If We Walk Together Communities, NGOs, and Government in Partnership for Health—The IPP VIII Hyderabad Experience

Item

Title
If We Walk Together
Communities, NGOs, and Government in
Partnership for Health—The IPP VIII
Hyderabad Experience
extracted text
If We Walk Together
Communities, NGOs, and Government in
Partnership for Health — The IPP VIII
Hyderabad Experience
■<

Kirrin Gill

&

The World Bank
Washington, D.C.

Contents
Foreword 5
Acknowledgments 7

Summary 9
Improving Health and Well-Being in Hyderabad 11
In Partnership with NGOs and the Community 13
Expanding Outreach through NGOs 17

The Link to the Community 25
Women's Health Groups and Community Revolving Funds 29
Innovative Schemes 31

Measuring Success 35
Learning Lessons 39

The Emerging Path 45

Appendices 47

Appendix A: NGOs Collaborating with IPP VIII in Hyderabad 47
Appendix B: Achievements of Hyderabad's Participatory Approach 47
References 49

3

Foreword
m he Municipal Corporation of Hyder1 abad took early and creative advan­
tage of the support offered through
India Population Project VIII (IPP VIII)
to form partnerships with local NGOs
and women's community groups to
improve the lives and health status of
the city's slum dwellers. Previous India
Population Projects had gained valuable
experience through their work with
local NGOs in two specific areas, run­
ning selected Family Welfare Program
health facilities serving slum areas and
carrying out sterilization-related activi­
ties planned by the national Family Wel­
fare Program. But, as the Census of
1991 indicated, the country's urban
areas were growing rapidly, as were
their slums—and with this geographic
growth came growing health care
needs.

include NGOs in its activities, and the
second urban project to do so (after IPP
V). IPP VIII’s design incorporated ele­
ments of these activities from the three
earlier projects, and it also incorporated
the flexibility to adjust design specifics
to accommodate differing local realities
(in terms of both health status and NGO
capacity) and use lessons learned from
experience. Among these innovative
design elements were the importance
given to the inclusion of community
women's groups, as well as NGOs, in
project activities and recognition of the
need to foster the working relationships
of these groups, as well as the more vis­
ible relationships between municipal
authorities and NGOs.

The project offered local NGOs and
women's community groups the chance
to carry out a wide range of participato­
ry activities related to program goals,
including health promotion, vocational
training, and social clubs for women liv­
ing in the slums, and enxironmental sani­
tation and selected health sendees. Each
of the four project cities—Bangalore,
Calcutta, Delhi, and Hyderabad—have
in fact met these challenges to some
extent, but none so comprehensively as
Hyderabad, both in terms of the range
of responsibilities carried out by NGOs
and women's groups and in their will­
ingness to offer and accept such respon­
sibilities.

In mid-1994, implementation of IPP VIII
was beginning, with the goal of sup­
porting expanded and improved provi­
sion of Family Welfare services to those
living in the slums of these cities. Pro­
vision of these services would then con­
tribute to fertility reduction, as well as
to the lowering of maternal and infant
mortality and morbidity levels in the
slums. The project document noted the
intent that Family Welfare activities be
run as “a people's program,” and that
inclusion of local NGOs in projects
could “increase the pace of program
implementation by supplementing gov­
ernmental activities and bridging gaps
in communication between the munici­
pality and the slum communities.” Few
municipal corporations, however, had
invested significantly in health facili­
ties for slum dwellers, and few if any
possessed the resources to expand
their existing levels of coverage.

One challenge faced at the start of the
project was how to define the relative
roles of NGOs and community groups in
relation to each other and to govern­
ment. How can these interactions be
fostered in a manner consistent with
government and Bank procurement and
disbursement guidelines? This case
study describes the range of participa­
tory activities being carried out in
Hyderabad, the factors responsible for

IPP VIII was the fourth \\rorld Banksupported India Population Project to
5

current achievements, and the status of
efforts to assess health status out­
comes of these activities. The study
offers one approach to these issues,
which we believe is helping to create a
“sum” in Hyderabad that is greater
than its various parts.
A recent study of these issues by the
Operations Evaluation Department of
the World Bank recognizes that,
although participatory activities may
not absorb as large a share of project
resources as other components, they do
need a reasonable and timely level of
monetary support and management
attention to succeed. The need for man­
agement attention applies at all levels of
project implementation, including the

6

Bank's own project review allocations.
Focused resources are needed to under­
stand and facilitate these activities, as
well as to provide appropriate systems
support in key areas such as procure­
ment and disbursement. We at the World
Bank are grateful to the Fund for Innov­
ative Approaches to Human and Social
Development (FLAHS) for monetary sup­
port, to Aubrey Williams for wise advice
about monitoring these activities in IPP
VIII, and to the Consultant Trust Funds
of Spain and Switzerland for subsequent
support—and our deep thanks to all in
Hyderabad who joined us in preparing
this case study.
Catherine Fogle, SASHP
December 1998

Acknowledgments

T ike the project it describes, this
JlJ study has been an enriching and
participatory process. Many people have
contributed to its growth and develop­
ment, and they have shown a commit­
ment to the ideas behind it that is far
beyond any job description. At the World
Bank, Catherine Fogle, Task Leader for
India Population Project VIII (IPP VIII),
directed a three-year-long effort to
understand and encourage community
and NGO participation. For this study,
one of the products of the effort, she
provided guidance and encouragement
at every stage, from the initial search
for funding to detailed comments on
drafts. I would also like to thank
Richard Skolnik, who supported the
study from the inception of the idea, and
G. N. V. Ramana for his thoughtful input
and his review of the quantitative data.
Many others contributed their advice,
experience, and additions, including
Amar Bhattacharya, Richard Cam­
bridge, Meera Chatterjee, Christopher
Gibbs, David Marsden, Anthony
Measham, Indra Pathmanat han. Rebeca
Robboy Rashmi Sharma, Susan Stout,
Sam Thangaraj, and Aubrey Williams.

well as a great inspiration. One of the
driving creative forces behind this pro­
ject, she answered my relentless battery
of questions with meticulous detail,
grace, and humor. 1 am also thankful to
the others who made this project possi­
ble and helped in the development of
this study, including Rachel Chatterjee,
Secretary of Health and Family Welfare
for Andhra Pradesh; Mr. D. K. Panwar,
former Project Director of 1PP VIII; Dr.
Mastan Rao, Joint Director of IPP VIII;
Dr. Ranga Rao, the former Joint Director
of IPP VIII; and the IPP VIII Assistant
Project Officers for Women's Develop­
ment, G. Jyothsna, A. Mamta, and Narjis
Medhi.
I also wish to thank Pablo Bartholomew
for devoting his time to this project and
for capturing the vibrancy of IPP VIII in
his beautiful photographs, Andy McCord
and Sanjay Reddy for their support and
insightful suggestions, and Girija Devi
for her contributions. Finally, although
there are too many to name here, I am
indebted to the countless Link Volun­
teers, women's health group members,
representatives of NGOs, and IPP VIII
health and administrative staff who pro­
vided the details that have given life to
this description. This booklet belongs to
them, the partners in the exceptional
partnership described. It is the generos­
ity of spirit in the work of all of these
individuals, many of whom have little
themselves, that has been the inspira­
tion for this study.

In the Government of India. I am grate­
ful to Mr. K. S. Sugathan, Joint Secre­
tary of the Ministry of Health and Fami­
ly Welfare, for his support. In the Gov­
ernment of Andhra Pradesh, Kulsum
Abbas, 1PP VIII Project Officer for
Women's Development, was the primary
source of information for this study, as

7

!

8

Summary
If we walk together.

a path will emerge”

(A local saying in Andhra Pradesh.

T n the slum communities of the city of
1 Hyderabad, the capital of the southern
Indian state of Andhra Pradesh, a
remarkable partnership is taking place
between the women of the slums, non­
governmental organizations (NGOs), and
government health workers. These three
groups have joined together to work
toward improving the health and well­
being of women and children in some of
die poorest neighborhoods of the city.
Phis partnership is occurring under the
Government of India's Family Welfare
Urban Slums Project (in Bangalore, Cal­
cutta Delhi, and Hyderabad), also Lown
as India Population Project VIII (ipp
WII) riiis World Bank-supported project
IS collaborating with NGOs and commu­
nities to make a qualitative change in
die lives of women and children who live
in the slums of four major Indian cities.

In Hyderabad. NGOs and community
members are integrally involved in pro­
ject activities. NGOs work in partnership
with government health staff to mobilize
community members to form women's
health groups and networks of voluntary
community health workers. These work­
ers known as Link Volunteers, act as
the link between their communities and
health staff. Women from the slums are
chosen to be Link Volunteers on the
basis of their communication skills not
their formal education. In fact, some of
the most effective Link Volunteers are
illiterate. The Link Volunteers provide
women in the slum communities with
health and contraceptive information
and services and keep the government
staff informed of the health status of the
community.
9

translated from Telugu.)

Link Volunteers do not receive individual
payment for their work. Instead, their
communities are given a financial incen­
tive through women’s health groups and
community revolving funds. This money
has enabled the women of the slums—
perhaps for the first time-to finance
improvements in their neighborhoods.
hey have used these seedling funds to
improve civic amenities, such as sanita­
tion systems, wells, and toilets, and to
establish income generation schemes,
such as tailoring centers. NGOs help
the women identify and carry out these
initiatives.
1 he II P VIII experience in Hyderabad
is exceptional because it has succeeded
J"
“ llnusualIy high extent of
both NGO and community participation
and has shown strong health-related
results. There are 22 NGOs delivering
family planning and maternal and child
health services in 662 slums of the city
with each NGO having autonomous
authority over all project activities in
20 or more slums. Women from the
communities have formed 586 women's
health groups (WHGs) and more than
a.aOO have become Link Volunteers
Thousands of other community mem­
bers have joined the project’s innova­
te schemes, such as workshops for
first-time mothers, nutrition education
progr-ams for girls, and nursery schools
lor children. Since the start of the pro­
ject in 1994, outpatient registration has
increased from about 615,000 to
908,000, the rate of institutional deliver­
ies from 70 percent to 84 percent, and
prenatal care coverage from 91 percent
to 9n percent.

