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RF_DEV_4_PART_1_SUDHA

DR . &. I/- N

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0

EVALU/.TICN OF M.C.H. SERVICES
I

BASED ON URBAN HEALTH CENTRE,
CHETLA, CALCUTTA - 700 0 27.

i

i

i

BY
dr.

s.f.

I

MUKHOPADliYAY
/
Head, Department
r
of Preventive & Social Medicine and
Associate Professor of Preventive & Social Medicine
All India Institute of Hygiene and Public Health, 110,
Chittaranjan Avenue, Calcutta-700 073
6c

Officer-in-Charge,
Urban Health Centre, Chetla.

1
I. Programme Perspcc11ve

The area Chetla occuping WarH 82,83, 84 and 85 of district-IV
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of Calcutta Corporation.

It used to have the highest population
li

of slums in Calcutta and was confronted with health problem like
•

!’!

high infant mortality and maternal morbihity rate, epidemic of
diarrhoeal diseases.

I

tuberculosis malaria and nutritional disorder

J!

particularly under 5 age groups.

The environmental condition was awful having not adequate
provision of safe water to drink and no provision of safe disposal ofJ
waste.

I

i

The slum had particularly no shelter to live in and used the
pavements for sleep, cooking and other necessary things in life.
It wag indeed strongly felt that this community needed help.

in relation to health care and advise in the principles of healthy
1iving.

it was envisaged that this effort of achieving health of

these people, should be integrated with over all development of
i

human being i.e. linking the development in socio-cultural and

economic advancement

_

k

I

I - 2 - :

economic advancement.

With this view in mind. Government of India in collaboration
i

with Govt, of West Bengal and Calcutta Corporation with help from
WHO and UNICEF established a health centre named as Urban Health

Centre, Chetla.

Presently, this health centre, is responsible

health care with special emphasison preventive and promotive

i

services for the community which consists approximately 69

thousands population.
Urban Health Centre which is a field practice area of All

India Institute of Hygiene and Public Health was founded in the
year 1955 with the following service objectives ti)

To organise and delivery of community based compre­

hensive services to the slums living in the catchment

area of the centre.
ii)

To give special emphasis on health care of the mother

and children living in subsistence level.
iii)

To improve the nutritional status of the conrnunity
specially to vulnerable sections.

iv)

To support activities relating to improvement of socio­
economic and educational standard of the community.

For effective and optimal delivery of the service, it is
essential that the services are evaluated from time to time with

regard to quantity and quality of health care provided.

The

results would serve as feed back process which will be useful in

decision making process.
II. Method of Approach in Evaluating MCH Services

For evaluation of the services the following methodologies

I

i

« - 3

i

were adopted
1.

Scratinising the services record (Family Polder Register) card
, maintained with MCH & FP Section to cull out information on
different aspects of services provided.

2.

To conduct a sample survey to obtain information from the
community about the quantity and quality of services

provided.

3.

To work out the different health indices and examine the
trend with these indices which reflect the long term changes

in health status of the community.

III. FINDINGS:..

The service area of Urban Health Centre (UHC) comprises of

3 administrative decisions viz. A, B and C, spread over 2.2.sq.Km.
Total population (estimate) of the service area is 69,000 of which

about 29,000 are living in slums and the rest i.e. 40,000 belonged
to non-slum area. About 54 percent of the population are males.

I

About 40 percent of males are illiterate and 23 percent females are
illiterate.

About 30 percent of the non slum families are having

family pereapit>-income below Rs.75/-.

About 65 percent of the families are utilising the services
of the Urban Health Centre either exclusively or supplemented by

services rendered by other Government or Non-Government Agencies.
Most of the beneficiaries are urban poor.
IV.

a) Afatenafal C^re

The programme for antenatal are adapted at the centre isj1.

To register pregnant mothers as early as possible;

2.

To protect mother by giving Tetanus Toxid Immunization;

H

I
........ !■

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: - 4

3.

3.

To undertake routine V.D.R.L. Test to detect positive
cases of STD for treatment;

4.

To follow up the mother dicing pregneny period and to

examine and ascertain faetal growth;
5.

To treat anaemic mothers by diatetic advises and by

distributing folifer tabs;
6.

To refer cases to Institution for Institutional

delivery.
b)

Out come of activities

1.

Rerristration of Antenatal mothers-

1)

Out of the expected 1,300 antenatal cases among the
potential beneficiaries about 80 percent were registered

and cared for;

iii

75 percent of the registered antenatal mother got

protected against Tetanus;
iii)

V.D.R.L. Test of registered mother was undertaken (57%)
of which 9 percent was

Ve cases.

These cases were

referred to STD Clinic of the Centre for Treatment.

iv)

Follow-up of the mothers was done both at clinics and

at home.

About 70 percent of the registered mother

was paid 4 or more number of visits during antenatal

peridd.

v)

15 percent of registered mothers were examined for

anemia and these mothers were treated.

69 percent of

registered mothers were given to Folifer Tablets as a
toutine measure.

-I- ..

Q

i-5-i

V.

Job Functions and Out come Of Activities of Post-natal Care:
This includes follow-up of post-natal mother after the

delivery upto six months to detect complication if any for
necessary treatment, for acceptnace of family planning for

spacing and sterilization.

Out of the total Post-natal mothers

were paid only one visit during 1st 6 weeks after delivery.
However, 20 percent of these mothers paid more than 3 visits

I

from 6th week to 6 months time.

VI. Family Planning_Sery1 re
a)

The Progranrne for F.P. Service Includes —

1.

Registr*.!tion of eligible couple

2.

Follow-up for motivation

3.

Distribution of Contraceptives

4.

Arrangement for referral of willing cases for IUD,
sterilisation to Hospital.

5.

Follow-up for acceptors for detecting of complication
for treatment.
l

W Out Come:

t.

Out of about 6,800 eligible couples among the potential
beneficiaries 57 percent were registered.

2.

53 percent of the elegible couple accepted F.P. Method

as detailed below:-

IUD

5*1%

sx

Ligation=10. 1%

Oral
Pill

S3

Condom

Other conven­
tional device

u

16.9%
10.7%

10.2%

Among the Non-acceptors about 60 percent aged 30 years of
age and above, and about 50 percent were having 4 or
more no* of
children.

N

:

6 - t

VII.Job Functions :

a)

Ch11H Care:

1.

Registration of the children

2.

Follow-up of recording growth and development

3,

Immunization according to EPI Programme

4.

Referral under nutrition cases to nutrition clinic of

the centre.
5.

b)

Administration of Vit.A in Oil to children.

Out Come

1.

About 5,000 children of the potential beneficiaries

have to be cared for
2

Out of which 70 percent were registered

3.

Regarding follow-up of these children about 78
percent were paid 6 or more visit and 27 percent
were paid 10 or more visits within 1-5 years of

age.

More than 50 percent of the children were

paid more than 3 visites.
4.

65 percent and 66 percent of the children were
given complete doses of DPT and Polio vaccination

respectively.

Only 34 percent of the children

were given BCG vaccination.
5.

65 cases were referred to nutritional clinic.

. 7

7

VIII.

YEAR

HEALTH INDICES (RATES ARE EXPRESSED PER THOUSAND)

X

X

X

BIRTH RATE I
I

X

DEATH RATE

I
X
X

IMR

I
X
I

MMR

1957

40.7

11.9

77.9

3.5

1961

35.6

9.0

73.7

2.7

1966

25.7

7.9

73.0

4.0

1971

24.1

8.8

75.1

1.4

1976

22.7

9.6

88.2

2.8

1981

20.0

7.0

48.9

0.7

1982

19.4

6.8

46.9

0.0

1983

18.9

7.9

56.0

0.0

1984

18.2

7.4

46. 2

0.0

>1

« “ 3 - «
V

IX

X.

KgSPQNSES OF COMMUNITY-FOR PISONS OF UTILISING THE SERVICES
BY URBAN HEALTH CENTREr CHETLA,

1.

Near to house

33%

2.

Free Treatment

40%

3.

On Staff Advise

4%

4.

Good and Better Treatment

22%

5.

Others

1%

Remarks
The figures and facts as depicted here tend to suggest that

services utilised by the community are less than optimal level,

It

is evident that there are gaps particularly in immunisation
services

where improvement is a must to keep up the health status of the
children.

It is also imperative that service coverage should be ideally

100 percent to the community but have percentage of population that

left out of the coverage belong to the better economic class who do

not available services of U.H.C. for obvious reason.

Still periodic

visits to check families are essential to see that they are maintairrbg

Public Health discipline.

The Health para-meters in this area indicate

better average than National Level.(Annexure—3)

The fact that have

services are integrated and also emphasis is given to each component
service and thereby not diluting anyone of them for the sake of inte-

gration has been proved to be the key to the success of this
programme

Each health worker is trained and guided appropriately to give the
services in meaningful wag so that the impact of such exercise in felt

in Maternal and Child Health,

Nevertheless,

the fact ve mains that thej

service standard as set has not been accomplished (annexure 1&2).
Though the quality of service has been iro-proved, yet the quality of

service is to be increased in order to optimise the impact of the
services on health condition of the mother and children.

mch

eval UATION

AWNEXURE - I
standard)

1.

2.

3.

Standard
Antenatal

Visits
(at home or
at clinic)
Post-natal
Visits
(at home or
cl inic)
UP to i year.

5 per case

8 Per case

Family Planni

n'3 Work
(^gible
Couple Contraceptive
Practice)

4,

Health
< 0-5 YQSrs) Care Visits

75% Registration
65% ?
e
(by ^£S?Ptanc
1925)

National :
Level =37%)
10

Per child

i

V

MCH

EVZJuUATION

ANNEXURE - 2

0F measurement op performance AGAINST T:IE SET
~STANDARD---------------

Services

.

Achievement

Imgact

MMR = 0.0

A.

Ante-Natal

a)

Contact coverage

Not 100%

b)

Not fully Achieved

B.

Quantity
(No© of Visits)
Post-natal

a)

Contact coverage

Not 100%

b)

Quantity
(No. of Visit)

Not fully achieved

C.

Planning

a)

Contact coverage

Not 100%

b)

Quantity
(No. of visit)

Not fully Achieved

c)

Quality

Not achieved

D.

Chile Health Care

a)

Contact coverage

b)

Quantity
(No. of Visits)

Not fully achieved

Quality

Not achieved

c)

Not achieved

I

MMR =0.0

Birth Rate=18.9

IMR =56.0

i

tez—.....

i”

anuexure

URBAN HEALTH CENTRE

3

MCI-1

I
YEAR I INDICATOR
I
------------ 1-------------------------

i--------

1983 |a) Birth
l
™

_

i

Rate

1---------------------

ib) Death

i
i
i
b
i

Rate

id)

[e)
i
i
i
!

i

I
I
i

I 18.9

! 1985

I
I
I

I
I
I
I
I

!---------

[

7.3

; 56.0
I

{-----------------

|

0.0

I
4------------

Elegible

[ 5 3%
couple
!
P rotection|

x

,L
I
I
I
I
L.
I
I
I
l
U
I
I
I
I
I
I

r

i f) Practice
i
Immunisationj 65%
i
i
DPT
‘

-♦
i

jg) Polio
4---------------------

i
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!—

!h)

[YEAR

t

I

MMR

r

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•t-i

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j U.H.C.
iChetla

i-----------

[ C) IMR
I
+
-----------

EVALUATION

T. Toxoid
antena tel
mother
P rotec ted

i
i
i

a
i
i
i
i
i
i
i
i
i
-i

66%

75%

i
i
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i
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i
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i
b
I
I
I
I
I

31

12

_L60.0_
I

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2-3

i
j.

I
I
I
I
I
I
T
I
I
I
I
I

1

4I

I
I
I

I
I
I
I
I
I
I

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b
I
I
I
I
I

21.0

9.0

T

i Urban

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i
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4

I
J BY 2000 AD

L
I

x
I
I
I

NATIONAL TARGET

37%

70%
50%

60%

I
I
I
1,
I
I
I
I
1
I
I
I
I
I
I
T
I
I
I
I
I

HI

I
I
i'
i
i
i
i
i
i
i
i
-j.

60

IIs
2

60%

i

85%
35%

i

100%

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!,:• ■'Type"-!'
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ThArd'will be no Urban Centre for. a population of JO,QQO

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. Se^ssA A Family Planning services in suclr areas will bp

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'.. .;hospital,- dispensary ^or I’CH centre- ..., , .. ..
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(iY In'ke-epihg with'''the general policy of providing
^ ' SanningPhealth and .MUH services in
.integrated manner,
' ■ ’ uiban Family: Welfare..’Planning Centres will, as a. rule,
:,..
bf^tSh^to a'. Hospital, ’ MCH’ centre o> dxspenaary
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...

2

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functioning in thu sr.-a. ,

<li)' Where' no ‘hospital# ■ dispensary

JJ^5®g ioca,ted, ■ it' -

.?.(iii)‘ 'in 'case 'of' Urban.^ntros' run ^^^Cggt°^3tions
'■’UJ voluntary .Organisations, y^-erned^rg^^^ .

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i;,.^i»initt^^^^

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''?’Sh;^’^hi'r/';;:this' worH-'.' No-spic1^1 Pay.' for this work*; , ■>
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staffing pattern approved for rypc-J,-^
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'JNCH''c'Vntr s and h pens ary;/bt-giv on..,
Planning
C<ribr^-s*wiiJ-/
hospital?, MCH Centres,

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-rh $ .iouia. te cips,ly>«upsTO?ei «na ^ss.ssyl
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;
.of
-the" revised
pattern for the-. •.
:4\':.y.with the/, inip^etntptat^on
r;:
Pl anning Cent rds as, proposed /some
rr"'jrr
urban-Family
Welfare
PlSurplus,. They
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n
. necessary .■■ ,

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. ^..•jy^^<A^op^hhhir'^dnwitreff ebt Som1!^ .19?6. - ■
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- -.that date.'

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■.■•tors arc .ru<s»ast,a to r"Ji'JKJ'y,,, Govommcnt institutions or

..•Send a report ,to.this dtteou.
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Deputy. Secretary
Secret,aKy. v?"’'.i...'s .Ci; Kumar, . Deputy.
, y'yZ;
to Government of India.
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,py-of letter No." M. 12012/4/80 - FWB, dated 14th July, I960
. . / ,
Health an<4/FW (Deptt. of Family Welfare )■, New Delhi, . addressed ■.
to the Health- Secretaries of all the States and union Territories...

"■/
-*2_- I"-----—
----------------'r"/’.of
i=, India,
Ministry of’
4 _/
rom/the
Under...............
"'Secretary
to.
Government
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?",? Jgub; Family' WelfareProgramme - setting up .of
:r. '
-additional Urban FW. Centres (Type Ito
:://' ..-.III) on the basis of 1971 Urban Population- , ■ :
. ' \
during, 1980-81
,• )

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C.':"■■________________________________ ■

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. 'I 'am directed'to say-.that the question of bringing on
grounds the-basics inf rastructure needed- under thei-Family
„ ■
Welfare Prograpipg, in rural as well as in--unban areas as per
norjns, already laid down was discussed during the Annual
Plan. discussions for 1980-81 held in the Planning Commission.
' where' the repres entative’from the S-. ates/Union Territories,
Departmunt' of Family Welfare .and Planning Commission were
■present• ’.On the. basi^.,.pf the discussions i.eld, it has been
decided' fee take up establishment of additional 385 Urban ...
Family Welfare Centres as detailed below' in the States and
Onion Tofi'ltdrle.'.i on the basis of 1971 Urban population.

'.Type
I (10,000
(10, 000. ’to.
to.- 25,000
2 5 i .000 population)
popiilotion)
Type
II
(25,000
to
50,000 .population)
population)
iype\
Type III. ( 50,000 . arid above-)

...

185
100
10Q-

A W V .1
V. — — — ___________ - - r- . .-'The -State-wise
.distribution
of additional Urban^Centrcs
.- to be opencld \luring~ 1980-81 is given in Apper^lx I and the
' details of the staff to be sanctioned and appointed and^
and,
other expenditure: ^dmissible^ in <nch of the centre is given .
in Appendix^II.
•
\ ^2 »• '

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■

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-While ^^nctien'ing the opening of nddition^l urknn
.
'(family welfare-centra, the instructions given in para. 2- (il to
■. '(y), and-3 ■ (1) .to (iii) fin this Ministry's letter No. N. 19011/2/
' 75-PLY, dated '23.2,76 (copy -enclosed for ready reference/ may
bp kept in-view'and the Instructions, given below may be ■
’Strictly adhered-to:. ' ■
' . '
'! •

*

*!

i

,

-.i) Urban Family Welfare; Centres should
attached
\
to Hospital, FCH centre or a dispensary already
• / functioning in the ar^a so that the centre could
provide Services in Health, .Family Welfare- and
^MCH.in the integrated manner•
...

.

-ii) All'the..sub-divisional hospitals covered by
i. •... the U.K. Aid Scheme be provided with an Urban •
.Family Welfare Centre of th'^ t/po .entitled in
V/V;'’
case orL Urban. Cchtrc.1 is not already functioning;

■;

'• '
’

?
.

‘

ii-lx) Priority- may tic given in setting up of Urban
■■ ■'.
Family Welf are C^ntrls. now sanctioned to those .
.
aruas 'which do not hav^ an urban ..family welfare _jCentre/post partum c.^ntr^s already functioning,
in thu. vicinity and in urban slums.:,
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. ■

iv) Type III Urban Family Welfare Centres may also .
' •’•■/'be •‘allocated to voluntary organisations, who t
for thc; banto. ■ .For ^rc-itor ’.
. 7. / iovplvomodt. of.'voluntary organisations, due .
;
. - publicity may a"ls.b be. givon among th,e prgani-^■^^^IsabaJon^-'vzbQbaro already in th/ f;ipJ-fL-;

'■»'

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7777’7':47'

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4F J; /The' expenditure involved on the .GStabl;^^
.
. th^ .urjpan family' WQ3f are Centres may; bt .pct/.^rpm'the'."
1
^libp/tionp. that:-may bo-intimated during .l'98b>81 under
. tjig sub-hoM'' ■'Urban;'Faipi'ly Welfare Sorvictbe-ind-.reported
to th/ '.Depart ment/.of. Family Welfare through -quarterly .
-.

7.7.:- '
'/..St accordingly to' request th^t* the Opvornmcnt'.
.y
.of. Andhra Pradesh etc. may sanction the establishment
;;o'f :the Urban" Family. Welfare Centres and' creation of' the ;
* ■'/- posts/.admissible for'thorp.
A copy -of . the order, issued- ’ •.
•;/ \ may please be,endorsed to this Department., /
,
••
••.

/
This’ issues with the’concurrence -of Finance ■ ’• ;,f
Division vide Dy. No. 2192/80 - FIN.
FIN.I,
1/ dated .5.7.80. / ” ’

•I

Receipt,
Receipt' of. this letter may
may. please
pitaso be
b 'acknow 1 edged
and th^ datp .on which th centres ar_- established toget• her with t.he location may pleas bc- intimated tQ. .this
Department; in due' course.

4 7».

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’ for Director of K-"ilth ^nd FW Services
A

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- 3 There is a greater need for popularising
especially among
h'k uyounger^couples
y?Un??r couPles as a method of spacing. As S
such
uch, it is essential
that facilities
---- for
---- IUD
b ;•insertions are made available' at all the subcentres.. The
sanctioned are being equipped to
Jhe new Sub-centres
Sub-centra now
r,™.> being
i
provide these facilities.
7on\pW°
Un<^er Paniily vJelfareprogramme is admissible for construction of buildings for sub-centres.

worker
pa^tern
inputs given in Anne.xure H provide for a voluntary
nad *o L^-h2n?rari™ SV*'507" P';r 1TOnth- An out efforts should be
thoA/i?!-^
framed Dajs, as a - oluntary worker who are available in
LUC

VX-LXagGS.

necessary that proper reservation of posts for scheduled
from -m^hed^ed trities rw be .made and the reserved posts filled un only
xrom among these categories.
v
7

(UhE__ IV
-m nn lfn"Gxure to letter No. P1C019/4/85-^67' “
■ b-’iTO BE OPENED UNDER FAMILY
PROc<iWiME DURING THE 6TN PLAN.
(A) FURNITLJRE
.sl.._Pp... " . ......... ‘ Item ...
1, Examination Table (teak wood
1
2.
■1 ri t ing Table (Teak Wood)
1
3. ^rmless Chairs (Teak Wood)
3
4. Alm.ireh Steel
1
5.
Benches (T/W.) or steel
Steel
2
6. Basin Stand (Steel)
1
Stools (T.’J.)
2
8. Side Racks (T.w.)
2
9. Hod ic 1 ne C^G s t
1
10. Wooden Screen
1
11. Fcot Step
i ,
1
12. COat
1
13. Cot Wooden
1
14 zBed side Table
1
(B) SUNDRY ARTICLES

1,
2<
3.
4.
5.

6.*
7.

8.
9.

B|

h

Hugs
^rosene Stove
sauce pan with lid
water recepticle
^u^ber/Plastic,shutting
Shakir-Q Strip^(for measuring mid arm
circumference)
Talquist Hie scale
^rum with tap for storing water

2
2
1
1
1

2 meters
1
1
1

(K.R.YESHODzX)
Under Secretary to Government,
Health & Family Welfare Department.

"k

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;i • *’ .’; 4f-‘ •■’'w

Corporation of the City of Bangalore

A

■ '.

J
An appeal to the Public from the Health Dept'• I
to eradicate Mosquito menace by 7

rL

. 5. J

observing the following points.

I

■/ ’•’ '"('

'■

‘

' t

Clean the water tanks and other points where water is stored. . ; < i
1

atleast once in a week.

'

■

-

■ •

■ ■

Ditches, unused wells and such other places In your neighbourhood

2.

whore water stagnates should be closed.
■ > 3.

'4.

Take steps

,

« .|

to see thattto water stagnates at.any point.

' .

■ ij or from the washing of clothing
Water coming out from the kitchen
to underground without letting put
should be properly connected
1 •
into the open drain.

5.

I

6,

clean from broken jars, bottles, tyres, barrels
Keep the sorroundings cle
etc., where normally the water stagnates.

■

9.

• ri

■

.<
,|

..

.

Garbage and such other domestic wastages should not be put .into
the gutters, obstructing the flow of Sewerage Water.
'
Please introduce "Gambusa Fishes" into the wells,

8.

j

Water in buckets for extinguishing fire should be cleaned and
changed every week at Cinema Theatres, Factories, and such other

Publio places.
7.

1
J

>

.•■J 4

?. ■

I

1

if there1 are

.

-

j

any in your house.
Co-operate with the staff of the Corporation when they come; to

1
j

your place for spraying disinfectant medicines.

’j

.

, By devoting two or three hours every Sunday by observing the above A |
10.
’ steps, you can eradicate the menace of the mosquitos in your area. - ’ ' J

11. When fogging operation machine (smoke machine) works in yourarea once or twice in a month to kill the mosquitos, please ensure
to keep the shutters open & eatables covered.
J
Health Officer.
B'lore City Corporation.
_

!

Sri Balamuru^r Press, Mamulpet, Bangalore. Phone: 76104,

v

\J J

list of Wan Family IffiLFAKE CENTRES FUNCTIONING
IN KARNATAKA

AS OK 51-3-85.

i

Bis trict

I

Urban Fama. Ijr
Welfare Centro
located at
2

Run by whom
G overnmont /
Locc^. Body/
Voluntary
organ is at ion
3

Category

4

bangalore
(city)

1 ) Chall aram M. H.
Local Body
2 Dasappa M. H.
ii
3 Manvarthpet M.H.
ii
4 N.R. Colony M.H,
it
5. Pobhathi M.H.
it
6 Ulsoor M.H.
?: Shan
_____
_ M.H.
tin aogar
H
Q) dore Bank M.H.
II
c
9)' Munireddiyapalya M.H.
II
10) Rajajingar M.H.
’»
11) Azad Nagar II.
M.H.
J.
II
12) Goripalya M. H..
II
13) Ramachandrapura M.H.
II
114)
4) Magadi Ro al M.H.
•I
15) Ashok Nagar M.H.
II
16) Austin
1 T own M. H.
II
17 Jayangar M.H.
II
18, Ha numant han/a gar M.H.
II
19) West
— j cJ
of Chord RoM.H.
II
20) S es h a d ri p u rai II.
L.
M. H.
Vol.Organisat ion
21) M.L.T. Clinic M.H*
ii
22) Wilson Garden M. H.
ii
23) Bunasnunkari M. H. •
ii
24) Srirampura II.
M. IL
n
25) Subramanyan^i
jar M.H.
ii
26) P.G.Halli M.H.
n
x
27) Indian Red
Cross
Red Cro
ss Society
ii
28 Lions Club
•i
29. Sampangirama Nagar
ii .
30) Yeshvanth apura
31 ' Cox Towh
ii
I 32 Health & F.W.Trg. Centred
GoVernwnt
*-33) H.Siddaiah Ro fid A—x
n
34) H.a.L.
Public sector
undertaking
35 B.E. L.
it
36 I.T. I.
ii

<p\\<\y
’-rv

BANGAL0RE X1) Ramanagar
(DIST.)
#(J!) Kanakapur
Kanakapura
a
^-3) Chonnapatna
.
G 4) Boddab allapur^

Government
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II

II
II
II
II
II
II

II
II
II
II

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CIIELTKADUWA

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G ovorrn merit

III

KOLAR

% 1 ) Kolar Gold Field
) Chintamani
3) Chickballapura

Government .

