uidiu gives priority Io private
LtiliJrl
rimtUilLtl 1 biiAfiidC
mfrasmicnire investments, including power and water distribution, telecom ana transport
facilities It has supported private investment in urban infra structure through its investments in
ILfrFS. which provides long-Term financing for private infrastructure investments, and in
Stmdaiaui Home, which provides housing finance.
• *5
IFC is considering investments in Indian companies that will sponsor infrastructure
projects, that will depend, on tlie presence ol a suitable regulatory framework, transparent
processes for selecting project sponsors, a business environment in which investors can take
reasonable risks and the availability of a high proportion of long-term local currency financing for
projects that have domestic currency revenues. IFC is working with IBRDfTDA to help states
improve Liicii regulatory environments. it supports ine uevelopment of fruanciai maiKeis that win
help improve the availability of long-term finance for private infrastructure projects and housing
finance. fr offer? partial credit guarantee? to mobilize local currencv financing from Indian
■C————- — 1
■■■* -4 .-.X^,
w
I IlilUIVAWl AAXjUVUUvrlu.
T»~ r* -3 rJIz-I
rax
.
Il I
1-r-r- «.<> n r>'T“r> Z^
+
r-T--r*S rx (■r-"Z\z>-»“' z-.-'^ + r’
Tr'z^’z'—'
XX <> Ute«D
vUVvlvuxLwv Ji>uy o*UU.
IUiu xAwavaaJ
counterparts to enable it io ouer iocai currency financing for infrastructure projects.
1—...
*7
Cndrif
<»•*»/>7
—7«z»/z>«*Mz»r»
.- .
c//yjz»z»<
’
.Ute.
at
<<><**> ^>ilrs,pol oponpiac
fy
besides UK-DFID (formerly
\
J
<uid UTvICDF have eiliexed me uibau bcejie m India relatively recently, uom izi ID ana
UMCEk nave iocused mainly on activities aimed at me direct reduction of poverty. DbLDs
recent projects esneciallv in Andhra Pradesh, seek to improve sustainability and replicability by
11
This ssoticn :z board largely cr. hfathor O.P. (2000) ‘India: Urban Sector Assistance Review1, a
study dene uuuugit support £t via OBD, World Bank, to be used as an input into the County Assistance
Bvaluauou.
7
1R
Th? focus of external financial assistance has mainly been on urban water supply and
SuiutatiOu , >> 8—>y Cuiun—>> >/. i i .g. Cf——xx i,nov» xBlGJ has oeenpa*riculatry active m this area.
USAID has sought to develop municipal credit and capacity building of local authorities. Over
the last five years. the Asian Development Bank (ADB) has developed its urban lending
operations by supporting statewide urban development projects and credit lines for housing and
urban imrasiruciuie duough domestic imaucial intermediaries.
19
lessors Learned The experience of earlier operations supported by the Bank and other
development pm uiero ouO.. o
sustaiuubxC development of Indra s cities will require changes m
policies that discourage mobilization of local resources (lor instance in certain cases if more local
revenues arc collected allocations from ccntrallv funded schemes fall). It will also rcouirc
itliontics
service
providers so dial they ruin'd dieri expanding role in the decentralization process. Even experience
with poverty-rargeted projects, such as on-site slum improvements, show that they cannot be
expanded unless they are part of a wider city-level attempt at reform with an emphasis on urban
management and revenue improvements. Conversely, city-level reforms cannot be sustained
without the involvement or a range oi stakeholders, including community based organizations
and NGOs. This has been difficult to achieve in practice at anv significant scale though several
pilot projects hsve sHown potential. An important lesson emerging from these experiences is thst
elected xepieseiit&tives need to be involved Hom the outset.
20.
State level integrated projects have focused on promoting better urban management and
supporting investments in a large member of towns. Experience suggests such investment should
be driven by demand and participating towns should ’ seii-select" based on criteria that combine
their perionnance record with commitment to further reforms. Witfam these projects, an explicit
f<v_’’is on ■n<.'v*friv reduction need*5 to he combined with measures related (o unnrove urban
HltxucigvUiviiu cuiu Citj iCVCi iHiidouuCiuiC.
2 J.
Third it has become, quite evident that external aid flows and even the much larger flows
ci ircns*'‘r'*'£
sinres ,'hncmc^ to local
entrnot tdpdt The* huge need to
expand service coverage and meet the investment backlog of India's cities. These flows and the
reforms they support have to be designed to help cities and service providers mobilize local
resources effectively. They must improve access to commercial sources of finance, such as
lending by domestic banks, the capital markets and private equity tor revenue-earning projects. I,
was this recognition that lead to a generation of financial intermediary loans funded or advised in
particular bv the ADB. USAID and the World Bank in partnershin with domestic financial
institutions. The loans were meant to create a flow of funds with longer tenors, encourage self
selection by local borrowers who were interested m building a credit record and able io borrow ai
market terms, and improve the urban sector’s recognition and credibility among the financial
sector community. Early experience with urban credit lines in India suggests that the bottleneck
xO. sector dev clopmcn. is a dearth of bankable projects and xocal entities, cv cn n.ore than th— ImCa
of long-dated domestic debt resources.
22.
the overarching goal of the proposed urban strategy is to reduce poverty, this requires a
two-pronged approach, combining indirect measures aimed at overall economic development and
oppo* ..only
better pcrfoiuimg cities, end direct approaches to reduce pov ci ty by
itiipioviiig access io services, contributing io empowerment of die poor and reducing their
vulnerability. In turn, these two broad goals can be supported by three focus areas, as shown in
Figure '' support the decentralizalion process, strengthen urban governance and management,
and improve resource mobilization and Creditworthiness to help boost the pace of investment m
the sector.
8
Focus Areas for Urban Poverty Reduction
Figure 1:
bKnAii EOVeRI x REDUCTION
I Urban Poverty Reduction Strategies at State and Local Level I
ENHANCED ROLE OF
CITIES rv ECONOMIC
1
POVERTY TARGETED
1
APPROACHES
1
1
1
o
1
Cities that are:
Livable * Competitive
* Bankable
* Weil Governed and
Managed
o
I
1
1
1
®
i
Community based
Finance Svstcm
Scaling up of Slum
Programs
Reduce vulnerability
of the poor
1
1
|
j
j
1______________________________ 1
vA'acccl
■■■■■■
y.y.y.-.yyy.y
V
DECENTRALIZATION
t------------------------------------------------------------1
I URBAN GOVERNANCE I____________________
urban services
Fiscal
rerrormance
Linked Transfers
~v[A (?LVT\<yyxyrr
*
I
SYSTEMS
I
I
®
Unbundling
I
I
•
Municipal Services
Private Sector
I
•
I
I
I
I
I
I
I
I
I
I
I
I
I
I
a
development
Participation
*
a
Good
Muaicipal/Ulility
Practices
Enabling l and and
• ~
i
Housing Markets to
Work
Participation and
Role of Civil
Society
I
Proved
°
I
I
j
technical
assistance
Removing
information
constraints
*
Credit
enhancement
®
•
Terms
transformation
Community'
based finance
systems
23.
Enhanced Role ofCities in Economic Development. With economic liberalization and a
more open economy, states must compete to attract investments. As a result, it is vital that if
cities arc io achieve broad based growth of employment, incomes and investment they must
possess an enabling framework that permits firms and individuals to become more productive. In
competitive cities, output, investment, employment and trade will respond to market opportunities
9
3vi;.ainit'*lh- To be competitive. citie« need to be supported through appropriate forms of
decentralizatiOAi, improved governance, management and sustainable access to finance for urban
unrastrucrure. Measures in these three, strategic focus areas are discussed later. These will help
promote higher economic growth in cities together with more job opportunities. The link
between economic development and poverty’ reduction will require a better understanding of the
nature vi uiviiii economic grow in anti its likely impact on urban poverty J“
?“
Po'wfy Targeted Approaches. Along with these indirect measures aimed at poverty reduction
across the board through economic development, it will be necessary to target poverty directly to help
vulnerable groups participate in the urban economy. First, would be required measures directed at
empowerment and inclusiveness. These include more inclusive governance: the development of and
strenethening of cowmen:"’ based organisations of the poor; enhancing concerns about poverty’ in
government programs and in uie design or public-pnvaie partnerships; improved planning rules and
regulations to incorporate the needs of the poor in housing, land development and delivery of
services: and scaling no slum up gradation programs. Second, securitv for the poor would need, to be
enhanced uuougu sux,^mub«c access to eredi* aud insurance, greater attention to environmental risks
that uuect die poor disproportionately; and measures lo reduce asset poverty especially improvements
in the security ofland tenure for the noor‘J.
Z.J.
rx CaauCUa xSSuC ah iiiGi'Casillg die cftCCiivciicSS of vliiCCt iilCcfSuicS ttgaiiiSi pOVci’ty IS
appropriate targeting ol tne urban poor, lhe practice of using residence in ‘slum settlements’ as
evidence of poverty need s to be reviewed especia lly as many upgraded slums should now be de
notified. This requires urban local authorities to re-define slum settlements and to develop a good
data base on low-income settlements. The experience 01 urban poverty alleviation programs in
Kerala, which utilized more participatory methods involving a number of economic and non
economic criteria, needs to he assessed, for its possible relevance.
26.
Urban Poverty Reduction Strategies (UPRSr). Ar the state and the city levels, urban
poverty reduction strategies will be developed to frame urban sector projects and city
development strategics. The UPBS will be developed through a consultative process
incorporating a diagnostic or urban poverty, an analysis of existing poverty reduction programs,
and a review of relevant national and international experience. Poverty’ reduction requires
attention to the broader context of economic development. A.t the same time attention within the
sector slromd concentrate on ensuring tnat urban instifuuons and programs become mcreasmgxy
pro-poor and that necessary sociai institutions are supported and strengthened to empower the
urban poor. This applies to the local governments and their service organizations, as well as new
A.
Supporting the Decentralization Process
27.
The 74th Constitutional Amendment Act has provided the political, administrative and
fiscal basis for decentralization in India. It has given a constitutional status for the third tier of
government, and in principle sought functional and fiscal devolution to local governments. In
tKo
powers
to
^3^3
municipal lunciioiis <mu services icuidiiis partial. Experience across states nas ocen mixed m bus
respect ana needs to be assessed.
o
28.
Dcvofato;: of Urban Services. In tiro years following independence, there was erosion in
die powers and luuctionai responsibilities oi local authorities. Siaie-levei and federal agencies
S22 for exozspls ths nrguinstit presented in footnote 9 above.
Tciiurc issues are complex and will often require strong local political support, besides good
information base.
10
**
nmor:«mc
AVXkU uwuavi XtXVC.
ftiTvance
Hiough »nev oftei) too* responsibilities away noin
X U1O Uuc xCv* kV» U.I»A1X1 exited xCopOi'idlC'ilitlcJ xol Uxbail
t.
11±& Sxxtaegj
envisages, m line wins me spirit oi me /^m Constininonai Amendment Act, to help interested
states reinforce the accountabilitv of agencies involved in local development to elected local
representatives. This would require governance reforms and possibly restructuring of agencies
such as tire siaie water auu sewerage ovarus auu iauu development authorities, as welt as a
comprehensive review ot the municipal legislation in most states. ‘1 Devolution to the municipal
tier of ooyonwveD.t should not imnlv abureaucratic “munioipalirafion** Ln wind), the elected
oozpoz^xioii zets involved v»A*xi mv vfpoxotion of services pcrfomicd by locei civil servants* At u_iO
municipal level a dear separation between the policy and regulatory functions of the municipal
hodv and rhe responsibility of service providers will need to be evolved.10. Urban reforms will
otco art t.-v address now service providers can be kept accoimic.ble while
their
managerial autonomy and reducing political interference in day-to-day operations, staffing and
the setting of service tanri's.
29.
The devolution of urban sei vices would have to structured within a larger process of
decentralization reiorms and will include the transfer of functions and staff to appropriate levels
of government10 Some functions. such as regulation of service monopolies, could be performed
more effectively at the state level, while agencies at the central level would be best placed to
support comparative (yardstick) competition by collecting and publisliing performance
benchmarks across cities and states. State governments need to provide leadership to encourage
melrow'1n«n develimmwU. and slremzlhen Melronohlan Planning Commillees (MPCs)J7 During
die ucxOxuuon prcccso, stale go vcxxixxiciilo will have lo Help mumcipanlics and elected
representatives develop rhe capability to discharge their expanded role, it wilt also have to define
and monitor rales and processes that foster transparenev and accountabilitv in urban management
x'ri'uux Deceruz uxiauiiovi. Most states have set up Suite Tmance Vxommrssions (SFCs) oy
now thounh their performance has been uneven and their reports show inadequate rigor. Many
jv.
vlwip t;nvMTTimpnlw Kvjy/M 'JIVPri
‘imryw-lMryjp In (blS ?rnpoHl!r?(
C'AVZJV. MfcVXkXXVXVSXl IVXMkV SVZ IVlCu'dC wriu CXjZWXXVXlklxTe yXtllxV iiGJjvijly
.
TsSUtfS ibttl TtXJUll
VxCjiu^XX 14X1 <Z
impiementarion of incentive based intergovernmental transfers and evoiving a framework of sub
national borrowine. The link between the allocation of functional responsibilities to local
tIaCS'V OVQrO<CO flT-lll
lacks definition. This lack of clarity needs to
be addressed to create a hard budget constraint for local governments. For local governments to
plan their tmancial commitments in a multi-year view and become creditworthy there is also the
need to create sufficient predictability in transfer rules. RFCs in the first round of decentralization
reforms have decided not to assign any new revenue bases to local authorities though some
rationalization of existing taxes was attempted. More importantly, despite lip service to the need
for improved local revenue performance in most SFC reports not much attention has been paid to
this in practice. As a second round of SFCs are now being set up in most states it is on opportune
lime to ensure a better match betw een functional and financial assignments and a to design a
more predictable system for inter governmental transfers and a framework of rules for municipal
14
Only the state sovemment of Tamilnadu has undertaken such an overall review and reform of its
municipal legislation. The stale government of Punjab has also reviewed (lie legislation but has not
44
Also, refer to paragraphs 32 and 33 for further discussion on this.