This booklet describes the partnership
between the government, communities,
and NGOs. It examines NGO and com­
munity involvement in Hyderabad and
explains how the partnership functions
and how, by using an integrated devel­
opment approach, the partnership helps
the project reach the women and chil­
dren of the slums. It elaborates on the
roles of the Link Volunteers, women's
health groups, and NGOs and provides
details on 1PP VIII activities and the
other community development schemes

■’ mi-

10 —

begun by the project. Engaging people's
participation in a development project
is not an easy process. Few projects
have been able to achieve meaningful
involvement of communities, and even
fewer have tapped the potential of
NGOs. This booklet describes how 1PP
VIII in Hyderabad has been able to suc­
ceed. It identifies some of the factors
that enabled 1PP VIII in Hyderabad to
engage both communities and NGOs,
making partnership with the people a
reality.

Improving Health and Well-Being in Hyderabad
rp he Family Welfare Urban Slums Pro_L ject (1PP VIII) was founded on the
belief that collaborating with communi­
ties and NGOs on a development initia­
tive can help make real and lasting
change. Since 1994, the project has been
active in the slums of Bangalore, Calcut­
ta, Delhi, and Hyderabad to improve
maternal and infant health and reduce
fertility. A S79 million interest-free credit
from the International Development
Association, the World Bank's conces­
sionary lending affiliate, is financing the
project to expand and upgrade health
and family welfare services and increase
demand through awareness programs,
women's empowerment activities, and
community participation. To improve the
reach and quality of health and family
welfare services in the slums, IPP VIII is
working to build and renovate health
facilities, train medical staff, and pro­
vide medical equipment and supplies. It
is also using innovative strategies and
schemes to increase women's aware­
ness. status, and participation in the
project. The project design integrated a
participatory approach into the overall
project strategy, and it encourages NGO
participation in several project activi­
ties. As a result, all four IPP VIII cities
are working with NGOs and have mobi­
lized communities to form networks of
community health volunteers.

The project has engaged NGOs and com­
munities in identifying and planning pro­
ject activities and has provided support
for their own initiatives. Creative ideas,
such as giving NGOs autonomous control
over project areas and enabling women
from the slums to finance improvements
in their communities through revolving
funds, have transferred control over
decisions and resources to NGOs and
communities, catalyzing the process of
empowerment. This partnership with
NGOs and communities complements the
project's improvements in service deliv­
ery, which include 26 new Urban Health
Posts, 5 new maternity centers, and the
reinforcement of the infrastructure,
staffing, and supplies of the 34 existing
Urban Family Welfare Centers. The
involvement of communities and NGOs
eases delivery of sendees and raises
demand, and thus plays a critical role in
reaching the beneficiaries of the project.

Such an initiative in Hyderabad has not
come about easily. Reliable statistics
on Hyderabad are not available, but
research on the urban populations of
Andhra Pradesh indicates that the well­
being of women and children in the
cities is poor. One child in 16 dies before
reaching the age of one. Only 58 percent
of children 12 to 23 months old are fully
vaccinated, and one in nine has not
received any vaccination at all. Mothers
received prenatal care for 93 percent of
births, but only 70 percent of births took
place in a health institution (Population
Research Center [PRC] and Internation­
al Institute for Population Sciences
[UPS] 1995).

In Hyderabad, these participatory
approaches have resulted in an unusual­
ly high level of involvement of both NGOs
and communities. Twenty-two NGOs col­
laborating with the project are manag­
ing community-based activities in the
662 slums in the project area. They have
trained 5,581 community health volun­
teers and started 586 WHGs to help
reach women and children in the slums.
But what makes IBP VIII in Hyderabad
unique is the way and extent to which it
has involved NGOs and communities.

The situation is worsened by high
female illiteracy and early childbearing.
Although reproductive health statistics
for urban areas in Andhra Pradesh are
generally better than all-lndia averages
for urban populations, two weak spots
ii

stand out—female illiteracy and teen
pregnancy (UPS 1995). Both undermine
the reproductive health of women.
Among urban women, 33 percent are
illiterate and the average age at mar­
riage is 20. Early marriage inevitably
means early pregnancy, because few
women use contraceptives to delay
childbearing and space pregnancies.
Fifty-six percent of married women use
a modern method of contraception, but
for the vast majority this has meant
sterilization. Only 4 percent of married
women use modern methods of spacing,
such as the pill, IUD or Condom (PRC
and UPS 1995).

E

These statistics on the urban popula­
tions of Andhra Pradesh give only a par­
tial indication of the conditions of the
poor in that state's cities. Even in the
capital city of Hyderabad, physical prox­
imity to infrastructure has not meant
access to services for the people of the
slums. The available statistics on the
slum populations of Hyderabad confirm
that reproductive and child health
among the poor in the city is similar to
statewide urban averages despite the
proximity of the state's best health and
educational institutions (.Rao, Babu, and
James 1998). As in many cities in the
developing world, Hyderabad’s social
development has been neglected. Central
and state-level government support for
health infrastructure in India has con­
centrated on rural areas and statewide

i
12

programs. As a result, public health ser­
vices in Hyderabad are weak and inade­
quate to meet the needs of the large and
growing population of the poor in the
slums. A survey conducted in 1992,
before the initiation of IPP VTI1, showed
that fewer than half of the women in the
slums were aware of the existence of
Family Welfare centers run by the gov­
ernment (D. V Rao 1992).
Health problems are compounded by
other strains on the rapidly growing,
diverse population of Hyderabad, which
is both a seat of traditional culture and
a rising center for new technologies.
Friction between the Hindu population
and the large Muslim minority has
become a way of life in the city, periodi­
cally breaking out into severe violent
conflicts. The slum populations include a
large percentage of Muslims and other
minority groups, so tensions are particu­
larly high in the IPP VIII project areas.
Since the 1970s, the slum population has
increased more than fourfold. According
to the Office of Urban Community Devel­
opment, Municipal Corporation of Hyder­
abad, in 1971, 282 slums housed 300,000
people in the city. At the start of IPP VIII
in 1991, there were 662 slums housing
860,000 people, who became the benefi­
ciary population of the project. The rapid
growth continued, however, and, by 1997,
the Office of Urban Community Develop­
ment noted that this population had
grown to 1,260,000 people in 811 slums.

In Partnership with NGOs and the Community
“If local people are involved, the community will really listen. Link Volunteers
speak in the communities' own language. If the motivation comes from both
sides, then we can achieve our aims. Link Volunteers are particularly good with
tough issues such as fears about side effects of contraceptives. They can help
reassure community members because they belong to the community.”

Dr. V Anantha Kumari, who has been working in the slums of Hyderabad for seven years

T T nder the difficult circumstances in
U Hyderabad, IPP VIII project manage­
ment staff recognized early on that
change could not be imposed from the
outside. It would have to come from
within, with the active participation and
commitment of community members. To
mobilize community involvement, project
staff sought help from agencies with
close links with the community—NGOs.
In Hyderabad, as in many cities in India,
NGOs were engaged in community devel­
opment, women's initiatives, and health
improvement. In exchange for the active
involvement of NGOs, IPP VII1 project
staff were also prepared to give some­
thing critical—a degree of control over
the project.

Link Volunteers serve as communicators
of important messages and information
related to health, family planning, and
the well-being of women. They also pro­
vide some basic health and family plan­
ning supplies to the community, and col­
lect information on its health and devel­
opment status. The Link Volunteers
report this information to Auxiliary
Nurse-Midwives who then follow up on
community members who need services,
such as pregnant women, infants need­
ing immunizations, and newly married
couples requiring family planning advice
and services. NGOs also help collect
information from the Link Volunteers
and report on progress to health staff
and project management staff.

In most development projects that
involve NGOs, such groups are given
responsibility for specific, often isolated,
activities. In contrast, under 1PP VIII in
Hyderabad, NGOs are integrally engaged
in and responsible for all community­
based activities. In all of the 662 slums
in the project, 22 NGOs manage project
activities at the field level and act as
intermediaries between health staff and
community members. (See appendix A
for a list of the NGOs.) Each NGO over­
sees maternal and child health and
family planning activities in 20 or more
slum communities. They motivate com­
munity women to form women’s health
groups (WHGs), called Mah.ila Arogya
Sanganis, and identify and train com­
munity health volunteers—the “Link
Volunteers.”

NGOs and Link Volunteers hold two
meetings each month to ensure regular
communication between all the groups.
One meeting is held in the slum so all
the women of the community can attend.
The other meeting, held at the local
Urban Health Post (UHP), brings the
Link Volunteers and NGO representa­
tives from three slums together with the
Auxiliary Nurse-Midwife, the Medical
Officer of the UHP, and an IPP VIII
Women's Development Officer. These
meetings ensure that information about
the communities' health needs and sta­
tus reaches the health staff. They also
provide women with a forum to discuss
their other community concerns, includ­
ing those not directly related to health
or family planning. Holding one meeting
in the UHP helps familiarize the Link
13

Box I. Integral Involvement: The Multiple Roles of NGOs
in Hyderabad
Unlike many development projects in which NGOs are engaged in isolated tasks, such as
managing a health center or vocational training program, in IPP VIII Hyderabad, NGOs are

involved in all community-based activities. Their responsibilities include the following:

• oversee maternal and child health and family planning activities in 20 or more
slum communities

• identify, train and manage Link Volunteers
• organize and manage women’s health groups
• maintain a regular dialogue with community members and health staff through
- monthly meetings at the Urban Health Post for NGOs, health staff,

and IPP VIII Women's Development Officers
- monthly WHG meetings in the slum for Link Volunteers, NGOs, and

women from the community
- monthly meetings in the IPP VIII project office for NGOs and project officials
- quarterly meetings in the IPP VIII project office for NGOs and Medical Officers
- annual meetings of all the Link Volunteers in the city

• raise awareness of health and family planning issues by organizing
- health camps

- competitions for Link Volunteers and adolescent girls in the slums

- special programs, such as World Health Day and the Pulse Polio Campaign
• register vital events

• manage IPP VIII community-based health and development activities such as

- revolving funds for WHGs
- nursery schools
- schools for former drop-outs
- adolescent girls' workshops
- first-time mothers' workshops
• establish additional community development activities according to community

needs, such as legal literacy programs and income generation schemes

Volunteers with the health facilities and
staff, so they will feel more comfortable
using the services and referring other
community members to them.
Each monthly meeting lasts about two
hours. The meeting in the UHP consists
of a half-hour health talk given by health
staff, which is followed by an open dis-

14

cussion. During the discussion, Auxiliary
Nurse-Midwives collect information from
the Link Volunteers about the health and
family planning status and needs of the
community. The Link Volunteers also
bring up other problems and social
issues facing the communities, and the
representatives of NGOs, Women's Devel­
opment Officers, and the health workers

Figure I. The Partners in IPP VIII

IPP VIII
government
staff

Health
staff

help suggest appropriate actions and
solutions. The exchange of ideas during
these monthly meetings has generated
numerous other activities—both official

NGOs

Link
Volunteers
&
women's
health groups

Community
members

IPP VIII activities, such as workshops for
adolescent girls, and unofficial activities
that were established by IPP VIII NGOs,
such as schools for working children.