III
II
II

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KT
SHIMCGA

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belgaum

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Vol Organisation
2) UF'JC Bhadravathi I
Government
ii
iv5) UFUC Bhadravat hi-II
ti
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ii
1^5) UP WO Shikari pura

Government
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W 2) Gokak
3) Soundatti
4) Kashag
>ix5) Cantonment
6) Shi vaj in aga r
^v7) FPAI Belgaum-I
>^8) FIAP Belgaum-II
9) Sakeshwar

Government

B agalkot
^2) Bijapur
_ .
4b 3) FIAP Bijapur
.,^4) Talikct
>U‘5) Terdal

HF WTO Hubli
Municipal MH Old Hubli
Municipal MH Dh’arwad
G an es h pc +■ Hut) 1 i
FPAI Torvigall i Hubli
Ranebennur
7) Gajenaragad
^18) Naragund
S>9) Gadag
) Betageri
I Lu* mush war
OTTAHA KANN AD Ac 1 ) mi Kumta
.1
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2
Honnavar
>J
3 . Bhatkal.
IS 4) Sirsi
BELL ARY
1) D.H. Bellaxy
C.B., Bollaiy
Mb FIAP Bellary
4|4 G.H. Hospet
Chit. Hospet
Kampli
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^2)
3)
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4^5)

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2) Shira
Tiptur

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III
III
III
III
III
I
II

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II

ti
H

I
III
III
III
III
III
I

II

II
.

*

II

.

Vol. Organ! sat ion
ii

i 6 I

Government

Government

III
III
III
I
I

Uol, Organis ation
G o vernmont.
u

Government
Local Body

Ill
III
III
III
III

11

ji

Vol.Organ isation
Government
••

II
I

11
11

*

n

u

I
III
III
I

Vol.Organisation ' ,
Government
11
11

I

Governme nt
ii -

vol.Organisation .
Government
ii
ii

kA .

I
I
I
II

• III
.III
m
III
III
I
(V

.3

1

Tr ainning

Pr

em

or_
£and Evaluation

of Hea1th Services.
( New Delhi - August 5 to 11, 1985)

Work Paper

submitted

By

Name of the Project

rir R K Paul
Program Officer
CARE - Uttar Pradesh

Health Education in Primary Schools

Ju r a t i on

19BD

Ix^c at ion

82

Tirunelveli, Tamil Nadu State.

Pr o j e c t S. p on s or s

CARE Tamil Na.du,GOTN Education Deptt.

In 19 83, CARE Tamil Nadu and Government

of Tamil Nadu

jointly sponsored a Project in Tirunelveli district
of
Tamil Nadu tc cover the 3200 Pr imary Schools
1 students

for achieving the following objectives;-.

1

To create health awareness in the pupils of the
selected Primary School and the

2

teachers as well,

To create awareness in Primary School
.Teachers and
er jble them to identify and promote
proper treatment
of common diseas es which aflict primary
school-age
ch iIdren.

Process PglloA^dl
Cne teacher each from all the primary schools
of
Tirunelveli District was

trained by Health Education

Training Unit, CARE and ECERT,

in two batciies .

First

batch of to D?puty Inspectors of Schools
and 30 B .T.

assistants were trained as Key Resource Personal
and

contd . . .2

2

they,

inturn.

2

;

trained the other teachers
comprising the

second batch.
Two Health Education related materials
were developed
by CARE & S>CERTs1

Hand-book on Health Education for Primary school

Teachers.

2

Five different Health Education Booklets
for 1st
to Sth stai;durd.

3

To assess the leve 1 o f course assimilection.

Pre,

Mid

and Post tests v/ere conducted for the Key Resource

Personnel 6< Teachers .
Health Lducuclon v/as introduced as a curriculam of

Tirunelveli district and three periods for c acr. class were
allotted for Health Eduo. tier; in a week thru

a Government

Order.
The respect i.e. Policy for .-.ulation, administrative
decisi -jns and

operations 1 control all we r

w j_

At<r

Tamil Nadu and Depart 'ent of Education GOTH.

SCERT was assigned t?

of the Project.

task of evaluating the impact

This evalu.?tior. ’.ms conducted in 120 schools

xvhere 3600 school ch il m.-.,

were given a test.'
to comp ar

belonging to 1st to 5th standard

.k control ^rcup was selected near 'Madras

the results wi

results of this evaluntion

• t.he experimer.ta 1 group.

htt. chments

I k

II ) amply

proved the success of this project.

contd. . .3

The

s 3 ;

'The only- constraint faced
wh i Is evaluating the
program
was with resxject to
non-availabilit Y of another
con tr ol
group to compare the level of
bareness in the children,
covered under the program, with
another group, not
covered
in the program, in the
same district. To
circumvent this
similar group was selected
f rom a n ot her district
a little
far off frcm the project
area which did Not have
exactly
the same conditions
as the project area.
The booklet prepared for class
IV
V should have been
more exhaustive
on environmental pollution.
It was also
felt this program should be
continuously implerie nted
and
should be part of the
regular syllabus.
It was also felt
that tile Project should
cover the entire State.
The format used for
presenttlon of ttogran, evaluation
results was both
graphic and £lgurln, ( attachments
I & II)

Cover nme nt of TumiInadu
and C/iRE Tamil Nadu reviewed
the
evaluation results and
Government of Tamil Nadu
was
requested to continue and
expand the program.
to change in priorities
^nd funding constraints of
both CARE and Government
of Tamil Nadu,
no further follow
up action Was taken.

i
i

1

- >

At. t j c he rne n t - I

Percentage of Ccrrect Scores
on E,v a lu a t ion Que s t i onn a ire

TiruneIve11
Primary School

Control
Group

Students______
(No. 1650)

(No.150)

Standard

1

91%

4 4%

Stand ar J

2

82%

41%

Standard

3

7 7za

4 8%

Standard

4

7 6%

4

Standard

5

77%

41%

>
■4

GUJDEL INES FOR WRITING THE PROJECT PROPOSAL

(xvlodih

Hca-^ ,

Part £

1 .

Profile of the City
a . Geographic

b. Demographic
. Population

.
.
.
.

census, mid 1986 estimated
1981 census,
1993(mid year) projected popu1 ation
(Projection period , 1991-1995)

Decadal growth rate
Birth rate
Area
Density of population

. Age distribution
< in years)
0-1
1-4
5-14
15-44
45 +

Male

Rural

Ferna 1e

Urban

Total

c . Soc io-economic
— Education(Overall and female 1i teracy)
- Occupation
~ Income

d . Envi ronmen t
- Water supply
~ conservancy system (sanitation)
- Sewage
- Solid waste disposal
~ liquid waste disposal
- Other pollution control measures
e . S 1 urns

Population

1981 census mid-1986 estimated
1993 (mid-year) projected
(projection period 1991-1995)

Birth rate

Location o-f slums (show on map)
socio-economic conditions (as given in 'c'
Environment (as given in

1

'd'

above)

above)

z

t t ejaAQ

•

swots '
sqjoqos ’
(ueqjp)MT3 *

aww
n^jBAo
swots
squnqng
(ueqjri)MT3

•
•
'
*

aw i
IjejaAQ

•

swots *
squoqos '
(ueqjn)AlT3 '

aao
Z.86T

986T

S86T

V86T

aiea q;eaQ

£86 T

a^ea A^Tiepou (TTT)

sq^Jiq

I IT4S

aww
sqqeap teuJ3leW

awi
sqqeap quej-ut

aa3
sq^eap t*l°X

£86 T

9861

(A^td aqq JOf tlejaAO)
AqTteqjow (yy>

saseasrp atqeDyuoujwoD-uoN
saseasxp ids
saseasip atqeoTuowwaj
(atq^s?tdde
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(y >

uoiqenvs q^iean

ira>W'

'2

MF

«- '-I-

A4

r

.....

I

i

< iv ) Sex wise age-specific distribution of deaths (1987 or latest
avai1able)
Age Group
(In years)

Male

Fema1e

Total

Percentage dist.

Under 1 year
1-4
5-14
15- 44
45-64
65 +

(v)

Major Causes o-f deaths(1987 or latest available)

Total

Fema1e

Ma i e

Causes o-F deaths

1 .
2.
3.
4.
5.

(vi ) Fertility

1987

1988

No. of births

Ma 1 e

Fema1e

Total

Ma 1 e

Fema1e

Total

Ci ty(Urban)
Suburbs
S1 urns
Overa 11

3,

Health Care Facilities and services:

(i)

Dispensaries:

(i i) Hospi ta1s
(Govt. & private)

-

Govt.
Private
Charitable
General
special
Teaching

< i i i ) M . C . H . centres
( iv) Urban Family Welfare centres.
Institutions/practitioners of I.S.M.
( v)
Qualified/unqualified/
( vi ) Private practitioners:
registered

(vii)Units established under National disease
control programmes
(viii) Mobile Units
3

»

—

1Y

rn t

4.

Family Planning acceptors and couple Protection Rate
1903

Characteristics

1904

1906

1905

1907

City(Urban)
- Sterilisation
- IUD
- C.C.
- CPR
i
i

Suburbs
- Sterilisation
- IUD
- C.C.
- CPR

Slums
- Sterilisation
- IUD
- C.C.
- CPR
□veral1
- Sterilisation
- IUD
- C.C.
- CPR

Part I I

Chapter-I

:

Objectives, Targets and Strategy

ua

Obj ectives

problems and to strengthen the
To identity the
■Family
welfare/
Primary
Health Care Services to
delivery of
consistant
with
the
objectives
of the National
urban
poor
which
aims
at
taking
the
services
nearest to
Health Policy
step
of
the
people
and
ensuring
fuller
participa—
the door
Process
.
the
community
in
the
Health
Development
tion of

T arqets
Use targets set by Govt. of India for HFA bv 2000 AD

National targets by
2000 AD
1990

4

Present status
ot the city

Targets to be
achieved by 1995

f

Mi

|)—.. UJeL|;j ^ueg aAT6) ainpan^s amri

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(A
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sujnqaj pue spjouaq ( TTT
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qns snoTjeA qo suoxq duo j-/saxq t { xq xsuodsa j qof
(T
* uotqequaiua 1 dtut qaafoud joj- ajnqonjqs uoxqesuTebjQ
:

}uawabeuBW pue uopesTiie&jQ

/v-jaideqa

* ...
*
*

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pue
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uoj- GDTqsT&oi Aiddng
swa;T jaq;o
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uaATb aq 04 buTUTeuq uoTqequaTJO Auy
sjauoipejd xeoTpaw aqeATud
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ubat
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sqqn
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pue eaue
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saJTAjas Md
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*•

in-ja^depg

( TT

j-o sayjoba^eD snoijeA j-o buTUieJi

Y

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•saDTAjas {ejjaj-au jojsuot^pdoi uraq} pue spaq qo jqwnu ux aseaJDUj
squawajTnbau j-j-eqs
uoxqeDoi qqjM sqsod qqieaq ueqjn Mau

*
*
*
*

•pajysap uoTGuedxa/dn qas/paqeaj□ aq □} GaTiyiTDej- Mau
sqTun AjaATfaa aDTAjag
lejnqonjqsejfui
±0 buxuaqqbuajqs
pue 5aT;T{T3ef

:

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ubTedwoo 331 aATSuaqui ’ V
pue 5S09N
aqeATjd
quaujaAioAUi •£
pue sjauoxqX}oeud leiaxpawj
JsaDTAjas qoeajqno aAT^oaffa }-o quawdo 1 aAaQ
isaxqxixaef 1ejnq□njqsejqux qo buxuaqqbuajqg *1

aqq aq pinoo jood ueqjn oq saoTAjas
AjaATiap aqq buTAOJdwx jo± Abaqejqs aqi

sBuxmoiioj-

aje3 Hd/Md

AbaqeJ^s

>

wnafc;, jmfc«

Chapter-VI

items separately and
financial plan in tabular form shown
be 1ow:

Budget - Give details of

Years
I terns

I

II

III

Non-recurring.

1 .
2.
3.
4.

Bui 1 dings
Equ i pmen ts
Vehi c1e
Others

Recurring.
1 . Sa 1 ary
2. POL and
transportat ion
3. Med ici2ne^

4. Consumables
(other than
stationery items)

i

5. Stationery and
printing

6. Training
(Stipends,
Honorarium,
training
material ,
TA/DA etc . )

7 .. Others
(give details)
. Rent of Building
. Water/Electricity/
te1 ephone
, Maintenance of
Building
. Postage

8

IV

V

TOTAL

!
r

t

4

i

GANTT CHART FOR MO MITA RI KG THS PRO GIG S3 OF E-PI32-S NATION

r

Sub: Improving the delivery of Family Welfare /Primary Health Care services to the Urban poor (1991 - 1995)

31.
No.

.1

Activity.
2

Procedure
3

Level of
orginis-otion.

Who is
responsible.

1. Location of Health
post & Sub-centre.

l.Spot visit,survey.
2. Local leader
discussions.
3.

l)Health Officer
City Municipality.
2 )Commis sioner,
City Municipality.

2. Purchase of vehicle
and equipment.

Inviting quotations &
tenders. Placement of
orders with the firms
approved by Govt. ’

City Municipality
Commissioner.

3. Drugs.

by inviting quotations
& tenders by the firms
approved by the Govt.

City Municipality
Commissioner.

Requesting Directorate

City Municipality
Commissioner/
Health Officer.

4. Recruitment of
staff.
a) .A,B&C group•

b).Driver d D group

5.Health Cere.

Appointment through
Employment Exchange.

-do-

April
1991

June
1991

-do-

Aoril
1991

June
1991

-do-

Aoril
1991

July
1991

May
1991

July
1991

City
Municipality.

-do-

-do-

Institutional.

MO/LMO

Outreach by home visits

Sub-centres
Health Workers
(Male ^Female ) (1 for 5000)
riV/JJi
’lV.
XAtZCLX
Uli
UA c
MO/LMO,
Health
Sub-centre
Asst.Kale/Female. Heqlth Units.

Supervision.

Period gr
From To
6

Health Unit

■co-

n asoq d,

Type

7

Quantity

9

Readily see
Municipal Personal
Council. disc, ssion. bitGilding
rental basis
approval
needed•
Municipal Personal
F inance
S.OQlakhs council/
discussions.
Vehicle
equipment 1.00 lakhs Firms t0 letter
c orre s pondence •
supply
materials
Municioal Personal
S.OOLakhs
Finance
discussions.
council
Letter corres­
F irms
pondence.

Finance

I
A

3.0CTLakhs

Directorate
Doctors - 2
Deputation.
HealthAsst-4 , of Health/
Addl .Director
Pharmacist-2
Health workersj (FWxMCH)
Maie£Fe sale -24.
Employment
Driver - 2
Providing list.
exchange.
Group-D
4
Drugs,
equipments
vehicles.

Required
quantity.

-do-

Records
apparatus.

/ To be
arrived.

-do-

Vehicle

Continous activity.

I
Support nee ded
From
8
Type

Self

Health units.

prescrib ed
timings.
-do-

Munici pal authorities •

...2/-

J

1

2

2

3

6. I.S.C.Activity.

1) Health Sducation
materials•
2) Mass meeting.
3) Group discussion.
4) Mass Media.

1

4

6

1) MO/LMO.
1)Sub-centres.
Continuous
2) Health workers
2)Health Units.
activity.
Health Assts.
3)DH5cFWO.
3) Dist.Health Organ.,
4)Di^FWS.
4) Directo-.ate of Health. 5)City Municipality.

7. Records & reports By recording relevant l)Municipal Health
maintenance.*
entry in the registers Officer.
forms, records and
2) Health Workers.
reports.
3) Health Assistants.

8. Monitoring.

5

Obtsinihg monitoring
reporcs in prescribed
formats/MISS.

Municipality
Health Officer.

-do-

Municipality.

7

8

1)Publicity officer.
1) D.C.
2) ?omplets.
2) Dffid?WO.
3) Public addresssupport.3) Municioality.
4) VideoZTAjr
4) Community.
5) Fiin show & Radio.

-do-

Reed, registers &
r-cords, forms
will be assessed.

Regular &
continuous.

Forms
registers
calculators & if
possible computers.

Insisting of
. regular system of
building of
records & forms.

9

Needs reputatio.

Strict compliance
with fixed dates.

1) From the lower
category

progress will
assessed and corre­
mea^sure s^will
ctive measures^
2)Municipal council, be insLitfe&C5-^

i

j

I

I
$

-

1
(

I
i
I

I
1

I

I

-4-^
SI . No.

J
A

£M2^XCX*.

Nfl-.*, .Of. ,P.Q,sfc.

1. Medical Officer(MO/LMO)
2. Pharmacist.
3. Lab”. Technician.
4. 01e rk-cum-Typi gt.
5. Health Worker(Female)
6. Health Worker(Male).
7. Health Assistant(Female)
8. Medical Social Worker.
9. Driver.
10. Attenders.

1
1
1
1
6
6
1
1
1
2

liscfiiiiLtiirs.:
Recurring:
Staff salary.
Drugs.
P.O.L.
O.E.

3.5 lakhs.
0.30 lakhs.
0.12 lakhs.
0.05 lakhs.

Total.
Equipments.
Vehic.e.
Others.
(Rent for building including
Sub-centre & P11C), Electricity >
water?phone etc.

3.97 lakhs.
0.25 lakhs.
1.50 lakhs.
3.00 lakhs.

4.75 lakhs.
Grand total.
Rs. 8.82 lakhs.
Approximately Rs.9.00 lakhs.

From the above calculation it is observed that each
health post requires 9.00 lakhs per annum and two health
post of this prop sal requir-s 18.00 lakhs per annum.
Taking into consideration only rec’irring expenditure the
cost involved for 5 years is as follows:

7 '
*

5
I

Per annum

Rfiou rrin^:

.

For too units*

Salary.
Drugs.
POL
OE
Others.

j

7.00 lakhs."
0.60 lakhs.
0;24 lakhs.
0.10 lakhs.
6.00 lakhs.’

35.00 lakhs.
3.00 lakhs.
1.20 lakhs.
0.50 lakhs.
30.00 lakhs*

.
Total.
13.94 lakhs.
.One time non-recurring expenditure for two units.
Equipment
Rs.1.00 lakhs*

69.SO lakhs.

Rs.2.50 lakhs. '

. Vehicle.

Total.

3.50 lakhs.

G rand Total for 5 years .for two health post=Rs?3.201akhs

2. Since the slums have been more or less have come lip
in two different parts of the city it is planned to establish
the health post separately one for each congregation of slums.
Since it is not desirable to bring up new building for health
post which takes lot of time, it is proposedto hire the
building on rental basis which has also been provided under
the budget.
It is proposed to recruit the staff who have already

been trained in the Government institutions and’therefore no
separate training is required except for orientation which
will done with^th^coordination of State health Directorate.
All the^services will be delivered through home visits.

The building which is to be hired for health post is
also visiualising the minimum bed^of 6 required for
emergencies purposes. Apartfrom this there is no need to
have more inp-tient facilities.

...6/-

6 A good referral^port will be built up by means
of providing referal oetrteas to avail services from Medical
ollege Hospitals. In this connection special coordination
efforts will be brought in through Directorate 'of Medical
^ucation.
strong
referalsupport
supportwill
willalso
alsobebebuilt
built
_■
A Astr
ong referal
with U.F.W.Cs by coordinated efforts with the Additional
Director (FW&MCH).

I
i

♦

' Since health unit'd are closely kept with slum population,
there Is no necessity of functioning'of iaobile units.

The NiMHOS is _implementing the Mental Health project
in Bellary district.Therefore all the staff to be recruited
for these^health post wli; bo'trained in batches to taplomnt
the same ^si™ area^ end neeess ry records and reports
will be brought in.

3. .The delivery of comprahensive health care services in
urban slums is unique and is being implemented for the first
time. Therefore all the jprivate
'
Medical practitioners and
NGOs will be actively involved for extending better cooperation
qnd coordination. All the medical practitioners will be
provided with referal cards for“ referring needy cases to
the health post/MediCnlCollege hospitals.
'
Necess ry vaccines
will be made available for the ■voluntary organisation coming
forward. Some of the practitioners
1 —
----- > willbe
made as Depot
holders for
and chloroquine tablets, It will be explored
also to provide some of the medical practitioners with
anti TB drugs with strict supervision over them in maintaining
proper case cards.

<'•

- 7 -

• C ■ a c t i vj t i a .q:

. '
3 reKular activity the field worker like Health
salstant hale and female, health worker Male and female are
carry ng „ut health educational activities under different
progrades regumny which Is more or less in line with the
activity. In this connection the Directorate of Health CF
-vices and District health organisation will bo requ£ed to
plan their activities
sonas„ to cover these health noqf for to
wvibies, so
shows'*^8 Ib0 a°tlVities 111 “ better manner like video film
volnnt
",eetln^ involving local leaders. The help of
en^d7fMSmcSatlOn an'5 °ther 10031 b°dies wU1
enlisted for IhC activities•

•^he time schedule j the methods and the
frequencies
will be decided later.

fir ran i p.a ti on a andLKana Fremont:

Since the Senary Munlelfallty is envisaged to have only
two health post, the
! necessity of separate project officer
for implementation and monitoring does not arise. The
present health officer of the municipality is capable of
lookingafter the working of these health post who is already
working under overall control of Commissionerof City
Municipality.
den R®gar^inE the Job responsibilities it is alroady^H
wm t C eg°ry W1SS by Go^rnment of India and the same
will be considered with modifirations wherever necessary..

Regarding the maintenance of records and returns a

JXh
te ra!eting f°r °ne °r tW° dGys Wil1 be held in eacR
1th post and the importance of recording, reporting
...8//•

i

- —rWU ,

-------

H

8

will be brought to the notice of all the staff and
will be insisted to maintain the same as per the
time s chedule.when once the! s taff becomes familiar
with
building up of records^the :
rpports and records will be
streamlined
------ 1 as per MIES pattern^

4

be held for one day in a monthat each health unit. During
the review meeting different
—.J program'>o3} ths targets and
the achievements will be discussed in detail through
monitoring forms which will be devised. It is also
proposed to fake Tv
up­ surprise visits, inspection, spot
checks in the usual
course of supervision.

■

■

I

, C- VV.
A ssessment of Family Welfare/Primary Health Care
in Urb^n areas(specially in slums) for the cities
with population over two lakhs.

•

■

CO"
Intr oduc t ion 8
p.

I

!

I

i

I
I

.. One.of the. salient features of Primary Health Care
. . .. emphasise on the equitable distribution of health resources,
At present the population in the Urban areas are devoid of
.comprehensive health care services, because of lack of
organised health infrastructure, the rich and the middle
class people will be in a better paying capacity t o g»t
services from private clinics and Nursing Homes but the
population belonging to low.socie-economic group and
specially of slums are f?clng.actte scarcity of health
infracture facilities within their reach.
-SWacii-VEiaJ Taking into consideration of this difficulty
it is desirable to put up a project proposal for improving
the delivery of FW/P.H.C. services to the Urban poor.
In this connection the Bellary City has been selected for
taking up thid project during the peiiod from 1991 to 1995.

I

r,

i
i

■f'-WT ■WT

. Taxgeiat
A 11 though the goals of National Health and
Family Welf-re programmes by 2000 AD as spelled out under
National health Policy 1983 are available, the targets and
goals to be achieved by Bellary City/District is to be
workedout.
Bellary District is‘one of the 20 Districts of
situated in the northern part having population
of^l.5 million. (Azj j|Ue^ H
.
The Bellary city as per 1981 census has a population
of 2,01,579 and by 1995 the projected population will be
5,21,000 lakhs.

p.t.o.

1

- 2 -

«

>

The Bellary City administration is lookedafter by
A
the City Municipality having one elected President, one
Vice President and 35 Councillors. Regarding the health
activities there is one Health Officer of Asst. Surgeon
cadre with 7 Sanitary Inspectors and two Malarial insnectors
lookingafter the jurisdiction of City Municipality.
The City Municipality Bellary is not running any hospitals
of its own and the people of the City a re availing the
services from Medical College Hospitals and Urban Family
Welfare centres run by tie State Government. Therefore
because of the lack of outreach services in the City the
people of the city especially of slum areas/low socio-economic
groups are not at ail having either the basic health
services which is very important to achieve the health for
all by 2000 AD by slum population.

i

i

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i

The Sellary City is having water supply through pipes
and the availability of water is not sufficient and also
hot constant.

Regarding the sewa/age system.it is.not meeting the
demand of the people. Therefore majority of the people
use open air for defeactlon which is providing ample .
opportunity for contamination of water which is made
■available at low levels in the form of pits.

Along with the other municipalities of the State, the
Bellary city Municipality is under the overall Municipal
administration of the State.
The present set up of health administration at the
Bellary Municipality is very small as brought out earlier, looking
at the personnel involved it is observed that except for
sanitation and malaria control programme, no other
personnel is working so as to provide comprehensive health
care services to the City population including the health edncatioj

I
!.

«•

'-3• Slzaiaos
All though soiiscea form of health services
are available through UFWCs and.Medical College it is
desirable to have the following stragey to improve the
delivery of BW/PHC services for slum population.

1. Creation of infractural facilities.
2. Development of effective outreach services.
3. Involvement of private medic nl practitioners an<} NOOs.
4. Intensive IEC campaign.
5. Organisation and management.
The budget require^ for implementation'of the various

components brought above strategy has been workedout separately
(see appendix I).
'

Creation of Infracture facil ity: . ,

The Bellary Citg has at present 19 declared slums
having,a population about 20,000 and seven yet to be declared
as slums having population of a bout 5,000 and the projected
population of slums by 1995 will be about 60,000.
A s per the National pattern regarding the creation of
health infracture it is observed that one Sub-centre for
every 5000 population having one Male and'one Female Health
worker and. one Primary Health Centre for every 30,000
population with proscribed pattern of staff covering
recurring and non-recurring expenditure. It can be said
from all standar&the same norms hold/ good for the
creation of infracture in the urban slums also with little ■
difference In the staff pattern and non-recurring expenditure.

t
The projected population of 60,000 by 1995 call for
establishment of atleast two Urban health post(equivalent to
the present Primary Health Centre) of the National pattern),
with the following pattern of staff and expenditure.
...3/-

/

I

SOLVING PROBLEMS AND MAKING DECISIONS
i.

When a group (or an individual) is faced with solving a
problem or making a. decision, there are five steps which can
be followed* These steps will make for greater clarity and
effectiveness while considering the problem or the decision,
and they will also lead to a better final decision.
1.