''
Some of the states in the country that have set an ambitious decentralization agenda including such
reforms are Karnataka, Kerala and Maharashtra It is likely, however, that these reforms have focused more
in rural institutions. An assessment of then experiences, especially with respect to urban sector needs to be
made.
17
This is essential as in the coming decade a large proportion of urban population is expected to reside
ui moan agglomerations with a population of a niiliioii plus. Murnbai lias taken lead oy appointing several
independent members in iis IvIrC drawn uom NGOs, business and finance sectors.
11
borrowino In thp cnse of both transfers aud borrowings, it would be imnortant to design
iiiccutivcs for improved porforiuoiioc at tlie local level. Uoxl below illustrates some of the early'
fiscal deceniriuizafion experiences in inaia.
I
I
I
i The 74th C'urnsiiunion Amendment Act (CAA) vests responsibility for usual aspects of decentralization
I with the state legislatures, guided by recommendations of State Finance Commissions (SFCs). The first
I SFCs were appointed in 1994. The recommendations of most SFCs have been accented bv state
I legislatures though they have not always been implemented. The experience in fiscal decentralization
fVx*"
'
I
I
I
I
I
I
I
1
I
I
I
I
Expenditure responsibilities: I he Twelfth Schedule of the CAA suggests functions for devolution
to urban local bodies (ULBs). though these powers are with State governments to be assigned
through municipal legislation. The actual assignment of functions has varied in different states and
x^as KAwpOaidcd ZmSC g*i past ixis4tutiuiiuat xcgacics. Staxc agencies continue tc play sn important role
for civic functions such as "land development and water. Therefore, changes in responsibilities for
expenditure will require significant institutional reform. Even in a state like Kerala, where
administrative decentralization has been attempted, management, of water remains with a state level
authority’’.
iiSSigiuiidili'.
x.xOst
xxosl
Sx Co xCCvxxxxxxCaUCa vUxiuxxixulxOxx Wxlxi jdjiiC IxxXCo uxid IxO IxCVV
I
I
I
I
taxes were assigned to ULBs. as a result, the ULB's lack an appropriate match between
expenditure and revenue assignments and they are also constrained by inadequate information.
Recommendations of several SFCs to improve the revenue collection, accounting and financial
I
I
I
I
I
Xx-cut^'/l v/o’u.i.jb' jj-ja/a. xfevOxxxxilvxalauOaS xCguxdllig tliC vXlcixl txxxd Syslxlxxx of IxluxSwT to be
iI
i
I
I
I
I
I
I
I
i
I
I
I
I
nn*r»ajs *"
Bc ^'*,**<s ^OthsS*^
n rig
■ «^sr,ej+ F?",01-,
made by die SFCs have varied uom uansieis juroui a general pool as in Karnataka and Taniiinadu,
to transters linked to specific taxes in Kerala. Share of ULBs in total local transfers has been
around 15 percent as in Kerala. Karnataka and AP. with exceptions such as UP (70 percent).
Tamilnadn introduced performance-linked transfers, though the share ofUT.Rs has been lower at 8
tiarx •>!
.vtprnnnA io 1
ilOC
^yStdHS
uuou GvG£i vuiiouauivu vj u. tixvA Ui ixGvqUuxV uixOl'HiaxlOxx.
Sub-nuiiunui burrowing: in the past, most urban iimasiruciure was financed through budgetary
allocations, leading to considerable inefficiency and little regard tor financial viability. This was
aggravated bv debt write offbv some of the SFCs as in UP. The increasing potential of commercial
borrowing for urban infrastructure, directly th rough the market or commercial financial
informed? snes, requires n rvi? bssed
framework thst would pppiy to fdl municipal authorities
v»iiG Wulii. tv LvxxOVv On COxxxxxxeiCxixl U
l xxxxS
tO UliSUTC liHtuiCially viability cuid IxxxxxxxxiiZe uxC xxoK Ox
defaults. Wiui considerable market interest in the sector, it is necessary to ensure that ULBs do not
’shop around' tor a lender with weaker conditionality.
I The national Eleventh Finance Commission (EFC) has placed emphasis on improving finances of local
I nuthontics. In most ststos, the second SP^?s
also now in place. Their mandate includes addressing
I
these issues. Special focus, as also highlighted by reconixiicxidalioxis of tlie Lieven Ih Finance
I
I Commission, is required on improving resour ce base of ULBs, wider use of user char ges, str engthened
I accounting ana auditing systems, design of transfer system and a framework for local borrowing. Wniie
suggesting transfer designs, second SFCs will need to address issues of autonomy, equity, predictability
I and simplicity, while ensuring local incentives for improved performance.
I
3.
juuipi'OVcd Ui'baii GuVci’UftiiCc aiid iVlaiinjiCiueiii
31.
Good urban governance, is the. key to providing incentives for improvements in urban service
delivery. It focuses on inclusive planning and management, accountability and transparency, and
12
ensurino security for citizens. especially the urban poor and disadvantaged. A number of different
areas vital for good governance are identified below. llieir introduction and linked institutional
rransformarion necessitates continued service or professional urban managers. This requires
attention at the state and at times, national level as it may entail changes in recruitment rules and
policies. Therefore, it will need to be integrated with macro reforms.
32.
Unbundling Municipal Services. Evolving appropriate institutional arrangements through
suitable unbundling of municipal services is die key starting point for any wider reform orocess to
achieve aeooUxfatbilf. ExLAotiirg arrangements do no, disdiguisu adequately between politically
mandated service standards and the need to define the necessity for autonomy and accountability for
optimum operational performance. Tn the case of urban water management institutional reforms arc
noooccorx r Vr> warf'Mr cjonoroilraf
'ommcrci?.!
2nd dsy-to-dsy ^2^2^2^222^ fron?
inappropriate political micrierence. While a political mandate will be important in determining the
service levels ana coverage, responsibility for efficient operational performance would shift to a
corporate entity It will employ necessary professional staff and could serve one larse municipalitv.
rats
several local tueus. inis may lequue smaller municipalities to use pooling aiiangements ana
coordinate with other munictnalines. Unbundling to introduce competition and achieve greater
con.ano arfinronrur nrtll nlcr* no rolpv^JTlt foT TP.^.Hy OfllCT JHUUlcipsl °?TViC‘?S BOX ? 1?C^OW
ovaHC I vveiit ixud illiiO vduVC Way S Ox
Solid W&dtc lii Uibdll CCiliClS. C&Icful plcLiiiUilg &t ulC
municipal level to identity such services and to introduce appropriate measures tor contracting or
outsourcing through private, sector NGOs or community groups would be necessary.
I
Box 2;
Unbundling Municipal Services - Solid Waste Management
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1 Horizontal and vertical unbundling ot services to improve service efficiencies and competition is critical
I for initiating institutional reforms in municioal services. The one municipal service where this has been
I attempted in several Indian cities is solid waste management. Many forms have been tried, with vertical
j unbundling across: i) primary collection, often with residents’ associations or NGOs, ii) secondary
1 ccucctiun and tiansportauon, ofteu ccntraclcd out to private sector, through service contracts, arid in)
| sanitaiy disposal of garbage, largely iluougli concessions to private firms (with over 50 such deals
| completed or under preparation across the country).
I
I ytimicipa! Corporation of Hyderabad (MCH) has evolved a system of unit-based service contracts for
■ Secondary collection and a<~>:i.»poitanon, wlaeli icsponoe innovatively to the suite.vide, xieeze on
| additional recruitment. Day arid night units, in terms ot localities, are tiefineu to ensure small anti viable
| contracts. The Corporation has contracted out about 60 percent of the total municipal area through the
I units. which has imnroved collection efficiency to over 92 percent Within this component, horizontal
I ....t..... 41... ,. • <,
nnr
b — qI-Iq CO^tT— **Vo T- — — —
+„ nnmibn
«<*11
Q—»
HoO
i uitioduCeu a sciiciiic tu ptuViuc uiccimVos foi paiLicipatiOii uy residents associations and NGOs.
i
I Concession contracts tor disposal in several cities have largely focused on compost-based systems,
I thoudi seme recent cases use new technology for electricity' generation. These contracts are now being
! Iwt LMnniwtifivnlv with private sector (eking fell investment responsibilities arid appropriate risk
I .11....... c.mi,41,->r. i..,
imp—ovc crirvz s^rv’ces t-*1 m-twri-i ?fy some new
I vvUu'acui riov* exp>uru LuUulmg across secondary collection, transport arid disposal, as new private sector
I capability and interest emerge. In Tamiinatiu, horizontal bundling across small towns is being tried to
| establish a viable regional waste management facility. There is a need to ieam from varied experiences
I across cities in India, identify lessons for further imnrovements and develop industry' benchmarks.
I
'
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j There is a need to learn from varied experiences across cities in India, identify lessens for further
I improv ernon<s armueveiup industry ucndimarks.
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-
x -4» if. cputcOr I. sj'l CmICZ 0x001x11lability villi alSO he OvixlvV vd tllTOUgh pi"1 » UiC
sector participation (PSP) in delivery or urban services. If the introduction of PSP is well
dcsisncd. it can be a means io introduce competition, to clarify- contracts and delineate roles bv
placing regulatory and policy functions at arms length from the provision of services. The
ptmiai v objective oi PSP is io provide iixceniives for performance and operational autonomy in
management, it is likely that the extent and nature of PSP will vary' across sub-sectors and even
within unbundled component' For example, collection, transportation and disposal for solid
i > cu,provide
.... opportumi.Co xoz x ST, **mg*r*g ftOm jvxii*ilp.v out vice contracts icndcxcd
lor a limited number of years in solid waste collection and street cleaning, to a long term BOT or
nrivatc ownershin of a landfill. For water, the potential for PSP is high, but as discussed in a
note for UWSS each city should define specific arrangements that recognize
iu> initial constraints and best serve its objectives. Given the sector’s monopoly features, the
development or a regulatory framework that ensures tariff decisions are made with a greater
degree of independence from short-term politics is an essential requirement for significant private
involvement in water. "'Pro-poor” water PSP transactions and regulatory practices will need to bo
designed, with early consultation of communities, to ensure dial the urban poor benefit Horn the
efficiencies gamed in operating water utilities commercially. The important role of small-scale
independent providers {commimi^-^'n^ed or ^rnull private enterprises) m extending urban
services io die poor should be icco^iiized and levelaged as an iiite^iui pal i o± pro-poor utility
relorm designs.
.54.
( -rood Municipal / (juiuy Practices. Horn tor core services managed directly by the
mumcinal aulhoritv and for services that are unbundled or contracted out some nrmcinles of
pqv
(poop
din
teF
some xwal rmuauves iw iiiuvuuce stivu practices. liie fouovvmg types ox reforms, ouildmg upon
recent development in a number of Indian cities, should be supported hy Bank operations m the
sector-
•
improved Financial Management and Planning: to build capacity to manage their
finances through imoroved revenue, generation and collection performance, financial
„i—":"£ expenditure management, capital investment planning and budgeting within
local financial capacity, predictable processes for setting user charges at cost-covering
levels while designing targeted programs lor the neediest, effective expenditure controls.
and accounting, auditing and procurement reforms;
o
Consumer Orientation and Public Disclosure: procedures for providing adequate
information to customers (related to service levels, new plans, costs and subsidies in
service provision j, ,o consult taCni on new plans through public x.earmge, a custom .or
effective l etlxessal of consumer grievances and assessment of operational performance
and its public reporting with tools such as: development of citizens’ charters for local
services, rmblicahon of annual subsidies and annual environmental status reports and
pCHOwiG use vl ICpOIt CUIUS j
a
Participatory and Consultative Governance: approaches to enable participation of
different civic groups, women, community based organizations, organizations of the poor
and vulnerable and IvGOs in planning, budgeting and oversighvmomtormg at community
and citv levels.
14
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Zhm o.
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ovt/u sfLumcipal Practices — So/tic LocalInitiatives
A number oi local initiatives demonstrate the nature of improvements in municipal practices
undertaken throuch initiatives by civil society or municipal / state governments:
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uuiuwi Gx .tv-v/ o inw. uiv> . ixGixG x kxxixxxo CvxxlxC, xJtcxxxgixlGx v <xiC Lioxxxg
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and monitor public opinion regaining me delivery of urban services, The parameters used
include: consumer saustaction, extent and coverage of services, costs faced by consumers, and
aricvancc rcdrcssal by service provider. They use various methods includins: household
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Rcpcrt Carizfar Urban Sarricas: In cities such as Bangalore. Pune, Ahmedabad and Delhi a
xvpGFt vixado
lG viiuibixoix
<iuvey<; focus; group discussions. case studies, information from and interviews with service
"^hese
^*gh r'z',3fs linked to
sueges^ d’^^aiisfecticn among consumers
oCvkzoouig six Vices uivxuuuig
speed inouey . GuiiCi’dliy, tlie poor have fared worse and
consumers spend very targe amounts on coping with service inefficiencies and unreliability.
These studies also point to many simple and inexpensive measures for service improvements.
JImproved accounting is crucial to support better nlannina
and ensure government accountability to citizens through improved public reporting.
<jG
v vxixxxxvxxx Ux x axixxixiixUG xxixo blui xvd <x SuxleVVxdc ilxiUixtlvC xGI iiCCxU<il based aCCUtuxtiiig xGi all
uibaxi local bodies, supported by a state level accounting code and manual, preparation of
software, capacity building support to ail ULBs with hardware support and annual awards for
good performance. The Bank’s Tamilnadu Urban Development Project and USAID FIRE
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provided support for review of the now state Accounting Code. Several other states, including
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Annual Reports on Status of Environment and Subsidies' Amendments following the 74“
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project have supported this state initiative The Indian Chartered Accountants Institute has
a x ix xxixLuvu
ujixd XldlicuuoxiUu. IxiivC iiloG xxxitidlcd oliiii lar efforts.
CAA in Maharashtra nrovide for mandatory Drenaration of annual reports on status of
environment and subsidies in services. The renort on the status of the environment discloses to
aomevad during tf.e year. limo Narnioipul Corporation prepared tire first such report in ’557 and
several cities now prepare annual reports. The Report on Subsidies is to assess subsidies in
municipal services, identity their sources and the benefits different groups receive. Thane
Municinal Corporation has started preparation of such a report with assistance from the
USAID’s FIRE project. The state government has also initiated work with all municipalities in
t‘na Mora
Cnon rannrro will
nryyrny/imriyrp
yy or-fzyv-yp nrify a
fyiitna th? pOlltlCS.!
ivyi vooiiuru v vo xix uxvxx uvvioiuub, ixxVxtivMxxg GxjUgvu UixOCixuOxx, xXixG. pxGvxUG d. uixov xUx XUllxxC
ittsuuutuiiug oi subsidies.