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16

Expanding Outreach through NG Os
*7n this area there is no hospital or health center nearby. The people don't
know about the IPP VIII health center. The people here wouldn't take medicine
from government health staff who came to the slum. They were afraid that
medicine meant family planning and would sterilize them. Then we started
these health camps and convinced the people to come. They now come and
meet with government doctors, get medicine, and know where the health cen­
ter is."
Gita Devi, NGO Coordinator from the Confederation of Voluntary Agencies (COVA)

The Role of NGOs

4
-4

groups, such as the poorest populations,
and controversial topics, such as the
reproductive health of adolescent girls.
NGOs are also flexible and able to devise
innovative approaches and low-cost
solutions (Malena 1995, Sundar 1994).
By involving NGOs in the project, IPP
VIII in Hyderabad was able to tap all
these strengths of NGOs. In addition, it
gained another cadre of project staff
closely linked with the slum communi­
ties, which increased the outreach of the
project in Hyderabad's slums.

pt ommunity health workers and WHGs
are widely used in health projects.
However, they are usually established
and managed by already overstretched
health staff. Although health staff, such
as Auxiliary Nurse-Midwives, benefit
from having additional hands at the
community level to carry out their tasks,
the management of the community­
based networks places an additional
administrative burden on them that they
ma> be unwilling or unprepared to take
on. By allowing NGOs to manage the
Link Volunteers and WHGs, IPP VIII
Hyderabad planned to benefit from com­
munity-based networks without adding
to the responsibilities of its health staff.

NGOs also benefit from collaborating
with the government. First, they gain
resources and a source of support. They
are also able to gain legitimacy by work­
ing with the system, as well as pilot their
own innovative activities and work on
innovative government schemes. If suc­
cessful, their schemes may be expanded
to a far larger beneficiary population
than one NGO alone could reach, facili­
tating a process of institutional change
and reform (PRADAN 1996).

Project officials recognized that working
with NGOs had other advantages as
well. NGOs are able to effectively man­
age community-based networks of
health volunteers and women's groups
because of their understanding of cul­
tural contexts and experience in commu­
nity mobilization and promoting local
participation. Many NGOs are communi­
ty-based organizations and are known to
and trusted by their communities,
increasing the credibility of the project
and facilitating its activities. NGOs con­
centrate on filling the gaps that are not
addressed by existing programs and are
better equipped to handle neglected

Despite these mutual benefits, in many
development projects—if NGOs arc
involved at all—NGO participation is
limited to discrete activities, which are
often peripheral to the project. For
example, NGOs may participate in
health activities by helping to mobilize
communities and raise awareness, a
role for which they are not likely to get
17

fl

any financial support. NGOs also may be
involved in such health-related activities
as managing a health center or conduct­
ing an Information, Education, and Com­
munication program. Alternatively, they
may be involved in social development,
such as vocational training or managing
a day care facility for children. Other
than such clearly defined activities,
NGOs often have a minimal role. They
have little say in the planning or evolu­
tion of the project. They are provided
with support for their project-related
activities, but they have little control
over those resources, since the activities
and costs have been defined by project
management.

Responsibilities of NGOs
in Hyderabad
In IPP VIII in Hyderabad, the role of
NGOs is considerably different. NGOs
are involved in identifying and planning
activities and manage all project activi­
ties in the communities. NGOs help bring
IPP VIII sendees to the community and
the community to IPP VIII health facili­
ties. As an intermediary between the
health staff and the community, they
inform the people in the community
about available health services and reas­
sure them about any doubts and con­
cerns. They also help keep health staff
and project management staff apprised
of the needs of the community. Their
main responsibilities are establishing
and managing networks of Link Volun­
teers and WHGs. To date, NGOs have
trained 5,581 Link Volunteers and have
started 586 WHGs. In addition, NGOs
promote access to reproductive health
care by encouraging registration of
pregnancy, prenatal care, immunization
of pregnant women and children, and
deliveries in health facilities. They work
with health staff to increase demand for
project services, such as temporary and
permanent methods of contraception.
Monthly reports and meetings at the IPP

18

VIII project office give NGOs a chance to
report on progress to the project man­
agement staff.
NGOs conduct baseline surveys in the
slum communities to assess the current
status of family health. They work with
health staff to raise community aware­
ness about health and family welfare
concerns, such as hygiene, nutrition,
and the need to delay marriage until the
legal age of 18 years. They organize
activities such as health camps and
mobilize community members for such
special programs as the government's
Pulse Polio Campaign. In addition to
these IPP VIII health activities, some
NGOs are collaborating with other gov­
ernment departments to bring programs
for tuberculosis, leprosy, and disabled
children to the slum communities.

Innovative NGO Activities
NGOs also manage and mobilize commu­
nity members to participate in the
diverse range of innovative schemes
supported by IPP VIII Hyderabad. Health
staff come to the communities only for
short periods, but NGOs, by contrast,
are an ongoing presence in the commu­
nity. As such, they can judge the commu­
nity response to the activities and sug­
gest changes to existing programs and
ideas for new activities. NGOs, Link Vol­
unteers, and WHGs help identify, plan,
and manage these activities and encour­
age community participation. These
activities include saving programs, nurs­
ery schools, school for former drop-outs,
adolescent girls’ workshops, and first­
time mothers’ workshops. Some of these
activities focus on broader development
concerns, such as education and women's
empowerment, while others focus on key
reproductive and child health concerns,
such as adolescent reproductive health
awareness. Because of the high rate of
teenage pregnancies in Hyderabad, sev­
eral project activities focus on adoles­
cents as a key target group.

Box 2. An Impressionable Age
In Aman Nagar, the IPP VIII Adolescent Girls' Workshop made a lasting impression on the
young girls in the slum communities. Sixteen-year-old Najma Begum talked candidly about
her experience at the workshop:
I had heard about the pill on TV, but I didn't know much about it—what it
was for, how to use it. I was too embarrassed to ask, but at the training,
we learned all the details. Some people believe that if you keep taking the
pill for years, that you will never be able to have a baby, but the doctor said
that is not true. I also learned about the IUD. I had never heard of it
before. I liked the third day best. We learned about the development of a
woman's body. We laughed a lot and felt shy when we saw the book, but
the teachers told us not to be ashamed. They said, “You will be married
one day, and this is what you will face.” Then we realized the importance
of the book. My mother doesn't tell me about these things because she is
ashamed. I am going to show the book to my older sister. She will be upset
at first, but I will explain things. My mother was nervous about my coming
to the workshop. She came the first day and saw that they were all

women—no men—and that it was a nice place. Then she let me stay.

Since the excitement of the adolescent girls' workshop ended, the girls in the community
have been requesting more activities. With the help of the Confederation of Voluntary Agen­
cies (COVA), they have formed an adolescent girls' group that meets every month. They
also began a cultural troupe for adolescent girls. The girls in the troupe have developed their
own plays about issues they think are important to their health. They perform the plays in
their own community and in other slum communities of Hyderabad. Said 15-year-old
Zaheeda Unissa, “We made a play and went to the other slums to show the girls there our
play. Since the training program and these plays, we have made about 300 friends!' Added
16-year-old Aishiya, “They were all Hindu girls where we went, but they didn't want us to
leave. They followed our rickshaw.”

While carrying out health activities and
innovative schemes under 1PP VIII,
NGOs are also able to respond to the
broader development needs of the slum
communities. NGOs have helped commu­
nities to identify and establish other
needed development schemes and raise
the funds for these additional activities.
Collaboration with NGOs began in May
1995, and their involvement has sparked
numerous activities, such as adolescent
girls' groups, legal literacy programs,
income generation schemes, and NGOrun nursery schools. (See the “Innova­
tive Schemes” chapter of this booklet for
more details.)
Some of the additional development
schemes started by NGOs arose from

IPP VIII innovative activities. For exam­
ple, the adolescent girls’ workshops cre­
ated much excitement and interest in
further activities for adolescent girls.
The girls who attended the program
voiced the need to have a group of their
own, with regular meetings. NGOs
helped them organize groups, and 150
slums now have active adolescent girls’
groups.

Benefits of NGO Involvement
The flexibility provided by IPP VIII has
given NGOs the freedom to establish
these supplementary schemes. The
needs of slum communities differ from
one area to another, and the skills of
NGOs also vary. Each NGO has tailored
19

4

r

they conducted a review of NGOs in
Hyderabad. They then held a two-day
orientation workshop for NGOs in which
80 organizations participated. Staff
introduced objectives of the project and
asked NGOs about their areas of interest
and possibilities for collaboration with
the project. Initially, 40 NGOs applied to
work with the project, and 8 were cho­
sen to take over slum areas and set up
networks of WHGs and Link Volunteers.
Each year, more NGOs have joined the
project to take over the management of
other slum areas. Selection of the NGOs
was based on several criteria: (1) regis­
tered status as an NGO, (2) expertise
and experience, (3) structure and partic­
ipants of the governing body, and (4) an
audited statement of accounts for the
three years preceding the application.

At the same time, project management
staff also instituted procedures to
establish and encourage NGO involve­
ment. A request to the state govern­
ment to issue an order outlining gov­
ern men t-NGO collaboration provided
the legal framework for approving NGO
activities in a government project. The
project team developed a standard con­
tract. which specified the administra­
tive, technical, and financial responsibil­
ities of the NGOs. The contract was flex­
ible enough that it could be used for
each of the 22 NGOs, so time was not
wasted developing tailor-made contrac­
tual arrangements for each NGO. Clear
reporting requirements and a standard
monthly reporting form for NGOs eased
the rex'iew of progress. After some initial
delay in clearing project activities
through government channels, the pro­
ject management officers decided to
develop an annual action plan for all
community-based and NGO activities.
This plan allowed all activities for the
year to be cleared simultaneously,
reducing the chances of delay in
approval or problems with funding flows.
A diverse range of NGOs is collaborating
with the project. Although most of the

NGOs specialize in community develop­
ment, about a quarter of them focus on
health, while another quarter focus on
women's concerns. The majority of the
NGOs are local organizations, but some
are national and one is international.
(See appendix A for the list of the
NGOs.) Monthly meetings with project
management staff give the NGOs an
opportunity to discuss problems and
progress. The meetings also provide an
opportunity for all the representatives of
the NGOs to meet each other to raise
common concerns, exchange ideas, and
build on each other’s strengths.