I Define the problem

^sk yourselves nUhat is the real problem before us?'7 If
you cannot agree on what the problem is, you certainly will
not agree on the solution! A clearly-defined problem is
already a great help towards a solution.
* What appears to be the problem may be only a superficial
sympton. Underneath there may be larger and deeper issues.
f

Express the problem in nHow to. . . •' terms.
terms.
Do not say,
ut,, JJiJ The problem is
the problem ife moderating discussion ,,
ut
how to learn to moderate discussions effectively'.
COLLECT POSSIBLE SOLUTIONS
Ask yourselves, !what are the possible solutions to
this problem?’7 Make a list of all the ideas, possible
solutions and suggestions without evaluating any of them.
<The process is similar to 7 brain-storming ’) .
It is important to separate the collecting of ideas in
this step from evaluation- The evaluation should come only
in the third step. If you evaluate ideas in this second
step, itwill inhibit the contribution of further ideas.
Make the list of possible solutions as long and complete
as possible. Some people believe that the quality of the
final decision depends on the number of possible solutions
collected during this second step.

2.

»-**«*—*»■

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II • —. «■-

bWi I|II wfcw ■

ai ■■

3. Evaluate the pqssible solutions and choose the best
Ask yourselves, ‘’Of all the alternatives we have listed,
which is the best solution?"
Weigh the pros and cons of each possible solution.
Encourage dissent and disagreement among the members
of the group. This will help in the completed examination
of every possibility. Beware of easy agreements-they
probably have not been thought through completely. At the
same time, avoid being defensive or making others feel
defensive. Try to separate the ideas and solutions from the
individuals who contributed them.
There are two important aspects to an effective decision
One is the quality of the decision. Ask yourselves,"loss
this decision accomplish our purpose? Will it effectively
solve the problem?17 The second aspect is the acceptability
of the decision to those who have to carry it out.
If you find that you now need further information or
an expert opinion, get it before the decision is made, not
afterwards!

' i7 V i ’ ’ '*•

CCiV’^;;\
J.

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5’1

)._• . Marks ft°ad
^.SSOOOl

I

-2Consider whether the group itself is ready to make a .
decision. Sometimes groups (like individuals) need time to
’think over’ a decision before finally making it.

4. Implement the decision
Decic a on the steps for implementing the decisions. Ask
yourselves, “who is going to do what? When? How? Be sprcific
plot names against actions.

A decision which does not include details of how the
decision is to be implemented may be ineffective and even
useless. Lots of good ideas are never translated into action
because their implementation is not taken care of

As well as deciding who will do what , when and how, there
may be other questions, such as, ■‘who else should be informed
of this decision?.
5. Follow-up

Ask yourselves, n Hou will we check on how this decision
is working in action?rs It is important that the group decides
at the time they make the decision how they are going to
arrange for follow-up and feedback

2purc,e2 HcOrath E.H
u-.mo, Basic flanagerial Skills for All,
' XLRI. Jams had pi jr, 1978.
PEOPLE IN DEVELOPflENT - A Trainer’s Manual for
groups John Staley.

Training Paco..- VII

i

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I

PAVEMENT DWELLERS: IF STONES
COULD SPEAK
Srikiifui BuiIinula

^"XNL. NIGH I in July I MS I, the palliclic
V^shcllcis of thousands of pavement
dwellers in Bombay were demolished in
the midst of one ot the worst monsoon
downpours. The hapless victims were
loaded onto buses and trucks and dumped
cilhci al the outskirts of the city or al vari­
ous poims along the Maharashtra bolder,
with the unspoken message: “Go back to
where you came from!”
Thus began one of the most symbolic
sagas of the lack of even a semblance of
social justice for the poor in our country.
I he wholesale and illegal deportation of
thousands of Indian citizens from a city ol
then union also characterised the growing
desperation ol city authorities in their
attempts to “clean up” the city, and their
total lack of awareness of the continued
rural-urban differentials which render all.

such measures futile.
ironically, this inhumane and ill-consi­
dered step brought its victims to national
prominence as nothing else had ever done.
These residents of the city's footpaths,
who could never command the slightest
attention in the countless years when they
formed as one journalist put it, “the vast
legion of bais, mochis, dhobis, milkmen
and newspaper boys who toil to make
(our) lives more liveable”, shot into the
limelight only when they were cast away
like so much chaff.
The demolitions did not last long. Irate
journalists and civil rights groups promptly
obtained stay orders, and thus launched

one of the most histone cases in the annals
of social litigation. The case reached the
Supreme C ourt in no time and Was sub
judice for nearly four years. The central
arguments were around the issue ot the
"right to life” as guaranteed in Article 21
of the Indian Constitution. But on 11 July
19S.S, altci years ol arguments and
counter-arguments by both sides, the
'court delivered a judgement remarkable <
mainly for its ambivalence. While acknow­
ledging all the factors which led inexorably
to the rural poor ending up living on the
city's footpaths, it gave the municipal
authorities permission to evict them trom
the pathetic abodes they had set up. I he
only sop to their conscience is that "prior
notice” had to be given to the victims, and
no demolitions were to be carried out
before 31 October — the end of the mon­
soon.
Voluntary agencies like the Society lor
Promotion of Area Resource Centres
(SPARC) which were working almost exc­
lusively with this section of Bombay’s
poor, were shocked. Where were the
pavement dwellers Io go? And how many
would be affected? We decided to find out.
and after an exhaustive search-, concluded
that nobody knew how many pavement
dwellers lived in Bombay city. Perhaps
this was one of the main reasons why
demolitions were being considered as an
entirely feasible proposition, at least from
a logistical viewpoint.
This data search also made us realise

that pavement dwellers arc highly visible
on the one hapd — as "eyesores” on the
supposedly "fair” city of Bombay — but
entirely invisible as human beings with a
history, a role in the urban economy and
the right to build a future like the rest of
us. This very invisibility was depriving
them ol the right to participate in any deci­
sion about their own future in the city.
Experience had also taught us that in
•the absence of hard statistical evidence,
any attempt to present the pavement
dwellers' case was discarded; one was
invariably dismissed as a bleeding heart
do-gooder who was not "objective” on this
issue. Some concrete evidence of their role
in the city's life would have to be gener­
ated if we wished to confront the popular
attitude which regarded them as expend­

able parasites.
Since it is a small organisation of only 5
people.SPARC decided to census only •
one city ward (E
Ward, or the BycullaMazagaon area) and
the major arterial
roads of the island city.which the Bombay
Municipal Corporation
had announced
would be major targets for
demolitions
namely. P D’Mcllo Road, Rcay Road,
Scwrcc Road, Scnapati Bapal Marg, Tulsi
Pipe Road, and E Moses Road.
A questionnaire designed to elicit basic
individual and family data including
income, occupation and migration history
was administered by a dozen hired inves­
tigators who were constantly supervised by
SPARC staff, and with the continuous

14 Science Age Nov-Dec 85

4

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support and involvement of the pavement
cent; and of course an overwhelming
families themselves, the census was com­
majority of 94 per cent of this category arc
pleted in four weeks between 30 August
women. Not surprisingly, skilled workers
and 30 September 1985. At the very out­
like motor mechanics, metal workers and
set, when the census was planned, wc had - powcrloom workers account for a mere 12
discussed the issue of the people’s “invisi­
per cent, virtually none of them being in
bility” with them. They readily perceived
the organised sector. About 7 per cent of
this and regarded the census as an activity
wage-earners arc in various other occupa­
of vital importance to them. This was the
tions, including a good number who are
chief factor which enabled us to complete
municipal workers.
the exercise so quickly — people saw it as
As far as per capita daily income is con­
their own need and made it succeed.
cerned, the census showed that the vast
Thanks to electronic data processing,
majority, or 74 per cent of all earners,
the final results were made available by
were earning less than Rs 18 per day
the second week of October, and the
which is the minimum wage for Bombay.
report, “Wc the Invisible" was released on
So while they provide the city with labour
14 October 1985.
for the essential tasks which organised
The census yielded a total population of
labour docs not like to do. they do so at
26,583 from 6054 households living on the
wages so low as to put the possibility oi
pavements of just one ward and the major
anything but pavement housing beyond
arterial roads of the city. Forty-three per
their reach.
cent of the total population were gainfully
What is more, the census showed that
employed in some 90 different occupa­
pavement dwellers subsidise their own
tions, almost all in the informal sector.
labour not only through low overheads on
The single largest occupational group
housing, but also on transport. A stagger(some 33 per cent) arc the unskilled man­
ual labourers — the construction workers,
hamals,
coolies,
handcart
pullers,
dockworkers and hcadloaders without
whom much of the economic and commer­
cial activity in the city would grind to a
halt. Small traders come next (nearly 22
per cent)— the vast legion of bhajiwallas,
fruitwallas, macchiwallas, paan-bidiwallas, pavement hawkers and vendors who
bring myriad daily necessities to the
doorstep or the street corner for thousands
of middle-class consumers at a cost well
below any shop. These arc followed by the
self-employed
(14 per cent) — the bar­
bers, cobblers, tailors, carpenters, electri­
cians, plumbers; not to mention the purseand wallet-makers, rakhi-makers, the
scrap-collectors and re-cyclers.

Fl

Domestic servants account for the next
largest occupational group with 12 per

ing 85 per cent of all workers walk to work
or walk as part of their work (like the ven­
dors, scrap-eollcctors and handcart-pul­
lers) and do not even enter a single form of
public transport in the city. A mere 15 per
cent use buses or trains.

All these statistics combined seem to
show quite clearly that while pavement
dwellers arc contributing to the city's
economy, they do not make any demands
on civic services cither for housing, elec­
tricity, water, sanitation or transport.
Food for thought — for those who can still
think objectively on this issue.
The migration history of the pavement
dwellers is a pathetic talc, the never-end­
ing search for survival which is the lot of
the poor and dispossessed in anv society.
First of all, an amazing 14 per cent of
families said that the head of the house­
hold was born in Bombay, and so were not
really migrants in any sense. Of those who
had migrated, and contrary to popular
belief, 34 per cent, or the single largest
group had migrated from various parts of
Maharashtra itself. Families from Uttar
Pradesh were next with 20 per cent fol­
lowed by Bihar and Tamil Nadu with
around 10 per cent each. Karnataka (6 per
cent). Andhra Pradesh (5 per cent),
Gujarat (4 per cent) and West Bengal (3

per cent) were the other major states.
Some 8 per cent of all’migrant households
came from various corners of the country.
Although there is a widespread feeling
that the problem of pavement dwelling is a
recent phenomenon, over 70 per cent of
the migrant households have been in Borh-

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Nov-Dec 85 Science Age 15

bay for more than a decade. Of these, 17
per cent have been in the city for over 25
years, and 6 per cent have been here for
ncai ly four decades! Only 17 per cent have
migrated in the last 6 years, a mere 6 per
cent having arrived in the last year.
Moreover, the majority of these house­
holds has been- living on a pavement
(either the present one or another one)
ever since they came to the city. One
unanimous response was that they all saw

pavement dwelling as a temporary mea­
sure, to be endured only until they could
save enough to acquire belter shelter. But
they soon discovered that even slum huts
are exorbitantly expensive in
Bombay
( anywhere from Rs 10,000 to Rs 25,000 )

and even these are difficult to find.
What kind of persons or families decide
to leave their own habitat and gamble on
survival in the city? Our census figures
indicate that it is the poorest of the rural
poor: 1 itiy-Cwo per cent of migrant pave­

ment households had owned no assets
whatsoever in their native place — not
even a tool or implement. Another 27 per
cent had owned only the hut in which they
lived, but no land, animals or other assets.
This is substantiated by the data related to
pre-migration occupation, which revealed
that some 61 per cent had been landless
labourers and unskilled manual labourers
prior to migration.
f inally, we come to the reasons for mig­
ration. It should surprise no one that 62
. pci cent of the reasons staled were related
to unemployment, poverty and hunger —
“bookhc mar raiic the", “kuch kam nahi
milta lha”, “kamayi bahut kam thi”, “pet

nahin bharta tha”. Another 10 per cent
were due to loss of parents, widowhood,
or family disputes where their land was

demolition and eviction of all ‘‘unau­
thorised" dwellings would do well to con­
sider the following implications of the cen­

seized and they could no longer make a liv­
ing in the village. A large number of these
were women who were cither abandoned

sus:
First and foremost, the heart of the
problem oi pavement dwelling - not only
for Bombay but every growing industrial

or widowed, or dispossessed alter the
husband’s death. Interestingly, the major
findings of this census have been very
closely paralleled by the • preliminary
results of an all-Bombay census conducted
by the College of Social Work in Sep­
tember-October 1985.
It is clear therefore that pavement
dwellers supply the city with a vast pool of
cheap labour and also provide it with
goods and services which would cost much
more in the organised sector. Far from
being a burden to the city’s economy, they
arc a self-supporting group, with a higher
than usual ratio of workers to non-workcrs. They clean oui homes'and gaibagc,
move goods from one place to the other
• ■ spectrum
'...... 1 of
and make available a whole
oi
which is the
goods and services at a price
|
result of their own undervalued labour
They live on tne pavement because no
other alternative is affordable or available
to them — not even the slums, l hey have
fled from the unemployment, landlessness
and poverty of their rural homes. How­
ever affronted we may be by the dirt and
indignity of their wretched living condi­

tions on the pavements, to them the lack
ol dignity on a full stomach is far better
than the spurious dignity of hunger and
starvation.
The champions of the “clean city"
movements, the strident advocates ol

area of the country, including Bangalore,
Madras, Ahmcdabad and Hyderabad —
lies in the continuing disparity in the
development of rural and urban areas. As
long as the bulk of investment continues to
. How to the cities (notwithstanding the
“rural development" rhetoric), the influx
of poor rural job-seekers cannot be stop­
ped, let alone reversed — demolitionsj>r
no demolitions. Ihose who contest the
right of these people to live on the pave­
ments must ask themselves what they are •
doing to defend their right to survival in

their native areas.
I bis means that the only long term solu­
tion to the problem of urban congestion
and slum and pavement dwelling is the
rilpid and equitable development of rural
areas and .nail towns. To wish away cur­
rent migration trends without addressing
this issue is to live in a fool’s paradise. We
have to face the reality that these trends
arc not going to change in the near future.
Consequently, urban planners, city
authorities and the affluent sections must
stop living in their world of make-believe
and make further in-migration the basis of
their planning exercises — particularly tor
housing and land-use. It is time to under­
stand that the petulance al having' their
“fair" cities “fouled" by slums and .pave­
ment dwellers is both illogical and illinformed. it is the very levels of financial'

investment, industrial development,.pro­
fitability and affluence which they enjoy

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16 Science Age Nov-Dec 85

0

that create the spin-off .effect of a huge
informal sector with its insatiable demand
for cheap, unskilled labour. Numerous
experts have pointed out that almost every
major .organised industry is increasingly
“farming out" work to small units in the

/

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informal sector because it is cheaper for
them to do so. Of course it is, because
these small units employ labour at well
below minimum wages and do not have to
provide any of the benefits which
organised labour takes for granted. It
should not be beyond anyone's powers of
comprehension that those who provide
this cheap labour are — indeed have to be
— slum and pavement dwellers. There is
no other way they can work for such
wages. Thus the city generates a demand
for the labour provided by the poor, but
docs not deem it necessary to house them
or provide a space for their shelter.

This argument is always countered with
the plea that there is no land and no funds
for such housing. Unfortunately, neither
of these statements is true: studies have
pointed out that there is adequate land in
Bombay, should the government wish to
acquire it; and if World Bank aid can be
sought for traffic flyovers and bus fleets,
why not for housing?
City authorities often ask why they
should* be responsible for providing for
people whom they did not invite to the city
in the first place.
rhe.answer is that they may not have
issued a direct invitation, but. the level of
industrial development which otherwise
benefits the city is a de facto invitation.
However, it is certainly true that the sole
responsibility should not rest on urban
authorities. Urban migration is a national
problem and both central and state gov­
ernments have to participate in — and pay
for — its resolution. But as long as the
onus falls on city administrators, it is vital
that they recognise the nature of (he
phenomenon and ally themselves with the
poor in demanding assistance. They must
see that as more of the rural poor march to
the cities for survival (and as long as (hey
do, indeed, find it here), affordable hous­ t
ing has to be made available to them; and
for this city planners must aggresivcly seek
aid from central, state and even interna­
tional funds. Moreover, they must them­
selves take on the role of drawing atten­
tion Io the factors contributing to urban
migration and demand I change: if city
administrators feel ill-used at having to
tackle
the
culmination
of
present
economic trends, then they have as much
stake in demanding change as the poorest
landless labourer.
Finally, the unjustness of quietly accept­
ing the cheap labour of the urban poor but
not wishing to see or hear them must be
honestly faced. A society which permits
and in fact depends on this large mass of
unskilled and underpaid labour must also
live with slums and pavement dwellers.
And if we don’t want the latter, we must
find the land and resources to house them

properly. The time has come to question
the middle-class utopia that wants clean,
beautiful, orderly cities but also its maid­
servants, bhajiwallas and cheap manual

labour.
The crisis awaiting the pavement dwel­
lers is the result of this kind of utopian
thinking. The tragedy is that even the
proposed demolitions arc not going to
create that utopia. How can they, when
the deep, complex dynamics which have
created the problem will not be touched,
let alone changed, by the physical removal
of their outward manifestation?

I.cl us accept once and lor all that pave­
ment dwellers arc being made the
scapegoats for urban ills of which they arc
the symptom, not the cause. Among other
things, they are blamed for dirtying the
streets. But what of the garbage-strewn
streets where no pavement dwellings
exist? They arc blamed for causing traffic
blocks and hazards to pedestrians, but it is
never mentioned that a major cause of
traffic congestion is the
increasing
number of vehicles on the road. Why do
the worst traffic jams in the city occur at
points where no pavement dwellers live?
Why is it that the time-worn suggestion of
experts to move offices and wholesale
markets out of the southern end of the city
— which is the real cause of congestion —
has been repeatedly shelved? And even if
demolitions are “successfully” carried out,
how will it be ensured that these and simi­
lar others do not eventually return to the
pavements? Will a police force be created
to patrol every city street from now till
eternity?
The human instinct for survival is inde­

structible. So is the right of every man and
woman to better the quality of their lives.

.lust as the sons and daughters of the
affluent are leaving their country for the
material advantages of the developed
world, so arc the impoverished abandon­
ing their precarious rural existence for the
security of a full stomach in the city. Why
do we deny the one and not the other?
Let no one imagine that we hold a brief
for pavement dwelling. No human being
should be forced to such an existence. But
no solution to such a major and multi­
faceted problem is justifiable unless it is
based on the needs and aspirations of all
those affected. Today, the proposed evic­
tion of “illegal” slum and pavement dwel­
lers reflects the aspirations (that too the
naive aspirations) of the bettpr-off, but not
of the poor. If the survival of these sec­
tions is not served by any proposed action,
is it a solution at all? And if it is, how can it
be effective or permanent, much less just?

SRILATHA BATLIWALA
Ms Ratliwala graduated in literature from the
Central College, Bangalore and did her MA in
social work from the Tata Institute of Social Sci­
ences, Bombay. She worked for thel bundalion
for Research in Community Health, Bombay,
for eight years and is the founder of the Society
for Promotion of Area Resource Centres
(SPARC^an organisation working with poor
migrant women.
Nov-Dec 85 Science Age 17

1
Bharat Jhunjhunwala

B7/64 SufdarJung Enclave
New Delhi II0023
Tel 605142
/

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.

I write to you to exi^lore a strategy tor breaking the fetter of
political parties on our system.

My limited work in the slums and trade unionism while 1 was at the
Indian Institute of Management, bangalore and subsequently in an
afforestation programme at my village in Jhunjhunu have convinced me that
we are able to make only very nominal advances in non-qiarty mass wonk
because of the opposition of political parties. Similarly, my experience
in managing my strawboard factory was that positive labour policies were
misused in narrow political interests..
Nevertheless, the non-party mass work movement has grown and today it
encompasses.ecological, civil liberties, rural development, science
education, community health, eye camps, trade unions and farmers organisations.
Yet, this movement is unable to decisively influence the national policies.

Secondly, the Janata experience has shown that all political parties
have a tendency to degenerate. Mter all, We persons who join political
pal*ties do so because they have some ambitions to come to power.
It is my submission that rv possible solution is for the non-party
movement to consciously exercise a check on die political power. There
already exist a large number of individuals who have a history of shunning
power. Such persons do not see a role for themselves in todays dirty politics.
The non-party muss movement has to consider supporting such clean persons
to contest elections. These independent legislators, unrestricted by party
diktats,
diktats could keep the government in check and also support mass workers.
While this movement must stay away from jjower it cannot afford to stay
away from politics.
I have recently made limited surveys in Bihar, Bengal, Orissa and
Haryana and found that everywhere *there already exist both politically
conscious individuals and mass work organisations who are amenable to such
political intervention. What seems to be wanting is a clear conception of
the complimentarity of each other*

The experience of independents in the elections so far is inadequate
to draw conclusions because there has been no movement oi independents, nor
have they been backed by non-party mass organisations. We have to consider
making a concerted effort to make such political intervention without
wanting to come to power and without '’organising” ourselves. We con establish
communication between the xndividuuls and the muss orguninutions locally
with an understanding that we are part of a larger movement.

b\^

y?C
U

I seek your suggestions in tills direction:
to concieva
oil a; uon-purty
uioviweut on the basis
1, Whether it is realistic 1----of ideas alone?
2. Would you advise that we concentrate our energies on a small state like
^Ajfturyana which is due for elections in 193^?
r
■
^tta y°u suggest names oi any people’s cadidates , uOU-party individuals,
7 una mass workers with vnoiu a dialogue could be started?
the benefit cl your experience on the issues.
I hope you shall give

1 h°DG V°U Mhali ^ive WC
<lAw

ia^ggssgl C^rt^VZtzyC^

in their own ranks and the quali­
Voluntary Work as Countervailing Power corruption
ty and credibility of their work suffers. By

organising the masses the Voluntary Agency
can cover a much larger area without fall­
I
particularly to overcome bureaucratic ing into this administrative trap. Thus the
tyranny. An intransigent government may be limitation df size can partly be overcome by
The Framework
considered one which ignores such volun­ an organisational approach. Needless to add
ONE common feature of the series of the tarism as irrelevant but is willing to make that organisation of the masses is the only
three articles that appeared in the EPW in concessions under pressure. A decadent method to raise mass consciousness. The
February 1984 by Rajni Kothari, D L Sheth government may be considered one which masses are both the end and the means of
and Harsh Sethi was their perception that is outright antagonistic to any suggestions social change. Thus the organisational work
although the voluntary work movement was or criticism from such voluntary workers has to be undertaken in its own right.
significant, it lacked a theoretical framework and adopts a repressive policy towards them.
Organisation of the masses also change
in which to understand its role Kothari calls The countervailing power must be such that its colour depending upon the government.
it a “theoretical lag”1 and Sheth mentions, can respond to any of these governments—it It helps combat bureaucratic tyranny where
(hat they “suffer from the absence of a rele­ should be able td change its own form in the government is positive; it acts as a
vant theory of transformation”.2 This note response to change of government. The pressure where the government is intran­
is an attempt to make some suggestions countervailing power must be able to guide sigent; and it takes a revolutionary 'form
towards such a theoretical framework.
the positive, pressurise the intransigent and where the government is decadent. The im­
As the name suggests the basic feature of displace the decadent government.’And it portance of the organisational dimension re­
voluntary work is that it is undertaken has to be able to achieve this without itself mains unchanged in all situations.
voluntarily and it is free from state control.
assuming power or losing its independence.
The third dimension of voluntary work
There exists today a growing body of in­
In order to achieve this objective, we sub­ is interaction with the government. Only by
dividuals who do not aspire to slate power mit that voluntary work has to have three interaction can they overcome localisation
and yet want to contribute to the society dimensions: (i) relief and development; (ii) and assume a national dimension. Our sub­
meaningfully while preserving their in­ organisation of the masses; and (iii) inter­ mission is that they must contest elections
dependence. Their inspirations are varied- action with the government.
as independents without forming any party
religious, ecological, science education,
The primary concern of voluntary work or federation. The objective is to reach a
health, civil liberties, peasant organisation, is the well being of the common man. It critical minority of volunteers to the
relief and charity. They also have varied would, therefore, be futile to argue that relief assemblies and the parliament such that the
ideological orientations—religious, Gan- and development acts against social trans­ ruling party is ideally reduced to a minority.
dhian or Marxist. Yet they are all in agree­ formation, for, what is the purpose of social Ixt us say that out of 500 scats in the parlia­
ment that our system needs change.
transformation it not relief and develop­ ment the ruling party has 200, the opposi­
In our increasingly integrated society ment? It is a different question altogether tion 150 and independents 150. The ruling
social change requires direct interaction with if a decadent government obstructs such party will need the support of at least 50 in­
the government at the national level'. Such relief and development, imhat case, these ac­ dependents to get any legislation through.
interaction requires organisation which, in tivities have to lake the back scat and the
This would mean (hat the thought of these
turn leads to the loss of the Independence emphasis has to shift on displacing such a
150 independents would become decisive
of these voluntary workers. This is the basic decadent government. The relief and deve­ although they are not in power. These in­
duality that they confront—their indepen­ lopment work has value in all situations. It dependents could easily stop the passage of
dence and their commitment to social provides policy suggestions where the any bill or secure the removal of a corrupt
change. If they strive to preserve their in­ government is positive, it indicates the pro­ minister. In this way the independents would
dependence then they have to, by definition, gramme for pressurisation where the govern­ require a national force without assuming
eschew organisation and that reduces their ment is intransigent; and it leads to an
power themselves.
efforts to magnificent small experiments alternate policy framework to be imple­
It is not necessary or even desirable for
without being able to bring forth social mented upon the displacement of a decadent
the independents to form any organisation
change. Some method has to be found so government.
to either get elected or to coordinate their
that such individuals can be effective in
The organisation of the masses is qualita­ efforts in the parliament. There are inherent
social change without the loss of their in­ tively different from relief and development
problems of corruption and degeneration if
dependence. It is our submission that such in that the Voluntary Agency does organise
these independents were organised. Organi­
a strategy may be that of a diffused counter­ development itself but organises the masses
sation would be inherently counterproduc­
vailing power. These individuals and groups to demand development from the govern­
tive to free debate and articulation. The
on the strength of their work already con­ ment. The difference between the two can
debate among these independents would
stitute a countervailing power structu’e. perhr.p-; be illustrated by an example. In
hold the key to legiskiticn. Therefore, the less
What is required is that they bqcomc con­ relief and development work one would
organised the better.
scious of their power.
organise the distribution of fodder in
The second set of questions emerge on
Social change requires interaction with the famines and establish centres for artificial
how do we anticipate to get independents in
national government. The government itself insemination .for
w. impiovement w
,U,W!>
of, ,„„
milkn yields
such large numbers elected? The masses have
changes its colour. Thus^this countervailing in the cattle. In contrast, in organising the
elected upto 10-12 per cent independents
power structure has to be such that it can masses one would organise mass protests
even when they had no conception of their
respond effectively to changes
- in the govern­ against the Block Development Officers and
role in the parliament. Most independents
ment. I:e?0;VCrn,ncnt
categorised the Primary Health Centres to make avail­ elected presently arc not backed by mass
as positive, intransigent of decadent. A able the’facilities that are received for them.
work of the type mentioned above. Our
positive government may be considered one The organisational dimension helps over­ masses have lately demonstrated great
that treats such voluntarism with due come the administrative trap. In undertakacumen in exercising their Noting rights. It
respect, solicits their suggestions regarding ing large-scale relief and development work
is our responsibility to explain to them the
policies and also seeks their assistance in im­ the Voluntary Agencies (ends to get entrap­
futility of merely changing the party in
plementation of the various programmes, ped in administration and finance and also
power and the necessity of electing in­