Advanced Locality Management (ALMs) in Mumbai. Citizens’ initiatives supported by the
Municipal Corporation of Greater Mumbai have introduced community based local self... .
+t,.^.j«l. .iif. ATT. X. CpmiTllttCCS orr.
+<.
n Apr tho lonr 1 *1;*
...... rMUcamOu ,.m...c.pal offiCvio will. an emphasis oi. so.id waste mai.a^ei.iei.., local
loads and par ks. Tile municipal authority has assigned special officers to attend to die ALM
issues, ensure tirssemmanon of information coordination witn municipal aiirhoriry and
incorporated clear guidelines with time benchmarks for grievance redressal. Earlier efforts on
similar lines have also been made in Pune (Express Group of Citizens) and Bangalore
(‘Swabhiman Movement’). Over 600 ALMs, with about 50 in slum areas, have been set up in
l.fun.uai o * er d.e
gear's.
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15
35.
Land and Housing .Markets to Work. An important aspect of urban management
is to support weii tuncnomng land and housing markets. In India, while There has been
considerable debate in this regard action has been woefully lacking. I,and use regulations, titling
™d permitting remain one cf the least transparent end ineffective areas of urban management.
Red tape is still pervasive auu leni-seeKing practices adversely impact the poor, as most or them
lack land tenure. Urban busmesses, housing markets and the development of mortgage imance
are also affected. The strategy will help reform-oriented states and cities build the capability and
t.—.. ...atm., sy ...... x»x
..gsnuuvu ttuu iA,uttg. .. »* xll oCck to help them practice imogruicd
planning or iand and infrastructure development and review building rules, regulations and codes
(with a view to making the regulations less arcane, more transparent and better enforced
ocrsoorollt r
It would mcdco possible ths reduction of*
pivkcutuax uciaya, uic liuxiLui^ vi uiaci c uouaiy auuiuniy and uie suiiphiiGaiiun and acceleration
oi procedures lor tenure regularization including de-notitication. 1 hat would enable them to
reoularire tenure in ungraded slums It would also allow improved access to housing finance.
Cspo„Ai,xA, xvx ...c
xxC..,. l»uw juuutK/<m^tion is c,»o0 vita, ,o impxOvC ,,>c CxxOCu'*, cncoS o* die
local piopeity tax uuti occupaucy or propel ly-based service charges.
Pwrrfcfppffott
ofCivil Socf^fi'. Improved governance includes systems and
processes that provide * space’ and a ‘voice ior civil society, which includes representation of the
poor ana arsadvantagea. Such participation should take place at different levels from the ground
level with the conmuinitv to consultations on policy so its rationale, is widely understood.
Informed dialogue will lead to greater ownership of any changes that are being introduced. In
lids context, it is also necessary io review the provisions and actual experience of ward
committees, under the 74“ Constitutional Amendment Act m different states. The effectiveness of
govemmenl-promoled community structures under the poverty targeted schemes of Government
cl .irdij, and in several suites such us Ammra Pradesh arm xverala win need to be assessed.
C.
Improving Resource Mobilization and Financing
37.
An important focus area in die operational strategy is to boost investment by developing
appropriate financing arrangements for urban infrastructure. Indian cities have so far depended
mneth- on grants a>jd soft loans from state and central governments and to a much smaller extent
on external aid Hows. These have financed their investments in service expansion and capital
improvements, i he india infrastructure Report shows that these sources can meet only meet a
fraction of the needs of cities with their huge service gaps and rapidly increasing demand. Some
interesting local projects have and can be advanced with those traditional sources. However,
expanding services will require die dcvelopmeui 01 larger and more predictable municipal cash
flows. These m turn will need to be used to leverage commercial sources of debt and private
pniiitv A nre-condltinn to this hapnejiing is that local governments, utilities and projects need to
1-.-.-..—— „ I->
A
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- r- -—— — I
“mL*
XZWW'AXAW ‘----- -a'X 11VJ WAVzW v/x UV*|/|XV* X AVI taarO 1O 1U1|Z1VA11V11W«MVX1 VZA. j£/X WJ^ZX-'I. VJr
—m
* VAVllll
Box 4 hereafter (page i 7) refers io some recent experiences and shows rather uneven progress in
this kev area.
38.
India has a high private savings rate and a relatively developed Imaucial sector. It may not
need specialized channels such as Municipal Development bunds (MDbj or a Specialized
Financial Intermediary (SFT) that have focused only on financing of urban or municipal
m tvasL. acruxc and Hav a been used ywith xixxxitcd success ovcmlly m othc, devOxcpxxxg ecunlixCo
liiai have weaker financial systems. Ramer, the challenge is io improve the creditworthiness of
cities and infrastructure projects so that Indian financial markets take a responsible interest in the
18
A MDF giaiieially focuses on improving efficiency of resource transfers from higher levels of
government, and a SFI helps build a credit culture on commercial terms among iocai governments.
16
sector rbotb in loos’ government debt and in financing private concession? for local services).
Dealing v.'itli real '.'.Oild creditors would provide local governments with added incentives for
"rarmg-dnven imanciai discipline and disclosure.
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Box 4: Implementing Property Tax Reforms
the ccmam of docontrolization there needs to be a correspondence bettreen expenditure
i Within
assignment and local resources, 111 this context, property tax is a key local tax source. Despite its
I potential, property tax in most Indian cities has not been abie to nioniiize significant resources nor
I has it been a buoyant tax. Most state statutes have been affected adversely by factors related to
I definition of their tax base, its linkage to the provisions of Rent Control statutes and a large
I number of exemptions available to different properties and lax payers. The main issues are a need
i to: a) de-link the tax base fircm provisions of the Rent Control statutes to ensure tax buoyancy; b)
I
I develop an appropriate definition of tax base (capital or rental value) to avoid ambiguity and
I create a link with market prices, c) ensure periodic updating of the tax base to ensure buoyancy; d)
I rationalize and remove unnecessary or inappropriate exemptions; e) standardize the rent/vaiue
I assessment to ensure simplicity, rationality and transparency; f) ensure effective and efficient
I collection; and u) identifv mw’roT.’nale stale level si’i.’uort for valuation.
I
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I xii iwaiii yams, properly cax iciorms nave been introduced by: a^ city authorities xlne in Patna
simplifying the basis of tax assessment and in ivnrzapur and Mysore improving lax assessment
i and collection practices; b) the Government of India through issuing guidelines to states for
I propertv tax. and cl several states, including Tamilnadu. Gujarat and Uttar Pradesh through
i
introducing new provisions in their statutes. Tamilnadu and Gujarat governments have passed
l/.'v.-.U*.
c rl.x. Ml* ^Q2S
-ao*,o
Vi
At uiivCu'v uJ ACj pi’QpClty CiiajautCiiouCo iCdViiig ulC dCtiiai UiX IcVcl tO ufi oCCiQCd by diC
Ltuiii<jiiuet> within mange specified by ute state government. Limited information avaiiabie
iI ioviu
on impact or these measures suggests that m Tamilnadu, property tax collection has increased by
I over 60 oercent Tamilnadu is also exocrine use of information technology such as GIS mapping.
i y/nwh w’H
*—ox
eiiiiv.nw verP.'rT’.’.^j’ce of (?.*. adTiimwlration svstems. To enhance efGcieiiev and
r vvs
r rnv rtrnronnzniwit nntlovnl ctnt/v.
minh
T 1 L> ria-irl T/’
I uiuvxiUvtiu mium o^if uobtioomCilu
The Eleventh Finance Commission has recommended more emphasis on "property and land based
taxes’ for local resource mobilization. To achieve this, propertv tax reforms in India need to be
assessed in terms of: legal framework for property tax (tax base and exemptions), development
OxglxxlxZaxlOxx oxxd xxxuxxagCxixexxx vapaUlly fill pxUpCx ry llxX lx.dxilxxxislralfoxx (vixlxi local laid stale
authorities).
Urban sector projects can be developed within “project finance”, “corporate (or utility)
framework. In the two first types of projects, the
sccuiiiy of lenders and sponsors is Imkcd to project viability or at least to the viability or die
specialized utility or concession by which the project is built and operated, t his approach is
relevant mainly for revenue-earning sectors like- water, even though similarly structured financing
arrangements can also be considered in tax-funded sendees (e.g. a transport investment with a
shadow ion, or a landfill BOT with user charges collected by the local government as a
component of local taxation). These projects / utilities can also mobilize private equity as part of
39.
lbeir 1’Pvrtcmg structure. An important concern m developing these types of projects is to ensure
axil. Axlaxx xxxxdx.xx_y xxlg * .ability IS aOixjuu. Il la xxllpOxlam mill 1x11 Viable p£O;CClS lire HOI Uxashcd by
explicit or implicit contingent liabilities accepted by higher tiers or government, in the- second
type of local government projects general municipal revenues are pledged for debt service. To be
xxffi’vnt.iro ex
rccpiircs 2
assessment offurore niumoipel revenues, thpir
17
hnovspcv »nd risk®
or ‘'oti-discrerioiwrv expenditure®. a sound approved multi vear
VVpA.UA Ml . CSUUV 11, pAlA/A C/llM
.V SvVUA llV L,i 11, i l M,Ci i 1C11 VI . 1 11 Cy S/aVIaIl. 110 . Cliipi.llMi Oil 1A
blanket stare government guarantee and like those developed on a project finance basis should be
based on sound underline credits.
ill icvcin veils. a riumOei vl lilltUlvltU HIS 11 lullOlio 41111 Commercial viillKS ill UlUia nave
shown interest in financing urban infrastructure. However, three constraints have inhibited this
tv.
co far’
first, on me demand side, there have been lew bankable investment opportunities often
because the irnderlvine cash flows were too weak or too unpredictable (a result of low
A„_2aaL z,^ lzrjvz.1 — ZTT
—V ZT
,AT oe3 4z-.~-.-df <*<,«* ' •*
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zvl Z,*TT- ®-**TZ Z. *, J -£• T •» p *T Z» TA r> 1 ZT fl T AV. TA-S fW> «•
, t, . - . .-1 wa akzwma - v • --- » ■----r-.-j jz viz.zvzZiVU
AUi'Ovitzzlw,) Luuvxv*-. UaO, UXaU 1UUV U.VUv.1 fcrj O.j. tltl Ci-l 4,
hui enable umuiuiai huurinaiivn including poui financial accounting, auditing and
disclosure and a lack oi clantv on institutional roles).
«
Second, mosi urban auihoriiies lack commercial credit histories and recognition by the
market as viable entities while tnerr experience m using a stream of future revenues
("rather than tangible assets) as loan or bond collateral is limited
•
And third, the short tenor or most iocai debt inhibits its relevance tor infrastructure.
41.
By foe using on these specific constraints, rather than helping set up or finance ad-hoc
instruments such as MDF or SF1 the strategy will aim to help “crowding in” the emerging
interest of the FIs and commercial / coo'rerative banks in the sector.
42.
Among the above three constraints, the first (lack of bankable projects and borrowers) is
clearlv the most important. Even the best-developed capital markets w’ould be of little help to a
orilir.' ZX«* z» 1z-.z-.zv1
COSaX
rnrTAtcTMf rL.z-.r- 1z.z-.1zz- z. «-z»1 £X1VO aV
Vi’IIaCIi 1* Cfc*H
bvuow. Tins is die situation mat almost every city and water uuiity m inuia races wiiii ine
(unfortunate) exception of some cities that soil levy octroi. Therefore, the strategy will iocus
mainly nn the credit demand side and help reforming cities improve their revenue streams and
z:______ .U..1________ ______________ *
, II.IM V ,,., . ■
, .4
Tx —111
K-r-M *1--f'l —
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Xfc » • AAA X1XZ4 ■'(/<■.• AAAW VV.jJl.VA.AVV VZA IVAAVaVAO klUVA AAJV Xj iXjXxX t • aXa JlAV/ 4 X AXA .VLi V »z
projects with iocai governments or service agencies, which fail to signiucandy improve their
performance in these critical areas. In addition to this iocus on improving the underlying credits.
ciinnnrT non rio r»rxr»ciriormt rXr nrmooi notrolnnmor»f fpz-'liT->ir>a1 accicianna
XX
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irrtryrr>x.-orr»op+ ry£* C.red’t
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-
uiiuiuiduuii, cicuil cjQjuiuiccxiicjLiL I.USCU sc ice iivciy), duu paiauci uiiaiiGiiig wim commercial
lenders.
40
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utbaa imiasuuciuie is a complex process. Il requires the participation of multiple stakeholders, a
sound incentive framework, inputs from experienced advisors, and considerable need for capacity'
huildmt? tmd. lettmmu hy doing. Even though considerable adaptation might be required for each
city a acv. oUvccsjIua profccvi m the early surges ol a idoim process could serve as good practice
benchmarks and have a ‘public good" value as examples. Several states have created Project
Development Facilities that provide grants or small loans to help cities fund the advisory support
they need to advance innovative projects. Financing of technical assistance required by
paidcipaimg cities, can be a component of Bank operations in the sector. Box 5 (see page 19)
provides brief highlights of such efforts. The Bank can also advise interested states and cities of
other resources in the sector, such as PPTAF for private participation in infrastructure, or Cities
a ii;.,. . -
18
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Box 5: Proiect Support Facilities for Infrastructure Investments - Emerging Experiences
I
---------- ,----------- ----------------- 1----- -- --- - ---------...----------- ..— —l«..G- 1----------.;—.J 1U- ,—m».Pl
WOO. Mlliucv OvWSsX vmvi|411OVO MX XXXMX«AxXUV<w X Wky^xMX^U. LaXV i-UUVUl
I
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hupoiiance of piojeci development for attracting private investments in infrastructure. Over a dozen
different initiatives have emerged in the iast few years, t hese are either pure project support facilities
such as the Andhra Pradesh Intrastructure Investments Facility (APilfr), or the ones in Uttar Pradesh
fUPIIFY Punjab fPUFl Kerala (I-KINL West Bcncal (I-WIN) and Rajasthan 6PDCOR1 or integrated
i Qgonoidc r»rrt%.-t/4tn<T r»rotor»f n«xxi»1r»r»rriari+ *?P.d
!
i
Slip*? 01*1 Slich 2.® ?T! ^3171’1119(111 (TN^^DPT
/T nCi'V't---- J 4"«.U------- ,+ /TiTTCA
♦!,„
m y^T* fsv'fe- V'n- —
- ------------------------ v---------------------- - -- --- -----------y-— c—“ j- ~x -iir.vsr or. s-u-xCo, -x_,uvimncnL* tm... .-.wxxkvG -..-x
, pxxVd.iv SCCiOi CliuuxtS x.6x pnvciiC CdplUxi aliil /01‘ UEtLii'cL^CluCkiL, cLS Qii'CCt pai'tiiefS ill tllC facility Ok'
j through outsourcing.