To prepare the NGOs for collaboration
with the project, 1PP VIII provided a to­
day training course for all the selected
organizations. The training involved four
days of practical field experience and
six days of theory. For field experience,
new NGOs are attached to an NGO
already working with a project to help
them understand field activities and how
to mobilize community networks. The
process of selecting Link Volunteers is
emphasized because it is one of the
most difficult and important aspects of
creating a good network. The six days
of theory focus on several topics, includ­
ing general health, reproductive and
child health, gender, thrift and income
generation programs, and the girl child
and education. Once they have been
trained, NGOs are responsible for train­
ing Link Volunteers in their areas.
Health staff also receive training to help
them collaborate with NGOs. 1PP VIII
training for Medical Officers and Auxil­
iary Nurse-Midwives includes a session
on collaborating with NGOs, which
explains the rationale for working with
NGOs and outlines the process of work­
ing with NGOs and Link Volunteers and
related issues, such as management of
community revolving funds.
IPP VIII provides each collaborating NGO
with funds for the salaries of project
coordinators, training of NGO staff and
Link Volunteers, travel, administration,

21

Box 4. Encouraging Participation: How Did It Happen in
Hyderabad?
Getting NGOs and women from the slums involved in the project was not easy. Numerous
steps were taken:
I. The administration of the project created a dedicated, all-female management structure
for overseeing women's participation and community-based activities:
• one program officer with management skills and experience working with
government and NGOs and in the field
• three assistant program officers for extensive field-based work
2. Project staff developed procedures to promote NGO involvement:
• a request to the state government to issue an order outlining government- '
NGO collaboration, thus providing the legal framework for approving NGO

activities in a government project
• guidelines and selection criteria for NGO participation
• a standard contract for NGOs, specifying terms and conditions of collabora­
tion, including the administrative, technical, and financial responsibilities of
the NGOs
• reporting requirements and a standard monthly reporting form for NGOs
• an annual action plan for all community-based and NGO activities
3.

4.

Project staff selected and prepared NGOs for collaboration with the project by
• developing a comprehensive profile of NGOs in Hyderabad, with help from
other government departments and development agencies
• organizing a two-day workshop for NGOs to introduce IPP VIII and discuss
possibilities for collaboration
• providing a 10-day training program to prepare the selected NGOs for
project work
NGOs established networks of community health volunteers and women's
groups in the slums by
• holding IPP VIII orientation meetings in each slum
• holding additional meetings in slums to measure sustained interest of Link
Volunteer candidates
• working with community members to select one Link Volunteer for every
20 families

• training Link Volunteers for four days
• initiating WHGs in each slum
5. NGOs established other IPP VIII innovative schemes in slums, such as adolescent
girls' workshops, first-time mothers' workshops, and nursery schools.
6 Project staff expanded collaboration with other groups by
• holding orientation meetings for other influential groups in the communities,
such as local private medical practitioners, women entrepreneurs, and
female community leaders
• collaborating with other government departments and private groups to
bring other community development activities to the slums, such as the
HUDA Urban Forestry Nursery Scheme
7. NGOs and community members were given the flexibility to plan and establish
community activities:
• NGOs identified and began additional development schemes needed by the
slum communities.
• WHGs planned and funded community schemes using revolving funds.

22

and supplies. NGOs also are given health
education materials, including videocas­
settes, charts, and books. The project
also requires NGOs to contribute some
resources to the project. The purpose of
this contribution is two-fold. First, the
NGO contribution is a demonstration of
its firm commitment to the project. Sec­
ond, the contribution helps ensure the
financial stability of the NGO involve­
ment. Past experience had shown that
government funding can suffer from
irregularities and delays. When an NGO

did not have an adequate level of its own
resources, such delays threatened a pro­
ject and even the existence of the NGO.
To avoid such problems, the oroject
requires the NGO to show that it has a
certain level of financial stability and
can provide some of its own resources
for the project. Specifically, IPP VIII asks
each NGO to contribute some funds for
supervision of the program, the salary of
its NGO coordinator, travel, administra­
tive expenses, and provision of resource
persons and materials.

— 23

24

The Link to the Community
“We are Hindus. We used to be afraid to come to Muslim slums to work. But
we've never had a problem. The Link Volunteers help us with everything. They
made us feel comfortable in the neighborhood. They give us tea, invite us to
their homes. They bring us children for immunization. ”
—Sujata, Shanta, and Marilama, Auxiliary Nurse-Midwives from Aman Nagar,
Part B Urban Health Post

to prevent infant diarrhea, iron supple­
ments, paracetamol (acetaminophen),
vitamin B complex, condoms, contracep­
tive pills, and cough tablets. In addition
to raising awareness about good health
practices and family planning, Link Vol­
unteers discuss other concerns that can
affect the well-being of women and chil­
dren, such as women's empowerment,
education, legal literacy, and the special
needs of adolescent girls. They also
manage community savings groups and
assist NGOs in carrying out other health
and community development activities,
such as health camps. Link Volunteers
are not required to work during any spe­
cific hours to carry out these activities.
They can meet with the families in their
houses at any time that is convenient
for their own normal activities and
schedules.

Responsibilities of Link
Volunteers
A s their name suggests, Link Volun1\ teers provide the connection
between the Urban Health Post and the
community. Community members and
NGOs work together to nominate a Link
Volunteer who will be responsible for
every 20 houses in each slum area. In
the slums of Hyderabad, each house is
usually the home of one or more extend­
ed families. 1PP VIII management staff
chose the house, rather than the family,
as the unit for the Link Volunteer for the
sake of simplicity. Although they initially
tried to use families for this purpose, it
was easier to allocate and keep track of
houses. The Link Volunteer provides
these families with information on
health and family planning and keeps
track of their well-being and current sta­
tus, and she informs the Auxiliary
Nurse-Midwives about the households’
marriages, contraceptive use, immuniza­
tion status, pregnancies, births, deaths,
occupations, and school drop-outs.

Link Volunteers do not maintain record
books. Instead, they orally report to
the NGOs on their activities and the
health status of the families in their 20
assigned houses. Reporting takes place
at the monthly meetings in the slum and
at the Urban Health Post with NGOs and
health staff. During these meetings,
NGOs work with Auxiliary Nurse-Mid­
wives to transfer the oral reports of the
Link Volunteers to record books, a
process that otherwise would have been

Each Link Volunteer has a small target
population, so her responsibilities do not
require an extensive time commitment
and she is able to give greater individual
attention to each family to whom she is
assigned. Her responsibilities also
include referring patients to health facil­
ities and distribution of some medical
supplies, such as oral rehydration salts

the sole responsibility of the Auxiliary

Nurse-Midwives. Having NGOs as inter­
mediaries between Link Volunteers and
health staff aids the project in working

25

Box 5. Link Volunteers in Action
Networks of Link Volunteers in Hyderabad expand the outreach of IPP VIII by

• reporting on the well-being of the occupants of 20 houses, including births,
deaths, occupation, marriages, school dropouts, contraceptive use, handi­
capped children, and widows

• assisting Auxiliary Nurse-Midwives with outreach activities in the slums
• communicating important messages about mother and child health, family
planning, gender issues, legal literacy, women's status, thrift schemes, and special
health programs
• acting as depot holders for oral rehydration salts, contraceptive pills, and condoms
• helping organize IPP VIII community development activities such as WHG
revolving funds and nursery schools.

wdth volunteers of all educational levels.
Two monthly meetings with NGO repre­
sentatives and health staff and an an­
nual meeting of all Link Volunteers in
the city promote the exchange of ideas
and build a sense of communal strength
among the Link Volunteers. Table 1 pro­
vides a comparison of Hyderabad’s Link
Volunteers with community health work­
ers in other IPP VIII cities, to explain
what makes Hyderabad's volunteers
exceptional.

The Process of Involving Link
Volunteers
There is no minimum level of educalion required for Link Volunteers. Some
of the most active and articulate Link Vol­
unteers in Hyderabad are illiterate. They
are selected on the basis of communica­
tion skills and age. The requirements are
simple: women between 15 and 45 years
of age who are able to convey a message.
The level of education of Link Volunteers
ranges from no education to degree hold­
ers, but is, on average, at the fourth or
fifth grade level. The women selected arc
often respected and older members of the
community whose advice will be taken
seriously by their neighbors.
Link Volunteers in Hyderabad are not
paid individual salaries or honorariums.
Instead, their community receives a
26

small amount of remuneration as a
group, through the revolving funds pro­
vided to each community WHG. Women
are encouraged to become volunteers
not just for monetary compensation, but
to gain skills and access to information
and benefit their communities. Despite
this lack of personal monetary benefit,
NGOs report that dropping out is not
common among the Link Volunteers.
Since many community volunteer pro­
grams suffer from high dropout rates—
even those providing monthly salaries of
Rs. 500—the low dropout rate in Hyder­
abad is an achievement. Most of the
Link Volunteers are employed and so
earn their income from other sources.
The purely voluntary nature of the Link
Volunteers program also strengthens the
sustainability of the project and helps
avoid the politicization of the Link Vol­
unteers. This is important, because local
political parties have interfered in pro­
grams with paid volunteers to ensure
that their supporters get the positions.
NGO representatives train the Link Vol­
unteers to prepare them for their work.
Initial training lasts for four days, and
this is followed up by two days of “rein­
forcement” training twice a year there­
after. The training includes sessions on
maternal and child health and family
welfare; women’s empowerment; women
and legal literacy; and the girl child,
adolescent girls, and education.