Bharat Jhuiijhunwala

Economic and PoHlicn’ Weekly
Vol XXJ, No 14. April 5, 19»6

597

April 5, 1986

ECONOMIC AND POLITICAL WEEKLY

dependents to exercise check on a continuing conscious and conscious desires. Once a per­
basis on the party in power. There is no son does become conscious of his un­ sense, they have held, enjoyed, found in­
reason why, with a proper understanding conscious nature he begins to realise that adequate, md transcended • power and
of the decisive role of this critical minority, other acliviles, however tempting they may money. Thus we propose that there do exist
the masses would not elect 30-40 per cent appear, do not satisfy his self and thereby such individuals who have understood their
independents. And we must also rely upon develops a capacity to resist those influences unconscious predispositions and the desire
to be one with their fellow human beings
the masses to weed out the corrupt amongst which distract him from his self.5
harmoniously. Persons like Gandhi and
the independents as well. Many powerThe unconscious predispositions may be
hungry individuals and disgruntled elements towards science, arts, knowledge, money, Jayaprakash Narayan may be said to be
desirous of power will surely try to pose as power, ascetism, adventure, social esteem, more notable examples of this phenomenon.
committed to such thinking. Any organisa­ c,.c:. A Person who realises that his self- The same motivations surely exist in lesser
mortals as well, but being ‘lesser’, they lack
tion of the independents to weed them out -aifinnation lies ...in adventure wuul
u hoi
would
not oe
be the ability to influence events individually
would itself stand the danger of corruption easily distracted by temptations of money
and see no clear role for themselves in the
and decadence. Thus Jet us rely on the or vice-versa. ’It would
■ therefore
H
be false to
masses to decide upon the ‘true’ indepen­ assume that every individual would in­ present political context. It is our submis­
sion that a mere consciousness amongst such
dent.4
evitably desire to wield power if given an op­ persons that as a diffused group they have
In such a scenario the independents in the r
wnvuiportunity. It is of course correct-to assume
a
rO,C lo p-ay in the national scene
assemblies and parliaments would play the that those who seek self-realisatioi
.on in power is sufficient to make them active. Such
role of guiding a positive government, or. mopey would -----tend to wield their power
pressurising an intransigent government and and money for their own enhancement sciousncss would enable them to pcrcicvc
as a part of a movement which
exposing or replacing a decadent govern­ rather than that of the society, because their themselves
is bound
ment. Without themselyes assuming power own self-affirmation lies in more power and - ------- J together by a common thought
they would act as a strong corrective. More mure money and no: in the betterment of rather than a common organisation.
A problem arises in tha: the realisation
importantly, in our era when all ideologies the society. Ip other words, while it is natural
have been reduced historically outdated half- that those whose unconscious predisposi­ of one’s uncoHsciou- p’-edisposit,ons is an
truths the debates among these independents tions are those of money and power are likely eminently personal attain Thus they cannc'
would help arrive at correct policies. Thus, to pursue their desires unscrupulously, it serve as a criterion for public identificatic
without starting from ideological positions would be incorrect to assume that every in­ ol such individuals. The solution to this rid­
we could start evolving a correct theoretical dividual would use money and power in his dle must be left to the masses, They must
framework by a dialogue. In this context, the personal interest. It follows that the political be the final judge as to who is not after
participation of independents from different parties aspiring to capture- power are power and money.
Thus we base our strategy upon the per­
ideological inspirations—Marxist, Gan- primarily constituted of such individuals
dhian, religious, nationalist, liberal and who seek power and it. must be accepted that sons who realise their unconscious pre­
capitalist—is to be welcomed. What is essen­ they would pursue power per st? irrespective dispositions; preferably those who have
tial is that those individuals eschew power oi its implications for society. They are fun­ transcended power and money; who are ac­
and be engaged in developmental and damentally not interested in society. They tively involved with the masses and who can
stand their final scrutiny.
organisational activity among the masses
will pursue their own interests, i e, power.
These things being so much in the domain
Conscious of inadequacy of all ideologies * or them corruption’ would merely be a tac­
we must invite dialogue to arrive at ap­ tics to achieve their objectives. This would of the individual are never definitive. It is
propriate policies for our situations, this apply, it seems to me, to all political parties inevitable that a good many persons ap­
dialogue will essentially take place within irrespective of their ‘ideology’. We are deduc­ parently satisfying these criteria will them­
these independent legislators backed by ing this proposition from the psychology of selves find that they still desire power and
------ o; — money and they may ‘degenerate’. Such
voluntary agencies and the government
incividuals who constitute these parties. To degeneration must be considered a part of
would have to be guided, pressurised or forc­ the individual, ideology too is but a means
ed into following those policies. It is not the to satisiy his desires. Thus apparent ‘ideo­ the process and we may only rely on the
tusk of the government to evolve correct logical’ convictions must be watched masses to weed out such persons.
What is fundamental is to generate the
policies. The goverment’s task is to execute cautiously for they are more often than not
them and that is all that we may expect from likely to be means for capturing power. It consciousness that such individuals as a dif­
fused group could form a countervailing
it.
is lor this reason that voluntary workers r
power and force the government to work
have been ambivalent towards all parties in without requiring------theirr own organisation.
II
power whether it be BJR Janata or CPM. fSuch consciousness in itself would prompt
The Motivation
Psychoanalyst Erie Eromm submits that suc,‘ i^'^'ns to intervene in the political rpriro­
For our suggestion to be meaningful we one of the deepest desires ot all human be­ cesses on their
t’
own, a task that they presenthave to establish that there exist a large ings is to overcome their separation from ly disown because they see no role fc^ them­
number of persons who do not want power. ■j’her-huBKHi beings- h'j oihet words, Fromm selves as isolated individuals.
We invoke psychology to establish this pro­ leelsdhat in each one of us is a deep long­
In essence, by distinguishing between the
position. The human psyche is largely form­ ing rp “unite himself in some form or other predispositions of those who seek power and
ed during childhood. The childhood impres­ with men, with the world outside".6 It is my money and those who seek harmony with
sions become the unconscious desires or submission that in many persons this desire the people, we can create a countervailing
predispositions on being covered by the is both pronounced and conscious. Such in­ force which is near power yet outside it, and
subsequent impressions of adult life. But dividuals seek to unite themselves with which being rooted in the masses guides,
they do not die out and continue to exert.a others positively (non antagonistically) and
pressurises or displaces the government
powerful influence on the individuals’ life. consciously. Among them are also those who without itself assuming power.
As adults some individuals become aware also realise that their nature is not to weild
There are many tactical questions that
of their unconsious predispositions and by power and money because power and money
would fallow. These relate to finance, the
living, according they achieve harmony inherently separate one from another.
within themselves; others do not become Among them are also those who have ac­ question of purity of means, tactical elec­
aware of their predispositions and continue tually held power and money not found that toral alliances, ideological and religious
to live a dichotomised life between their un- satisfying and thenceforth shunned it. In a motivations, means of creating a national
consciousness, etc, which have to be dealt
.-J

598

,

i

ECONOMIC AND POLITICAL WEEKLY
with as they arise. What can be asserted is
that it is the independent individual himself
and his involvement with the masses that are
the central considerations. Ample scope for
experimentation all secondary questions is
to be encouraged so as to help clarify the
issues themselves. Once the individual stands
scrutiny we must leave the rest to him.

JII

1

Ideological Inspirations
We have already mentioned that ideology
has been but one weapon in the hands,of
power-seekers to achieve their objective. We
now briefly review the Gandhian, the Marx­
ist and the Hindu ideologies in this reference.
Barely a few months after India achieved
independence Gandhi realised that the Con­
gress had outlived its use. The Congressmen
in power were becoming corrupt. Power,
Gandhi emphasised, inevitably corrupts.
Thus Gandhi advocated that the Congress
must be disbanded as a political party and
must convert itself into an organisation of
constructive workers: “By abjuring power
and by devoting ourselves to pure and
selfless service of the voters, we can guide
and influence them. It would give us far
more real power than we shall have by go­
ing into the government... There are about
half a dozen constructive work organisa­
tions. I do not send them to the parliament.
1 want them to. keep parliament under check
by educating and guiding the voters’’7 Gan­
dhian solution to the problem of controll­
ing power was to establish a second loci of
power in the constructive workers who
without assuming power themselves would
nevertheless be powerful and would be
able to keep a check on the power of the
politician.
The constructive workers did eschew
power and devoted themselves to mass work.
They may even have been in a position to
decisively influence the voters if they had
been more conscious of their own ‘power’.
But they confronted an altogether different
problem. All the political parties were ‘cor­
rupt*. Where then was the choice? It mat­
tered little whom they sent to the parliament.
Thus the constructive worker could hot play
the role of keeping the parliament in check
by being able to influence the voter. Since
power inevitably corrupted the elections pro­
vided only a choice to the voter to chose
from amongst the corrupt and the construc­
tive worker could only influence that
choice. This, Gandhi, had apparently not
anticipated.
The solution to this riddle emerges if we
realise that parliament cannot be kept in
check by merely influencing the voters
although that is absolutely necessary. The
‘check’ has to be exercised not only al the
elections but within the parliament itself on
a continuing basis by a group of construc­
tive workers who abjure power. It is this
critical minority of constructive worker
parliamentarians that was lacking in

April 5, 1986

Gandhi’s formufation.
Lenin coiifronicd a similai problem after
the Communist patty had captured power
in Russia. The task before the party had
hitherto been to capture power..Now the task
became to organise the economy. Ijenin said
that in this work the party must on the one
hand check the administrative machine! y of
the state and on the other hand it mud direct
the whole peoples. I cm.n emphasised the im­
portance of the party and party leaders in
evoking the creative work and participation
of the peoples and he was opposed to any
dilution of the role of the party via-u-vis the
workers.8 Thus Lenin was conscious of the
two toles of the party—organisation of iht
masses and interaction with the government.
T his would indeed be an ideal formula if
(i) the party were to exercise control over the
highest echelons of the government and the
state; and (ii) the diffeiences within the party
could be resolved by an appeal to the verdict
of the masses.
In Lenir>’s formula, however, the highest
authorities in the government were those of
the party and the party leadership could not
be expected to exercise a check on itself. The
party was only to exercise control over the
bureaucrats, self-seekers, landlords, capita­
lists and opportunists who had sneaked into
the party, the government, the Soviets or the
working class movement. Thus the party
could not be an effective check on a
degeneration of the higher echelons of the
government because they were party bosses
as well. Secondly, in Lenin's formula, all fat
tionalism (or dissent?) within the party was
to be suppressed, if necessary by force,
because once in power the “ideological and
organisational unity of the party is no longer
an inner party affair but a national require
ment”.9 Thus when the Left Social Rcvolu

tionaries attempted to take their issues to the
masses, Lenin had them suppressed by
force.1" Thus the party could neither exer­
cise a check on the government nor take an
issue to the masses. The party was an un­
checked entity in which all power of the state
and all venues of appeal to the masses were
concentrated,
In this way Lenin himself laid the foun­
dations of degeneration of the CPSU:
“Comrade Stalin, having become General
Secretary, has unlimited authority concen­
trated in his hands, and I am not sure
whether he will always be capable of using
that authority with sufficient cau­
tion. . .Stalin is too rude.. . I suggest that
comrades think about a way of removing
Stalin from that post and appointing
someone else.. .being more tolerant, mote
loyal, more polite and more considerate to
the comrades, less capricious, etc”.11 Note
that Lenin writes of “thinking about a way
of removing Stalin”, i e, there was no inter•> :I machinery to check such capric-ou.sness!
The only solution is for the party to
disown power fundamentally and undertake
the role of organising the masses and check­
ing the government on a permanent basis.
And to check degeneration within even such
a party the less organised and the more dif­
fused the better. When confronted with a
decadent regime ,like that of the Czar, such
a parly, however diffused, may well put its
might behind a more progressive leadership.
But once the patty assumed power itself all
checks in the system vanished.
The Indus Valley civilisation far excelled
its contemporary Egypt, and the Guptan
Golden Age prospered in India when the
Roman Empire was destroyed by barbarian
invaders. It is our submission that such un­
paralleled achievement has its roots in two

The Indian association for Women's Studies
announces
The Third National Conference on Women's Studies

at
Panjab University, Chandigarh
October 1-4, 1986

Theme: Women, Stmjjgles, and Movements
roi more information contact

Or. Lucy M. Jacob
General Secretary
Indian Association for Women’s Studies
L/3-D, University Campus, JAIPUR 302 004
or
Dr. Pam Rajput
Organising Secretary
Third National Conference
Department of Political Science
Punjab University Chandigarh 160 014

599

I
April 5, 1986

f
economic and polhical weekly

checks upon the king that were built into our
the role of the other vdsile continuing to ex
same though! is expressed in ihe Gila HI. 33:
political system. The first check, common
ercise a check upon the oihcr.*1'
the man of knowledge acts u; accordaiiue
perhaps to most civilised world, was of one
It is. iLi'ielo.'c, mu sui-missH/n that (lie
with his own namie”.
king upon the other. Conquest was supposed
central is?.uc i> that of conuoiling (!•< govern
6 i.iic I romm. ‘ Ihe/Xn of Uving”, Barnern,
to be the chief ambition of a king and suc­
mem This contro’ can be effectively exer­
New York, 1963, p-6.
cess was considered to be contingent upon cised by independent peis.j..s who are both
' D G Tendulkar, “Mahatma”, Vol 8, Publicaa prosperous and lightly taxed populace.
tooted m the musses and ‘.Jose to power
mms Division, 1969, pp 227, 283
Thus the king was advised to strive for mass although not weilding powtv them selves.
8 “V 1 Lenin: A Biography", Progress,
prosperity and avoid acts of popular fury.
These independent persons are the Gan
Moscow, 1966, pp 420, 430, 460, 470.
In this way the feai of other kings served dhian constructive worker, the Marxist Piuty
9 N K Kmpskaya, "Reminiscences of Lenin”,
as a protection against over exploitation of comrade and the Hindu Brahmm. In spec.’lic
New World, New York. 1970, pp 533-6;
the masses.12
"V J Lenin: A Biography", op cil. p 462.
circumstances where a government is deca­
This, however, was not sufficient. The dent these independents may focus upon
10 Krupskaya, op cit. pp 476-7.
king was advised to appoint councillors on
11 ‘ V | Lenin: A Biography”, op cit, pp 549-50.
their mass organisations and lead a mass
the basis of merit, to listen to these Brahmins
12 A L Basham. “The : Wonder That Was
revolt for the replacement of the decadent
and to stand by their decisions. These
India", Rupa 1982, pp 90. 126; R Shaima
leadership. But thereafter they must not
Brahmins were powerful and even stronger
Sastry. “Kautilya’s Arihasastra”, Mysore
assume power themselves but again act as
than the king himself.13 The king was ad­
Priming and Publishing House, Mysore,
a guide and a check upon the new leader­
1967, pp 287, 296. 308.
vised not to touch the high born people as
ship. If they were to assume power they
13 A (, Burndl, “The Ordmanccs of Manu"
they could cause trouble not to punish an
would themselves be subject to ail the
(Manu Smriii), Kalyarii, Ludhiana. 1922,
assembly of influential men as it could
degenerations that are aitendcm to the ex­
P 328; Basham, op cit, p 101
backfire.14 These Brahmins, although not
ercise of power, this diffused ‘.'ounterva’l14 Sastrv, op fit, pp 364, 385.
wedding power directly and primarily engag­
ing power already exist;.V iiove to beconie
15.. Bitsham, v. cj. ?
t •i o h .nambi.
ed m Atudy and teaching could be expectec’
conscious ol it. Ideas become a material
“Ancieni India”. Mandian, New York, 1969,
to be more objective in their perception of
force once they g:ip the masses, it is the idea
p 52: Sastry, op cit, p 300; Burnell, op til’
the reality and therefore could guide the king
that we must clarify.
p 89.
properly.
16 Kosarnbi. op cit, pp 121, 172.
A king who did not abide by these dic­
17 Burnell, op cit. pp 13, js, 329.
tums incurred the wrath of the Brahmins
Notes
18 Sastry, op cit. p 6; Basham, op cit, p 126.
who might have even organised a mass revolt
19 Sastry, op cit, p 8; Burnell, op cit. p 152;
1
Rajni
Kothari,
‘
The
Non-Party
Political
against such an impious king. Likewise
Basham, op cit, p 115.
Process’, EPW, February -I, 1984, p 222
Anhashastra advocates that the people must
20 Basham, op ch, pp 126. 142; Burnell, on ci'
2
DI. Sheth, Grassroots luitiaiivus in India”,
march against a wicked king and Kosarnbi
P 301.
EPW, February 11, 1984.
mentions that the peasants oppressed by
3 Marx writes, “At a certain .Mage of develop­
heavy taxes would go on a strike by refus­
ment, the material product!■.. forces of
ing to cultivate their lands. Manu Stnriii also
society come into conllict will, the existing
recommends the boycott of a bad king.15
relations of production... Ftom forms of
Japanese Foreign Investment
The Brahmins were on the other hand
development of productive forces these telaJAPAN s foreign investments ranked third
engaged in winning over people by their
tions '.urn into their ieiuus. Then begins an
in the world in 1984, up from fourth place
opsn and disseminated teaching and by ac­
era of social revefution “Pfefact to a
ting as technological innovators and pioneers
and surpassing West Germany, according to
Contiibmion io rhe Critique ot Poliiical
in undeveloped areas by improving agri­
a white paper just released by the Japan Ex­
Economy”, F^ogress, xMoscow 1970, p 23.
culture and cattle-breeding.16
ternal Trade Organisation. Japan’s outstan­
In Marx s paradigm a positive ijovernmem
ding investments amoujned io $ 37.92
In this manner the Brahmin-eouncilior,
is m-.?? whi.-h
in fa-oar .u dneiot mem
bihion. a 6.9 per cent share of the world's
of productive forces, an iulransigcnt govern­
rooted in the masses, was a powerful cheek
ment is one which allow:, productive forces
total $ 549 billion in investments. Japan
on the king although not himself in powei.
io grow under prcs-..uC, and a decadent
lagged far behind the United State’s $ 233.4
He would guide a wise king as his councillor
government is one wmeh positively thwarts
billion (42.5 per cent) and Britain’s $ 85.3
and organise intrigues or mass revolts
the giowth of produ-.-n.c turces by preser­
billion (15.5 pci cent), but was Just ahead
against a bad king.
ving those iclutiuns v; uoduemm ahich
ot West Germany’s $ 36.6 billion (6.7 per
1 here was a difference between the
have become fetters on
growth of pro­
Brahmin and the Kshatriyas. The duty of the
cent). At the end of 1983, West German in­
duction and thus begun an cr;.i of social
Brahmin was to study and teach and he was
vestments abioad had stood at $ 38.9 billion
revolution, i e, displacement
.. Jcvadein.
advised to “ever shrink from honour and
or
7.19 per cent of the world estimate of
leadership.
should always be desirous of disrespect
'* 540.8 hillion, •-omno.red 'o Japan's j. 32.;
-4 H.V-.h Snm.-Croons in A Xtv i
, (;f
because he thus sleeps with comfort” He
billion or 5.95 per cent.
Transformation’, EPW. Febrmury 1984..
was supposed to live by his intelligence and
1 he 17./ per cent increase in Japanese in­
p 310, mentions the dislike for authority and
his mam weapon was his speech.17 In con­
vestment abroad in 1984 was due partly to
hierarchy among the voluntary workers.
trast the duty of the Kshatriya was to under­
sharp increase.'* in investments in North
This dislike is well founded.
take protection of the people and to achieve
America ’and Europe. Japan’s direct in­
5 The conflict between co-.i.u.ous and the un
conquest of other lands.'« He had to ad­
vestments in the US in 1984 totalled S 3.4
conscious is the cemral contribution of
billion, almost double the figure for the
minister punishment to the enants as pro­
Frued. See Ridwru Wellheim, “Freed”,
sperity was supposed to exist where punish­
Fontana, London 1971 fora concise exposi­ previous year.
tion. R D Laing has emphasised lhe impor... .....................
Of the total -world
foreign investment of
ment was meted out correctly.19 Although
he occupied the chair he incurred the dis­
•ance of early childhood impressions. Sec
S49 billion, which represented
...... ~ J a 1.5 per
his “The Facts of Life”, Penguin, 1977. The
pleasure of many and was continually sub­
cent increase over the earlier year, $ 455.7
importance of knowing one’s inner nature
billion,, or 93 per cent, was shared by six ma­
ject to intrigues, assassinations, defeats, etc.
has also been emphasised by humanist
in this manner the temperamental requirjor industrialised countries including
psychologists like Abraham H Maslow,
ments of the Brahmin and the Kshatriya
C anada $ 31.3 billion and Netherlands $ 31.2
“Towards a Psychology of .’king”, Van
bihioii, in addition to the four countries
were very different which made one abjure
N'Oslrand Rain|i0ld, Nev. y-.,rk, 1968 The
already mentioned.
600

USAID - PVOH - II
WORKSHOP ON PARTICIPATORY DEVELOPMENT

May 6 -10, 1996

^ori<
^axtiai[iat:oriy

A(Jn

Q.2, ^uykCalialjad. UnititulLonaC- 11O 062

-

!> •
t.

1

2. What is
Participatory
Evaluation?
Participatory evaluation is a process of collaborative
problem-solving through the generation and use of knowl­
edge. It is a process that leads to corrective action by
involving all levels of users in shared decisionmaking.

T'

The most important principle guiding participatory evaluation
is the utilization of findings at different levels and in different
ways. When stakeholders are involved in the process that leads
to the findings, the likelihood increases that they will use the
findings to take corrective action.

3

The partnership approach to problem-solving differs from the
usual process of project evaluation. The users became actively
involved in the development of the evaluation framework, in data
collection and assessment, and in the planning of follow-up
activities. As a result, corrective actions can often be taken di­
rectly and promptly, and the evaluation process itself contributes
to the building of local capacity for decisionmaking and commu­
nity-centered development. Participatory evaluation is thus
crucial when the overall goal of development efforts includes local
capacity building.

■■

u

I

p
Bl
Id
R'J

J

Fully involving users means reaching out to anyone affected by
decisions that are made: local community members; government
and community officials; project and program staff. As the pri­
mary users of improved water and sanitation services, women are
particularly encouraged to play a pivotal ioJe

Participatory evaluation does not preclude the involvement of
external experts, or hiring people for different aspects of data
collection. However, the expert plays a facilitating role in partner­
ship with the community or program staff, rather than being the
“expert supreme" who decides in isolation how the evaluation
will be conducted.

Results from participatory evaluation procedures can usefully
feed into conventional evaluation exercises required by most
agencies at midterm and upon completion of a project. However,
since the essential nature and purpose of the two processes is
different, their respective methodologies are distinct and should
not be confused. These differences are summarized in the box on
page 12.

9

I

i

I

i

I

I

i

I

i.i ~

Characteristics of participatory
evaluation
Among the distinguishing characteristics of participatory
evaluation are:

Collaboration
Problem-solving orientation
Generating knowledge
Releasing creativity
Using multiple methods
Involving experts as facilitators

i

Collaboration
The process of building local capacity through collaboration is
more important than the methods used or the output. Usually
the collaborative process improves the quality of the output and
the relevance and interpretation of findings.
Collaboratixe decisionmaking among all those affected by
project decisions includes "beneficiaries" as well as program and
project staff. Special efforts are made to ensure meaningful
10

participation of those traditionally overlooked—women, children,
the poor and junior project staff such as extension workers.
Project staff are closely involved with the users in collecting
data and responding to requests for technical advice. However,
simply asking community people to respond to questionnaires
does not qualify as meaningful participation. Similarly, merely
including women on household survey teams does not equate to
women's involvement or collaboration.

Problem-solving orientation
Participatory evaluation is oriented toward developing an
understanding of a problem or situation in a way that can lead to
timely action and resolution.

The driving force is not accountability to outsiders, but rather
human growth and development at the local level. Community
participation taps into the creative potential and knowledge of
people and further builds their capacity to direct their own devel­
opment. Thus, participatory evaluation becomes a process
whereby the participants in a development project are empowered
to learn and take effective action in solving problems.

Generating knowledge
Participatory evaluation aims to generate knowledge among
local people, at the community and at the project level. When
users are actively involved in data collection processes, informa­
tion becomes transformed into knowledge and leads to self­
sustained action. Consistent with the goal of capacity building,
knowledge generation can be distinguished from information
collection in several key ways:
• Information is bound up with reports or machines;
knowledge with people
• Information often consists of discrete, unrelated units;
knowledge consists of a network of interrelated units
comprising a whole system
• Information can be collected easily through multiple
choice questionnaires and surveys; systems of knowl­
edge cannot
• Information can be controlled by a few; knowledge
resides in all
• Information without context has little value; knowl­
edge involves interpretation and attaching meaning to
information.