I
1 The initiatives arc a response to an undcrstandinc that development of bankable investment
: rnnvirlnnjlip*.' rwuiiru
urir tn^cwtricj
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i vppot tuxuuCo. .'x^l tac.uucs cmpuasize supporting processes or project development and policy
I reform rainer than actual investment support by governments, rheir aim at the project ievei is to
| leverage limited government resources through market borrowing or direct private sector investments.
I Most facilities focus on a variety of infrastructure sectors and increasingly the focus is on smaller
I Tir.iTMr-lw w, iH iirr.un mlruvfrut’liiTW Mri.ur.nrur w« u Luv s-c'lor
(
•
-
-
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......................... o ,.w
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I
I .3 rc.au«u.y iCcc.1l .u.uauvcs, uicy iiccd to oc assessed .or uiiccuvcness and uie tiaturc of support
i they require, io match institutional responsibility for services reiateu io project development support.
i capacity building of stakeholders, credit enhancement and actual investment finance appropriate
I unbundling of existing agencies will be necessary. Kev operational issues for urban infrastructure
I faIsM tn inetitntinnsl siTAnoements and its positioning witbin die wider statewide infrastructure
I -—c-imtiativcc.
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I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
44.
Removing information Constraints. The strategy proposes io address the lack of market
recognition lor the sector. This could be enhanced by disseminating information and analysis about
the urban sector performance and opportunities, providing opportunities for interaction between
........c. -u.w I...... pa.uC.paz.t3 and by mczc—sing Tic c-ppc..imity for commercial frnaacial
institutions to make investments . An important element of the strategy would be knowledge
sharing and would help local change leaders network with peers and gam information on good
rvra r-fri r»cxc nicowkaro
45.
Credit Enhancement, in the early stages of market development, partial risk guarantees that should not blur the judgment of commercial lenders and investors in appraising and assuming
commercial risk could be more effective than dedicated lending facilities in leveraging private
investment turn debt. The guarantees should be designed in die why that reduce lender's exposure
to risks created by government itself without creating moral hazard or unmanaged contingent
tiuh'hlie-* for the Hsc. This could relate, for instance, to (he uovemment’s failure to imnlement a
uuuLi luuexmg .v.mw.u pzoviiied m a concession contract. The Infrastructure Development
Finance company (ilifC; has developed a back-stop facility for take-out nuance to enhance
tenor of commercial bank Joans for infrastnictiire Recently MTGA has also been approached bv
several private investors that me contemplating projects in urban infrastructure in India, for
example in me water sector.
oiicu oppoi um.u<-o mr interaction are necessary for awareness regarding concerns and incentives on
boiii sides. Suaiegic pai ucipation oi CBrls in such evenis wiii also enhance their market recognition.
19
Rank lending, in India (under the Tamil Nadu Urban
?Vrw«
j-z'- *1 Avjw<t/ ckiiw vuicr oC'LLuuiics,
uirough fmanoial intermediaries or an
apex
second-
ner insnmnon, has oeen used to enhance me Tenor of aebr instruments onerea by domestic
lenders, including for municipal credit The proposed strategy docs not expect TBRD/TDA
1
Ae »-o Fc « ~T?C”?
~Vyh
rj riQynrp<(yt5 1 fTT! d^*~
Q®1 dlw
^UUtlS
nriauvial mierme diaries, it can raise complex policy issues. It may distort competition in die
financial sector. it could also create an exposure for the sovereign that partly denies the purpose
of diversifying away from central government funding of !<>?al investment It can create
opcmtioiim dT1.1OvL4.dcs as vicll. The Budk 3 safeguard and fiduciary obligations may rcouirc it to
appraise both me intermediary s iinanciai position and credit processes as well as investments in
sizable individual projects. In addition, credit line operations do not address the bottleneck for
♦vuirMZMr'oi credit development m India, which as tventinned earlier is the underljmi^ credit
weakness oa me xmai borrowers arm projects. However Bank lending in die urban sector will be
designed to leave space lor commercial co-lmancing. this could be achieved by capping the
percentage of project costs financed by TRRD-TDA or by targeting Bank lending to poverty'u, „-------- —-Ul. Zu ,
1VXU.VU Ov.<z_x-
._„n J f-------------------------------------
KzJ-LvAjI*O XZA ^/xvjwujj
bJLlV ivj. AUIWUVVM 1XV111
V’AvtA UVMlWCl. K>Uvll VW”
unauciug could be eueciive in providing u reform umbrella’' for commercial lenders uud
exrendmg the terms of the aggregate debt mix used by uarticmatmg cities.
-7 :.
x tiv abvvC tuoCuSSioil SuggCotS itkii it liluy be possible iii ilididii COiivUtiOllS to illOVC aWay'
from me municipal development fund ana specialist financial intermediary concepts to enabling
existing domestic financial institutions to enter the sector hv providing nolicv and project
1
sole^'ti'* moasTTrr‘S fo** ^dit °nb.nnf>rr.cr.T better market mfnrrr.ti on, and
appropriate measures for leuur eriiituiuement. Appropriate imancing uud institutional
arrangements, through unbundling oi these functions to different actors’"", will need to be evolved
in r^ur-p
ivr (Jllv 1TI
W? th k*?Y slaveholders.
48.
A caveat, However, needs to be added to this approach. India comprises states at
different levels of development. The le vel of financial sector de velopment and the risk
perception of existing notional / regional commercial financial intermediaries arc likely to van/
signiUcandy across states. A rigorous assessment is necessar y in this regard rot a given state
to identify an appropriate financing arrangement. Domestic credit rating agencies can help m
this process. In cases where the existing situation does not oeimit development of sustainable
credit markets, mainly due to a lack oi viable borrowers, the locus should be on policy and
managemenr reforms, bunding may inen be limited to Technical assistance and small
performance-based grants for local governments that make progress towards improving their
fmmtccs. Bank experience shows that supporting dedicated financial intermediaries that lend
ai nvii-markei terms mio non-viable credits is neither useful nor sustainable.
49
if dip ctrMesv is to succeed in creating renlicable financing aiiansements for the
occ»or, there mus* bo a aCvOx pACj*mg xiolu xOx tmauomg mstitutions. This may require roxorms
at the siate level, especially lor states that operate subsidized credit systems through ivlDr or
SFI. It will also require that states adoot clear rules for municipal borrowing. This could
maomTroc such as ^'O2Tovzm<* caps find the reontrement that eny municipal bond
issuance shvulu have an mdependent and published investment grade rating. Thus, a xey
rcr examuie. see reterson ^2000). building iccai credit systems . World riank. for a discussion on
“unbundling ot all the functions that traditionally have been packaged together in Municipal Development
Funds”. These functions include: technical assistance in preparation of municipal investment projects and
in advice on nrivatization alternatives: assessment of municipal creditworthiness and capacity to borrow:
and mailing loons to municipalities and construction/project management oversight. State level reforms for
ul’bdii xLialiCxlIg aiiaiigCiilCiitS Will liCud to uddi’CSa this ililpOi'ixLiiL CGilCCili of liOWtO Uilbuiidlc alia tO CilSUic
these services can be piovideci uu municipalities in a sustainable manner.
20
element •>> the reform
for state urban sector assistance will be to review and
restructure existing lixiCtiicLuc. arrarigenxeixts, nitermediaries ii any aixu. related state policies.
oovemmenr oi India wm need to ensure Thar its sector objectives are being pursued
consistently through onerations and policies of Housing and Urban Development Corporation
.'Xi?
h^*2imcdimy for urb^n infrastructure and housing.
5U.
Supporting Community Based Finance Systems. Another important element is support
for micrav.fi nance systems tb*t orovide access to credit for the poor and 1 ow~ineome groups.
-tk
i__ j C_____ * j:x r-_
XXXV, JLL»U» VV V.OWL. »vz pxv,*»xv vXwkix XXZX xxxxvxxlxz ^VXlVlUUjjj. ULslX»X 1x^,0 V*O V'ViA V*O XtXVk^X XK/X VXvUJ.1
for shelter or community infrastructure. Over the last lew years, the Government has
provided considerable support through NAB ARD. lSTDBT and Rashtriya Mahila Kosh (RMK)
*e c elf-heir stoat's. NGOs end micro-finance irstirntiors either directly or through financial
iii&tiiuiiOiis suvij da uie Gviuuieiviai oak.s Tins lias created a oasc of ms utuirons providing
financial services to tne poor and low-income groups though most financing is at subsidized
rates Fven the limited Rinding
available through
ITT JDCO and TTDFC for financing«* shelter
—
--xbx1 fi.C pdOX'
.0 >■ — xx.vx.xxxC (JC.;xx>
tcd.
x xxCoC ^,1 O^jLvxxxxo xxxC XxO X Oj^zCX^fiX.^ Jit u.c
scale ilicy aie leuuiied even iliouali they may be reasonably targeted. In the long run, lire
element of subsidies could inhibit integration oi micro-lenders with the overall financial
d.-cTome
Rnv r\ ixoipyi.- oiixpryxorxyoc tK? ?.ri*?ro?.ch sdopfed for the preparsfion of the India
Coiimiuiuiy xxil'ias lx~uculic Projcci.
I
Bax a: Linking i'annul and Comrnnnuy Based r inancing Systems
i
I
Building on the financial sector development in India, a proposed Bank project India Community
i
!
I x^ox'po.auQix rn z■ Cy, a piCxiiiCi eoxiiriiCiCia. xxLiaiicioi Institution, is foe main project agency and
I
i will route Dank financing to poor and icw income communities rnrougn a variety of community
based financing institutions (CBbls), to selected local authorities (for external connections to
I municibai svstcmst and to onvatc sector fixi.is to nrovtde these services to the doo— on a
I cuvluinuhip liuvnc
i xixv piiiiiaij uujvuuvd Oi xx^xx 10 iO liiipiGVC UiC ilVilig COilditiCiiiS .ii pUOX &11G. 1OW IfiCOiliC
I
I ncighbuihuuus unuugh. ilj suauigju aiiiauces oi die main financial iineimediaiy, HDFC, with
I CBbls; b) development ot a Community Support f und (CSF) for sub-project development and
I canacity buiidins for community driven, oarticipatory approach to ncitthborhood infrastructure
innn-xitirig wrid
I OH***“*v**T*"v«c
i
a
Comm'jr'.ilv Inlrastrucliire Guarartlee Facility (CIOF) to provide partial
♦‘Iazx
« zl zvr.
It f
p> ••
1
j-0
k7xiu.xv.ux i^xuIxuS xxGiii uiC xxx xx> iuiix jupuii uiGviui x>v v CiOpliidil FuliXx (jSi>x y uTC CXpCClUil lO
I
I support the CSr and Ci<rr.
I
I A number of commercially run domestic financial institutions have shown interest in the
I infrastructure s«^ctor and in smaller community level projects. The successful implementation of
I ■his pilot operation to!! enable market integration and expansion, os al! lending under ICIP will be
I ai bioadly iiiaikct terms to be sustainable in the local market.
I
I
I
51.
Supporting Community Based Finance Systems. Another important element is support
for micro-finance systems that provide access to credit for the poor and low income groups.
They may be used to provide credit for income generating activities as well as later for credit
xOr k>xxCxtCx or co...iFtUii *ty mfru^u. tic-nixc. Over the last few years, the Govemmeixt has
21
nrovidfd .-■■MxiJprf.Me oimkuttiunnob NABARD. SIDBI and Rashtriya Mahila Kosh fRMK)
»v s.,_» Lc.p groups.
micro-xiiiuiioc institutions either directly or through xiuanoial
institutions such as rhe commercial banks. This has created a base of institutions providing
financial services to the poor and low-income groups though most financing is at subsidized
rates. Even the limited fending available through HUDCO end HDFC for financing shelter
xor inc poor and low-income groups is subsidized. These programs are not operating at the
scale they are required even though they may be reasonably targeted, in the long-run, the
element of subsidies could inhibit integration of micro-lenders with the overall financial
52.
Other recent trends include the emergence of networks and associations of communitv
kocoJ
r.
«r»or«T»ir<.->y»c» i
. ■
•
Vic » onj ^R^O^ClVll SCClwpr ?SSOC1H^*OUS th PT ’’YOrk f^I th?
.
71
f.’rd
T-
*
i.
'
1Y!
,
nvusuig uuu uui<isuucluic. x uxiuex, a special iasn i orce oil ouppoiuve x oiicy anu
Regulatory rrameworK tor micro-finance was set up as a result oi a policy forum organized m
1998 Tn 1999 its first Renort nrovided ‘an important sten in identifvino the constraints for
luc ulcus ox
—:— x:---------- t_ i:-------------- 1 .1.-2—----- „—:„a
XA.LXVXV XXXXWXX./V XXL XAlUlU UXlL,
X^CjXXXlVS*
UWUW,mWOXV XXXXVU .