Box 6. Two Link Volunteers
G. Ellu Bai has been a Link Volunteer since IPP VIII began in her community To make her liv
She d e WanheS dlSfheS,'n a middle-cl- neighborhood near her home in Muggugudusilu slum
She dropped out of school after seventh grade and isn't sure of her exact ag^but thinks she
is about 50 years old. She has
a great deal to say about the changes in her community since
the start of the project:

n our slum a lot of progress has occurred. Before, everyone used to have
five to six children and their health would be ruined. Now they have two
or three

We used to go to private doctors, but now we go to the govern­

ment health center. Private doctors charged a lot of money. This wasn't a
clean slum before. Then IPP VIII helped us learn how to clean the area to
put tra,sh m plastic bags and collect it. Before, women used to only listen to
what their husbands said. Now they tell their husbands to listen to what
they say!

v ay Laxm,. aged 24 has been a Li...
1UTC,
KUtcnl Boul, s|um for three
Link Volunteer in Kutchi Bouli slum for three

husband ,s a car mechanic. She explains, "I learned a lot after becoming a Link Volunteer
ig a Linkhave
Volunteer.
We used to sit alone in our houses. We were scared to go out. Now women
the

courage to go out and talk to people. We used to be told that if you eat a banana when
you are pregnant, you won't get a male child. We learned better in our training, and I want

entire slum6^0

W°rk' ' 3m dO'ng something for the betterment of the

Table I. How are

New Dehli

Bangalore

Hyderabad

4th grade

I Oth grade

None

2,000

5,000

20 houses

Reporting

Informal notes

Three record books

Incentive

Rs. 500 per month

Rs. 500 per month

Required education

Population

—

Community
revolving funds

- 27

28

Women's Health Groups and Community
Revolving Funds

m o build a strong relationship
I between health staff and the slum
communities, IPP VIII has formed
women's health groups (WHGs) in the
slum areas of Hyderabad. Established
by NGOs, these WHGs give NGOs an
opportunity to raise community aware­
ness about health and development con­
cerns and to learn about the health sta­
tus and needs of the community mem­
bers. WHG meetings are attended by
NGO representatives, Link Volunteers,
and other women of the community.
Each Link Volunteer is automatically a
member of the WHG within her commu­
nity. During the meetings, NGOs catch
up on what has happened in the commu­
nity in the past month and find out
about births, marriages, pregnancies, ill­
nesses, and deaths.

fund for each slum. The funding respon­
sibility is a shared one, with each
household in the community contribut­
ing one rupee per month. Women
belonging to the WHG decide how to
use the funds with guidance from NGO
representatives. The community contri­
bution to a plan must be at least 30 per­
cent of the total cost of the scheme, and
the Medical Officer at the Urban Health
Post maintains the accounts. Funds
must remain in the account for a yeai
before they can be used; thereaitei, the
only constraint on the use of the money
is that it be for the betterment of the
community.
IPP Vlll management staff originally
thought a revolving fund would be a
good way to build community ownership
of project activities and familiarize com­
munity women with banking procedures.
The success of the funds, however, has
exceeded expectations. Despite the short
time since project start up and the limit­
ed amounts available, the funds have
sparked numerous initiatives. WHG
members have financed a wide range of
activities, including a library for girls,
repair of community wells and drainage
systems, construction of toilets and com­
munity halls, and initiation of income
generation and training schemes. Income
generation schemes include tailoi ing.
embroidery, wedding equipment rentals,
and the construction of a building for a
child care center. One community that
established a program to rent tents and
utensils for weddings is using the profits
to fund a low-interest loan program for
community members. Private lendeis
usually charge 10 percent interest per
month, but the new loan scheme charges
only 2 percent per month.

Most important, such meetings give
women in slum communities a chance to
raise their concerns, get their questions
answered, and work toward solutions
with assistance from NGOs. The NGOs
do not restrict the discussions to health
or family planning. The women who
attend are encouraged to talk about any
topic of concern to them. This allows
the women of the community to lead the
discussion, rather than the NGO repre­
sentatives. Women discuss a wide vaiiety of topics, from problems with water
and sanitation to domestic violence, ten­
sions between religious groups, and
alcohol abuse among the men in the
communities.

IPP Vlll provides seed money to each
WHG for community revolving funds.
Depending on the size of the population
of the community, IPP VIII contributes
from Rs. 150 to Rs. 300 per month to the
29

Box 7. Fostering a Community Spirit: Women's Health Groups
and Revolving Funds
Even crowded slums can foster isolation. Women in the Hyderabad slums have often

remarked that before the initiation of IPP VIII. they never got together as a group. Now,
even though many WHGs have been meeting for several years, there is still a sense of excite­
ment as the women gather for their monthly meeting. In the Sunder Nagar slum, women at
the WHG meeting talked about what brings them to the meetings. “We used to get bored in
our houses. Nobody came to our homes. Now we go to meetings and we have become a bit
cleverer," said Nagamani. “We had no experience. Now we know about everything. Every­
one in the area knows who we are. When any official from the government comes to our
slum, they come to see us," added Bismillah Bee.

The revolving funds have instilled community women with a sense of achievement. In Nanda

Nagar, the drainage water was getting mixed with the drinking water pipeline. The WHG
used the fund to construct a septic system to ensure that the drinking water would not be
contaminated. The Link Volunteers purchased all the materials and supervised the entire con­
struction process. In Muggugudusilu, the WHG used the fund to buy equipment for wed­
dings. Indian weddings are huge affairs, and they often result in large debts, particularly

among the poor. The WHG uses the equipment to subsidize community weddings and other
events, as well as to earn additional income. G. Ellu Bai, a Link Volunteer in that slum,
explained, “We spent Rs. 5,000 on dishes, pots, and pans for weddings. We rent them out at
half the market rate. We put all the money we've earned back into the fund. Next we want

to buy a wedding tent.” The revolving funds have also increased the recognition and impor­
tance of women in the communities. Women in many of these slum communities can now

walk through their neighborhood pointing out the improvements they have made possible.
The fact that women—even illiterate women—have been behind these initiatives has sent a
clear message that even the powerless in the poorest communities can take action to better
their lives.

30

Innovative Schemes

"We watched a film about a young girl and saw her deliver her child. We saw
the tests that doctors do when you are pregnant. Now that I have seen every­
thing, I am learning little by little, and I am not scared of the hospital or the
doctor. I told my husband that the doctor said that because I am young, I
shouldn't have another baby for five or six years. I learned about sprouting
lentils for vitamins. I told my mother, and she said she would give them to me
every day!”

—Asha, 16 years old, after attending the Primi Mothers' Workshop for first-time moth­
ers. She was six months pregnant but before the workshop had not seen a doctor for pre­
natal care because she was afraid of injections.

m o generate community involvement
1 in the project and build demand for
health services, IPP VIII has started
numerous innovative schemes for the
slum communities of Hyderabad. NGOs,
Link Volunteers, and WHGs helped to
identify, plan, and manage these activi­
ties, as well as to mobilize community
involvement. Many of these activities go
well beyond family planning and focus
on broader concerns that affect family
health, such as women's empowerment
and education. Because of the high rate
of teenage pregnancies in Hyderabad,
several project activities focus on ado­
lescents as a key target gi’oup. The main
project activities are described below.

ences and are given a chance to make
friends and have fun. They are also
given an informative booklet about their
reproductive health.

Promoting open discussion of sexuality
among young girls from the conservative
Muslim population of Hyderabad was a
challenge. NGOs and Link Volunteers
went door to door in the communities to
explain the purpose of the program and
reassure parents. Mothers were also
invited to the first day of the program,
so they could see for themselves how the
program was conducted. The community
response to the program has far exceed­
ed expectations. To date, about 9,000
girls from 150 slums have participated.

Adolescent Girls' Workshop

Thrift Program

A program for adolescent girls aims to
reach girls at a critical age to influence
their reproductive health behavior dur­
ing womanhood. The three-day program
teaches girls about their health and
reproductive systems. The workshop
goes beyond a purely biological focus to
discuss such issues as women's status
and the importance of female education.
Interactive methods, such as games and
opening warm-up exercises, help break
through initial shyness. Girls are
encouraged to discuss their own experi-

One of the largest schemes is the Thrift
Program, which NGOs have begun in 153
slums. The program encourages commu­
nity women to save money and provides
them with access to low-interest loans.
Each member of the program is asked to
contribute one rupee per day. The
money is used to provide loans to the
members at an interest rate of 2 percent
per month, instead of the usual rate of
10 percent per month. A total of 4,311
women from the slums of Hyderabad have

31

06949
■ft,

now joined this program and have togeth­
er saved Rs. 2,469,263.

Primi Mothers’ Workshops
IPP VIII has held 123 one-day workshops
for first-time mothers to help them deliv­
er their babies safely. During the work­
shops, mothers are given a prenatal care
checkup and information on breast feed­
ing, care of the newborn, and how to
keep healthy during pregnancy. The
workshops emphasize the importance of
delivering in a health care facility and
raise awareness about safe delivery
practices, high-risk symptoms, and fami­
ly planning. They give young women a
chance to ask questions about their con­
cerns and have an open discussion with
health professionals.

Play Schools
Because of the high rate of illiteracy in
Hyderabad, IPP VIII has established 65
child care centers for children aged
three to five to encourage a habit of
going to school. These play schools also
create a link to the health system for
young children. The Medical Officer of
the Urban Health Post comes to the Play
Schools each month to provide health
checkups and immunization to the chil­
dren. IPP VIII has hired local artists to
paint bright animal motifs on the
schools, making them a highlight of the
neighborhoods. About 2.000 children
have been enrolled in the Play Schools.

Nutrition Education Program
The adolescent girl is the future mother.
To ameliorate nutrition deficiencies
among the populations of the slums, this
project is collaborating with the College
of Home Sciences in Hyderabad to teach
girls how to cook nutritious, economical
meals for themselves and their families.
To encourage participation, the girls’
mothers are also invited to attend the
program. To date, about 3,060 girls from
102 slums have taken part in the program.

32

Open Schools
Research in India and elsewhere has
shown that raising female literacy and
school enrollment rates has a positive
effect on lowering population growth
and infant mortality and on improving
family health, and translates into higher
economic productivity and income-earn­
ing potential for households. To bring
female school dropouts back into the
mainstream of the educational system,
IPP Vlll has introduced 30 Open Schools
in the slum communities. The schools,
which are managed by NGOs, have flexi­
ble hours and are taught in both Telugu
and Urdu to suit both Hindu and Muslim
girls. Girls who complete the course of
study are eligible to take the govern­
ment's seventh grade exam. About 900
girls have been enrolled in the schools.

Sanitary Facilities for
Girls' Schools
In the slums of Hyderabad, government
schools often have no working toilet
facilities for girls. The girls, who have
fought against long odds to attend
school, are forced to endure the discom­
fort and embarrassment of having no
place to use the toilet. To reduce the
school dropout rate among girls, IPP VIII
is providing sanitary facilities to 10 gov­
ernment schools for girls located near
the slums.