Releasing creativity
An interviewer arriving in a village with questionnaires in
hand knows just how difficult it can be to get people to sit down
long enough to give frank answers to questions.

Box 2-1. Differences Between
Conventional Evaluation and Participatory Evaluation

Who

External experts

Community members,
project staff, facilitator

What

Predetermined indicators of
success, principally cost and
production outputs

People identify their own
indicators of success, which
may include production
outputs

How

Focus on "scientific objectivity";
distancing of evaluators from
other participants; uniform,
complex procedures; delayed,
limited access to results

Self-evaluation; simple
methods adapted to local
culture; open, immediate
sharing of results through
local involvement in evalua­
tion processes

When

Usually upon completion;
sometimes also midterm

Merging of monitoring and
evaluation, hence frequent
small evaluations

Why

Accountability, usually
summative, to determine if
funding continues

To empower local people
to initiate, control and take
corrective action

Participatory methods are creative and fun, and learning in
this environment builds self-esteem and confidence essential for
initiating action. People become involved in defining and carry­
ing out the work. Through the participatory process, tasks like
mapping, drawing and sorting pictures release such energy and
enthusiasm that the challenge often becomes bringing the process
to a close rather than struggling to keep it going.

Using multiple methods
Participatory methods are eclectic, borrow from many disci­
plines, and are adapted to meet the specific jobs at hand. If
available tools are considered inappropriate, new tools are created.
Validity and reliability are achieved through the use of mul­
tiple methods and by including different users and stakeholders in
consensus building. Because those affected by a project are
included in the decisionmaking, with consensus governing the
process, large sample surveys are unnecessary. Since community
members have many demands on their time, shortcut simple
methods of sampling, data collection, and analysis are preferred.

With emphasis placed on the use to which findings are put,
results are disseminated in a variety of ways adapted to user
preferences—slides, videos, pictures, stories, role plays, discussion
groups, workshops, and written reports of different lengths and
different formats.
12

Involving experts as facilitators
The role of the external expert, if any, is to facilitate shared
decisionmaking throughout the entire proceSiS of participatory
evaluation, including identifying the purpose of the evaluation
and selecting methods of data collection and analysis, field
implementation, and disseminating and acting upon findings. If
experts are involved, their role is to merge specialized expertise
with local experience and indigenous knowledge and learning
systems.
The task of the facilitator is to share ideas, help people consider
options, and let the process be taken over as far as possible by
users, community people, and project staff.

In addition to the technical skills they bring, participatory
evaluators must also have strong skills in facilitation, as well as
humility, respect for others, and the ability to listen. They must
also have a strong belief in human potential and a high tolerance
for ambiguity. When many people are involved in decisions and
tools have to be adapted or developed to fit the local situation,
decisionmaking naturally takes longer and is less clear-cut ini­
tially than when one person or a small group is in control.

13

However, because participatory evaluations use simpler, shortcut
methods, the overall process is usually quicker than conventional
evaluation.

..

The participatory evaluation cycle

A-

Agencies committed to supporting community self-evaluation
processes invariably find that they must adopt similar approaches
themselves. More than a technique, participatory evaluation is a
framework from which to operate.

Hence, it is important for project agency staff not only to be
familiar with the methodology of supporting community involve­
ment in evaluation, but also to utilize similar approaches in their
own work at the agency project level.
At the project level, self-evaluation takes place frequently and
at any stage in the project cycle. The distinction between moni­
toring and evaluation then becomes blurred, as information
steadily flows through the project, to be analyzed and used to
shape plans, and bring about corrective action.

I'*

w

• d
a

■

14

1

Plan

Plan
Act

Act

Asstss
Self­
evaluate

Analysis
\
jf Self- x
<
evaluate

Analysis
\
# Self­
zb evaluate

Source: Jake Pfohl, "Participatory Evaluation: A User's Guide," PACT.

Reflection

'Self­
evaluate,

"Impact"?

Whether at the community or the project level, the following
questions must be answered to create this information flow and
conduct an evaluation:
• What are the objectives of the evaluation?
• What are the issues and problem areas that must be
addressed, and what information is needed to do so?
• How should the information be collected?
• Who should collect the information, and from whom?
• How will the data be analyzed?
• What does the information mean?
• Given the meaning of the information, what actions
are appropriate and who will take them?
Local stakeholders—those who will be affected by a project and
must have the capacity to sustain and make it effective—are
involved in asking and answering these questions. Local people
participate in deciding whether an evaluation should be under­
taken, defining the purpose of the evaluation and determining
how the information is collected and used in follow-up actions.

Many books and guidelines on conducting evaluations already
exist, and such readily available information does not need to be
reproduced here. Some examples of workshops that have focused
on differing evaluation objectives, and changing conventional
evaluation to participatory evaluation are included in the appen­
dixes. The following guidelines, however, are important to keep

Field Insight—Sri Lanka
In a village in Sri Lanka, the village water
committee requested the assistance of an
external evaluator to determine why the
level of community interest in and finan­
cial contribution to a water project was so
low. Working with the committee, the
evaluator developed a very brief question­
naire and then probed in depth one or two
issues of particular interest to the commit­
tee. Since the community was small, every
adult was interviewed.

The data were analyzed and a meeting was
held with the village women to discuss the
findings. What emerged was a perception
among the women that the burdens and
benefits from the planned piped water sys­
tem would be unequal. Specifically, the
higher castes and those that were better off
were thought to be contributing less and
benefiting more because of the proximity
of the water to their houses.

in mind when adopting participatory evaluation methods.

Meetings were held with all the stakehold­

Keep your methods simple

ers and solutions negotiated. The layout of
the piped system was changed to ensure a
more equitable distribution of the network.

While the methods used depend upon the purpose of the
evaluation, in general, participatory evaluation calls for simple,
shortcut methods throughout the entire evaluation cycle.

Source: Adapted from Tahemnessa Abdullah
and Marieke Boot, IRC, 1990.

15

&

I* f

•'

1

For example, use informal sampling methods where possible,
and sample from different parts of a settlement: the rich and the
poor, the users and the non-users, men and women, and so forth.
Checklists can be extremely useful, especially when developed
in collaboration with project staff and community people. These
can be used tor interviews, group discussions, observations and to
direct household surveys.

Make a special effort to include women
Participarory methods are very useful in reaching those who
are often excluded in decisionmaking, particularly women. How­
ever, unless special efforts are made to involve women and build
their confidence, they will usually be bypassed in participatory
evaluation activities, as well. Commitment and sensitivity to this
issue are essential throughout the evaluation cycle to ensure
inclusion of women and improvement in the quality of their lives.

Involve the users in analyzing data
Data analysis techniques that involve users in discussing
findings and formulating recommendations and follow-up actions
arc more effective than meetings in which final reports and
recommendations are presented.
16

Involving community members in activities such as drawing or
making a three-dimensional map can become the basis for partici­
patory planning, monitoring change and for data analysis and
evaluation.

Supplement brief written reports with alternative methods for
disseminating findings, such as community and project staff
workshops, photographs, slides, videotapes, open-ended stories, or
role plays. All have proven useful in increasing the likelihood of
follow-up action.

Don't sacrifice effectiveness for "accuracy"
The purpose of self-evaluation is to enable the users to under­
take new or corrective action. The issue of the accuracy and detail
of the information collected must be viewed within this context.
In most situations, the margin of error or lack of precision that
can be tolerated is much higher than that for scientific, academic,
rigorous research.
For example, traditional household surveys devote much time
and effort to accumulating detailed information on family size,
household composition, income and wealth. However, whether
household size is 6.7 or 6.1 has little implication for the commu­
nity in designing water and sanitation systems. The same is true in
trying to assess income by rigorously counting chickens and land
plot size.
For the purpose of participatory monitoring and evaluation,
ranking households into three categories may be all that is
needed. Since rural communities usually have intimate knowl-

0)

K4

Source: "Evaluating AIDS Health Promotion/' WHO Report, Issue 11.
17

J.

edge about themselves, they can quickly rank families by size,
wealth (rich, average, poor), presence of children under five years
of age, female-headed households and so on.

On occasion, greater accuracy may be desired, such as when
the number of diarrhea episodes is being tracked. Here too,
experience indicates that village women, using a calendar and
simple drawings, can keep track of the number of diarrhea epi­
sodes of their children.

Get only the information you need
The biggest temptation in any evaluation is to try to find out
everything at the same time. Resist the temptation, and help
other people resist it! The guiding principle should be "optimal
ignorance." Generating information that is unnecessary to the
purpose of the evaluation is a misuse of time and vital resources.
If information needs are varied, use a phased approach; evaluate a
few issues in depth and get a general sense of the other issues.

There is no formula
There is no formula for participatory evaluation. The only way
to learn is through action. The question to keep always in mind is:
"Does this process help users generate information to solve
problems they have identified, using methods that increase their
capacity to solve similar problems in the future?"
Any tool or technique can be participatory or not depending on
how it is used. The key is who makes the decision and who is in
control. Project staff and evaluators often find that one of the most
difficult challenges in participatory evaluation is giving up total
control, or "letting go" of their notion of the right way, the right
question, the right wording, the right order, the right answer.
While there are as yet very few documented examples of
"pure" participatory evaluation in the water and sanitation sector,
there is gradual movement toward participatory applications of
conventional techniques, as well as the creation of new tools and
techniques that can be put in the hands of local people.

18

Box 2-2. Start, Stumble, Self-Correct, Share
Participatory Rapid Appraisal (PRAl is one among a

The core of good PRA is our own behavior and attitudes. It involves:

• being self-aware and self-critical
• embracing error
• handing over the stick
• sitting, listening and learning
• improvising, inventing, adapting
• using our own best judgment at all times.

So we can ask who lectures, who holds the stick, whose finger wags,

Whose knowledge, analysis and

priorities count?
Ours? Theirs, as we assume them to be? Or theirs as they freely express them?
Good PRA is empowering, not extractive.
Good PRA makes mistakes, learns from them, and so is self-improving.

Good PRA spreads and improves on its own.

bad^y^what can^e karS'hlw JaXdXtSS'can^heT others to do better?

Source: Condensed from Robert Chambers, 1992.

USAID - PVOH - II
WORKSHOP ON PARTICIPATORY DEVELOPMENT

May 6-10, 1996

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Capacity

KEY INDICATORS

PRE­
PROJECT

• Number and type of facilities created/ service
deliveries planned (hospital, health care
centers, logistics, medicine; equipments, etc.
• Support systems established (doctors, nurses,
para-medics, mid-wives, family planning
workers etc.)
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for women

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Output

• Number and types of facilities planned and
actually created
i
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actually maintained and operational
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required and actual number of visits by
health practitioners
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and actual
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(WHERE APPLICABLE)
APPRAISAL
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TARGET
PROJECT

eFfiurz
Impact

Family Planning

• Number and actual users of family
planning methods
• Referral cases and follow - up
Prevalency rate

• Fertility rate/ Ave. family size
• Mortality rate

• Crude birth rate
• National mortality rate
• Neo - natal modality rate

• Infant mortality rate
Health
• 'ncidence of epidemics

* Incidence of diseases by sex
* Incidence of infections and dhiarrheal diseases

• Life expectancy at birth
• Percentage of new births’having birth
weights of at least 2500 gms

* Proportions of infants covered through MCH clinics

' Proportion of women receiving ante­
natal care at hospital health centers
• Percentage of deliveries in institutions
• Infant/Child immunization

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WORKSHOP ON PARTICIPATORY DEVELOPMENT

May 6-10,1996

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PRADAN’s Community Banking Experience;
Madurai and Ramnad Districts of Tamil Nadu

t
i

Purpose:
- making credit accessible to rural poor women
- facilitating them to control and enjoy benefits of financial resources .

We translate this aim into reality in the following phases:
- Harnessing internal financial resources of the women in small but viable groups
- Interacting with local commercial branches and district level government departments
- Establishing a member - managed banking institution at the cluster level; and
- Enhancing the members’ credit absorption capacity by introducing and establishing
viable micro enterprises.

Localised Financial Institutions for Women,..

S.No

Features

First Generation

Second Generation

Third Generation

I.

I'OCTJS

I. Mobilising savings to
meet consumption lending
on their own.

I. •
I’volving
jcivjugs
products lo meet non­
productive
(essential)
purposes of members.

I. Acqiinhig the legitimate
status
as
«J
financial
intermediary in lending to

2. Collective effort to
redeem the debts with their

2.
Creates *
support
institutions to share the
financial
functions , eg:
Cluster bank or Federation.

2. Financial linkage with
bankers to finance existing
income
generating
activities.

own savings.
finance
3.
Sustained
cash
linkages
through
credit facility with bankers
to
finance
prodoclhc
activities.
•I. * Becomes
a
single
window for lending by
linking . with
multiple
financial sources. ■

poor women.

3.
Financier
to
nr”
business initiatives uilh a
tie-up with business suppon
institution.^^

< •
•I. Promoters4 ^of Chic
i)n)Knnnmc*i wilh firiauui.il
investment.
5. tv Promotes’'*•?> similar
initialises in ocu locations.

2.

Time

First two to three years.

3.

Terminal Year
transactions

1. Savings to the tunc of Rs.
15000 to 2(XKX) per village
level group.

Fourth year to sixth year of

Seventh year onwards

iiiri.iiion..

2. Lending to the members
to the tunc of Rs. 3(X)()0 to
50000.

4.

Thrust

ComtnuAily Organisation

r- T < -5 t? 1
. *•
1. Each year savings and*
disbursement Io the tunc of
Rs. 5(XXX) per group.and
8roilPthe long term savings of Rs.
2. Lending to the tunc of I lakh for group lending.
Rs. 2 to 4 lakhs per group.
2. Lending tp lite tunc of 4
lakhs per group ahmuallv.

I. Multiple savings to the
tune of Rs. 1 lakh per

Technology cG Credit ; - 1 Credit n^orptlon - business
support (credit phis).
Financial area

1
i.

1.GROUP DEVELOPMENT
i

1.1 SHORTLISTING BLOCKS
i

I

•1.2 SELECTING POTENTIAL VILLAGES
1.3 "SEEDING THE IDEA­
1.4 GROUP FORMATION
- IDENTIFICATION OF THE POOR
k

★★★

WEALTH RANKING PROCESS DEVELOPED

PURPOSE:
IDENTIFICATION OF POOR FAMILIES TO FORM A HOMOGENEOUS SELF HELP
GROUP IN A VILLAGE/HAMLET

STEPS:
1.

- PREPARE CASTE-WISE LIST OF HOUSEHOLDS
- PREPARE SMALL SLIPS FOR EACH FAMILY

2.

-SIT WITH 3-4 VILLAGE ELDERS
- THEY CATEGORISE SLIPS INTO 3/4 GROUPS
- THEY SHARE THEIR CRITERIA FOR SEPARATION

3.

- REPEAT STEP 2 WITH DIFFERENT GROUPS / CROSSSECTION OF
HAMLET POPULATION

4.

PREPARE LIST OF FAMILIES IN CATEGORIES 3-4
COMBINE ALL LISTS
★ ★★
GROUP FORMATION AND SAVINGS MOBILISATION
GROUP DEVELOPMENT

EXPOSURE VISITS
LEADERS AS RESOURCE PERSONS

ANNUAL FUNCTION
APPOINTMENT OF A LOCAL CADRE
DEVELOPING NEW PROCESSES

INTERACTION WITH VETERANS
LEADERSHIP TRAINING, MEMBER EDUCATION

- SYSTEMS
tv

I
I

i

- EXPANSION BY THE PEOPLE

2. ESTABLISHING A MEMBER-MANAGED BANKING SYSTEM AT THE CLUSTER
LEVEL
2.1 STAGES OF DEVELOPING A CLUSTER ASSOCIATION

- CLUSTER INTERACTION
- FOCUS OF INTERACTION
* PROMOTE EXCHANGE OF IDEAS
* COLLECTIVE LEARNING
* DEVELOP RAPPORT ACROSS KS
* BREAK INITIAL INHIBITIONS ABOUT KS
* CLARIFICATION SEEKING, CONFRONTATION, DISCUSSION, DEBATE
* FORUM FOR US TO TRAIN THEM

CLUSTER ASSOCIATION
- FUNCTIONS
* PROBLEM SOLVING (E.G. CONFLICTS)
* GROUP DEVELOPMENT (ENSURING PROPER CONDUCT OF MEETINGS, ENABLING
RESOLVE CONFLICTS)
* PROMOTION OF NEW GROUPS
* ASSET CREATION AND MONITORING
* PROMOTION OF NIDHI
* EACH FUNCTION COORDINATED BY ONE COMMITTEE LEADER AND
SUPORTED BY 2-3 MEMBERS

ROUTINE FUNCTIONS

- REVIEW OF GROUP ON MONTHLY BASIS AT CLUSTER MEETING
- APPOINTMENT AND SUPERVISION OF CLUSTER ASSOCIATES (WHO
EXTENDS SUPPORT IN ADMN AND ACCOUNTS)
- RENT OF CA BORNE BY KS ON EQUAu SHARING BASIS
CLUSTER NIDHI

- AFTER 8-10 MONTHS OF CA INITIATE FINANCIAL FUNCTIONS THROUGH CN
FUNCTIONS

- GROUP RAISES APPLICATION FOR LOAN

- INITIAL DETAILS DISCUSSED IN GROUP MEETING
- ON THE GROUP'S APPROVAL IT IS PRESENTED TO CLUSTER
- BOD SCRUTINISE AND INITIATE DISCUSSION TO SANCTION
- AFTER CONVINCED ABOUT NEED FOR AND PERFORMANCE OF K, LOAN
SANCTIONED
- UTILISATION AND FOLLOW UP MONITORED BY MANAGER AND 1-2 MEMBERS OF
BOD

/

1
A
i

Women Managed Financial Institutions (WOMFI)

Institution
,SCWG (Saving
and credit by
women in ­
groups)

Cluster
Association
a). Promotional

Function________________ Why
• Managing of savings and • To enable the members to
manage the SAC activities
credit transactions
Indcpendtiy al a hamlet
• Smaller credit needs
level.
through own savings
• Leveraging money from • Primary unit for handling
transactions directly wtth
other institutions
• members.
•__________
•
To
provide
promotional
Promotion &
support on a continuous
strengthening cf W SAC
basis at local level for long
groups In neighbouring
10-15 parimary
term oontinulty and growth
villages within the
groups of a
of primary groups In a
vldntty of 5-10 kms
homogenous
particular geographical
. socio-economic » Long term sustainability
area.
for the primary groups
context

membership
15-20 poor
women
(Individual)

Lavel
Hamlet

At 3-5
villages

fcrr?.-

through mutual support
and cooperation.
~~
Creating greater access •
to credit for primary
group.
Leveraging funds and
onlend to primary groups
Strengthen the financial
systems and managerial
•
capability of primary
groups

(institutional)

bXFInandal

-

NIDHI’A
financial
wing of
cluster
assodatlon
... j.

[Federation
a). Promotional

•—

•

•

.

Block level

100-200 primary •
groups
(Institutional)
•

I

s•

b). Finanda!

R-

•

To Increase the access of
primary groups for meeting
various-‘non conventional*
credit needs of higher order
and fill the gaps in credit
demand at local level (3-5
villages)
To channelise funds to
primary groups mobilised
directly and through
federation.
__

•
Building solidarity for
groups at block level.
Relating with block level
•
development
admit •'',r!’tion.
Promotional activities for
development of primary
groups.

To provide a block level
integration for community <
banking effort.
To promote continuity for
the programme by women

Greater access for credit •
to primary groups.
Leveragining loan funds
•
■ from apex financial
Institutions HUDCO.
(NABARD, SIDBI)

To fill the credits gap not
met and managed by .
cluster NIOHIs.
To manage and relate the
collaboration with apex
organisations which are
focussed on specific activity (Housing, .
Business) and the quantut
of support Is huge;
•

I

1

■ I

I
The ihter-dependcncc between these institutions and their roles are shown below:
...
n

■

■

’S-r •• •■

’•‘

.

"'

’

cl

:
'

'

PRADAN
Phase of
development during
each generation
Explorer & initiator
Pre-formation

.

i ‘--Sr.

it
•

•

.

...

:

Women managed
Institutions

•»

.

.

•

'

<

Bankers

Observer

On looker

. >

Formation

Promoter & Facilitator

Passive Participant

Observer

Stabilization I

Coach

Passive Owner

Experimenter

Stabilization II

Resource person

Active Owner

financier

Growth

Advisor & IGP

Manager

Collaborator

Self-propellant

Collabuiuiur &
financial advisor

•

"

Initiator

Diversification

Business support

ill

*

- DETAILS SHARED AT SUBSEQUENT MEETINGS
t

- NO COLLATERAL BUT PROMISSORY NOTE FOR ALL LOANS EXCEEDING RS 100
PER INDIVIDUAL . .

i'

PRESENT STATUS: 20 cluster Associations in Madurai and Ramnad

- 6 HAVE INITIATED CLUSTER NIDHIS
-11 IN ASSOCIATION STAGE
- 3 IN INITIAL INTERACTION STAGE
FEDERATION - A BLOCK LEVEL FEDERAL BODY OF KALANJIAMS

- IMPLEMENTATION OF GOVERNMENT SPONSORED SCHEMES
- PROMOTION OF NEW GROUPS.
- CONFLICT RESOLUTION
- TRAINING
- CONSULTANCY TO GROUPS IN OTHER BLOCKS
- FINANCE TO PRIMARY GROUPS FOR HOUSING, DEBT REDEMPTION ETC.

- PHASES: INITIATION, CONSOLIDATION AND GROWTH.
- PRESENT STATUS: 3 FEDERATIONS: ONE IN GROWTH STAGE AND TWO IN
INTIATION STAGE.

USAID - PVOH - II
WORKSHOP ON PARTICIPATORY DEVELOPMENT

May 6-10,1996

''Joi

aiticifiatoiy

czjila

^2, [Duglrtaftaljadr (Jndituhlonat- 11O 062

U <»*/•//><• eh’f'mmt Vol.??-?-ftio 9. pp I?" I ?6H |V94
I Isrs ici St icnt c I id
Printed in (neat Hniain
(HOS 7SO\A*4 $7 (K> 4 ()(Ml

Pcrgamon

0.W .750X194 >00050-6

Participatory Rural Appraisal (PRA): Analysis of
Experience*
ll
ROBERT CHAMBERS'
Institute of Development Studies. Brighton

Summary. — The more significant principles of PariKipatoiv Rural Appraisal (PRA) concern the
behavior and attitudes of outsider facilitalors. including not rushing, handing over the stick.’ and being
self critically auar.* The power and popularly of PRA arc partly explained by the unexpected analyti
cal abilities of Itkal people when catalyzed by relaxed rapport, and expressed through sequences of par
ncipatory and especially visual methods Fvidence to date shows high validity and reliability of infor­
mation shared by local people through PRA compared with data from more traditional methods
Explanations include reversals and shifts of emphasis from etic h emic. closed to open, individual to
group verbal to visual and measuring to comparing, and from extracting information to empowering
local analy sts

I

INTRODUCTION

Participation is now widely advocated and docu
mented as philosophy and mode in development te g .
Cemea. 1985). but the gap remains wide between
fashionable rhetoric and field reality. One practical set
of approaches which ha^ coalesced, evolved and
spread in the early 1990s bears the label Participatory
Rural Appraisal (PRA) This has been described as a
grow ing family of approaches and methods to enable
local (rural or urban) people to express, enhance, share
and analy ze their know ledge of life and conditions, to
plan and to act
PRA Juiv manv mjuqw. Th**
d-rect is rapid
rural appraisal (RRA) from which it has evolved
RRA itself began as a response in the late 1970s arid
early 1980s to the biased perceptions denved from
rural development tourism (the brief rural visit by the
urban-based professional) and the many defects and
high costs of large-scale questionnaire surveys
(Chambers. 1980: Carruthers and Chambers. 1981;
Longhurst. 1981) PRA has much in common with
RRA but differs basically in the ownership of infor­
mation. and the nature of the process: in RRA infor­
mation is more elicited and extracted by outsiders as
part of a process of data gathering in PR A it is more
generated, analyzed, owned and shared by local
people as part of a process of their empow erment
PRA also flows from and shares much with other
approaches and traditions These commonalities and
debts include the idea that local people can and should
conduct (heir own appraisal and analysis, found in
activist participatory research (eg . Freirc. 1968).

many forms of diagramming, derived from agro­
ecosystem analysis (Gypmantasin et al.. 198(1.
Conway. 1985. 198b. 1987): the importance of rap
port and of the emic-ettc distinction, from applied
social anthropology. and an understanding of the com
plexity. diversity and riskiness of farming systems and
poor people s livelihoods, from farming systems
research (e g.. Gilbert. Norman and Winch. 1980:
Shaner. Philipp and Schmehl. 1982) PRA draws on
these traditions and shares much with them
The more developed and tested methods of PRA
include participatory mapping and modeling, transect
walks, matrix scoring, well-being grouping and rank­
ing. seasonal calendars, institutional diagramming,
trend and change analysis, and analytical diagram
mmg. all undertaken by local people Among many
applications. PRA has been used in natural resources
management (soil and water conservation, forestry,
fisheries, wildlife, village planning, etc ). agriculture,
hea’th. nutrition, food security and programs for the
poor (MA Xoit v. 1988-: IDS. 1993)
By early 1994 activities labeled as PRA have, in
v anous forms, evolved in or spread to at least 40coun­
tries in the South, including Bangladesh. Bolivia.
Botswana. Brazil. Burkina Faso. Cambodia.
Cameroon. Chile. Colombia. Costa Rica. Ecuador.
Egypt. Ethiopia, the Gambia. Ghana. Guatemala.
Honduras. India. Indonesia. Jordan. Kenya. Mali.
•Thr paper r the second in a three-pan senes examining
participatory rural appraisal The first paper appeared in the
July 1994 issue of World Dt vrlopmrnt (Vol 22. No 1)
’Final revision accepted February 23. 1994