V*V » VXVjl i*
22
tt.„
1> VO|?X1V kUV
euons made both by the government and by CBFIs themselves, it appeals that die oveiail leach
of these institutions is limited. Recent eiicns to develop a regulatory framework and provide
oanooin.- rvm IrJirirr accicronno r>rviilr? nnnon fliaiT- nnco <ryv«*T
ajuvsv xuCaSuxvo
ir» q rr.oro ciicfunoklo yrictr^npr
nviuu uxov nCip t/xuig a Wide ViUiety' 01 iUiaiigCiilCili'S Vv'idiiii ci OlOud lUguiaiOi'y
frameworx. Key issues laentuiea for capacity assessment by me Bank s sector work include:
organizatioual/legal forms lending methodologies, role of self-help groups, lack of emphasis on
and icguiaiuiy uainewuik are access io capital markets, institutional tiansiormadun and seiiresulation ~ Another kev area would be to support measures to enable the commumW based
to fimMrir’e eonnnimi tv inIrHMtn•{•ture for
poor HTyl low-income
CviixLixunit'XCo. A piVpUbCu. xjULux piOjCvl OCiiig developed Vv'idi U1C
v ClxUlidit Ox ilitilci illid
in nrnvuU
Housing Development f inance C orporation aims to demonstrate the viability of such financing
products (refer to Box 6 — page- 21). M
53
Fouwe on oeetor rMnwv. Most analysis of urban infrastructure investments bi°hliph,ts the
luudc^uacy oi public rcscurccs m relation to the requirements. One oi the Bank s comparative
advantages is its abiiiiy to provide sizeable volumes of iong-term funds for critical investments ar
competitive terms. This suggests the oossibilitv of leveragms these resources in a strategic and
n tn It rr, t> roonnor tq f»T,f>xrif4o n/lom>oTa inoonfnron
vs
nl
rofr»rywc
' I ly-ir txrtll
enable siicngdicmng die demand bide 101 ultimate miegiadon widi die markets. Boili GOI and
state / local governments will have to evolve through consensus a minimum reform program for
state and local governments to avail public resources including those of the Bank. When an
----------- j _ —
----------- ------------------ --
C'Wb vx UJULZZJL&XZVMUZ XVXVXXX1J X.XV MV1XL.VL. UOOXOHUXVV
OUllvu
.—j vlUvO >»xx» Ow xfillivv. IV IXXV'OtS
and there will be no automatic emidement. me ownership oi reforms by slate and city
sovemments will be the kev asnect in such an aonroach. This will reauire a demonstration of
rnn-.rr.ii-monT or»rl fKo imfiafinn r>f*r^formc
BOX *7
2^ nyoi^deS brief highlights of
outivrvxdv oCCvvx iCxOiiiiS uCiiig uuxvxi up uxtuCI tiic OiigOiiig BaUri xuiiuCu iduiii iSauu. ui'Oaii
.Development project).
zi
For example, Sa dhan has been formed as an association of the CDFIs and has taken up work on
issiies such as self-reculation and capacity building. An association of agencies working in the habitat
ccpfnr hoc alcrv haan ranoritlv rXrrna/4 ac Tnztta Bahita.t ForUTTl CIFTBAFV
22
23
TX7rwM 'Pr»«,V ( I rjl'll'l’l lTlaz»Ur»^r«n1 \Tzx»a ... T„rl«n' ESW CH
T?lb****
N£l£S’Oil).
World 2crJ: (1299), Toohnioal Moto - Indic: ESW az Miorc-Fizazce (Movezibsr- December 1999 Missicz).
A px'opvocd Btuxk pxujcct bciiig developed with the Government of mdia and Tiouslng Development
Finance Cuipuiauun aims to demonsuaie die viability oi such financing products.
22
i
Rax 7: Tamil Nadu State Reforms for Urban Development
I
I The Bml: fended Second Tamil Mede Urban Development Project (TbTUDPII) focuses on
yivuiwmlg duuC WiviC iuocui svliO! iCxOniio iuOlig Willi xhiailCiiig liiudll illuastlliCilire luVCotlilcllto.
I Stale vrovemmenl of lantii rsaau wonts cioseiy with the laniii btadu Urban Development runti
I (TNUDF), winch also provides investment tmance to ULBs under the project An asset
I management company with icadina domestic private financial institutions as majority couity
usirtnpTv’ rnwiiwijes TNUDI* i»rolession*i!lv. This varltiershiv between (he OoTN and TNTJTVF has also
i^ioszifrvss fc*“ t2s *c ■**'*^°***.*?-cq rsfion'is 1 'NUj
n^so *''*o\ndss sttiLtsgic
I io xGvtix jjv'vCixxxxxvxxuS ixx GCvvxGpxZxg cxxxtx xxxxpxCxixCxxLxxxg CUxxxxxxCx vxixlxy sfrUviixTCkl xxxfrcLSu iidixxC
I
I projects and accessing capital markets.
I
Government of Tamil Nadu has taken the lead in formulating and implementing statewide sector
I reforms! If is the first state in India to introduce uniform municipal legislation and reforms in
municipal
Tt
shifted from cash to accrual system of accounting in IcchI
govcuhxxCxIls, uitiOtiuced peifox’fxiatice monitoring systems and computerization of municipal
I
I 1'unclions, it has simplified property tax mechanism with a movement to an area-based system of
property taxation. The State has also empowered local governments to raise resources internally as
well as from the market The institutional development component apart from building capacities
i
i of munic»p«« staff and elected officials, supports development, a nd implementation of city
I dc’.'clcpmcnt strategies (CDS). The project also finances implementation of reforms, the most
I
I
xxxxpvx uxjixi.
wzxxxxxxCx vku u.vwOuxxiixxg xxx xxxUxii vipcilx lx«JS, xxxuxxxvlpdl pUxxVxxxxuxxCC xxxUxXxlOxxxxg
I systems, the use oi GiS and a simplified iand use planning precess.
I
2H.
Min jeer to requests by rhe stares ana GO! the design of reform agenda provides rhe rngger
for Rank’s involvement in different states As stated in. the CAS the Rank nrefers to concentrate a
suiies . r uiauuiuu is also coiisiuacu iOjl piojccis oi particular merit in oiiiei states, as wen as lor
federal programs. Under the urban strategy, states that have a strong overall reform program would
he ’?iven ^refereuce for develoomQ nrboji sector projects though a commitment to specific reforms
iii ulax. luvmh Svvwi »■»j-xx. still </c xxc^cooxuy. 11* vesLxiieixt xjlx xioii-xOCUS Sixxes can also be vOixSiueied ii
they have particularly strong programs within the urban sector (see Annexes i and 2).
xiiiplvHivfitxiiLivn
»•
55
The emphasis in implementing the strategy will be on helping states build a statewide
framework and support programs that encourage good urban governance and management.
Within these statewide programs, reiorm-oriented cities would self-select and apply for iinanciai
and advisory support to improve services within a City Development Strategy (CDS) framework.
Tqe^e measures wdl enable *he urban investments to be more sustainable. o
56.
Partnerships and Coordinauon, fhe urban reform agenda’s complexity and its wide
coverage, mean that coordination among the. external agencies for investment and capacity
building assistance could m.a-rirr.ir? the possibility of success. Mechanisms for such inter
agency coui uiuaiiou will need io be developed, or existing ones sirengdieued. io share
experiences and plan coordinated actions, where appropriate, on an oneoine basis. Such
ir. 1,TT.>ht,n
/•tv
I.. .wii^Tiil i<>
■X".
_ ... ..
- ..X . —
xxxjkxxxvxxx^ xxx Ujomj uvvivr
.....<-> .w.ih domestic fmimcial institutions to explore co-
23
vj\.v>o.
■^’juzCClfiC iViiuo Oa w>\sj\*xuCiiC*A UCxiOilS V0U*U. iovl"l*i*<w. jOiA**- kxC v CxGplulviit vi SvuiC Hi v
sec.Tor strategies ana stare level reiorm agenda, participation in awareness and dissemination
measures, joint committees to identifv participation in capacity building measures based on
xvi acv <u'C<» vi uiuaxi iciviiu.
5?
s?k>etivitv
Sector Priorities Within the strategic focus areas, prioritization is
CSSClLtld xxz CaaOKAAw xaaO Ovlvvtxv-U x#a wCmltlvu vLud Op Ox C* ix\>iAO.
It A»> UAdv xaCOxzSSxXjL
iO x«SSCSS xhO
potential match 01 Bank Group instruments to issues identified earlier. The strategy envisages
that selection from among the wide rar.se of kev issues will be through demand articulated bv
ornro or'rJ '.-x/xol r>m ramtnanrr
A o o rpcnlr •r»x£»'i mtroc iTnfto*- rliofrorlc C.-xr- Mvofoot'
—
-T “------------- ---------------------- o- ------------- , I-lCuixUw- U--------------------------------------------- -..X-lx. „U.uXl----- .bl
implementation will be designed iv be demand responsive. Demana win oc aiticulatea through
consultations, project rules or, wherever possible and appropriate, market linked processes.
This is in line with the medium term perspective of the Comprehensive Development
—J u.,
—rf’rwn 11A1AVU tuv
„„ UV*1AUA1 v*
A . '-.'.' --'.I <» |^X^X>A y, -1“
AUX- Oj^ZJlXAL XZA XzAVjr X> X V X> AV'pAl AXZJUl t K> CJL X* tX-U~*X- O
z
driven by clients and stakeholders.
^5
T'o cprpo oifronf eoioz-»rir\r»
fta+amnnp^ bv th? terms of Rank s urban sector onerations.
Tile sudic^Y envisages die city (small, medium, metro and mega-ciues> as the center of the
urhan strategy with particular locus on civic services, the mam assumption is that well
functioning cities are. essential for economic growth, to provide better living conditions and to
^*2'hscc poverty * H~" provides the raticiidw for th° selection of the strategic focus areas
primarily improvements in city euiciency, effectiveness and urban governance, h is expected
that these kev reforms will converse to reduce urban poverty in a significant and sustainable
MDil vr»MTrr»*»r
59.
1 nree- Strands oj Strategy implementation, fne various members of the frank Group,
such as the. World Bank. MIGA and the World Bank Institute fWBD. will iointlv implement the.
iiighiigni* uic activities envisaged under each stiunu tuiu inc iciaicu potential insiiunieuts ana
various stakeholders it has been eviaent that the information base and anaiyticai work in the
sector arc noor. inadcauatc availabilitv or access to basis urban data makes rational decisions
r^>»zx»xx«t^rx xwx-x zxt-< »-p r»»-« rx •, z4x-i-f,/x,x1lr
I Ixxrlzvr- rlx,/-.
x«x A0C ooz ortov
*^V tiT
will work wim kjovciiiiricni 01 India and niicrcsieu state governments io enhance the
knowledge base m rhe sector. Activities under this strand will help to till this gap. The focus
will be to bu ild capacities of key stakeholders in the urban sector through knowledge
61.
It w’ill involve activities related to i) comparative performance assessment in priority
management, citizen orientation, monitoring anu evaluation activities, u) development 01
templates and toolkits in Key areas of governance and management reforms (refer to Annex
1): and iii) knowledge sharing and development through workshops, publications and visits.
TTU117
—1 J TS^I—» XAWXA
o-x-U,.,x
1rx AA*
ti- I AXAlXZ ’’AVW^V Ul ■%«.» AAA^
x
, f V4AV*
» «... « ». AJjO.l.WfcV *«AXA
*«,»
* X/ rn
AV1V
AX'AX IX'Al
programs. Euurls wiii be made Lo carry out diese activities in close partnership with domestic
msututicns. network institutions and associations of key stakeholders. This will ensure wider
ur»<l tti'it"
effective di.“”emina(ion of information as well as local ownership to achieve
24
Vi J
vl
1C1 .. I .~~' > C, 1 . >1 I vxviilt^ ulC 1 VilO 1 llJ'll CXj/vl.tllvvS ullU llllvV,“110 t*
include analytical and advisory activities (AAA) oi the Bank as well as special technical
assistance protects developed with cither GOT line ministries, interested state and local
------ -- ~5 It is essential that knowledge management is made participator,'. To fill the
gap between pionouncciueuU al seminais and ground level policies and actions so common
m India it should include more frequent visits and exchange between policy makers and
nrao.titioners
A key emphasis in this strand will also be on developing an appropriate framework for
62.
urban novertv reduction stratepv (UPRS1 at the state and citv level. This will rcouirc a diaenostic
a o c or c vwor T
i irkor' v» rvsjos-vx r
rowanr <>•£ r»ocT
'r‘'*"'2'<VT'2I22C
tQ
up SuCvcsaiul ucjulvilbudUUIi cxiOiio aliU xucxiilxyiii^ ac\ COuipUlieiitb Oi UPRS iluOUglx a
consultative process wim critical stakeholders. Ongoing preparation for an Andhra urban sector
nnerarinn incornnrates <mch an approach. Box R below provides brief highlights of the Andhra
T>___ J_-l- T T_1_____ Ti_______ r> ~
------------ T»-----j. A t.MVUXA X--* XZXfciJ A Xz » VI « » A X.XZ MMWXAXZ4A A rOlCVV,
I
I
I
Box 8: State Urban Povertv Reduction Strategy - Andhra Pradesh
veui pGVcxiy ni rTviidiiici x lausioii 10 Xiigii Wiul iCCCiil cSuiildtfS uiat Suggest tiiiu
pCi'CcliL Oi
I population is beiow me official poverty iine. ihe incidence of poverty is iikeiy to be higher in iarge
i and medium cities. More importantly, the limited information suggests poor performance on non
I income dimensions of urban povertv. For the Government of Andhra Pradesh CGoAPl reduction of
I urban Tyiveriv i«
I.,1(« Inriir-l^nii vision and sl.rategv. Ils approach includes coniniunilv based
wr.^11 no
n-fl, o *'*•*-' n- fbl2T'Co<* r»Q'r’ar»sn»'z»n n*"'d
n'•o jrja«x£ Q-C
G ... 1 »«1
I
I uodtCS. It liaS CxiiplidotZcu the development and Sucxigtliuliiilg Ox COlixiiiUXiity based giOupS, especially
I
I those consisting of women, to undertake both economic activities and neighborhood ievei
I in Iras true nire improvements. Special schemes of the Government ot India as well as matching funds
I from the GoAP’s Janmabhoomi scheme provide suooort to these grouns.
f
qz
I
I i«
*ts pevov” reduction initiatives, the Hank is developing an urban poverty reduction project
I With GgAP. xxkiS Will uiVOxVC cl tWO pxOiigCM. oppiOaCiL lj dii’CCt Support to xiiuiti-SeCtoxux COiiiliiuiiity
I
I focused and managed investments to improve quality of iife of the poor and iow income
I communities, and 11) strengthening capacity of urban local bodies for poverty reduction through: state
wide urban sector management reforms: citv level implementation of kev management reforms such
I as property tax reforms and supporting better functioning of land markets: along with investment
i
I
I
I
I Investment frnance will be within die framework of a City Development Suaiegy (CDS). Die needs
I tor nnanciai support will be assessed realistically based on the local capacity ot those ULBs that
I show adequate nerformance imorovements and cover their operation and maintenance costs in a
I wiiwfuinurito TriunriMr FjnwTiriid wssiMtwrice will h?
kj enable vwrlvdpy(».<w of other domes hv
n»sz4 tXF.ll
riavm
I ♦••xn r,A. n I ... zrt.fnr.
i
I
I The project envisages funding support from die Indian Cooperadon focusing on capacity building in
I select small towns to initiate tne retorm process and facilitate their access to resources from the Bank
I nroiect The Sank cceraticn will also follow foe nerformance based approach asreed between the AP
I Government and DFID for foe implementation of the DFID sponsored Andhra Pradesh Urban
I CzxMNrxrxz.
rUn 'Dz^zs* ‘D*zx«z»z»t- l" A ^37 Tctz\
•v-nvxlr'*T'O*ltr'd IT
30 ClCSS I tOV.IlS OlwSC
I
i
WV1 V41X4CXLXVZ14 MW»TV\rA* L/WL&1 plGjvCl, VVA1A L/C
uiUKAUlOiiuX
I
roi cxampic. an ongoing r cchnicai Assistance Project for Economic Reforms widi die GUI also includes a
ccmpcnent ler urban sector reforms. Special IA projects at the state ievei may also be developed, as necessary.
figure Z;
JACnVllftS
i'uiw Sunnus ofSiraiegy Impiemeuiatiori
::::
f-TO'rtAtlALl^SlKUMrm*/ I POlEht'jfAt
_________ ! projects
r
tn.