Health Box Scheme
Link Volunteers in some communities
carry Health Boxes containing oral rehy­
dration salts, condoms, and contracep­
tive pills. These boxes have been provid­
ed lo 100 Link Volunteers, who circulate
them among married couples to popular­
ize the use of spacing methods and oral
rehydration salts. The Link Volunteers
explain how and why to use each prod­
uct and report to the Auxiliary NurseMidwives on which community members
have accepted the supplies. Birth control

it
;

a.

®1

t

pills are provided only to continuing
users, and the Link Volunteers refer
women who show an interest in taking
them to a doctor for first-time prescrip­
tions. 1PP VIII provides supplies for the
boxes and received some support from
private companies for this project.

School Painting Competitions
'lo raise awareness of health issues
among school-age children, 1PP VIII
organized a painting competition on
health themes in 17 government schools.
Hach competition began with a health
talk and a discussion about health
issues and the rights of the child. This
was followed by a painting session in
which the children illustrated the issues
discussed. The winning paintings were
reproduced in a calendar. 1PP VIII orga­
nized the competition and supplied two
tetanus toxoid injections to each partici­
pant. UNICEF funded the calendar.

Street Beautifying Programs
A sanitation program to keep streets
and allenvays clean lias been organized
in 12 slums involved in 1PP VIII. “Street

beautifiers” go door to door in each slum
to collect garbage in a flatbed rickshaw.
1PP VIII project staff asked the Reddy
Foundation, which originated this pro­
gram. to bring the scheme to 1PP VIII
slums. Support for the program and the
training of street beautifiers is jointly
provided by the Reddy Foundation, the
Municipal Corporation of Hyderabad,
and 1PP Vlll.

Urban Health Post
Management
Four NGOs have taken over responsibili­
ty for managing one IPP Vlll Urban
Health Post each. The NGOs have
appointed their own staff and are pro­
viding health and family planning ser­
vices and supplies in accordance with
the government's Family Welfare Pro­
gram. The NGOs retain administrative
control over their own staff and are free
to take up other health issues in addi­
tion to health and family planning.
Some NGOs have started specialized
health programs in their Urban Health
Posts for diseases such as tuberculosis
and leprosy.

33

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34

Measuring Success

through innovative schemes. These inno­
vative schemes have also addressed
other project aims: improving women’s
status, reaching key target groups, and
establishing innovative health initiatives
to complement government services.

A4 ommunity and NGO involvement in
Hyderabad has had widespread
effects on the lives of the people in the
slums of Hyderabad. Although the
effects of these participatory approaches
are difficult to evaluate and quantify, a
range of different indicators can help
assess their impact. These indicators
include numeric achievements in per­
sonnel trained and activities initialed,
project outcomes, and fulfillment of
social development objectives.

Appendix B lists the other activities that
have been indirectly started by IPP VIII
through community revolving funds and
NGO collaboration with the project. A
total of 76 activities have been planned
and financed by community women
through the project's revolving fund
scheme. Community members have also
benefited from the activities started and
financed by the NGOs working with
IPP VIII. Adolescent girls in 150 slums
have begun their own adolescent girls'
groups, and 25 slums have income gen­
eration schemes for adolescent girls.
Legal literacy programs help people in

Table 2 summarizes the numeric
achievements of community and NGO
involvement in the project. The involve­
ment of communities and NGOs has
expanded the outreach of IPP VI11 both
by creating new cadres of workers for
the project—NGO coordinators. Link
Volunteers, and WHG members—and by
reaching additional community members
4

Table 2. Achievements of IPP VIII Innovative Schemes
Objective

Achievment

Expanding outreach

22 NGOs
5,581 Link Volunteers
586 WHGs

Improving women's status

376 revolving funds
I 73 Thrift Programs

Reaching key target groups

123 Primi Mothers Workshops
Adolescent girls' training in ISO slums

Nutrition education for girls in 102 slums

65 Play Schools
30 Open Schools
Establishing innovative health
initiatives

Sanitary facilities in 10 girls' schools
100 Health Boxes
I 7 school painting competitions

Street beautifying programs in 12 slums

4 NGO-managed Urban Health Posts

35

before the start of the project to 95 per­
cent in 1998. The rate of institutional
deliveries, one of the key concerns of the
project, increased from 70 percent to 84
percent during the same period (PRC and
UPS 1995, P P. Rao et al. 1998).

98 slums, while 23 slums have education
programs and 6 have Urban Forestry
Nursery Programs.
IPP VIITs participatory approaches have
also increased the impact of the project
by raising demand for services. Link Vol­
unteers and NGOs helped the slum com­
munities to learn what services were
being provided, where to get them, and
why they are important. Use of health
facilities and coverage in the project
areas has expanded by almost 50 percent
since the start of the project. Outpatient
registration increased from 614,888 in
1994-95 to 907,728 in 1997-98 (Municipal
Corporation of Hyderabad 1998). Other
coverage indicators are also showing
signs of improvements. Prenatal care cov­
erage has increased from 91 percent

These preliminary outcomes, however,
are also due to other supply-side project
interventions, such as training of health
staff, provision of medical equipment and
supplies, and construction of health facil­
ities. Although NGOs and Link Volun­
teers have played a critical role on the
demand side, because all project inter­
ventions were begun at about the same
time, it is not possible to measure the
effects of NGO and community partici­
pation separately from those of other
interventions.'

Figure 2. Utilization of Services: Outpatient Registration of IPP VIII
Facilities in Hyderabad
1,000,000

900,000
c
o

800,000
£
700,000
—
oo
(D ' 600,000
Qi
«-< 500,000

U

O
Q_

o

400,000

300,000
200,000
100,000

0
1994-95

1995-96

1996-97

1997-98

Year

1 In the initial years of the project, NGO and Link Volunteer involvement was implemented in only some project

areas, offering'an opportunity to compare project results in these areas with those in areas without NGO or
community involvement. Preliminary analyses, however, showed no difference in the results in these two areas.

The lack of findings can be primarily attributed to the short, two-year period for which comparable results were
available, which provided little time for the interventions to show an effect.

36

Table 3. Primary Stakeholders Participation in IPP VII
Stakeholder

beneficiaries
Link Volunteers and WHGs
Adolescent girls

NGOs
Implementing officials
Local leaders and private

medical practitioners
Other government

Level of Participation

Info, sharing

Consultation

Collaboration

Empowerment

***
*#*
#**
#**
***

***
***

**

***
***

***
*
***
**
*

**

**

*

**
*

departments

*** High. ** Medium. * Low.

Social development objectives also bene­
fit from a participatory process. Tradi­
tional health and family planning indica­
tors do not capture the broader develop­
ment gains achieved by increasing
individual skills and building local
capacity. For example, reproductive
health indicators tell us only a small
part of how revolving funds and adoles­
cent girls’ workshops affect people's
lives and well-being. IPP VIII’s innova­
tive approaches have made qualitative
changes in people's lives that are better
described by nontraditional indicators.
Outreach through NGOs and communi­
ties in Hyderabad has affected such
social values as self-reliance and
empowerment. These values are, in
themselves, important development
objectives and provide a worthwhile
rationale for a participatory approach.
(For a discussion of differing aims of
participation, see Mayoux 1995.)
More important than the numbers of peo­
ple involved in IPP VIII is the way they
have been involved—the level of their
participation. The World Bank divides the
participatory process into four levels:
information sharing, a one-way flow of

information; consultation, a two-way flow
of information; collaboration, shared con­
trol over decisionmaking; and empower­
ment, transfer of control over decisions
and resources. (For other qualitative
frameworks for assessing participation,
see Lineberry 1989, Schmidt and Rifkin
1996, Schneider and Libercier 1995.)
Information sharing and consultation
are common processes of development
initiatives, but achieving collaboration
or empowerment is more difficult.
From a qualitative perspective, IPP
VIH's accomplishments in Hyderabad
have taken two forms. First, a wide
range of stakeholders have been
involved in carrying out the project, and
divergent groups have been active in
determining its direction. These stake­
holders include key target groups, such
as adolescent girls and first-time moth­
ers, as well as influential resource
groups, such as local leaders, other gov­
ernment departments, and private med­
ical practitioners. Second, IPP VIII has
raised the level of participation by each
group of stakeholders. Rather than
focusing on exchange of information, IPP
VIII has enabled stakeholders to have an
active role in project decisionmaking.
37

I

In the case of Link Volunteers and
WHGs, NGOs, and implementing’ offi­
cials, the project has transferred control
over decisions and resources to the
stakeholders, thus empowering them.
Through the revolving funds, Link Volun­
teers and WHGs identify, plan, and
finance their own improvement schemes.
NGOs are empowered through their key
role in identifying, planning, and manag­
ing 1PP VIII innovative activities, as well
as in initiating and financing additional
community development activities.
Implementing officials of the project,
such as Medical Officers and other
health staff, help to decide what IPP VIII
activities should be established and how
revolving funds should be used. Howev­
er, these stakeholders have limited con­
trol over other project resources.
Other stakeholders have also benefited
from the participatory process. Adoles­
cent girls have been involved in planning
additional project activities, such as
adolescent girls' groups. Local leaders
and private medical practitioners
exchanged information with the project
staff and collaborated on planning addi­
tional IPP Mil activities in the slum
neighborhoods. Other government
departments also collaborated in carry­
ing out some new schemes in IPP Mil
slum neighborhoods, such as the Urban
Forestry Nursery Scheme.

There are still many other things, how­
ever, that could increase participation in

38

the project. Although NGOs, Link Volun­
teers, WHGs, and implementing officials
have some control over decisionmaking
and resources related to their own activ­
ities, their sphere of influence does not
extend to overall project planning and
budgeting. The project could benefit
from greater input from these stakehold­
ers on the planning, management, and
financing of the project as a whole. In
particular, NGOs and Link Volunteers
could be particularly useful in monitor­
ing and evaluating the progi*ess of the
project. A strong, participatory monitor­
ing system would increase project effec­
tiveness, as well as increase the stake­
holders' sense of ownership and
accountability.

Greater involvement of all the stakehold­
ers in the project may not be possible or
desirable, however. This is particularly
true in a project such as IPP Mil Hyder­
abad, which involves a wide range of
stakeholders. Transferring control over
decisionmaking and resources to some
groups may not be in the best interests
of the project. For example, it may not
be necessary or helpful to have other
government departments control the
resources of a health project. Similarly,
private medical practitioners may have
a conflict of interest with the project,
since improving inexpensive government
services might decrease demand for
their own services. Therefore, some col­
laboration, rather than empowerment, is
adequate for such stakeholders.