WORLD Pl VI I OPMLN1

I2M

4

Effective RRA and PRA have been found to
require practitioners and facilitators to follow basic
principles Some are shared by RRA and PRA. and
some have been additionally evolved and emphasized
in PRA
The principles of RRA and PRA have been
induced rather than deduced they have been elicited
by trying out practices, finding what works and what
does not. and then asking why Although different
practitioners would list different principles underly ing
RP.A and PRA (see e g.. Grandstaff. Grandstaff and
Lovelace. 1987. pp 9-13; Grandstaff and Grandstaff.
1987a; McCracken. Pretty and Conway. 1988. pp
12-13. Gueye and Freudenberger. 1990. pp 10-19)
and these have been evolving over time, most might
include and accept the following:

— Optimising tradeoffs, relating the costs of learn
mg to the usefulness of information, with tradeoffs
between quantity, relevance, accuracy and lirneh
ness This includes the principles of optimal igno
rance — knowing what it is not worth knowing, and
then not Irving to find it out. and of appropriate
imprecision
not measuring what need not be
measured, oi more accurately than needed, follow
mg the dictum attributed to Keynes that it is bcltei
to be approximately right than precisely wrong
— Triangulating (Grandstafl. Grandstaff and
Lovelace.
1987.
pp
9 10.
Gueye
and
Freudenbcrger. 1991 pp 14 lb) meaning cross
checking and progressive learning and approxima
tion through plural investigation This variously
involves assessing and comparing findings from
several, often three
— methods
— types of item or sets of conditions
— points in a range or distribution
— indiv iduals or groups of analysts
— places
— times
— disciplines
— investigators or inquirers
and combinations of these
— Seeking diversity, meaning looking for and
learning from exceptions, oddities, dissenters, and
outliers in anv distribution This has been expressed
in terms of seeking variability rather than averages
(Beebe. 1987. pp 53-54). and has been described
in Australia as the principle of maximum diversity.
or "maximising the diversity and richness of infor­
mation” (Dunn and McMillan. 1991. pp. 5. 8). This
can involve purposive sampling in a nonstatistical
sense. It goes beyond triangulation; for it deliber­
ately looks for. notice^ and investigates contradic­
tions. anomalies, and differences, and includes neg­
ative case analysis

(a) Principles shared by ERA and PRA

(b) Principles additionally stressed in PRA

— A reversal of learnin#. to learn from local peo­
ple. directl>. on the site, and face-to-face, gaining
insight from their local physical, technical and
social knowledge
— Learning rapidls and progressively, with con­
scious exploration, flexible use of methods, oppor­
tunism. improvisation, iteration and crosschecking,
not following a bluepnnt program bui being adapt­
able in a learning process
— Offsetting biases, especially those of rural devel­
opment tounsm. by being relaxed and no: rushing,
listening not lectunng. probing instead of passing
on to the next topic, being unimposing instead of
important, and seeking out the poorer people and
women, and learning their concerns and pnonties

Of these shared principles. PRA puts special stress
on offsetting biases, and the associated changes in out­
siders’ behavior. In addition. PRA in practice mani­
fests four further principles
— They do it facilitating investigation, analysis,
presentation and learning by local people them­
selves so that they generate and own the outcomes,
and also learn This has been expressed as "handing
over the stick” tor pen or chalk) Il requires confi­
dence that “they can do it ” Often the facilitator ini­
tiates a process of participatory analysis and then
sits back or walks away. taking care not to interview
or interrupt
__Self critical awareness meaning that facilitators
continuously and cntically examine their own

Mauritania. Mexico. Namibia. Nepal. Nigena.
Pakistan, the Philippines. Senegal. Siena Ixone.
South Africa. Sn Lanka. Sudan. Tanzania. Uganda
Vietnam. 7-ambia. and Zimbabwe PRA has also been
spreading from the South to Australia. Canada.
German). Norway. Switzerland and the tinned
Kingdom Much of the innovation has been in the non
government organization (NGO) sector, especially in
India and Kens a. but increasingly government agen
cies have been adopting and adapting PRA
approaches and methods Increasingly, loo. graduate
students arc conducting then research in a PRA mode,
and university faculty base shown interest in over 20
countries 1
Empirically, much PRA has proved powerful and
popular This article sets out to present and analyze the
principles, insights, validity, reliability. and modes of
PRA. and to understand the nature of its power and

popularity •

2 THE PRINCIPLES OF PR A

r

F

12"

PARTICIPATORY RURAl APPRAISAI

behavior This includes embracing error — wel
coming error as an opportunity to learn, facing
failure positively — “failing forwards”, and cot
reeling dominant behavior
Personal responsibility PR A practitioners tend
to take personal responsibility for what is done
rather than relying on the authority of manuals or of
a rigid set of rules This is in the spirit of the words
of the one-sentence manual (Peters. 1989. p 378.
KGVK. 199)) “Use your own best judgement at all

1

times"
— Sharing of information and ideas between local
people, between them and outsider facilitators, and
between different practitioners (encouraging photo
copying and non attribution), and sharing field
camps, training and experiences between different

organizations, regions and countries
Interestingly, the principles shared by RRA and
PRA arc mainly epistemological, to do with obtaining
information and gaining knowledge, while those spe­
cial to PRA are mainly personal, iodo with outsiders'
behavior and altitudes This contrast indicates the
emphasis in PRA on how outsiders interact with local
people

3.

DISCOVERIES” OF PRA

and learn Metaphorically, and sometimes actually,

they "hand over the stick” of authonty.
Lxx al people then do many of the things outsidcis
formeih did (and believed, often enough, that only
they could do) I ax al people make maps and models,
they walk transects and observe, thoy investigate and

interview, they diagram and analyze, they present
information, they plan In consequence, they arc more
in command of the investigation, they own and retain
more of the information, and they arc strongly placed

to identify their priorities for action, and then to deter
mine and control (hat action
The participatory orientation of PRA has given
new impetus to (he development of methods Some of
the more gifted facilitators of PRA have delighted in

the lack of blueprint Participation then generates
diversity; local people play a part in interpreting,
applying, and sometimes inventing methods them
selves Local people and outsiders alike arc encour­
aged to improvise in a spirit of play. What is done is

different each time, the outcome of a creative interac­
tion. In consequence, the four years 1990-1993 have
witnessed inventions and generated insights, at first
especially in India Reviewing the participatory inno­
vation of these years, four salient findings stand out
w hich explain some of what appears different and new
about PRA; local people s capabilities; the value of
relaxed rapport, diagramming and visual sharing; and

Practitioners of PRA have a sense that they have
broken neu ground But every historian knows that
little is new under the sun. and what appear to be
methodological “discoveries" are often only rediscos enes (as pointed out in Rhoades. 1992). What is not
disputed, however, is that PRA practitioners are often
surprised at first .by w hat happens, and experience a
sense of personal discovery of the unexpected To
understand this requires a closer look at the contrast
between traditional research and RRA on the one

hand, and PRA on the other.
Major differences between the more extractive
data gathering of traditional research and RRA and the
more participatory data sharing, presentation and
analysis of PRA. are found in behavior, attitudes and
roles, in data gathering the outsiders dominate. They
determine the agenda, obtain and take possession of
information, remove it. organize and analyze it. and
plan and w nte papers and reports Outsiders appropnate and come to own the information. They hunt,
gather, amass, compile, and process, and produce out­
puts In PRA. in contrast, these are largely reversed
Outsiders encourage and allow local people to domi­
nate. to determine much of the agenda, to gather,
express and analyze information, and to plan
Outsiders are facilitators, learners and consultants
Their activities are to establish rapport, to convene
and catalyze, to enquire, to help in the use of methods,
and to encourage local people to choose and improvise methods for themselves. Outsiders watch, listen

the power of sequences of methods.

(a) Local people

capabilities

The first discovery has been that villagers have a
greater capacity to map. model, observe, quantify,

estimate, compare, rank, score and diagram than out­
siders have generally supposed them capable of.
Participatory mapping and modeling (Mascarenhas
and Kumar. 1991) has been a sinking finding An ear­
lier work on mental maps (Gould and While. 1974)
did not fully reveal the nchness of detail and discrim­
ination expressed recently by villagers in India and
elsewhere through participatory mapping, and which
has been known at least since the early 1980s

(Kenyon. 1983) A working hypothesis is that in gen­
eral rural people in the South have more extensive and
detailed mental maps than the urban people in the
North who earlier were (he main source of insight; and
that given the right conditions and materials, they can
express this visibly on the ground or on paper, either
as maps or as three-dimensional models (for example,
of watersheds). These have shown the huts, houses
and people in a village (social, census and health
maps), the surrounding village area (resource maps
and models), or specialized information (theme or
topic maps). By early 1994. thousands of such maps
and models had been created in over 30 countries.
As with mapping, so with quantification, estimat-

WORLD Pt VLI DPMI N7

1256

el

mg. comparing, ranking, scoring and diagramming,
loeal people have shown themselves capable of gener
atmg and anal)zing information far beyond normal
professional expectations For example, when facilita
Kirs have prov ided local people with the occasion and
methods to relied on and rank problems and opportu
nines as the) perceive them, the) have anal)zed and
presented then preferences — lor improving their
farming svstems, lot managing and using common
propen) resources, for better livelihoods, lor health
interventions, for species mixes in tree nurseries, for
the qualities ol new varieties of crop, tor amenities
and their location, tor development actions m their
communities, and so on To enable these capabilities
to be expressed, the practical principle has been to
assume that people can do something until proved
otherwise Participatory mapping and modeling. Venn
diagramming, matrix ranking and scoring, and other
methods have then turned out to be not one-oil excep­
tions but near-universals and largel) independent of

culture or literac)
A further discover) has been that local people who
are ahead) familiar with a PRA approach and meth
ods are themselv es good facilitators (Shah. Bharadwaj
and Ambastha. 1991). and often better than outsiders
The Aga Khan Rural Support Programme ( AKRSPi
(India) has found its trained village volunteers being
inv ited bv other v illages to come as lacilitator/consultants to help them (personal communication. Parmesh
Shah> It has even been known lor a village volunteer
to write to AKRSP stall and state that the) arc going to
carrv out a PR A but that ' )ou do not need to come
(personal communication. Ap<Hirva O/a).
In all this, both lhe participator) methods and
lariitliar local materials have helped in enabling local
people to express and analyze their knowledge and
preferences

(bi Bi huxifr iind m/'piHi

The second discovery is the importance of out
siders behav lor and establishing relaxed rapport early
in the process
Rapport is a key to facilitating participation
Relaxed rapport belvvcn outsider and villager, and
some measure of trust, arc minimum predisposing
conditions tor PRA In the past, two extreme types ol
interaction between outsiders and rural people have
missed man»r opportunities the rushed and unsell
. ntical rural development tourist has had neither the
tune and nor the sensitivity to get far beyond fori’.al
mutual misunderstanding, and some fastidious sixial
anthropoloeisls have allowed so much lime and
shown such sensitivity that they have come to believe
that only through prolonged residence can g»M»d
rapp< n and good insights be gained I he twocontrast
mg cultures" — ol rushed v isitor. and of resident par

licipanl-tvbscrvcr - have concealed the potential for
gaming rapport early and well, and early enough and
well enough for the honest and accurate sharing of
detailed knowledge and values To a hardened old
hand" at rural development tourism (the senior offi
vial "I was born and brought up in a village." "I am a
farmer mvscll." You can t pull the w<x»l over my
eves") this might seem unnecessary he (most arc
men) or she knows it all and assumes he has an auto
malic gorxi rapport with all rural people To a sea
soned social anthropologist (lhe university professor
It uxik a vear before the) would tell me that
Hhis
might seem an affront it would be unfair if others m a
short time could achieve what had taken her (rela­
tive!) more arc women) or him so long For anyone
who has endured and struggled through months of res
idcnce and participant-observation to achieve rapport
and insight, learning a new language and living a new
life, it could seem unlikely and even unwelcome, that
other outsiders should find ways to establish rapport
and gain good insights more quickly and with plea­

sure. participation and fun
Empirically, though, the finding again and again
w Ith PR A has been that if the initial behav lor and atti­
tudes of outsiders are relaxed and right, and if the
process can start, the methods ol PRA themselves fos­
ter further rapport Early actions bv outsiders can
include transparent honest) about who they are and
what they are doing, and participation in local activi­
ties. especially being taught and performing local
tasks Personal demeanor counts, showing humility,
respect, patience, and interest in what people have to
say and show, wandering around and not rushing, and
paving attention, listening, watching and not inter­
rupting. Then local people quickly lose themselves in
activities such as participatory mapping and modeling
and matrix scoring. In contrast with questionnaires,
they are not simply providing information to be
handed over and taken away The information is
theirs They own it. but share it They often enjoy the
creativitx ol what they are doing and what they them
selves see and learn through their presentation and
analvsis. The pleasure, tun and utility ol what they
have been helped to start doing express themselves in
rapport By reinforcing rapport. PRA methods thus
sustain and strengthen the participatory process of

<

which they are a part

DiaitrtiHiiHiiut <ni</

\hiirini;

The ihird discover) is the popuhnl) and power ol
pjriKipaiorv diagramming and visual sharing
Diagramming and visual sharing are common ele
inenis m much PRA W uh a questionnaire survev.
iiilormali<»n is appropriated hv the outsider It is trans
lerred from the words ol the person mierv icwed io the
paper ol lhe questionnaire schedule The learning is

I

I

PARTICIPAIORY Rl'RAl APPRAISAI
one off The information becomes personal and pn
vale, unvenfied. and owned b) the interviewer In
contrast, with visual sharing of a map. model, dia
gram, or units (stones, seeds, small fruits, etc ) used
for ranking, sconng. counting or quantification, all
who are present can sec. point to. discuss, manipulate
and alter physical objects or representations
Triangulation takes place with people crosschecking

4

and correcting each other The learning is progressive
The information is visible, semi permanent, and pub
lie. and is checked, venfied. amended, added to. and

owned, by the participants
For example, in participatory mapping and model
mg. villagers draw and model their villages and
resources, deciding what to include, and debating,
adding and modifying detail Everyone can see what is
being "said" because it .s being “shown “ In shared

1257

debate and anal) ms lead to people’s decisions about
the proportions of different species to be planted,
and the numbers of each required in tree nursenes
(Meera Shah, personal communication).
— a village social map provides an up to date
household listing which is then usrd for well being
or w ealth ranking of households which leads in tum
to focus groups w ith different categones of jcoplc
who then express their different preferences, leading
to discussion, negotiation and reconciliation of poor
Hies (Swift and Umar. 1991; Mukherjee. 1992).
— matrix scoring or ranking elicits villagers’ crite­
ria of value of a class of items (trees, vegetables,
fodder grasses, varieties of a crop or animal,
sources of credit, market outlets, fuel types . . )
which leads into discussion of preferences and

diagramming, information is diagrammed to repre
sent, for example, seasonal changes in dimensions
such as rainfall, agncultural labor, income, indebted
ness, food supply and migration Paper can be used for

actions
Longer sequences have been devised and used in
full PR As In Kenya these have been part of a stepwise
sequence (PID and NES. 1989) in India, for example
with the AKRSP. the sequences have been less codi

diagrams, but the ground and other local materials
have the advantage of being “theirs." media which vil
lagers, whether literate or nonliterate, can command

fied and more in a style of systematic improvisation,
though with specialized sequences, for example for
appraisal, planning and action with degraded forests,

and alter with confidence The diagram also presents a
visible checklist or agenda which is theirs

or with identifying and working with the poorest
The power of such sequences is fourfold First, the
commitment of participants increases, making further

(d) Sequences

The fourth discovery is the power and populants
of sequences of participatory methods
Some of the participatory methods have been
known and used in the past (Rhoades. 1992) There
art now some new ones, but perhaps more sinking is
the power which has been revealed of combination^
and sequences (Shah. 1991) To take some examples

— with participatory mapping, villagers draw not
one. but several maps, which become successively
more detailed and useful or which present new and
complementary information The map is then used
as a reference for other planning, and is retained by
villagers for their own monitoring and evaluation;
— social mapping provides a basis for household
listings, and for indicating population, social group,
health and other household characteristics This can
lead to identification of key informants, and then to
discussions with them;
— a participatory resource map leads to planning
transect walks in which villagers who made the
map act as guides for outsiders The transects in
tum lead to the identification and discussion of
problems and opportunities, which then lead to list­
ing and ranking options or “best bets";
— a participatory resource map of an area of
degraded forest, and a rootstock census of quadrats
in the forest earned out by villagers, leads to a cal­
culation of numbers of trees to be planted, and

action more likely, more spontaneous, and more sus­
tainable Second, sequences triangulate, and reveal
errors or omissions in earlier presentations (see e g .
Pretty eial.. 1992) Third, the different activities inter­
act cumulatively, each activity adding a dimension
and details which qualify and ennch others, so that
taken together the whole becomes more than the sum
of the pans Fourth, all concerned leant through the
process, through local people sharing what they know.
through observation and through analyse. In such
ways as these, participatory methods fit well with a

flexible learning process approach which is even more
open-ended and adaptable than much of the earlier
RRA: and they have the advantage that they usually
enable local people to use their own categones and
entena. to generate their own agenda, and to assess
and indicate their own pnonties.

4 VALIDITY AND RELIABILITY
Some facilitators of PR A have been exhilarated by
a sense of liberation and discovery. The presentation
and analysis of detailed knowledge in maps, models,
matrices, diagrams and the like by local people has
impressed them deeply in a personal way which has
challenged preconceptions, and affected beliefs and
behavior See Table I for remarks of NGO staff.
The expenence behind these and similar state­
ments is a fact For those who make them, the evi­
dence of personal expenence convinces

WOR1 OP! VFlOTMt Nl

I 25K
lablr I M(i() tiafl rrrruirki
After partuipaU*r>
mh ial mapping

After FRA
experience
After FRA training

"I have been working for eight yean
in thiv village. bu( I never va* it
like Ibis before”
“I shall never go back to
questionnaires”
”1 have been trying lo get (ho
information in (ho village for six
months, and now wc have it in two
afternoons"

Validity and reltabthly can also be assessed in
more conventional ways Validity here refers lo the
closeness of a finding to the reality, and reliability
refers to the constancy of findings Highly valid find
mgs are also highly reliable, but where there is a sys­
tematic bias, reliability can be high but validity low
Validity and reliability are not absolute values There
can be tradeoffs, through optimal ignorance and appro
pnate imprecision, where lower validity and reliability
can be more cost-effective, and can enhance utility
through less cost or greater relevance or timeliness
Most large questionnaire surveys present any
assessment of RRA and FRA with low standards of
comparison (Certain routinized and repeated survey s
like (he National Sample Survey in India, and some
national census surveys, may be al least partial excep
lions ) Critiques of rural questionnaire surveys have
found them often badly designed, badly implemented,
and badly analyzed (sec. e g . Mons. 1970. Campbell.
Shrestha and Stone. 1979. Daane. 1987; Gil). 1993).
Even so. it is rare for a survey to be subjected to full
critical scrutiny, for results to be tested for investiga­
tor oi enumerator bias, treating (he questioner as an
independent vanable, or for methodological problems
to be discussed in repons of survey findings
This is. however, no reason for anything less than
critical ngor in assessing the validity and reliability of
RRA and FRA approaches and methods The conven­
tional tests most readily applied concern measure­
ments and numbers Let us therefore examine the four
mam areas where RRA and FRA have generated
numencal data or insights which can be compared
with those from questionnaire surveys or other stan­
dard sources These are farm and household surveys,
wealth and well-being ranking, village censuses, and
rainfall data

(a) f-arm and household surxexs

In five cases comparisons have been made
between the findings of an RRA approach and a con­
ventional questionnaire survey
Collinson * I 1981 j Exploratory Survey of a farm­
ing system, involving some 20 professional persondays. was never contradicted in any major way by the

\

subsequent longei. drawn out and more expensive
Verification Survey which represented the majoi
commitment of professional lime and funds
Eranzel and Crawford < 1987) systematically com
pared a quick and light survey with a longer and
heavier conventional survey in Kenya and found no
significant differences attributable lo the methods
Rochelcau and hei team (Rochcleau er al. 1989)
working on agroforcstry in Kenya used a chain of
informal in-depth interviews, and group interviews,
and compared the results with a survey of a formal
randomized sample of 63 households They found that
“the formal survey look three times as long and repro
duced the same mam results as the group interviews
and chain of interviews, with less detail and coher
ence” (Rocheleau ei al. 1989. p 21)
Inglis (1990. 1991) led a team which used a reper
toirr of RRA techniques to gather kcal forestry
knowledge in Sierra Leone in an area where a lengthy
questionnaire with 278 questions had already been
applied The RRA results were presented four days
after the last location was surveyed, but the question
naire report was still not av ailable six months after the
completion of fieldwork Comparisons of the ques­
tionnaire survey and RRA data showed sharp discrep
ancies in two localities where the questionnaire sur
vey’s findings were implausible and its validity
suspect As Inglis points out
if information is wrong to begin with, no amount of
statistical manipulation will enable it to help the project
staff make good decisions
In contrast, the RRA sur
vey was completed in a much shorter time, the results
have been produced in specific locational reports that can
be individually used as discussion papers in the field in
follow up surveys As research biases, mistakes and
omissions are admitted and not lost tn a mass of ques­
tionnaire codes, the decision maker can see how the
information was generated, how important factors were
revealed, and how the best bets were arrived at (Inglis.
1990. p 107)

Bemadas (1991 (reports that in Eastern Visayas in the
Philippines, highly structured questionnaire inter­
views identified declining soil fertility as the most
pressing problem of farmers Bemadas explains that
"The staff themselves had formulated the questions on
the basis of w hat they felt to be priorities The problem
areas considered were predetermined based on the
outsiders point of v iew "Two years of research based
on the questionnaire survey findings did not match
farmers needs and circumstances, and the developed
technologies were not adopted by them An RRA
approach was then used, with informal discussions
and dialogues and open-ended interviews with guide
topics This led to the discovery that the most pressing
problem facing farmers was the long fallow due lo the
growth of a weed cogon (Imperata cylindrical
Relevant research could then begin

PARI ICIPAIOm RURAl APPRAISAI

In these five cases, then, the outcomes o! the RRA
approach, compared with the more formal question
naire. were variously more valid, less costly, more

timely. and nunc useful
A cautionary counterexample is a case of the worst
of both worlds Pettier (1992) has analyzed a one
week survey through interviews of 30 farmers con
ducted by a researcher in Northern Zambia, and
described as an RRA Pottier argues that in such hur
inwnMtivUv to the context, to who
ned interviews an i
is being met. to what is being said, and why . can lead

4

to misleading conclusions, in this case that food secu
ntv had been enhanced by growing maize The inves
ligation was. it seems, rushed and wrong The lessons
arc many, and include that humed one-off individual
interviews are liable to mislead whatever the label
attached to them, and that respondents can react by
giving responses which, for reasons such as prudence,
politeness and favorable presentation of the self, arc

reliable but invalid, and thereby convincingly gencr
ate and sustain erroneous myths

(b) Ranking
Ranking and scoring have long been pan of the

repertoire of social anthropologists People in commumtie' rank other individuals or households for
characteristics as vaned as aggressiveness, drunken­
ness. industnousness. or more commonly some con
cept of respect, honor, wealth or well-being (Pelto and
Pelto. 1978. pp 82-87; RRA Notes, No 15. 1992)
The most common method is soning cards into

piles, earned out either by local individuals in private,
or by groups Different informants often use different
numbers of piles for the same community , but evi­

dence is consistent in finding close correlations in
rank orders between different informants. Silverman
1966. p 905) found that •‘there was high agreement in
the relative rank of most persons” when three infor­
mants in an Italian community card-sorted households
according to their entenon of rispetfo (approximately
prestige) Hill (1986. pp 41.75) suggests that to vil­
lagers. relative household living standards can be a
matter of passionate concern. On the basis of field

work in West Africa and India, she concluded that
rural people (unless themselves too poor and disabled)
are able to assess the relative wealth or well-being of

members of their community far more accurately than
are townspeople This has been borne out by much
subsequent wealth or well-being ranking Grandin
(1988) found that correlations (Spearman s Rho)
across informants in 12 instances of wealth ranking
(using a total of 41 informants) averaged 0.77 (range
0 59-0 96) The correlations of each informant with
the final score averaged 0.91 (range 0 84-0 98)
Silverman. Hill and Grandin are all social anthro­
pologists and so might be expected to have developed

k

good rapport before the exercise The test is whethei

without a s4Ki.il anthropological training and relation
ship, the methyl can also be reliable and valid 1 hose

who have facilitated such ranking exercises have usu
ally found them easier than expected (sec RRA Note'.
No 15) ami usually report high correlations between
the rankings given by different informants or groups
Some triangulate rankings through discussion
Hill s three informants in Nigeria thrashed out dis
crepanctex between themselves (Hill. 1972. r 59) In

a PRA mode, on similar lines, MYRADA in South

India has evolved a method of successive approxima
lion in which separate groups rank households, ami
then meet to reconcile differences (personal commu
mcation. Vidya Ramachandran). a procedure which is
used in selecting households for anti-poverty pro

grams
A companson of a formal survey w ith wealth rank

mg for identifvmg the rural poor was conducted in
1992 by the RUHS A Department of the Christian
Medical College. Vellore. South India A survey with
a pretested structured schedule was administered to

412 households by five very experienced investiga
tors, collecting data on type of house, caste, education,
occupation, ownership of assets, number of dresses
’ ,■ income. A “professionals’ clas­
per person, and year!)

sification” was then compiled, based on a composite
~
index calculated for each household. A separate com
munitv classification through wealth ranking was
facilitated, and conducted by groups of knowledge
able local women and men In making their classifica
lions, those local analysts took into account a wider
and more nuanced range of considerations, such as
types of ow nership of land and of livestock, types and
amounts of debt and repaying capacity. types of job.
whether permanent or temporary, bad habits, and
capacity to give children education. The two classifi­
cations coincided for 62% of households About half
of the 38% which were discrepancies were investi­
gated by senior researchers in careful detail, including
home visits They found the community classification
correct in 92% of the discrepancies they examined
This confirms that community classification by

wealth ranking is accurate Also it highlights the limi­
tation of the professional classification specially when
it deals with economic level (RUHSA. 1993. p. 20.