I •
»A
.....
Cumpaiutivc peixuiiumicc
| ”
1
*11
|1
i........ ......................................... i
ACvOvvuvii rn.u .uiootvogo Uirmu^
f| *
xxiipicmcUuiuOii Ox ^uvcilidliCc
j suaicgy xui pOvcfxy uxigCLcU
vuveiuiiiciic oi inula
State governments
Local governments
Domestic financial
1 .
1 i.
i
a interventions
1
TA G.r Tiru’ei’l ilHV*-1oi>rr<Mii(
...1
• Kesuuice mouinzauun,
creditworthiness ol local governments
and utilities, and improved access to
commercial sources of finance
Sfrcnw Two: —
1
irwtfluhiinw iGviwIirfir /
g
g
8
8
"
3
I
j
8
il
i| miougfi viucs Alliance
|i •
•" ' "
...
a
B
:1
1I development funds
1 (existing / new)
j
i __./ ’
1
j « otate uroan sector project nnxeu
3 to commitment of state government to
1 an ‘agreed reform agenda’ including:
: nranaration nfTJPRd decentralization
63.
Lending unougii i eciuiicai
Assistance Projects
| ■> Learning and Innovation Loan | •
’
1 «
i fLIL)
•
I ana management reforms
3 ■> Development of commercially
1 viable urban infrastructure projects
1 Willi PSP
1 .
--------------- i-.i:____________
1
...... ",------- ]
Guvcinincm oi India
o Stare governments
| ♦ Domestic research
1 institutions
1 * Private ad^dsory
J
1| SSi"v’iCcS
1 <» Network associations iijj
1
1 and institutions
1
1
1
I
•
rtJiiuyucaa tuiu Muvisory
Acrivines
Technical .Assistance
11 *
I M&E
» o
Templates and toolkit
u zi ar :alon mant
j v
...................
i
i assessment wnn nencnmarKing and
■' '.'.’■—J
i FARTNERSVfT.iEXTS i
o uenoing inrougn a state uroan
sector project; with cities self
selecting on the basis of
(wrformance and reform orooress
» Teciuiicai Assistance for
development of municipal
creditworthiness
x^omcsiiv piujeci
« state governments
» Participating cities
and utilities/
concessionaires
institutions (existing <
new)
« Government of India
Z.ocr?/ Tbirovtyfons. The second strand recognizes notable local
urnov aliens rangmg xiom private sector participation tor solid waste management m Hyderabad,
introduction of fuii commercial accounting system in Chennai Municipal corporation. property
tax system improvements in Patna consultative community nlannmg processes in Bangalore and
nrtyfl rV»o
‘/ithovt STut1?
IH
Aumcuaoau. As occu highlighted in die country assistance evaluation fox urban sector and earlier
stakeholder workshops it provides an opportunity to engage more directly with municipal
andinrities through sustainable intermediation.
64.
inree types oi activities wiii be supported under this strand, rirst, implementation oi
governance and managementreforms. for which considerable consensus exists in the countrv.
S”*‘‘r'OTT for
V/OI’lc? ko nrwnrornrl iTrvrlov rlvo Cvroy»f1 1
26
TTr»«4or yU<o prro*vrl •Atrvrliyto virfyiylrj Ko
M%.:■»
111 iilt-*s«-* iHlin II1N HI' Ji W!^C’,
'll HliniPIllHI II
f»•? Mlii-r- lljMiil zii r-ziv ill iriiiiU!
SCxVIOv v*v-Aa"» Ciy ulld giCvVlx-i XCSpOxxSi * OxiCoS MX SCx~»iCC px Vz**1v*Cxlj tv
iaav
cinzen $ concerns, Funding coma t>e rnrough a 1A Project or through a hne or credit
arranecmcnt with commercial tv oriented financial intermediaries where these can be funded on a
r»—A
v 1 provides — llluc'tr2^'Vr* 1’Sr of" tHc tj’pO .T r*0Vz'mE*HCC did
xiioxia^cxucxiu xcxvixila, ullex xu^xixiguia Ox vuxxciii Status OH ixiCSd Uliu the possibility OX JLUiilUiig
these on a commercial basis.
<_________ j
->
—:n -——u
* X wvvvia^* C>*z» V± V.WXA » A.A.ZLZ •» aaa uv.i^^vxk <Av r V.r t t v-z hi,
«
v.z .
............
virlionvi utit.rj,
, <vtO»v Hl 1>V.» .
; Kirast tna ure projects with a focus on private sector participation. The Bank will support
technical assistance efforts required to prepare quality’ projects. Bank will also explore the
- ---------------------- ,
on*»r»0»^' T.-> rvv.^nonoo
orrnn <-» o> »v» o*» rc
------------- rr---------- ------------------------------------------ -------------------------- — —x-- —..—--------- - --------
co.
lhe trurd set of activities under Strand 2 are development ofCDS / seeding up strategy for
poverty targeted interventions Tba CDS framework is visualized as one of the key building blocks
__ a.,
___
i->---------- -i-x-1 —i-------— n—L. r'T>c
----------------JLKZA
KXX»- r>
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«» HV v> XXV.T (_»VVM4 VAX xz MAA UUV..Vj-|^ . A-VAXXJ <ZXZV AAA.iJ AAVZ A 111* I V XVVUUVW VllVWUXI XZXX UUMX VU OAAA^
Huaiiciai uonsuaints — a new gcneiuuvu of CDS would suenguien the link between a city's vision
and its reform needs. Its development will be based on a broadlv shared understanding of citv’s
<?n/>ir>_/azxnr»r'*T»-ir» <rfn;»(?+»irA c^nsfr^ints end nrosnects b^^ed on
*m?.brtic?.l assessment. The
xz...
. . ..
..........................................................-<.- .1 ’...................... _______________________ _______ a.
.
. . .1............... :
’a’
_ ...3_____ ...a.
ovxiouxiauw piuvwavo, auppuxlcu. uy anaxyixcui iiobcosiHCuxs vi uic gvaxa, pxiuiiuvs ana itQuiicmcmo
will help identity city priorities, lhe strategic plan of action will be operationalized through the
preparation of specific products such as: city level capital investment plans, city financing strategy
*s-“ zJ *»
z. 4^-oi-0 CT-T •
V^XX. V. WXV fV.V..; XWMMWVAWAA
.
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o
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strategies and city consultations under the UNrir, UNCHS and UNDP's ivieuopoiiian environment
Improvement Program (MblP). the Urban .Management Program (U.MP) as well as the experience in
- L.-----------
. .--------- --------------
x
-j'- - <—
6/.
wnue each CDS exercise will be unique, m general a three-phase approach is envisaged.
A first ‘scoping out’ phase, will provide a quick assessment of readiness of various stakeholders.
A
ctctct«-.«xz<
-rx-AzxvzA A*-*_z4z.v-.-rk ct».<4 oV'Z'kr+^CTCT^ r»l-.CT»?CT -tr» r»CTCT<-»c<C Ctyil<‘t'1^*CTCT z>wz4 VnM/Jo
*kzr ..▼“kz.ra
economy, die nature and causes 01 poverty, as well as potential, cons it amis and str ategic option.
bmallw a third phase will consist oi consultative identification of cib/ priorities and formulation
nf cnpr-ific nlfiHG for nr»vertv rprhi<-fir»ii and finftneino ciTfifooipq
aa
‘
AV
Sunnnrf for «^DSv tn intpre«tt»d
X' A
innovation i ,oan (i j i j. i he commirment of horn rne ciry and srare governments ro undertake
participatory and consultative process will be essential.
vo.
3u<ariU jJrifcc. Iffiplcrficrmn)' dciriut i ullcy I\.ejun?lS.
Wuue support io local xmiOvuilOiib is
essential as a first step and will provide an opportunity to respond to emerging windows of
nnr.nrtnidtv st 1rx-^ IfWtd imnnrftjnt «nr1 nften difficqilt noljcv reform? are also .necessarv «tj foe
„*Xa___ a___ Tn_:„
j
:—j~_-^+^,4 a—-------------------------------------------------------LfWW.XZA XW WVAAAV T Xz Z WVW.1A1MViV AWUUA.U. A AAaO ..VvAAV. 11W • V IV XZXz AAlA£SA XZ AA A V-Ai . XA UxAXZVAv^JlA x/XZ.AA AAXVXJXZA
state ievei urban sector projects and other operations to support development of commercial
■financing svstem*.
69.
^raie Urban Secror Invesrmenr Projecrs. Implementation of key sector reforms will
require a political and bnreancratic commitment from state governments. In turn foe Bank will
luij Will build vli Lxiv Vrvfk dllCddy bviiig developed Willi lliC HuUSlug Be*clupiuCIil PiuciliCC CoipuiciuUii
(KDFC) xbi HiiailCiiig COiihliLuixty HiuoSuuCluxC uii'Ougll COiiiiiiiiiiivj bdSCd fluHiiCiilu, iixaiiuiuOiiS.
Uiidti UiiC UX Luv Bdilk piojvCih iii iliv siztik UX Tttiuilliildu, CXXOI IS al UvVclopiiig diid iiidiiibUcaiiliiig CDS lldVC
been iiiiuaied. Exaiupicb ux scaling up ox povcrly labeled iuierveulions in utc eounlxy are vety xcw. One such example
is the sium nct-wcikm* progtaiti in Aimicuauad. even here, however, alter initial successes and considerable innovation
in inuiu-stakchcidcr partnerships, the pace er eilcris and impieineniaucn has been siow.
27
Governance and manaoemenf reforms listed in Annex 1; show a readiness and commitment to
niujor decentralizetioii and tmancmg related policy reforms, and agree to develop an urban
poverty reduction strategy (refer to Annex 2). State urban projects may have different focus.
However, for a particular sub-sector focus, particularly for water, commitment on specific
minimum reform agendo, m illuctrotod in Annex 2 under water sector reforms will be essential
. v.
xwdv«</v&
ftuu'i/uiiuiiu/i u/ilc i "iiiiAiiCiilj'. vjivCU jildia 3 COxupuxuuvC advailuigC Hi ICxUiS vl
development oi its capital markets ana tne existence of several market based institutions for
financing infrastructure the Rank will seek to sunnort access bv local Government borrowers to
c. mrnmcrc-d immome
sms. .A.X vzmetr* o^*
T,om*ce,e ''°n VW WawjzxVXwTT,
O ever
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.<!.-«<»■
T.T. . . .», WAX — w V
„n^,,tni
inmkcis uvnuwnig tinough bonus, use oi commercial financial imeimeuiaries as well as pooled
borrowing arrangements tor smaller entities and projects. However, considerable efforts will be
r/-»onir*3d <<' pr«vmoiM G >5« ^"
t
>.
v._
ti
wn<1 r*M»n1>u<yrv reforms Horned *d deve1or»iTi«» these JirrnroacheM
im1
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.
xuguxau/xj xxujLxiC*«vxxx xvx uxvuxi xxxxxUSixuCtiixC 'pxvjvvuj, i*ppx vpxxiiiC
xxxvxixtxxxxc.. uv»viV^uivui
controls and reguiarory mechanisms for municipal borrowing . tariff reforms for key urban
services, norms for financial disclosures as well as bankruptcy legislation for municipal
t1»O OTAorrUtAO mtOTWn t-zvInTzvzl to Z>T»r»Tt tT. <t
■ ----------------------------------- C------—------------------------------------------------ —^Z WZ.
r'T *1*0 ’ TV c’1 TTV •'I z» O r>ZVZ»T<-VT T^ZVTtcirSTY z»y,z?
------------------------------------- LwU -------- ,
----- .U.
proviucm uulu mauagcmeui as well as mipiovmg die operating and regulatory namewoik 101
debt markets, the emphasis will be on readying the urban sector with bankable investment
or»p.'vri’
ithi-imk;
- ------------
:.. xi.„
wn«l
1o
Mvwhle access fo GnMnci^l markers through credil enhancement
,.Mo-.- n w-owi-J^e, i,r;.rk:„u: j.x- -,x'„
JUj/jZVlt XXX CXXV WIXXJ pXXLtOVO.
... „.;+i.
-OVZV «z yiuuuvo VXXVX xxxgxxxxgxxxo vx i* yivyvovu xxuxxxt vpvxtxxxvxx vvxtxxxxx
this framework in the western state of Gujarat.
xxt/.v P.' liiipi'OViiig RcSOuiCti. iriUUuiiuuOii uiiu FiiiuilCiiig
Cities m Gujarat have relatively better management systems, greater autonomy and functional
responsibilities than in most other states in India There are also several financial intermediaries
Tnleresled in viirinorlipg urban mvuslrntml
I
Dusnilu Ihusu n<lvnnlw<res Guinrul’s urban w(<>r suHurs from
..*-L.nv. oa—T»r»
o1
o^‘e*n*’o nvirl
-------- v------------------------------------ --------- ,, t------- - —--------- -------- -r.