Learning Lessons

"We call this a program of trust. We knew we needed help to really reach the
women and children in the slums. But to get help, we had to trust others and
give them room to work as they wanted, to allow them to be creative. NGOs
have an incredible ability to adapt and respond to the needs of a particular sit­
uation—that flexibility is the ‘great wonder' of NGOs. But it can only flourish if
you give it a chance."
Kulsum Abbas, IPP VIII Project Officer for Women's Development

m he project's active NGO and commu1 nity involvement in Hyderabad is
exceptional, but what explains this suc­
cess? What factors led to such an unusu­
ally high level of both NGO and commu­
nity participation in the project? This
section discusses some of the aspects of
the project, in order of their priority, that
have contributed to its success and that
offer relevant lessons for other develop­
ment projects.

tance of NGOs. The slum communities
also benefited from the additional com­
munity development schemes started by
NGOs. Providing this degree of flexibility
to NGOs required project staff to give up
some of their own power and to have
confidence in the abilities of the NGOs.
However, confidence and trust was
shown only after careful procedures
were followed to ensure that the NGOs
selected would be able to carry out thenresponsibilities. Selection procedures,
extensive training, and standard report­
ing and monitoring procedures were
developed to secure successful NGO
participation.

NGO Authority
NGOs in Hyderabad carry out all com­
munity-based activities within specific
geographic areas, enabling them to
become integrally involved in all project
activities. In these areas. NGOs have the
flexibility to make decisions, innovate,
and pilot new initiatives. This freedom
allows NGOs the creativity to use their
individual strengths to complement IPP
VIII project interventions. By delegating
authority to NGOs, the project gained
another cadre of staff to help supervise
and administer project activities in the
slum communities. This freed health
staff from the additional burden of man­
aging community health volunteers and
WHGs. In fact, because of the small pop­
ulation per community health volunteer
in Hyderabad, the management of the
large number of Link Volunteers might
not have been possible without the assis-

Intensity of Participation
The multiple levels of participation open
to communities and NGOs in IPP VIII
Hyderabad has encouraged their
involvement in the project. Participation
has been increased and intensified by
involving community women and NGOs
in numerous roles, as well as in deci­
sionmaking and control over resources.
The project's community revolving fund
has catalyzed health volunteers and
WHGs and started numerous new
schemes by enabling women to plan and
fund improvements in their communi­
ties. NGOs and Link Volunteers worked
with project staff to identify, plan, and
monitor IPP VTII innovative schemes and
39

4

complementary community development
schemes. The intensity of engagement in
the project has enabled NGOs and com­
munities to have a meaningful role in
how the project has taken shape. Given
the power and resources to make impor­
tant decisions—and see the results—
NGOs and women in the communities
have been encouraged to get more
involved in the project.

The Self-Reliance Approach
The project management team in Hyder­
abad consciously avoided a focus on
monetary gains in encouraging partici­
pation, and instead focused on building
self-reliance through increasing knowl­
edge, skills, and experience. Community
members were encouraged to become
Link Volunteers, not for money or any
other immediate benefits, but to join in a
process of learning, partnership, and
gaining greater opportunities. A smaller
population per Link Volunteer also
helped ensure that the Link Volunteers
could be more effective in carryingout
their responsibilities. Project staff
emphasized that 1PP \T11 w ould not pro­
vide handouts. Rather, the project would
increase women's self-esteem and status
by enabling communities to better their
lives through providing health and fami­
ly planning services, increasing skills
and awareness, supplying seed funds,
and providing guidance. To increase the
value of the community revolving funds
and build a sense of ownership, the pro­
ject requires the community to con­
tribute to the fund even- month (one
rupee per member) or to provide 30 per­
cent of the financing for any specific ini­
tiative. Similarly, NGOs are also required
to contribute staff and resources to the
project. The emphasis on self-reliance
has also strengthened the sustainability
of the project.

Field-Based Management
The importance given to community­
based activities in Hyderabad started
40------

with the foundation of the project's staff.
The project has a three-tier manage­
ment structure for NGO and community
activities: one Program Officer, three
Assistant Program Officers, and Coordi­
nators from the 22 NGOs. From the
beginning of the project, 1PP VIII Hyder­
abad ensured that there was adequate
staff specifically for women's develop­
ment and NGO and community activities.
The project initially hired one Program
Officer and then, as activities expanded,
it hired the Assistant Program Officers,
all of whom are female. These positions
emphasize field-level involvement and
commitment to building a close partner­
ship with the community. Each women's
development staff member is responsible
for a specific number of NGOs and
attends all the NGO's monthly meetings
and community-based functions. The
officers spend at least half their time in
the field working with community mem­
bers and NGOs. Collaboration with
NGOs also aids the management and
coordination of community networks
and activities. The NGOs work closely
with project staff and Urban Health Post
staff and help administer community­
based activities.

Integrated Development and
the Women's Empowerment
Approach
Although IPP VIII objectives focus on
health and family planning, the project
staff and activities also concentrate on
other development issues of importance
to slum communities. During WHG meet­
ings, members of communities are
encouraged to raise any issues they
would like to discuss. NGO representa­
tives do not restrict the discussion to
health or family planning issues. In addi­
tion, working with NGOs enables the
project to address the slum communi­
ties' development needs beyond health
and family planning. NGOs' broad
involvement complements and strength­
ens the role of health staff. The project

also places its maternal and child health
and family planning goals within the
context of women's empowerment and
development. Recognition of the critical
effect of female education and the status
of women on the behavior and health of
women and girls underlies many of the
project activities. This broad approach
has demonstrated to the slum communi­
ties that the project aims to serve the
communities’ needs—and allow the com­
munities to take part in defining what
those needs are.

Flexible Structures and
Procedures
As the project developed, project man­
agement staff established numerous
structures and procedures to guide NGO
and community involvement and make it
easier. To select capable NGOs, the pro­
ject team developed a systematic
process for collaboration with NGOs,
including guidelines and selection crite­
ria for NGO participation, a comprehen­
sive profile of NGOs in Hyderabad, and a

meeting with NGOs. To save time,
encourage more involvement and aid
review of participatory activities, IPP
VIII also developed standardized proce­
dures that use model contracts and
forms. It also continually developed new
procedures and refined old ones as the
project grew. Use of a standard, flexible
contract for NGOs, consistent with World
Bank guidelines, meant the project staff
did not have to spend time developing an
individualized contract for each NGO. An
annual action plan allowed all activities
for the year to be cleared in advance,
which promoted government review and
a regular flow of funds. Standard
reporting requirements and monthly
reporting forms for NGOs allowed
progress to be efficiently assessed. This
“fluid institutional environment” helped
foster partnerships between the govern­
ment, NGOs, and communities (Mans­
field 1997).

Institutionalized Dialogue
The project team institutionalized a
process for regular and open dialogue

Bar

®

41

through a series of meetings at several
different levels: in the slums (Link Vol­
unteers, WHGs, and NGOs), in the
Urban Health Posts (Link Volunteers,
NGOs, health staff, and project staff),
and in the project office (one meeting for
NGOs and project staff, and one meeting
for Medical Officers and project staff).
Such meetings ensure accountability
and facilitate monitoring of progress and
troubleshooting. This process of dia­
logue gives all partners an opportunity
to discuss progress and problems and
obtain guidance. Through monthly meet­
ings, Link Volunteers, NGOs, and health
staff have access to IPP VIII project
management staff; therefore, significant
problems can be identified and resolved
quickly (Mansfield 1997). Link Volun­
teers and WHG members also have
access to project staff through regular
field visits. This institutionalized
process of dialogue establishes a close
working relationship between all the
partners in the project, thus building
trust and strengthening partnership
(Kelly and van Vlacnderen 1996).

Complementary Roles
The role of NGOs in Hyderabad comple­
ments government services by using the
comparative advantages of NGOs. The
intermediary role of NGOs in Hyderabad
builds on their community-based
approach and their skills and experience
in community mobilization. Complement­
ing the government's role in providing
health infrastructure and services
avoids a sense of competition between
government health staff and NGOs
(Mansfield 1997). In addition, the project
approach builds on the strengths of
NGOs in reaching such previously
neglected target gi-oups as adolescents.
Hyderabad's high incidence of teenage
pregnancy and low level of female edu­
cation called for interventions focusing
on adolescent girls. Working in collabo­
ration with NGOs, the project began sev­
eral activities ’to address both adoles­
cent education and health: adolescent
42

girls' workshops to raise awareness of
reproductive health and gender con­
cerns, nutrition education programs to
improve health, and sanitary facilities
for girls' schools to remove barriers that
discourage female education.

Emphasis on Capacity Building
To prepare communities and NGOs to
participate in the project, IPP VIII
helped them build their capacity for
partnership. Project management staff
recognized that partnership requires
capacity building to enable all parties to
influence the development of a project
(Kelly and van Vlaenderen 1996). Capac­
ity building is particularly critical for
helping marginalized groups, such as
women in slum communities, to achieve
meaningful participation. IPP VIII in
Hyderabad put extensive efforts into
building the capacity of NGOs and com­
munity members, including a 10-day
training program for NGOs, a 4-day ini­
tial training for Link Volunteers, and 2
days of refresher training for Link Vol­
unteers every 6 months. Monthly meet­
ings in the project office, the Urban
Health Post, and the slum also helped
reinforce these training programs and
build networks among NGOs and Link
Volunteers. In addition, health staff also
received training and reorientation to
help them understand and support the
participatory process of working with
NGOs and communities.

Committed Leadership and
History
Committed individuals and history have
both played an important role in the suc­
cess of participatory approaches in
Hyderabad. Several members of the IPP
VIII administration have demonstrated a
personal commitment to the ideals of
participation that has gone well beyond
their project duties. The leadership of
these individuals has inspired and cat­
alyzed the partnership with NGOs and

women in the slum communities. Such
individual factors are hard to measure
and even harder to replicate.

In addition, there is not a sharp division
between the government and the NGO
sector in Hyderabad. Key IPP VIII man­
agement officers have had extensive
experience working in and with NGOs.
NGO officials collaborating with the pro­
ject have also had experience working in
or with the government. There is also a

history of attempts at NGO-government
collaboration in community development
initiatives in Hyderabad. Both the suc­
cesses and failures of these attempts
have been an important part of the
learning process in Hyderabad. Difficul­
ties experienced in past projects, such
as problems sustaining networks of
community health volunteers beyond
the project period, provided guidance
for what would be needed—or should
be avoided—in future attempts.

43
i.

1

gK:

I t
IA
.