and personal communication Rajaratnam Abel)
Health and physical condition are a complicating
factor Again and again, analysts who rank for some
concept of well-being include health as well as eco­
nomic condition A study in Bangladesh which sought
to separate wealth and health into two exercises, found
a remarkable degree of consistency between male and
female groups' rankings for wealth but classifications
for health which were similar in only about 40% of

cases (Adams. Roy and Mahbub. 1993). a discrepancy

important to investigate.
Another example is the ranking of the value of 30

1260

WORLD DI Vt IOPMLNT

browse plants as (red to lheir calllr by pastoralists in
Nigeria (Bayer. I9K7, 1988) Rankings for the most
important plants were found to correspond close!)
between different groups of pastoralists
Ranking exercises base limitations In a group, one
person ma) dominate and osemilc others With uell
being ranking some analysts base been reluctant oi
unreliable in ranking themselves, their near relatives
or their close fnends Shared concepts are needed for
consistent rankings In general though, as the exam

l)

pies cited suggest, there lend to be close correlations
between the rankings given b) different local analyst*.
This appears to be where four conditions obtain
where information is common knowledge, where cn
tena are commonly held and well understood, where
what is ranked is a matter of intense interest, and
where analysts do not perceive advantages in giving
false or misleading judgements These condition*,
have, to date, quite commonly prevailed

— In February 199?. in Kabnpathar village.
Bharuch District. Gujarat. Raibcn. a woman from a
neighboring village, and who was not literate,
facilitated census mapping b) women onto ranis,
leading to a full village census of 87 families, go
mg numbers of women, men. girls, boy s. bulhx ks.
cows. buffakKs. goats, donkeys and olhci mfoi

mation. completed and checked in about four
hours
— Abo in 199?, the National C ouncil for Applied

Fconomic Research undertook research to com
pare the costs, accuracy and reliability of a sample
survey using questionnaires and RRA/PRA meth

ods In an evaluation of the national improved
chulah (stove) program in Maharashtra State, an
NCAER team compared results from a sample sui
vey covering 120 villages in 15 districts, with
RRA/PRA methods m 10 villages in five districts,
carefully chosen alter stratifying the state in homo
geneous regions In these 10 villages participatory
mapping and other methods were used The demo

(c) Participatory- villafic censuses

graphic data derived from the participatory map
ping were much closer to the recent 1991 census

In participatory social mapping, v illagers show the
location of households In India in 1991 this was

than that derived from the normal survey methods
The study (N'CAER. 1993. p 91) reported The
overall conclusion
supports the claim of

extended by Sheelu Francis and others into participa
lory censuses Census maps have show n social details,
representing people and household characteristics
w uh local materials such as different seeds, stones and
vegetables, or markers such as Hindis (the small spots
Indian women place on their foreheads) A practice
developed by Anusuda and Perumal Naicker of
Kethanayakanpatty village near Madurai in Tamil
Nadu, is to have a card for each household and mark
details with symbols on the card These have been
placed on card- or on the ground on the maps or mod­
els to indicate lor each household the numbers of men.
women, and children, assets owned, wealth/poverty.
the handicapped, immunisation status, education, and
other information With an informed group or person,
a participatory census of a small v illage has been con­
ducted in less than an hour, and then other infonnauon
added by ‘interviewing the map"
Four examples can illustrate
— In May 1991. in Ramasamypath village, near
Tirtjchuli. in Tamil Nadu, a triangulation of cen­
suses took place In a FRA training organized by
SPEECH, an NGO. four groups of between
approximately five and 15 villagers used different

methods of analysis and presentation two did
social mapping direct onto paper, one made a
ground model of the village with a card for each
household, and one did a seed census onto a map
draw n on a floor Each group independently gener­
ated a figure for the total population of the village
All four processes generated the same figure —
355 The few discrepancies concerning occupa­
tions were quickly resolved in a v illage meeting

RRA/PRA adherents that it provides a highly reli­
able village level data base on quantitative as well
as qualitative variables
— In August 1993. in the village of San Mauricio.
Samar Island, the Philippines, about 20 villagers
took pan in census mapping (including informa­
tion on education, land size and tenunal status of
land as well as people) for their village of over 60
households The Barangay Captain and Secretary

said this was unnecessary as they had data on num
bers of males and females and their ages from their
own 1992 census and partially completed 1993
census But as the participatory mapping pro
ceeded. they noticed discrepancies and corrected
what they found to be errors in their own data,
in the end lakmg all their census data from the par
ticipatory process (personal communication.

Ditdit Pelegnna. 19931

(d) Rum full diitu

It has bee»- found that farmers will often readily
estimate days and amount of rainfall by month In
1988 two farmers in Wollo in Ethiopia estimated
numbers of days of rainfall by month for the previous
five years, and also indicated the pattern they rumem
bered from their childhood (Conway. 1988. ERCS.
1988. pp 50-52) A common method now is tor local
analysts to arrange a line of 12 stones for the months
of the local calendar and then estimate rainfall using
either seed' for numbers of days of rain by month or

rARTICIPAlOm RI'RAl AH’RAISAI

broken Mukv loi rcl.itnc volume. 01 both Some
t.irmciv in India have prelened to indicate depth of
soil moisture b\ month as K ing more roles ant lot
agricultural purposes (personal communication. J
Mascarcnhas loi Karnataka and Sam Joseph lor
Raiasthan) A refinement, invented b) women in
Galkada village. Badulla District. Sri Lanka in
Januarv IW. r to space the seeds to indicate the dr
tribution of davsof ram uithin each month
The question is how valid such data arc I armors
data on rainfall have several limes been found to differ
from those of nearby rainfall stations At Nugu Dam in
H D Koto. Karnataka, in August 1990. a discrepancy
was found but not further analyzed In rapid catch
ment analysis in Kenya (Pretty. 1990) when fanners
patterns of rainfall differed in six different catchments
and also differed from the “real" data from a nearby
rainfall station, this was judged to reflect spatial heterogeneits. without ruling out the possibility that the
fanners were wrong (personal communication. J.
Pretty) The only detailed analysis of comparisons to
date comes from Nepal It was (here in May 1990 near
Lumle that farmers for the first time indicated volume
and numbers of days of ramfall per month using seeds
for days and sticks for volume In 45 minutes, they
presented first a normal year and then a pattern which
thev said occurred one year in five Gill’s (1991)
painstaking analysis of their perceptions compared
with 20 years of daily rainfall data at the nearby rain
fall station shows that what initially appeared as dis
crepancies where the farmers were “wrong" turned
out on closer examination to show respects in which
the farmers’ judgements weie superior to the averaged
met station data Gill’s title “But how does it compare
w ith the real data'r’ captures the irony of the assump­
tion that scientifically measured data are necessarily
supenor More balanced conclusions are that there are
different realities, that farmers’ realities are likely to
he linked to agricultural utility and weighted by recent
experience, and that the issue is whose reality counts,
in w hat contexts, and for what purposes

<e) A rif^or of trustworthiness
Much ngor in the social and natural sciences is
linked u uh measurements, statistical tests, and replicubilits These are reductionist, since most realities,
other than discrete units (such as people) which can be
counted, have to be separated into or examined as
purr if thej are to be measured The simplifications
which result, even if the measurements are accurate,
mivs or misrepresent much of the complexity and
dnersii) of system interrelationships This leads to a
■ ondmon in which

I nfonunjiel). there appears to be an inverse relationship
Ktueen ngor and relevance in most social science work

I?M

Thr mas hr hcrauM- ngoi always requires some icdm
honism simr certain aspects of phenomena atr ncics
vuih excluded by any classifkalion and mcasuicmrni
Morrovei. thru changing nature lends to be ignoied
bcsausr taking this into account greatly complK.iics
analysis (liphofl. 1992. r ?MS)

The purpose of ngor r trust worthiness (Pretty. I9MM
Reductionist rigor is an attempt to minimize the elc
mem of personal judgement in establishing trustuoi
thiness That it d<»cs not work well in the social sci
enccs is only loo ev idem from the widespread mistrust
of the findings of questionnaire survey s If such forms
of reductionist rigor do not carry conviction, the chai
lenge is to find w ay s of enhancing both relev ance and
trustworthiness at the same lime
The experience with RRA and PR A contributes
here Relevance is enhanced through local specificity
local people define relevance and present, analy ze and
enhance their local knowledge Trustworthiness is
sought through the principles which have been
induced from effective practice (see section 2 above)
In pursuit of a ngor of trustworthiness, these can be
applied by outsiders in a combination of three ways
through active intervention; through management and
observation of process; and through the exercise of
cntical judgement
The active intervention of outsiders can be illu'
trated from Nepal Two groups of outsiders found dr
crepancies in the information on seasonality and
trends in agriculture which villagers had shared with
them

The response was for bodi groups to back to their s illage
the next das and reconcile the information, with their
respective groups of informants forming one combined
group, and with the statement “We got the information
from you yesterday and there seems to be some differ
ence Can you help us*1" And of course they did
Information flowed, arguments and discussions to«4
place among the villagers, among (he outsiders and
between both villagers and outsiders
Explanations
were given, corrections made, and it was a much more
satisfied group of researchers that relumed to the bast­
camp that night (personal communication. Jamc'
Mascarcnhas)
Discrepancies were thus recognized by the outsiders
and taken as opportunities to get closer to a consensus

reality
Second, there is the ngor of observed process
Outsiders initiate, facilitate and then critically observe
the process of analysis, especially with visual (map
ping diagramming, etc ) analysis by groups In con
irast with most questionnaire surveys, this group
visual analysis gives the observer time and freedom to
watch interactions, to see how much crosschecking
and correction take place, to assess the commitment of
analysts, and to judge whether information is being
distorted or withheld A group-visual synergy often

WORLD nr VH OPMI NI

I2t?

4

develops (Figure I) with cumulative group enthusi
asm. adding and amending detail in order lo create a
complete and accurate picture
Third, (here is the ngor of personal and peer judge
ment informed by self-cntical scepticism and aware
ness applied throughout Two of the cases desenbed
above pros ide a salutary caveat When the four groups
at Ramasamypatn all came up with 355 as the popula
non of the village. I was excited I collected the report
mg maps and diagrams, and labeled, arranged and
photographed them This positive evidence has since
been disseminated through copies of the slides Only
later did I think lo ask whether there had been any
exchanges of information or of figures between the
groups In fact I believe there was none But had the
groups come up with figures which differed, the ques
non is whether my reaction too would have differed,
whether I would have collected and photographed the
maps and diagrams The danger is selective recording
and dissemination of the positive Similarly with ram
fall, the Nepal case has been meticulously analy zed by
Gill and published But this was not done in the Kenya
and Karnataka cases. Had (hose discrepancies been
investigated further, they might, as in the Nepal case,
have revealed a validity in the farmers’ judgements; or
they might not We do not know Rigor requires con
sistency in probing inquiry into the whole range of
types of case To ensure this, shanng with peers, and
inviting critical review, is perhaps the strongest safe
guard
These foundations of ngor ment further explo­
ration, analy sis and application Pretty (I993)haspro
posed complementary foundations for analysis of
trestworthmess which include prolonged and/or
intense engagement, persistent and parallel observa­
tion. tnangulation of sources, methods and investiga­
tors. peer debnefmg. negative case analysis, and
checking by participants Of these, checking and cor­
recting by participants stands out as a strong test, in
practice often earned out through presentations by
local anaUsK w a Itffa 4ec<!
through
new tests of trustworthiness presents a frontier for

ANALYSTS

Grot^

jh—i-irrxXavvaA

a ’/
a (Mot’vabon

Vaual'

/
•
a
a

Tange*

*.a

a
■
a

/

Cro*i
ttwetOng
Convana

•■•••

//
Obaanra
rac**-»te
y
FACILFTATORS \[ FACILfTATORS !
Inftaia

Figure I Group \ouul *\-nrrg\ in PRA

PR A. and can be cipccled lo have applications for
much other inquiry and research

5 RI VI RSAI SANDRI Al ITY
Most of those who have innovated in developing
PRA have been practitioners, concerned with what
works, and what will work better, not academic theo
nst> concerned with why it works They have been
searching not for new theories or principles but for
new and better ways of learning and doing Pot them,
the power and utility of RRA and PRA. undertaken
w ith rappon and self-cntical ngor. arc empirical facts
of common experience they know that they work, and
that done well they can lead lo belter local develop
mem But the why9 Questions remain, leaving further
issues of explanation There is now enough expen
ence to suggest some answers
Elaborating and crosscutting some of the princi­
ples of RRA and PRA (see section 2 above), further
explanations can be posited under the rubnc of “rever
sals." meaning directions away from normal profes
sional practices and toward their opposites Four clus
lers of reversal intertwine, and are mutually
reinforcing reversals of frames; reversals of modes,
reversals of relations, and reversals of power
(a) Rtvcrsals ofpanic* From elu Io emu

An overarching reversal is from etic to emic. from
the knou ledge, categones and values of outsider pro
fessionals to those of insider local people
Conventional investigations are preset. Almost all
questionnaire surveys arc designed by outsiders uith
outsiders' concerns and categones. The) seek to elicit
responses to fill fixed boxes Whatever the intentions
that investigators shall probe under the category 'other
which lies at the end of the list of precoded responses on
the sheet, thej rarcls do. and where the) do it presents
problems later m coding and analysis To be cons enient.
reality is forced to fit the professionals’ familiar frame
The frame of local people is. however, usualls not
knowable in advance The reversal from etic to emic
has. then, to be from closed to open In contrast u ith
questionnaire interviews, semi-structured interviews
(Grandstaff and Grandstaff. 1987b) are more open,
conversations (Scnmshaw and Hurtado. 1987) more
so. and PR A mapping and diagramming perhaps most
of all In a semi-structured interview there can be a
checklist for reference, but not a preset sequence of
questions, and a value can be set on probing, on pur
suing leads, on serendipity In conversations, there
can be greater freedom and equality In PRA methods
such as participatory mapping and modeling, matrix
ranking and sconng. Venn or chapan diagramming
and well-being ranking, insiders can be even more in
charge of the agenda and detail, not only free to

PARTICIPATOm RVRAI API’KAISAI

cxpicss then knowledge and values, but encouraged
and enabled to do so The shill is from preset and
closed to panic ipatory and open

(b) Kc\cr.\nl\ of nuulcK

Modcx ol interaction and analyst' arc reversed
front then nomul directions in three ua\s horn mdi
\ idual to group. Ironi verbal to visual, and Iron) nica
sunnp to comparing
< i) / r<nn individual to group
Normal investigations stress mdi\ idual mtervieu s
Professionals need numbers Questionnaire sur\c>s
uith individuals or households generate commensu
rablc numbers convenient for statistical analysis In
RRA. semi structured interviewing can be with an
individual or group, but still with somewhat more
emphasis on the individual "interviewee*’ (see e g .
Grandstafl and Grandstaff. 1987b. pp 135-137) In
PR A. discussions with individuals can and do take
place, but there is more attention to groups and par­
ticipatory analysis by groups
Groups can have disadvantages, such as domi­
nance by one person or a vocal minority But their
advantages have been undervalued Typically, (hey
have an overlapping spread of knowledge which
covers a wider field than that of any one member
Paradoxically, and contrary to common belief, sensi­
tive subjects are sometimes more freely discussed in
groups, when individuals would not wish to discuss
them alone with a stranger Groups can also generate
numbers with observable mutual checking through
self-surveys, whether verbal or visual With visual
modes, such as mapping and modeling, expenence in
PRA has been that groups often build up collective
and creative enthusiasm, fill in gaps left by others, and
add. crosscheck and correct detail Triangulation is
then both instant and observable.

di) From verbal to visual
With traditional questionnaire surveys and semi­
structured interviewing, most of the transfer or
exchange of information is verbal This contrasts w ith
the visual mode of participatory diagramming This
includes social and census mapping, resource map
ping and modeling, seasonal analysis. Venn and chap
(iti diagramming, trend diagramming, matrix ranking
and scoring, and time use analysis, and i' often a
group activity
With visual analysis, relationships change The
topic may be determined, or at least suggested, by the
outsider, but the role is not to extract through ques
ions but to initiate a process of presentations and
analysis The outsiders arc convenors and facilitators,
the insiders actors and analysts The outsiders hand
over control, and insiders determine the agenda, cate

I?61

goncs and details The media and materials air often
those o! insiders
the ground, stones, sand seeds as
counters, sticks as measures, and so on I ye contact,
and insider's awareness of the outsider, are low
Information is built up cumulatively, and crosscheck
mg is automatic Otten, several or mahy people arc
involved Knowledge overlaps If half a dozen women
diagram a census map of their village, show mg women,
men. children, handicapped persons, and so on. not
everything may be known by each, but two or more
may know each item Debate can be lively because
everyone can see what is being said II can then be the
diagrams rather than the people who arc interviewed
Visual methods can alsoempowcr the weak and dis
advantaged Visual literacy (Bradley. 1992) is mdepen
dent of alphabetical literacy, and appears to be near
universal Visual diagramming is thus an equalizer,
espcciallv when it is done using the accessible and
familiar medium of the ground On paper, loo. the non
literate can diagram In Kiteto District in Tanzania, m
June 1992. a nonliterate Maasai young man. though
mocked as incapable by his literate colleagues, look a
sheet of paper, and went off and quietly drew a detailed
map of a large village area and its settlements. In
Pakistan, in March 1992. several nonliterate women
drew complex systems diagrams of their farms and
households with internal and external flows and link­
ages (personal communication. Jules Pretty)
Describing the expenence of the NeighbourhovKi
Initiatives Foundation (NIF) in the UK. Gibson (1991)
has pointed out that "ihe talkers nearly alway s win "
But with a physical model of their neighbourhood to
play with, timid people can physically put down their
ideas Often "people who put down an idea wait for
others to talk first about it. and then say themselves I
agree with you ” (Gibson. 1991) Similarly participa
tory mapping and matnees can enable marginalized
women to express their preferences and pnonties in a
physical form which does not entail personal confronta
tion with otherwise dominating men
Some contrasts between verbal and visual modes
are presented in Table 2
The shift from verbal to visual is one of emphasis
in PRA Diagrams are pan of the repertoire They can
be facilitated on their own early in interactions They
can aKo be pan of semistructured interviews or con
versanons Diagrams then present an agenda for dis­
cussion Interviewing the map.” "interviewing the
matnx.” and "interviewing the diagram” have proved
often the most fruitful, but also the most neglected,
stages of a discussion and diagramming process With
the visual, "a whole new set of questions and discus­
sion anses which docs not in the verbal" (personal
communication. James Mascarenhas) The verbal, as
shown for example with oral histones (Slim and
Thompson. 1993). will always remain important But
combinations of visual and verbal are stronger than
either on its own

i

WORLD |>l VLI OPMl N1

lablr 2 Coni ran a hrrwrfn vnuu/ and vrrtsd

Verbal
(iniervreu.
conversation)

i

Visual
(diagram)

Oulsairt's roles

Investigator

Ou i side i s mtxle
Outsider's interventions
Insida's roles
Insider's mode
Insida's au areness of outsider
b ve oontjcl
The medium and material are those of
The poorer, ueaker. and uomen can be
Detail influenced bv
Information flou
Acceoibilit) of information Io others
Initiative for checking lies uith
Cnlity for spatial, temporal and causal
analysis, planning and monitoring
Ou nenhip of information

Probing
Continuous and maintained

Respondent
Reactive
High
High

Initiator and ratals st
la<. ilitat mg
Initial and then reduced
Presenter and analvst
Creative
1 ou
I ou
Insider

Outsidei
Marginalised
Etic categories
Sequential
Lou and transient
Outsider
Lou

I mic perceptions
Cumulative
High and semi permanent
Insider
Higher

Appropriated b) outsider

Ouned and shared b) insider

(in) From measuring to comparing
Normal professional training is to make absolute
measurements So if trends or changes are to be iden­
tified. or conditions compared between households or
between places, this is through measurements made
either at different times, or of different things, or in
different places Our preoccupation with numbers
dnves us to ask "hou much9" For sensitive subjects
such as income, such questions can sou suspicion,
wreck rappon, and generate misleading data
For practical purposes, compansons without mea
surements are often enough They have advantages
Involving reflection and judgement, they are easier and
quicker to express than measurements The\ can be
elicited for trends and changes without formal baseline
data They art less sensitive, as has been shown by
wealth and well-being ranking, and by seasonal analy­
sis asking hou income compares betueen months is
easier to estimate and less threatening to reveal than are
absolute figures In addition, comparisons, as uith
matrix ranking and scoring, can in a short time elicit
complex and detailed information and judgements of
value inaccessible by other methods unless with great
labor Moreover, trends, compansons and weightings
lend themselves to visual shanng. with all its potential
gams in participation, tnangulation. progressive approx­
imation. and learning Companng can be quicker and
cheaper, and often more credible, than measunng

(ci Rf\t'r\als id relati<>n\ From reserve io rapport,
from frustration to fun
These reversals of frame and mode follou from
generate and reinforce a reversal of relations, from
suspicion and reserve to confidence and rappon

I nipouered

With outsider-insider interactions, there is a scale
of formality-informality, from the structured inter­
view with questionnaire, through the semi-structured
inters ieu with checklist of subtopics to the conversa
tion With interviews, and sometimes afso conversa

tions. outsiders ask questions and probe The outsider
usually maintains control and largely determines the
agenda and the categones. Eye contact is common
The interview ee responds, conscious of an interaction
with a person who is seeking information
An initial reserve of local people toward outsiders
is a commonplace Their responses are often prudent
to avoid loss and hopeful to gain benefits RRA and
more so PRA stress the process of gaining rapport
Some social anthropologists have expressed scepti­
cism about the relative speed with which rappon can
be established For their deeper and more fully emic
understanding, there is a case for more lengthy immer­
sion But the experience with both RRA and PRA is
that when outsiders behave well and methods are par­
ticipatory. good rappon usually comes quickly. This is
through outsiders being unhurried, showing respect,
explaining who they are. answenng questions, being
honest, and being interested, and asking to be taught,
being taught, and learning
In the classical view, much good fieldwork is
painful It entails long hours of collecting and check­
ing data Moser and Kalton (1971. p 296) observe of
questionnaire surveys An interviewer's interest is
bound to flag after a time
' Pelio and Pelto (1978.
pp 194-195) cite the case of an anthropologist.
Kobben. who had to make "a great sacnfice of time,
during a year of field work, to collect . . quantified
data on a mere 176 persons" and even then he felt
rather unsure of the validity of some of his data The
same authors go on to consider hou extensive survey

I’ARIK II’AIOM Rl KAI Al’I’K MS \l

d.H.t Irotu qucMionn.iiiV'* need' I” be disked .uni
qn.ililicd b> othci method'* .mil emu hide

all the p.iiin ijunis expressed a sitonp ilesire to ion
linuc the work and to go mio H more dceplv (Hahn
|QU| p lj Quite often dissatisfied with then Inst

Clr.itl\ the qii.miilicd d.iia »’l suncx icsv.iu h ot otln i
standardized mien iew mg icquiic Jose suppMi tr«’in
partii ipanl obscrvalmn and general inlonn.il iniervic"
rng Bu< the lomcrsr is equallv uue 1 he lesson rn all
this as Robben made clear r tlx.it held reseau l» emails a
both
great amount ol tedtous time lonsiimmg work
qualitative and numerHal tl’elio and I’cho |U7X PI'
|VJ IDS)

aiicmpi al a map villagers scrub it out and start again
with coiueniiaicd enthusiasm Again and again vil

Some carltct panic tp.ilof' resv.itch .iKo Milleted

works well it seems to be* a pood experience for ex civ
one ips-rsonal communicafion. J Pointing) lhe

*1
ftom being long and diavn out 1 he pdoi project tn
appropriate lechnologs lot pram storage in Rwaktia
( him village in Tanzania involved an outside team

residing in the village lot eight weeks 1 his was con
siderd a "short period ol dialogue, but even so the
application ol the dialogical methodologv was "time
consuming and tiresome (Mduma. I^S2. pp 2OV

2l3t

This contrasts with RRA Professional conveisa
tmns are mutually stimulating and interesting Of
catllekeepers in Nigeria who ranked browse plants

Baver (1988. p 8i wrote that "Pastoralists were ven
Milling to share their knowledge about browse plants
w uh us and appeared to enjov the interv lew s as much
j. we did ’ Reflecting on the comparison between a
topic RRA and a questionnaire sunev on torestn and

tuelwood in Siena Leone. Inglis tlQMI. p 4(h wrote
that the RRA approach enabled respondents "to enjov
j professional chat about their livelihood or kitchen
habits, instead of being subjected to an intrusive 278
question questionnaire bv bored enumerators
With PR A the contrast has usuallv been even
stronger Data are not collected bv outsiders, but
expressed and analyzed bv insiders A common expe­
rience is group-visual svnergv as illustrated in Figure

lageis in India have lost ihcmsches‘m mapping and
nitHlchng and otilsidcis have had lo learn not to inter

view not lo mlcnupl. not lo disturb their creamitv
1 here is pi ide in what has been made, and pleasure in
picscnting it to others In the words of a posh ard irom
Pakistan received as this is written "When PRA

cx|X’iicncc ol PRA is often fun

|J> A’< K M.//'<»//><’»»< > him) C\IKI< //'IV ft*
t m/'ttu< ///iv
Rcvcisals ol frames, modes and relations con
tribute to rcvcisals ol power In the forms which have
spread PR A has stressed abdication ol power and
passmi’ much of the imliativ e and control to I<k al pi o
pic. using the metaphor (and sometimes reality) of
"handing over the suck" tor chalk, or pen) From the

perspective ol power. PR A contrasts with the more
extractive data collecting nature of traditional meth

ods ol inquirv
In questionnaire mterv iewmg. power and initiative
he with the interviewer The questionnaire is "admin

istered to" the person interviewed The interviewee Is
a "respondent." a person who replies or reacts The
Latin
\ptmdert' means to return like with like The
questions and categories are those of the interviewer,
who also records the "response *’ The professional
concern is less with people — the respondents, and

more with what the) provide — the responses In their

ate Local people as analvsts K-rnme engaged jn Lan
e/hh' iixiLi! diagramming, a cumulative process of

textbook 5//n< ' Mcllhhh in Stnhil ln\i 'ititalion
I IM" 11 Moser and kalton have onlv two index entriC'
for
respondent." but 32 for "response
The

presenting, sharing, adding and correcting inform;',
non which generates interest and takes off with its
own momentum The role of outsiders then is to keep

responses matter m'»re. for thev are the raw material to
be mined, packaged transported and processed, the
commensurable output to be collected, categorized,

quiet observe, a- .ess. and support, and often not to

coded counted and conelated
In classical social anthropological investigation,
too th. ullimate aim hj' been lo obtain data w hich arc
then analv/cd and written up awav from the field
Participant observation demands and creates sharplv
different relationships to questionnaire survevs but the
bask objective remains similar Development anthro­

I Outsiders convene, provide an occasion, and initi­

interrupt isee Figure 11
For outsiders, in Devavarum s words t/?/M X///('v.
\o IV p |()i. "One doesn’t get bored repeating field
uork h is always interesting W hat is shared is often
unexpected and at times fascinating For insiders the
».native act of presentation and analysis is usually a
plca'ure. and also a process of thinking through
learning and expressing what the) know and want In

matrix storing for trees or crop varieties, using the
ground and seeds, it is a common experience for the
utsider to become redundant as the process takes ofl
a - villagers debate and score on their own After vil­
lage participants had made and analyzed models
i iHiiqiH th * i of their env ironmenl in Burkina Faso.