. ________ i,. f' ..
_t—
c_.
< _.
XxjALUlVlllg, UU 1 UXl£VlxXV41LO 1U1 UlUOll JuildJU UVIU1 V.
no OTtfl n Innlr o^* nn^zonnn+o
i A proposed Gujarat Urban Reform Project will support increased access to domestic capital markets by
creditworthy ULBs. At the state level, these efforts will be structured threuah dcvclcumcnt of a state
i level framework for local borrowing This will incorporate measures such as a mandatory credit rating, a
I
I
I
I aiieady buessed siaie Hiiaiices.
ozxsI.txzv z*t»
1z>r»n1 zlrxl^T
ot^z-1 tIo n onnn»'h*l ’ri'
1nnT%1zTTi*>Tow r 1or»<n1nrlen
' iloz.
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xCx jluu. jvvvuiiiivm giuumicvvo xvx xGviix vvxxvVvilxj^ iixxix V»in xcixiivC ixiC vixivivli vx ixxvdxi xvlivxxxg Cxi
I To enhance local revenue mobilization and increase credit worthiness, participating cities and towns will
I ftdnnt oroneify
reforms, modernize budaetinQ and accounting systems and improve billing and
"D ofo TTTx Z «
T TT } .
n 11 Unim non non to n o k-r n 11 Z\»n z»z» ^T,T,z1 r» »- > « A ZXZ-3 no Jot flno neoroot to ^«1Or»r»r»
I zvzvIlzYZTtTOTYn
__
--------------- ;. —. - ------------ --- ------- —• • - —----------- --—
x>—— [■-———»* — - r - -j - - - -w
_
I
I
I the iocai capital uiaiket 101 iniiasLiucime investment.
I
t zv
jj
l z
z tt
ouu <K>ac»mvut vi voniiiigcUL liabiiillcs uiivcai guvcuuiicub. In inicinduonai vxaaiplco vx piuuicuis wiih aub-xiduoual
uorxuwilux, VXLVU hiducqudiv dUjCUlioU XV COUxillgCUL iidbilidcd ildd ULLCII Cdlixvl piobicilld \XUi CAdxUpxC SVC VXHKA,
2vuu. 'SiiiniriM phases oiucccnuaiizauou. uuicaucnuic reibun and the regulation oi sub-nauouai policy in Diazii and
China’, university oiChicago).
28
71
Wnrlr tn Sunnnrt tlw TJrbew Acnwln Riporonc analvtical work will be
-------j ;............................... ,.u~- -j?h, ,
„i:_„4.’ , ..rxi,;„ x+^4-^^,.
itxjuxivu aaa wavunwx vx xuiyvinmi mvnc v\y ouvutjiu^u cuv vpivil4vav'aii»axzaavav'aa vx laxui juuivc,^.
ti,:,.
axjuo
crucial as inrormanon base in the sector is weak and it is necessary to draw on international
experience tor use in areas such as fiscal decentralization, private sector participation and
rAO”l''r.z>M
A <-« «-*>•/* n 1
V .lx ~rr. n-H n^r>o,intn
xx zj zx«*<x ton A ’VX Or r-»{* COor<-»»- ir.rr,xr«C
-- --- r —-- XX. XXJJ
—---- A. -X.XXXXWW-X ----- ..XAWxW
..XX ----- VXXXX.X.Xx>.XXXX_x
Xxxjx, Wx xTWWVWX xC^XXW« ~XX —
puaMOic pv11vico uiiu pivKioiiio uvea uvt caioi is uwou povciiy. 11110 luciuuco tuc delivery oimoie
elective social services and a comparative assessment oi poverty characteristics across regions.
For letter wu^rctsndino of the enhanced role of cities in economic development a better
is
impact on urban poverty is critical.
*70
r>£ the themes m the proposed three strands approach focus on
oonooifipc of
local ^wciJLiiiiciiis, especially wiiimi die chicigmg ucccjuualizauoii juauicwoik. Adequate
inionnation and analysis are not available in this important area tor meaningful support.
Emphasis is needed particularly on a better design for fiscal transfer systems to provide
area or sector work would be die incentive structure required to increase city efficiency and
competitiveness, fhcuah this is recoamzed as crucial amcne policv makers and analysts, little
nnfinrcronainn qRaiit if- ovtefe of vtrocanf
Thue
flyTAA Tutonht aroac f>f cc»ofr>r vxrOfV fr>T fh*> lirKqr*
SCvtvi cuC. ixiMtixi pOVCiiy’, iiovui aSpCviS Oi ucGciiudiiZdtiOii uiiu CvOiiOilliv uiCciiiiVcS foi
enhancing city competitiveness. Carefully targeted work in these areas will also help to
mainstream 'Urban’ in overall operations of the Bank.
73.
nuimchrnv ihe Sirmegy. inc suaiegy has been developed in close consultation with GOL
and with inputs from multiple stakeholders, lhe next steps include the initiation oi knowledge«b?*TTn*» whvthp«
tl»x»
xzv« vxOpxiAvilh tijuii x vrvvlvjr r urvnutivit.
ir»
x>jlaxav.i
Twrl'n*-rr«hiT’ wilb
A
A
’
VTvnivIrv of Tlrb^n
'*
iijv ovvOiid uild third Suaxxdo, liiv Biulxt vvllillluv uxv
preparation oi rue statewide projects already identified in Andhra Pradesh and Gu jarat and
identify and develop in close consultation with GOT. new operations in the urban sector. The
At^rr. .
* C •» « O’t01«
J nC «
rl
»-v-. r»T,V tVs nT V! «11 <v» rf\ 1x ’<» r» r/-»w "MV*-* <*
- --------—J —------------------ ------ --------- - ----- —
---- ---- XX. ---- o X.X.
W xxxxxxxx.
—... ..XXX W . WX. X W . WX XXXXXW X, --------- ---
cviuuauuu ua uH^uiuu auu new uwuh beuioi operations.
29
Annex 1: illustrative Urban (jovernance and Management Reforms
■"-------
■ ——ee—V* —* AA-
_ _ J?__--------wxv;<x____ |
I -JMKlXr* Wr
I!
I
S A. Financial management
I
3
I
-A-CCA
8
I
a
Fn
...
. ...
r ... .................................................. i~
|
3----------------------------------------------------------1-1
j Accounting and auditing
| ■
8
I •
8 Rndoefc and canital investment
I ■
S «!«-<,
I
r—'
i
J—------------------------------------------- —1_1
8
I
8 B. Service Delivery
I
8
I
8 TnnlT.HUin.r fnrTTWSS
’
li
Development of model guidelines for performance Jinked
fwAffAl
''VTX'—UtTt,’"* —•- n—U
8
I L>o
!
I
__________________________________________________________________ 8
I .
I .
8
I ‘
I--------------------- I—
8
Development of monei accounting cottes
TA for implementation of accounting and auditing reforms
“ '
PiptrAinnmonr nF rnod**l nonTrnnfcj t»nn narpamptiic ■frv
fl
UUldUW V1UU, bVA VAWO ....... ~~.......... °........ .
Review and plan for outsourcing of services
«J
i A far iocai con Tracts for coliecrian ana transportation of solid
g
waste, billing and collection of charges, etc.
fl
ij
Develnnmenl of model ‘jnidtdmes for w»ler tariff
I;
... A
8
------ x. ,.WVV
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SCuiiig du lOCdx icVcib
I,
ii Nolid waste management
| •
Development or guidelines for HSH for secondary collection,
»
8
I
transportation and disposal and community / NGO participation 8
for nrimarv collection
8
T A tor ncnoocrriarit zyF raphninnl ohnrnao For Col’H yxrr»cfa
8
5 C. Citizen Orientation
0
B
3
t~'/'HCTTare ann ror»r\r+ narrlc
I
|
I
I
1
8
I
8
8
1 •
T*»oiralr\rvrTi<sn+ nF mnnal rtfi?on«' rharforc Fnr rvturjif'inol cpr-tri<->oc
II
i
-.-A x'~_\—«.
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8
........................................... —----------------------------- ^.^-X^AAA, —
a
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8
!1
8
|
1CVC1
[I
J Citizens' grievance rearessal
i svstems
Q A^innul n-*TWvrl zxr, <c(tAfnv nf
fl
8 .. ..................... ...............
3
!
| «
1 .
Development ot guidelines tor citizens' redressai systems
TA for implementation of redressai systems at the local level
j
8
1 x
1
1
1 "
1
r)evebvHr>^ril of <mi<lelines Gw Tiren«mh<n» of servic*** MTjd
8
__ ‘ ‘.........................................................
——....................
,
tn iOi MiiUiu picptuduon Oi bciviccb / buUbioics 1 cpUiis dt lOCdi
ievei ana their insiiiuiionaiizauon
fl
J
g
g
30
n Decentralization
c ommitment to 'municipalization' with rationalization of assignment of functions
and revenues to urban local authorities, including autonomy in setting tax rates
and user charges
incentives iui iinpioven perlurmance
CorTirnilrnent (<i develop h stale level framework Gir Truinicipal borrowin;
oriented financing system
Commitment to develop appropnate institutional arrangements for policy and
project development support with private sector management
g vv'aier scciui
fi reiorms
Public uuwumxUKui regarding a fundamental change in tile role of government
in UWSS inciuamg introducuon ot PSP
Drafted an adequate tariff policy, targeting fol! cost recovery m a time-bound
manner
Coiiuiiitxliciit iO target tile pOOi' ill Wdicf diivi SdiiiidUOu Sudtcgy
Commitment to submit aii UWSS linked rinancing requests only with PSP
Initiated steps to reform the state level PHEDs or water-sewerage boards and
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31
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32
Cover
Story
Mr D Sreenivasa Rao of Catholic Hospital Association of India did a study on the health
challenges of slums. He was guided by Dr P Venkata Rao and Mr D Rayanna.
Health Action talks to Mr Sreenivasa Rao.
Why Slum Health?
n gut level...
OHealth Action-.
What in general are
your impressions re
garding health action
in slums?
Sreenivasa Rao: I shall be quoting
some of the reactions of health agents
working in slums:
‘In my earlier posting, I used to de
velop muscle cramps, and we were
doing a roaring business. Today, here
in this bloody posting, I hardly get any
clients.’
The Crux
main problems?
billion people — more than half of the
world’s population — will become city
dwellers.
penditure incurred on services will go
waste.
Problems are mainly at the
HA: What is the crux of the problem levelS.R:of urban
primary health care. They
with regard to slum health?
are of such dimension that if they are
S.R: By the year 2000 AD, over 3.2 not addressed immediately, most ex
Nearly half of this population will
live under conditions of extreme
deprivation caused by poor sanitation,
high density living, industrial pollution,
and economically prohibitive and in
accessible health services.
‘ How can I visit the villages that you
are talking about? Am I supposed to
visit them? What for? Besides, there’s
no jeep’
And the question forms: “Can one
achieve Health for all without decent
shelter, healthy neighbourhoods, ad
equate water, sanitation and timely
garbage collection? ”
‘These people are illiterate, lack basic
hygiene and really are in need of a
i wash’
Problems Galore
‘Public defecation is the number one
enemy. But how is that my business, I
mean what is the sanitation department
for?’
‘More than 95% of my patients are
anaemic women. Many times, I won
der how they are surviving! ’ This is not
the season for good work. Good work
means rainy season’.
‘I mean, just tell me, what has lit-:
eracy work to do with my health work?
These statements make us feel sad.
They do drive home a point that there
is a good bit of work to be done on the
attitudes of the health personnel working
in the field.
4 • Health Action November 1991
HA: What do you think are the other
These problems are:
★ the heterogeneity of the community
as compared to rural areas,
★ the emergence of individualism and
self-centred behaviour of residents,
manifesting itself in a relatively low
sense of collective responsibility,
★ the poorest of the poor are often
difficult to reach, although their need
for health care is the greatest,
★ ironically the main beneficiary of
the urban PHC is the relatively well
off, who already have some access
Challenge of Urbanisation
Rising Urban Populations
12.1 In 2001, India’s urban population, living in approximately 5,200 urban agglomerations, was about
285 million. It has increased to almost 380 million in 2011. Projections are that by 2030, out of a total
population of 1.4 billion, over 600 million people may be living in urban areas. Tire process of urbanisation
is a natural process associated with growth. It is well known that agglomeration and densification of
economic activities (and habitations) in urban conglomerations stimulates economic efficiencies and
provides more opportunities lor earning livelihoods. Possibilities for entrepreneurship and employment
increase when urban concentration takes place, in contrast to the dispersed and less diverse economic
possibilities in rural areas. This enables faster inclusion of more people in the growth process and is
therefore more inclusive. There is no doubt chat the condition of the poor in rural India must continue
to get major attention but the urban sector development should not be viewed as negating such attention
or weakening it in any way. On rhe contrary, we must acknowledge that there is a synergistic relationship
between rural prosperity and the continuum of urban development from small towns through larger cities
to metros. A holistic approach to spatial development is needed if the country wishes to achieve more
inclusive growth.
12.2 An interesting aspect of the urbanisation trend revealed by the Census is that the number of towns
in India increased from 5.161 in 2001 to as many as 7,935 in 2011. It points out that almost al! of this
increase reflects the growth of 'census’ towns (which increased by 2,532) rather than ‘statutory’ towns
(which increased by only 242). ‘Statutory’ towns arc towns with municipalities or corporations whereas
‘census’ towns arc agglomerations that grow in rural and pen-urban areas, with densification of populations,
that do not have an urban governance structure or requisite urban infrastructure of sanitation, roads, etc.
As more Indians will inevitably live within urbanized conglomerations, with densification of villages,
sprouting of peri-urban centres around large towns, and also migration of people into towns, the quality
of their lives and livelihoods will be affected by the infrastructure of India’s urban conglomerations. The
infrastructure of India’s present towns is very poor. Sewage, water, sanitation, roads and housing are
woefully inadequate for their inhabitants. The worst affected are the poor in the towns. As more urban
conglomerations form and grow without adequate infrastructure, the problems will only become worse.