1
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-

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44

I

The Emerging Path

by introducing a detailed monthly
reporting format for them. The idea was
for NGOs to collect statistics on numer­
ous health and family planning indica­
tors from Link Volunteers and then pass
them on to health staff at monthly meet­
ings. NGOs found the format too long
and burdensome and failed to complete
it. The project officials are now explor­
ing other ways for NGOs and WHGs to
have a more systematic role in monitor­
ing the progress of the project.

Monitoring
TA espite considerable progress in
\-J engaging NGOs and communities,
IPP VIII in Hyderabad still has impor­
tant issues to resolve. Project monitor­
ing and sustainability—both critical
issues—have not received adequate
attention. Although the project supports
the strengthening of a management infor­
mation system, the monitoring of commu­
nity-based activities has been weak and
appropriate indicators have not been
developed. Auxiliary Nurse-Midwives,
NGOs, and Link Volunteers collect infor­
mation on process and outcome indica­
tors related to health and family plan­
ning, but there are no indicators to
ensure accountability or evaluate the
effect of the participatory structures of
the project. Such indicators are needed to
measure the contribution of the NGOs,
Link Volunteers, and WHGs separately
from the contribution of traditional health
program interventions, such as upgrad­
ing training, building health centers, and
supplying medicines. In addition, there
are no measures to assess the benefits of
the broader development activities of the
project, such as the nutrition education
programs and Open Schools.

To capture the contribution of networks
of Link Volunteers and WHGs, the pro­
ject has begun using an indicator on the
number of case referrals to health cen­
ters made by Link Volunteers and WHG
members. The addition of such indica­
tors is simple, requiring only an addi­
tional column in an Urban Health Post
register with the heading “Referred by”
and options that can be ticked off, such
as Auxiliary Nurse-Midwife and Link
Volunteer. These indicators clearly indi­
cate the extent to which community par­
ticipation is contributing to project out­
reach. Although they are process indica­
tors and do not provide a measure of
impact, they can be easily evaluated,
converted to bar charts, and shared with
the community. Members of the commu­
nity can then see for themselves the con­
tribution they have made and the change
in that contribution from month to month,
which fosters a sense of achievement.
Through further discussions with NGOs
and communities, the project staff also
plan to explore other ways to strengthen
project monitoring and evaluation.

Furthermore, community and NGO
involvement in monitoring needs to be
strengthened. Although NGOs and WHGs
monitor the activities of the Link Volun­
teers and the progress of the project as a
whole, the monitoring process is not sys­
tematic. To tap the potential of NGOs and
community members to contribute to the
project, a system for input from commu­
nities and NGOs needs to be established,
along with meaningful—and preferably
community-defined—indicators.

Sustainability
Sustainability is problem of growing con­
cern to the project. Now that IPP VIII
has established wide networks of Link
Volunteers and WHGs, how will it ensure

Project staff attempted to strengthen the
monitoring role of NGOs in the project

45

I

that these are maintained after the pro­
ject period ends? How will the role of
NGOs be sustained? A prior urban slums
project in Hyderabad was able to devel­
op extensive networks of community
health volunteers, but these networks
collapsed after the project period ended
because the government had no funds to
support continuing the project and there
was no institutional structure to pay the
monthly stipends of the volunteers. IPP
VIII Hyderabad sought to avoid one part
of this problem by making the Link Vol­
unteer position purely voluntary, with no
monthly stipend. The project achieved
this by reducing the workload of each
volunteer and recruiting many more vol­
unteers to assure coverage of the project
area. As a result, the costs of maintain­
ing the networks are minimal. In addi­
tion, because individual workloads are
reduced, Link Volunteers may be more
effective in reaching each household,
leading to greater project achievement.

Nevertheless, the networks of Link Vol­
unteers and WHGs are encouraged by
the monetary incentive of the revolving
fund and the guidance of NGOs. The
fund requires a relatively small financial
input, to maintain, but will still require
some source of future support. The role
of the NGOs in the supervision of the
Link Volunteers and WHGs, project mon­
itoring, and identification of new com­
munity initiatives also depends on future
sources of funding.

Project management staff have been
exploring options for funding these net­
works after the end of the project peri­
od. To sustain the Link Volunteers and
WHGs, they are investigating ways that
the revolving fund could become entirely
community supported. They are also
seeking sources of support for the fund
in each slum from other government
departments. One such department has
offered to give each 1PP VIII slum with a
lump sum, which may provide some
additional financing for the community
46

revolving funds to be continued in the
future. Money added to the fund and
placed in a interest-earning bank
account could help keep it going. A
financial assessment is needed to deter­
mine the feasibility of these options.

Maintaining the role of the NGOs in the
project also will be difficult. Some NGOs
have the skills to seek their own sources
of support and funding. To keep NGOs
working in IPP VIII slums, the project is
exploring how to build the capacity of all
the NGOs to write proposals and obtain
funding to continue their IPP VIII activi­
ties in the future. Such capacity building
would also require the strengthening of
management and monitoring skills so
the NGOs would be able to effectively
run the community-based activities with­
out the help of IPP VIII project officials.

Replicability
Finally, looking beyond the reach of IPP
VIII, the replicability of the project will
determine whether it is judged a suc­
cess. Can the project's strategies be
replicated outside Hyderabad? Is it the
unique experience of Hyderabad and the
rare combination of a few committed
individuals that has made the project's
participatory approaches possible, or
can these approaches be applied more
broadly? Efforts to understand the pro­
ject's strategies and identify underlying
patterns and structures will therefore be
crucial. Transference of the Hyderabad
experience could mean not just duplica­
tion of the model, but also changes in
policy, such as the greater participation
of community volunteers and NGOs in
policy debates and research committees
(Chen 1994). Documentation of the
process of building participatory struc­
tures and evaluation of its impact will be
the legacy that this project will leave to
future initiatives. It is how these lessons
are understood and translated to other
projects that will define the ultimate
achievement of IPP VIII.

Appendix A: NGOs Collaborating with

IPP VIII in Hyderabad
Ankuram
Care of Widows (COW)
Centre for Operational Research and Rural Development (CORRD)
Centre for Holistic Advancement and Integrated Network (CHAIN)

Confederation of Voluntary Agencies (COVA)
Grama Nava Nirmana Samiti (GNNS)
International Union for Health Promotion and Education (IUHPE)

Leprosy Tuberculosis Eradication Society (LTES)

Mahila Sahyog Society (MSS)
Mahita
People's Initiative Network (PIN)

Pratyanrtnaya
Red Cross
Research and Development Society (RDS)

St. Theresa
Sampurna
Shivananda
Shivaranjani Educational Society (SES)
Social Awareness for Integrated Development (SAID)

Tejesvi
Upacor

Vijay Marie

Appendix B: Achievements of Hyderabad's
Participatory Approach

Activities Financed by Revolving Funds
No. of slums

Type of activity

29
10
7
5
4
3
3
3
3
2

Rental of wedding equipment

Tailoring center
Drainage repair
Community hall renovation
Embroidery center
Borewell repair
Tap repair
New tap connection
Sari sales
Public toilet construction or repair

47

New borewell
Road repair
Literary center

Canteen
Woolen and lace works
Small general store
Tenth-class school fee paid for girls

I
I
I
I
I
I
I

Additional Innovative Activities
Adolescent Girls' Groups
Legal literacy program
Urban Forestry Nursery Scheme
Income generation schemes for adolescent girls
Adult education program
Schools for child laborers
Play Schools run by NGOs

48

150
98
6

25
17
II
5

References
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Mia's Poor: Non-governvM
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ton, D.C: World Bank.

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Municipal Corporation of Hyderabad. 1998. India Population Project VIII. Hyderabad.

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Population Rese^ ch Ce^e An
y
Health
“
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Professional Assistance for Development Action (PRADAN). 1996. Towards a Relation­
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Schmidt Detlef and Susan Rifkin. 1996. “Measuring Participation: Its Use as a Manageri­
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Economic Co-operation and Development.

49

Sundar, Pushpa. 1994. “NGO Experience in Health: An Overview.” In Saroj Pachauri, ed.
Reaching India's Poor: Non-governmental Approaches to Community Health.
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Further Reading
Bamberger, Michael. 1998. The Role of Community Participation in Development
Planning and Project Management. Economic Development Institute. Washington,
D.C.: World Bank.
Bhatnagar, Bhuvan and Aubrey Williams. 1992. Participatory Development and the
World Bank. Discussion Paper 183. Washington, D.C.: World Bank.

Cernea, Michael M. 1985. Putting People First: Sociological Variables in Rural Devel­
opment. Oxford: Oxford University Press.

Chaubey, Selina. 1995. Reaching Out: A Campaign to Take Family Welfare Services to
the Slums of Bombay and Madras. Mumbai: IPP V Directorate, MCGM.
Clark, Maria Donoso, and Elizabeth Miller. 1994. Multilevel Participation: An Opera­
tional Model for Task Managers. Washington, D.C.: World Bank, Population and
Human Resources Division, India Department.

Marsden, David, Perter Oakley, and Brian Pratt. 1994. Measuring the Process: Guide­
lines for Evaluating Social Development. Oxford: INTRAC.

i

Municipal Corporation of Hyderabad. 1992. Municipal Corporation of Hyderabad India
Population Project VIII-Final Proposals. Hyderabad.

Narayan, Deepa. 1995a. The Contribution ofPeople's Participation: Evidence from
121 Rural Water Supply Projects. ESD Occasional Papers Series 1, Washington,
D.C.: World Bank.
. Design of Social Funds: Participation, Demand Orientation, and Local
Capacity Organization. World Bank Discussion Paper No. 375, Washington, D.C.:
World Bank.
Paul, Samuel. 1987. Community Participation in Development Projects: The World.
Bank Experience. Washington, D.C.: World Bank.

Professional Assistance for Development Action. (PRADAN). 1996. Towards a Relation­
ship of Significance: Interim Report on the Study of Relationships between Gov­
ernment and NGOs in Rajasthan. New Delhi: PRADAN.

Purdey Alice Gyan Bahadur Adhikari, Shelia Robinson, Philip Cox. 1994. Participatory
Health Development in Rural Nepal: Clarifying the Process of Community Empower­
ment.” Health Education Quarterly 21(3): 329-343.

Rietbergen-McCracken, Jennifer, ed. 1996. Participation in Practice: The Experience of
the World Bank and Other Stakeholders. World Bank Discussion Paper No. 333.
Washington, D.C.: World Bank.

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