Therefore. India’s urban agenda must get much more attention.
Urbanization - Challenge and Opportunity
12.3 As stated above, the expansion of urban India is the platform for industrial and modern service
sector growth and the creation of greatly improved income opportunities for the youth of this country.
In order to realize the opportunities that urbanization offers and to successfully resolve its accompanying
challenges, a combination of several initiatives is needed.
Challenge of Urbanisation
109
o First is to step up investment in new urban infrastructure assets and maintenance of assets. It
is estimated that a total of about Rs. 40 lakh crore (2009-10 prices) as capital expenditure and
another about Rs. 20 lakh crore for operation and maintenance (O&M) expenditure for the
new and old assets will be required over the next 20 years.
o Second, is to strengthen urban governance. A unified and effective administrative framework
is necessary in urban areas with clear accountability to citizens. The elective office of mayor
supported by the necessary administrative powers and machinery can provide the required
framework. Tliis may require significant changes in administrative rules to delineate clear areas
of accountability for elected representatives with reasonable tenures in office.
o Third, is to strengthen the 'soft infrastructure’ simultaneously with the building of the hard
infrastructure. Therefore, along with the strengthening of governance structures, the enormous
weakness in the capacity of human and organisational resources to deal with the challenges posed
by the sector must be addressed. Efforts must be made to redress this situation in collaboration
with State Governments, ULBs as well as private sector.
o Fourth, is to give adequate emphasis to long term strategic urban planning to ensure that India’s
urban management agenda is not limited to ‘renewal’ of cities. It must also anticipate and plan
for emergence and growth of new cities along with expansion of economic activities. Tire urban
planning exercise, therefore, has to be situated not only in the specific context of municipal
limits but also encompass the overall regional planning perspective.
o Fifth, is to address the basic needs of the urban poor who are largely employed in the informal
sector and suffer from multiple deprivations and vulnerabilities that include lack of access to
basic amenities such as water supply, sanitation, health care, education, social security and decent
housing. They are also not sufficiently represented in the urban governance process.
o Sixth, is to ensure the environmental sustainability of urban development. As this is a complex
process, which requires co-ordinated action on different facets of urban development; the
strategy would require creation of an institutional mechanism for convergent decision-making
so that cities become environmentally sustainable. Such an approach would be in line with the
objectives of the National Mission on Sustainable Habitats which seeks to make cities sustainable
through improvements in energy efficient buildings, management of solid waste and a shift to
public transport.
12.4
The urban agenda
mentioned above can be described under three headings:
o
o
o Desired Inputs
o Expected Outputs/Outcomes
o Instrument of Policy/Funding Intervention
Desired inputs
12.5 Long term urban planning must focus on the development of regions, not merely on the condition
of existing cities and towns. Within the region, the aim should be to identify small and medium size towns
and expanding villages that have locational or natural resource advantages for future socio-economic
growth. Spatial growth around such nodes may be guided by planning and investment of funds for their
infrastructure. Such nodes invariably have some in-built advantages, such as lower cost of land, but at
I 10 Approach to the Twelfth Five Year Plan
f'
»
/
the same time many serious drawbacks too such as poor connectivity and inadequate municipal services.
If such issues are addressed by longer term, and spatially wider urban planning, then both the pace and the
process of urbanization can be improved.
12.6
Urban infrastructure needs to be strengthened across the board. Primarily:
o Provision of basic amenities like safe drinking water, sewerage, waste management facilities and
sanitation facilities in urban conglomerations, while also ensuring that the urban poor have
access to these facilities at affordable cost.
o Improved water management, including recycling of waste water in large cities and new
townships.
o Transportation in urban centres is a major constraint. Currently, public transport accounts for
less than a quarter of urban transport in India. Therefore, urban mass transit including metro, rail,
electric buses and trams as well as other forms of public transport must be greatly strengthened
especially in under-served urban centres.
o Strengthening preventive healthcare, including 100 per cent vaccination, safe drinking water,
management of MSW and ambient air quality and aggressive control of vectors that cause
diseases. A National Urban Health Mission may be considered to meet these objectives.
Strengthening the secondary and tertiary healthcare systems using PPP models wherever
possible, and ensuring adequate availability of such services to weaker sections.
o For inclusive urban growth, policy initiatives must result in an enabling environment for
productive and dignified .self-employment. Permissions, as well as provisions of spaces and other
facilities for small enterprises are necessary. Institutions of self-help groups, producer societies,
and other forms of cooperatives can be one approach amongst others. The formation and growth
of formal enterprises may be facilitated too to enlarge opportunities for good employment
within the cities.
o The Skill Development Mission must be geared to creating extensive skilling facilities for a wide
range of contemporary occupations.
o Tic housing business is largely in the private sector. Government should consider using land as
leverage for market based strategies and PPP models to greatly improve the scope of affordable
housing for weaker sections.
o Tie condition and needs of the most vulnerable urban citizens must always be kept in the
forefront if urbanisation is to be inclusive. Without doubt, the most vulnerable are ‘street
children’ in Indian cities, who have no option than to live and work in miserable conditions on
the streets. Safe housing and care of the elderly is also becoming a major concern in Indian cities.
Expected Output/Outcomes
12.7 Tic emphasis on urban development, keeping in mind both quality as well as geographical spread,
should result in improvement of the ability of urban aggregations to gainfully accommodate migrants
from rural India.
12.8
Tic urban centres and their peripheries should become the launch-pads for expansion of
manufacturing and modern services. Economies and innovations within them should provide the
Challenge of Urbanisation
111
country with the desired global competitive edge in larger numbers of products. Such economies
of agglomeration would also enable the country to take full advantage of its diverse production base.
Ihus urban conglomerations can create employment opportunities for a variety of skills and talents.
12.9 Improved urban amenities and infrastructure would not only create acceptable quality of urban
lite for its large urban population including its vulnerable groups but should also allow India to realise its
full potential of emerging as a major tourist destination in the world - which it is not yet in spite of the
country’s ‘incredible’ range of potential attractions for tourists.
12.10 Urban centres have also to serve the interest ofS&T development and become centres of innovation.
However, in order to create the appropriate environment for the pursuit of higher education and scientific
and technological research special efforts need to be made to earmark those areas of urban space that are
best suited for it.
12.11 Policy in terven tions like the Rajiv AwasYojana (RAY), coupled with policy measures for augmenting
the supply of affordable housing, and expanded access of subsidized healthcare and education to the
urban poor should result in a significant reduction in the proportion of slum dwellers and in geographical
spread of slums.
Instruments for Intervention
12.12 Implementation of a comprehensive agenda for managing the urban transition requires action on
several fronts.
Governance
12.13 The regulation of urban centres is presently characterized by fragmented authority and responsibility
and weak political accountability. The 74th Constitutional Amendment Act (1994) sought to provide
clear constitutional status to Urban Local Bodies (ULBs). The range of functions that the ULBs are
supposed to discharge is very wide and is in most cases asymmetric with respect to their authority
vis-a-vis the State Governments and their financial resources. There is a need for adequate devolution of
funds under the 3-F principle of Functions, Funds and Functionaries.
12.14
Elections to most ULBs have been held bur these bodies must be invigorated
and enabled
o
to discharge their responsibilities. At present, ULBs have become are too subordinate to the State
Government machinery. It is imperative they have adequate autonomy to function effectively.
Tli ere is need for constitution of Metropolitan Planning Committees as well as for formation ofspecialized
planning development authorities like Urban Metropolitan Transport Authority (UMTA) to be created
under it.
12.15 It is also imperative to demarcate a careful division of responsibilities between State level bodies,
Regional planning authorities and Urban Local Bodies (ULBs). Therefore, the 18 functions listed in the
Twelfth Schedule of the Constitution must be broken into specific activities and responsibility for each
activity assigned to the level which is best suited to perform that function.
Capabilities
12.16 Administration and technical management of urban development must become more professional.
Technology must be deployed to improve service delivery and governance. Capacity building must extend
1 I2
Approach ro the Twelfth l ive Year Plan
to training of elected representatives in urban governance issues. Since these problems arc not unique
to any single ULB, the Central Government should catalyze an ongoing process of capacity building
and improvement by creating institutions of excellence as well as interactive forums for sharing best
practices.
12.17 Changes in power and capabilities of functionaries should result in their capacity ro discharge their
municipal obligations, as well as capacity to generate financial resources through taxation and fees which
will strengthen their autonomy.
I in.imiii"
12 18 The Government would need to continue to financially support both building capacity and
building urban infrastructure from the public exchequer till capacity is built in the urban local bodies to
promote PPP. The investment requirements for delivering necessary infrastructure services in urban areas
arc huge. The High Power Committee on Indian Urban Infrastructure and Services which was appointed
by the Ministry of Urban Development has recently submitted its report and has estimated that water
supply, sewage, solid waste management, storm water drains, urban roads, urban transport and urban
street lighting would require an amount of Rs. 39.2 lakh crore (at 2009-10 prices) over the next 20 years
to meet the requirements of the projected urban population, meeting currently established standards.
The Committee recognised that budgetary resources can at best play a catalytic role in channelizing
investment to this sector. There has to be a two-pronged strategy to bridge the gap in resources: to
create a policy environment for fostering cost-saving innovations; and mobilisation of resources through
innovative methods of financing.
12.19 Achieving financial sustainability through own resource mobilization of city level governments
through betterment levy, additional FAR charges, conversion of land dues charges, external development
charges and infrastructure development charges has been an important objective of JNNURM which
must be considerably strengthened in the Twelfth Plan period. Besides attracting private investment,
unlocking the value of land for financing infrastructure, projects, with intelligent use of Impact Fees and
higher FSI, should form a core element of policy initiatives. Better management of property taxes and
realization of fair user charges are other sources which need to be tapped by urban local bodies.
12.20
A massive push is needed to attract private investment in all areas ol urban infrastructure, both for
large infrastructure projects and for drinking water supply, waste water recycling, treatment of MSW and
treatment or urban sewerage. This should be done under an extended *4P’ framework—People-PnvatePublic Partnerships as experience across the world indicates that in urban renewal and management, the
role ol 'People' in design of projects and partnerships is crucial, much more so than in large infrastructure
projects such as highways, airports, power, power plants, etc. in which ‘People’ have a relatively limited
role in the ongoing governance of the projects and their outcomes. Therefore, best practices and models
for ‘PPPP’ must be evolved and deployed for India's urban management agenda to succeed. These PPPP
projects may become more viable if a subvention from property and other urban taxes is imaginatively
used to meet any financial gap in the projects where felt necessary.
L rban Planning
12.21 Urban planning is the crucial element in the whole approach to tackle the challenge of urbanization.
The City Master Plan should be a comprehensive plan, containing all details including futuristic
development. The Master Plan should form the basis on which further action can be taken by the ULB,
Challenge of Urbanisation
113
if they are to leverage the value of land, in whatever small extent that is feasible. Much more attention
should be given to ‘urban forms'. What is the shape and type of city that is desired ? The capacity for urban
design and planning must be developed to address such systemic issues taking into account all necessary
and inter-connected parameters. Urban planning cannot be limited to spatial allocations and engineering
solutions: it must encompass and connect various socio-technical considerations too.
12 22 There is an urgent need to shift focus towards an outcome-based approach that is based on service
level delivery rather than an approach that focusses only on investments and asset creation.
12.23 International studies confirm that there cannot be a model blueprint of a ‘world class’ city.
‘World class’ cities vary considerably in their shapes and flavours. Many large cities in North America and
Europe had to undergo substantial renewal and became world class through a process of participative
evolution. The spirit of Indian democracy and desire for further devolution makes it imperative that
urban planners of Indian cities master participative processes of planning that enable citizens to shape
the cities they want. In fact this may be the key to an ongoing process of urban renewal and growth in
the country.
Interventions by the Central Government
12.24
The Central Government’s thrust on guiding and improving rhe quality of urbanization in
the country must be intensified. The JNNRUM, the flagship program, will have to continue in some
improved form. It must be redesigned and improved to incorporate the lessons learned so far and to suit
the next stage of India’s urban renewal. The Rajiv Awas Yojana (RAY) has been outlined as another major
program for urban improvement specifically from the perspective of prevention of slums and improving
the condition of the urban poor. As mentioned before, there must be more coordinated management
of infrastructure within towns and cities. Therefore, Central Government programs must also converge
and the new JNNRUM and RAY should be integrated into a coherent program. Until the new program
is introduced in the Twelfth Plan, there must be no hiatus in the implementation of existing projects of
JNNRUM that have been partially completed. For this, a suitable transition arrangement will need to be
made.
12.25 Tire kev principles for designing the new flagship programme, derived from evaluations of present
programs, as well as the analyses done to frame RAY, should include:
o Take a ‘whole citv’ approach to planning and improvement (slums cannot be prevented by
focussing on just the slums: the layout and distribution of infrastructure of the whole city must
be considered)
o A ‘city master plan’ must be much more than a zoning plan and an engineering plan for rhe
'hard infrastructure’. It must address theconditionofsocial services and progressive improvements
in the 'soft infrastructure’.
o Focus on the needs of the poorest inhabitants of the city. The richer inhabitants are able to look
after their needs through private arrangements, and thus private enclaves will grow side by side
with ghettos of the poor if the needs of poorer citizens are not given primacy
o Better management of land use, and leveraging of land values to finance infrastructure
o Innovations in assignment of ‘property rights’ to enable poorer sections to participate in the
orderly development of cities by their ability to access finance
o Strengthen the ability of urban local bodies to finance the maintenance and building of
infrastructure
o Avoid 'one size fits all’ solutions
o Decentralise decision making and ensure participation of all stakeholders including the local
communities so that schemes arc suitably calibrated to meet local requirements and aspirations
12.26 The National Development Council, while reviewing the Mid-Term Appraisal of the Eleventh
Plan, had noted the importance of the urban sector for inclusive growth, as well as the challenges that
need high-level attention by the Centre and the States. A Sub-committee of the National Development
Council (NDC) has been set-up to focus on the urban sector. The Sub Committee will consider the
recommendation of the High Power Committee on Indian Urban Infrastructure and Services and
hopefully also deliberate on the issues raised in the Approach Paper. The findings of the Sub-Committee
and its recommendations will be invaluable in formulating the Twelfth Plan.
Position: 2815 (3 views)