L

I>S

pologists aim to be useful through their work in a more

direct manner, and manv anthropologists intervene in
their field for ethical reasons But the basic objective
often remains that of a researcher, leading to the
crowning consummation of data and insights
processed into a Ph D thesis, articles or a book
In contrast, the thrust of PRA is to reverse domi­
nance. to empower more than extract The objective

Z

i

/

1266

WORLD DFVl I DPMI M

sought by many practitioners is less to gather data, and
more to Mart a process Approaches and methods lend
to be what Scoones ind Thompson (1993. p 22) call
nrrformiiive” (as also with folk theater, stones.
rbs. songs and the like) through visualizations
break down the distinction between data and
analysts The initiative is passed to “them ” The stick
is handed over The pome actors arc the people The
outsider is less extractor, and more convenor, facilita
tor and catalyst Even so. two practical and ethical
issues stand out
The first issue is w ho is empow ered The easy. nor
mal tendency is for those who participate and w ho arc
empowered to be those who arc already more power
ful or less weak — the better-off. elites, officials, local
leaders, men. adults and the healthy, rather than the
worse-off. the underclasses, the vulnerable, lay peo
pic. women, children and the sick When this occurs,
the weak and poor may end up esen worse off Vi ith
women, the problem is compounded by their many
tasks which make it hard for them to find blocks of
undisturbed time enough for some of the participatory
modes of analy sts Deliberate steps have been repeat
edly needed to offset such biases, identify ing different
groups in a community , and encouraging and enabling
women to conduct their own analysis and express
their ow n priorities (Welboum. 1991)
The second practical and ethical issue is what the
shared information is used for The unselfconscious
shanng of information by local people through partic­
ipatory methods is open to abuse by outsiders PRA
method^ could be used as a tnck to lure unsuspecting
ole into parting with their knowledge Examples
are not yet known but can be expected.
A legitimate and sensitive PRA process can seek to
enable outsiders to learn, but through the shanng of
information in a manner which enhances people's

analysis and knowledge and leaves them owning it
The actual and the ideal, here as elsewhere, w ill rarely
conespond exactly But an ideal sought by some PR A
practitioners is a process in which people. and espe
cially the weaker and poorer, are enabled to collate
present and analyze information, making explicit and
adding to what they already know This happens, lot
example, thmugh participatory mapping ot a water
shed where the map is used by s illagers to plot cunent
conditions and plan actions, and is retained by them
for monitonng action taken and changes, or through
mapping and surveying degraded forest, deciding how
to protect it and what to plant, and then managing the
resource, or through matrix scoring for varieties ol a
crop which enables them to specify the characteristics
of a wish" sanely they would like The aim is to
enable people to present, share, analy ze and augment
their know ledge as the start of a process The ultimate
output is enhanced knowledge and competence, an
abilns to make demands, and to sustain action Instead
of imposing and extracting. PRA is then designed to
empower
The populanty and pow er of PR A are linked PR A
is not always well done But w hen it is well done, local
people, and especially the poorer, enjoy the creative
learning that comes from presenting their knowledge
and their reality They say that they see things differ­
ently It is not just that they share know ledge w uh out
siders They themselves learn more of what they
know, and together present and build up more than
any one knew alone The process is then empowering,
enabling them to analy ze their w orld and can lead into
their planning and action It is not the reality of the
outsider which is transferred and imposed, but theirs
which is expressed, shared, and strengthened In this
final reversal, it is more the reality of local people 'han
that of outsider professionals that counts

NOTES

I An illustrative but certainly incomplete listing is
Australia Bangladesh. Canada. China. Colombia. Denmark.
Eire. Germany. India Kenya. Nepal. Nigeria. Norway.
Pakistan, the Philippines. South Afnca. Sweden. Tanzania.
Thailand, fganda. the Cnited Kingdom, the fnited States.

Vietnam. Zambia and Zimbabwe
2 This anicle is based on the work of man\ people, loo
numerous io name, but I thank them all For comments on ear­
lier versions I am grateful to Tons Dunn James Mascarenhas
Jules Preus and two anonsmous referees Responsibilits tor
errors, omissioii* and opinions is mine alone

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RRA Kott s. No 12 (1991). pp 32-40

i

I 26*

InfliK

i

WORLD Df VI I OPMI M
Andre*
Stc*»n “HarvcMmf hxal foreMn know I
i

cdfc A field leM and evaluation of rapid rural appraisal
icihmques (or MKial foreMr) prvjev’ anal) ms.’
Dissertation presented for the degree of Master of S< renve
tl.dinhurgh I'niserMt) of Ldmhurgh IWOt
Krnson John "When a commumt) describes itself.
lofrilu■' ((klobei December I9KD pp 21 ?6
KGVK Miiini^t nifnt 1 rairunf; Munutil (Bihar Indra Knshi
Gram Vikas Kendra Ram hi. Bihar 19911
KKl rr<»<rn/inci of the J9X' Intrniafional ( ••nfrirfur on
Rapid RhkiI Appww1 Ru,al S)stems Research and
fanning
Systems
Research
Projects
(Thailand
I'nisersits of Khon Karn. I9H~I
I onphurst R (t d >. Rapid Rural Appraisal IDS Rullctin.
Vol 12 No 4tl9SH
McCracken. J A . Jules N- Pretts and Gordon R Conua\..4»r
Inirodm tian to Rapid Rural Appraisal for Aftiouhural
Dc\ flopmenf tLondon IILD. I9KS>
Mascarenhas. J . and P D Prem Kumar . • Participator) map
ping and nuHJellinp User’s notes. RR4 Sotos. No I?

<|99|j pp 9 20
Mduma. I K
Appropriate technolop) for gram storage in
Buakira Chmi village.’’ tn Y Kassam and K Mustafa
/Sirin ipators Research (Ne* Delhi
Societ) lor
PartHipator) Research in Asia. 19821, pp 198-213
Moris Jon R . Multi-subject farm surveys reconsidered
Some methodological lessons. Paper for the East African
Agricultural Economics Societ) Conference (Dar es
Salaam. March 31 to April 4. 1970)
Moser. C A and G Kalton. .Sunet Method* IH SihUll
Imestmation. Second Edition (London Heinemann
Educational FL»oks Ltd. 1971)
Mukherjee. Neela \ illagers’ perceptions of rural posert)
through the mapping methods of PRA. RR1 \oit s. No
15 119921. pp 21 -26
\CAEK Comparatise Studs of Sw iplt Simes an,I
PartH ipators Rural Appraisal Meihodoloiiit s (Neu
Delhi National Council for Applied Economic Research.
I i indraprastha Estate. November 1993)
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Researih The Struiture of Inquiry. Second Edition
(Cambridge Cambridge I'niversit) Press. 1978)
Peters lorn Thrtsinii on Chaos
Handbook for <<
Man■tiiemrni Resolution (London Pan Books. 1989)
. PH) and NES An inrroaumon
r^>ucipators Rural
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Inailulion* (ithurr and Chariot at Lan al Conununits Lfvel.
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Prciiv Jules N
Participatory inquiry and agricultural
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Prvtly. Julv' N Raptd Catchment Analssis jar I slension
Xk-ent* Sult s <>n ihr /99() Krru h<> Training Workshop for
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S Subramaman D Ananthakrishnan. C
Javanthi S Murahkrishnasamy and K Renganayaki.

”1 indmg the pvorvst in a 1 amd Nadu villige A sequence
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Hurtado. R.ipid Ass, *sment
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Populist Pt r spec use
Rural People 's Knosdedstc
Auric ultura! Rt search and Extension
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Discussion Paper 312 (Brighton IDS. Lmversity of
Sussex. December 19931
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■ Farmers as analysts and facilitators m participator) rural
appraisal and planning RRA Soles. No 13 (1991). pp
84-94
Shaner VI U . P L Phuipp and V. R Schmehl. Farming
Ssstems Research and Development Guidelines jor
De\elopmc Countries (Boulder. CO Uestvieu Press I982i
Silverman. Sy de! F . An ethnographic approach to social
stratification Prestige in a central Italian community
American Anthropolo^isi Sol 68. No 4 (1966). pp
899-921 (cited in Pelto and Pelto. 1978. pp 82-84)
Slim. Hugo and Paul Thompson. L.istenms: for a Chanel
Oral Test'”.'in\ and Dtseloprneni (London Panos
Publication' 19911
Swift. Jeremy and Abdi Noor I mar Purtn ipators Pastoral
Development in Isudo Distru t 5o< i<»« onotnn Researc h
in the Isiol, Lise slock Development Project (Isiolo.
Kenya Isjolo Livestock Development Project EMI
ASAl Programme |9S|i
I'phofl. Norman Learning from Gul Osa Possihihiies for
Purtu ipators Developmcni and Post Newtonian Sm tai
Sc iem e (Itha.a Cornell L mversity Press. 1992)
U elboum. Alice RRA and the analysis of difference RRA
Notes. No 14 i Dei ember 1991). pp 14-23

U

rtrgMmon

/.’/’"h 'll \ •*! ?? N<’ H> pp H17 l-t**4 I0'14
( opvnpht v ' 1^4 I
Sk ic»»« «’ I id
I'unlt d in (iic.il Hiil.nn AU nphix iCM’nrd

ums 7Mi\'M4 k ' no ♦ nno

(BO5-75()X(M4lOOOM*-2

4

Participatory Rural Appraisal (PRA): Challenges.
Potentials and Paradigm*
ROBERT CHAMBERS!
Institute of Development Sfudie\. Brighton. I K

Summarv
Much of the spiead of panicipatory rural appraisal tPRAi Js an emerging fanulv of
Approaches and methods has been latera’. South South, through expenential learning and changes >n
behavior with diftemni Incal applications Rapid spread has made quality assurance a concern, with
dangers from instant fashion . rushing, formalism and ruts Piomismg potentials include farmers own
tarmine systems research, alternatives to quesuonnaire surveys, monitoring, evaluat.on and latera
spread bv local people, empowerment of the poorer and weaker, and policy review Changes m personal
behavior and altitudes, and in organizational cultures, are implied PRA parallels and resonates with par
adigm shifts in the social and natural sciences, business management, and development thinking, sup
ponmp decentralization, local diversity. and personal responsibility

I

INTRODUCTION

The term Participators Rural Appraisal (PRAi
(Mascarenhas ei al. 1991) is being used to desenbe a
growing famil) of approache4- and methods to enable
local people to share, enhance and analyze their
knowledge of life and conditions, to plan and to act
PRA flow s from and owes much to the traditions and
methods of participatory research (e g.. Freire. 1968 k
applied anthropolog), and field research on farming
svstems (Gilbert. Norman and Winch. 1980. Shaner.
Philipp and Schmehi. 1982). and has evolved most
directl) from a synthesis of agroecosystem anal)si<
(Gypmantasin er al.. 1980; Conway. 1985. 1986.
1987) and rapid rural appraisal (RRA) (Agricultural
Administration. 19bI; Longhursl. 1981; KKU. 1987)
PRA shares some of its principles with RRA
direct learning from local people, offsetting biases,
optimizing tradeoffs, triangulating, and seeking do erMt). To these it adds its own principles which concern
the behavior of outsiders, facilitating anal) sis b) local
people, practicing critical self-awareness and responsibiht). and sharing RRA and PRA are compared in
Table 1 A major contrast is that in RRA information
is more elicited and extracted by outsiders, while in
PRA it is more owned and shared by local people
Some of the more developed and tested methods of
PRA are panicipatory mapping and modeling, tran
sect walks, matrix sconng. well-being grouping and
ranking, institutional diagramming, seasonal calen­
dars. trend and change analysis, and analytical dia
gramming. all undertaken by local people Modes of

investigation, sharing and anal)sis are open-ended,
and often visual, bv groups of people, and through
comparisons Among manv applications (RRA \'oft'
passin;' PRA has been used in natural resources man
agement (soil and water conservation, forestr), fish
enes. wildhte. communit) planning, etc ), program^
for women and the poor, agriculture, health and food
secuntv
PRA has evolved and spread from beginnings in
Ethiopia. India. Kenva. Sudan and elsewhere, and in
earlv 1994 is known to be being quite widel) practiced
in pans of Bangladesh. Botswana. Ethiopia, franco
phone Uest Afnca. India. Indonesia. Ken)a. Nepal.
Nigena. Pakistan, the Philippines. Sn Lanka. Sudan.
Uganda. Vietnam, and Zimbabwe, while stans have
been made in at least a score of other countnes in Latin
America. Africa and Asia Hundreds of nongovern­
ment oiEamzations iNGOs) have adopted PRA and
developed applications, as have a number of govern­
ment departments The use of PRA methods is being
increasing!) explored b) siudents and facult) in uni­
versities for research, and b) training institutes for
fieldwork Spread appears to be accelerating
This article reviews practical and theoretical ques
lions raised as this spread occurs both international!)
uithm countnes and within organizations While this

•Thr paper is the third in a three pan senes examining
panicipatory rural appraisal The first and second papers
appeared in the July and September 1994 issues, respti
lively

tFmal revision accepted February 23. 1994

1437

J

I

!•*

WORLD DrVLLOPMLNI

liblc I RRA and FR4 cofrqKirvd

Pervod of major development
Major innos ators based in
Main users
Key resource earlier overlooked
Mam innovation
Predominant nxxlc

Ideal objectives
Outcomes sought

ERA

PR A

Ute I97(h. I9K(K
Universities
Aid agent ie*
Universities
I ocal people’s knou ledge
Methods
t ilraciivc-elicitisc
loaming bs outsiders
Useful information, reports, plans, projects

late l9R0s. I99(k
NGOs
NGOs
Ctovcmmem field organizations
Local people's capabilities
Behas lor
f at iliiating participatory
Empowerment of kx al people
Sustainable local action and institutions

may be timely, it has also lobe tentative and to rely on
the writer’s personal experience and judgement PRA
approaches and methods will be examined in terms of

ods u hich generate figures, matrices and tables can be
immediately attractive Meamsrru/ (1992) found in
Mongolia that wealth ranking was useful in this con

how they have spread, quality assurance, dangers,
potentials and strategies, and finally paradigmatic sig

text as part of a 'hidden agenda’’ by giving "every
appearance of being the kind of hard’ statistical

nificance 1

method that Mongolian researchers and bureaucrats,
like their counterparts in many parts of the world, have
been professionally socialised to use and expect" (p
37) Similarly, matrix scoring for vaneties of a crop
provides not only fascinating and useful information
and insights (see e g.. The Women of Sangams.
Pastapur and Pimben. 1991; Dnnkwater. 1993) but
also good-looking tables with figures Scientists and

2 HOW PRA HAS SPREAD
The waj PRA has spread can be analyzed in terms
of three basic components and in terms of modes and

media

others, can be so impressed by farmers’ critena.
(a) Spreadsiressint; basu i umpiments of PRA

judgements and abilities as demonstrated in mainx
scoring that they go on from this method to others, and

progressively
The three basic components of PRA (Mascarenhas
ei al. 1991, p 35a) have been identified as methods,
behavior and attitudes, and shanng. Their significance
has been recognized and stressed in that sequence
The first basic to be recognized was participatory
methods to facilitate analysis by rural people. Some
methods were adaptations of those already widely
used in RRA. such as semi-structured interviewing
and focus groups Others such as participatory map
ping and mainx scoring were new: local people now
did what before outsiders had done, and had often

believed that only they could do
in RRA and initially in PRA. irajiung stressed the
correct performarnut oflbc methods Manuals, guides

and sourcebooks (e g. McCracken. Pretty and
Conway. 1988. PiD and NES. 1989. Gueye and
Freudenberger. 1990. 1991. Theis and Grady . 1991.
Campbell and Gill. 1991) covered approaches from a

more extractive-elicmve RRA style to a more partici­
patory-empowering PRA style They also varied in
the degree of formality or flexibility implied, from a

set stepwise sequence specialized for the preparation
of a Village Resource Management Plan (PID and
NES. 1991) to the open-ended listing of a menu w ;th
commentary (Campbell and Gill, 1991)
Methods have provided a professionally accept
able pom; of entry for the spread of PRA PRA meth­

become more participatory

in their

approach
Increasingly in PRA. a second basic came to be
seen as the behavior and attitudes of outsiders For

local people confidently and capably to express their
ow n knowledge, to conduct their own analysis, and to
assert their own priorities, outsiders had to step off
their pedestals, sit down, "hand over the stick." and
listen and leam Such behavior conflicts with much
normal professional conditioning and self-esteem. In
(he field, most outsiders find it difficult to keep quiet,
to avoid interrupting, to abstain from criticism, to
refrain from putting forward their own ideas In line
with this recognition, field expenence training came
to stress changes in how outsiders behave

Kumar

(1991). a leading trainer in the Indian Government
service, placed his main emphasis on behavior and
attitudes He made the counterintuitive discovery that
outsiders with less briefing about the methods were
more successful as facilitators than those who were
more fully bnefed To tackle the problem of behavior
in the field. Anil Shah, of the Aga Khan Rural Support
Programme (India) invented "shoulder tapping"

(Shah. 1991) as a corrective This is a contract
between outsiders io tap the shoulder of any colleague
who criticizes, asks a leading question, or puts for­
ward his or her own ideas
The most powerful and immediate change in

I4W

l‘AR1ICIPA7<»H> Rl’RAI APPRAISAI

•)

bchavioi and attitude* ha* been through DIY (do it
yourvclll Thi* entail* requesting local people lo be
teacher*, while the out*idcr* arc *tudcnt* who arc
taught to do □ local ta*k such a* w innowing gram
muddmg a wall, (hatching, spreading manure, weed
mg. transplanting, washing clothes, cooking, or fetch
mg wood or waler In a refinement developed by
Kamal Kat tn India, the outsiders arc videoed with
*ub*equent v icw mg and discussion of a playback both
to them and to villagers The impact can be strong,
btuh personally for outsiders, and in establishing rap
port between outsiders and villagers
These shifts of emphasis have found expression m
the content and style of training (Table 2) Didactic
training ha* taken longer, and has been mainly m the
classroom; experiential learning has taken less time,
and has been mainly in the field, and especially stay
mg or camping in villages As behavior and attitudes
have come to be recognized as crucial, so field expen
cntial learning has become more prominent
The third basic in the philosophy and practice of
PRA came to be recognized as sharing. For practition
cr* and trainers this ha* become increasingly a con
sciou* strategy and mode of spread It has two dimen­
sions shanng know ledge and shanng expenence
Sharing knowledge takes three main forms
— Local people share knowledge among them
selves, especially through analysis in groups and
v isual presentations
— Local people share that knowledge with out­
siders As a condition for facilitating this process,
outsiders restrain themselves from putting forward
their own ideas, at least at first, or imposing their
own reality
— Outsiders themselves share what they learn
with each other and with local people
In this spint. the emerging philosophy of PRA has
stressed open access to information and avoiding pro
fessional possessiveness. RRA Notes, which dissent'
nates recent expenence in PRA. has been free on
request, and has invited readers to photocopy and dis-

tribute pholiKopics Outsidcis have been encouraged
not to o*n ideas ot method* but lo make them open
access common property Putting local people first
has been stressed local mappers and analysts have
been given professional recognition through record
mg then names on then maps and diagrams, and
through then contributions to professional work (sec
e g.. The Women of Sangams. Pastrapur and Michel
Pimbert. 1991. Chidhan er al. 1992)
The shanng of PRA experience has been betueen
individuals, organizations, countries and continents
Some of this has flowed from NGOs in India such as
ActionAid. AKRSP. MYRADA. OUTREACH. Seva
Bharati. and SPEECH which have established, mam
tamed and disseminated this culture of shanng
Village camps have been made open to people from
other organizations Quite often, a training camp orga
nized by an NGO has included not just its own staff
but also people from other NGOs. from government
and from other local communities. Shanng of expci
ence has then been part of the rationale and culture ot
the camp: beyond the shanng of information by vil­
lagers. presenting it to each other and to outsiders, the
aim has been shanng among outsiders and between
them and villagers of daily experience, food, and
sometimes celebration, and shanng among outsider*
of learning through self-critical appraisal of process
Some international shanng South-South has been
in the same spint. In early 1992. three Indian NGOs —
Action Aid. AKRSP and MYRADA — hosted the first
international PRA field workshop lo which partici­
pants came from 11 other countnes of the South
Starting in 1990. tramer/facilitators from the South
have traveled to other countnes and conducted field
learning workshops By early 1994 tramer/facilitators
had gone from at least five countries in the South —
India. Kenya. Senegal. Sn Lanka and Zimbabwe — to
conduct PRA workshops in other countries both in the
South including Bangladesh. Botswana. Ethiopia.
Ghana. Indonesia. Lesotho. Malaysia, the Philippines.
South Afnca. Tanzania. Uganda. Vietnam. Zambia

Table 2 RRA and PRA Contracts m tratnint!
Didactic

(more RRA)
Aim
Duration

Stjle
Source of learning
location

Learning experience

Learn methods
Longer <*eeks)
Classroom then practice
Manuals, lectures

More in the classroom
Intermittent
Intellectual

Good performance seen to
be through
Sourve Chambers (1993a). p 99

Stepwise and correct application
of rules

Exponential
(more PRA)

Change behavior and attitudes
Shorter(days)
Pracuct then reflection
Tnals. experiences
More in the field
Continuous
Exponential
Flexible choice, adaptation and
improvisation of methods

WORl.n p| VLIOPMIM

1440

and Zimbabwe, and ak<» in lhe Nonh. including
Bulgaria Canada Denmark, (inland. Norwa).
Sweden. Swil?rrbnd and lhe United kingdom

(b) Minh t <>/ xprctid

i

Most programs in government, and many in large
NGOs. arc spread vcnicallv. from the lop down,
through central decision making, official instructions,
and formal training In government , obvious examples
include programs m health, water, irrigation, forestry,
soil and water conservation, credit, and integrated
rural development In agriculture an example is
the Training and Visit system for agricultural exten
sion
The spread of PRA. in contrast, has been lateral
more than vemcal. personal more than official, and
expenential more than didactic Unlike Farming
Systems Research, it has not required substantial
special funding for special units or departments It
appears to have been adopted, adapted and developed
because it has been seen to fulfill a need High-level
support in large organizations has been a predisposing
condition for adoption, but not in itself enough w here
staff have been instructed from above to use PRA. per
formance has been patchy. Classroom teaching has
also not worked well PRA has been internalized
much more through personal choice and field expert
ence than through official requirement or formal
leaching
Empirically. the manner in which PRA has spread
can be described under four headings
— Through field learning experience Field learn
mg experiences, camping or staying in villages, or
very close by. have proved powerful and popular
The Sustainable Agriculture Programme of the
International Institute for Environment and
Development (IIED). London, has facilitated over
30 such workshops in al least 15 countries The
World Resources Institute has been active in Latin
America In India at least a dozen NGOs had by
early 1994 provided such experience Not uncom
monly. after three to 10 days of a field learning
experience with villagers, a participant has left and
started to train^ukl >pnv)d PR-5
fc—r»» his own
organization and area
— Tii'tnivh o h^h: tout h: A short workshop, from
as brief as an hour or iwotoas long as a day or two.
has familiarized participants with some basics A
lew people have then staned using PRA methods,
learning as they went In one instance, two senior
staff of Samakhya. a large NGO in Andhra Pradesh
in India, saw slides of participatory mapping and
of "handing over the stick’ (ssrnbolicalls passing
authority and initiative toothersi. and immediately
adopted these in their procedure for forming new
cooperatives In other cases, after a brief work-

*hop. venioi official' have decided to permit,
encourage and \uppon PR A in their organizations,
enabling members of then Mali who were *o
inclined to adopt PR A approaches and methods
fi\ \ ilkifrr\ laintilomihotiitm up In the lai
eral mode, villagers who have gamed experience
with FRA base themselves become Irainer/facili
lalors Such lateral transfer to other villages and
sillagcrs is documented for AkRSP in Gujarat
(Shah rt <1/. 1991a) Village volunteers familiar
with FRA approaches and methods have become
consultants to facilitate FRA in other villages
In the bottom up mode, villagers train outsiders
or present their anal) sis to them With lhe AKRSP
in India villagers have become trainers for NGO
stall <Parmesh Shah, personal communication)
With MYRADA in India, farmers presented slides
of their technolog) to a high-ranking committee in
Bangalore and to a workshop in ICRISAT (lhe
International Crops Research Institute for the
Semi And Tropics). In other countries, such
reverse transfer of FRA experience and analyses
has been from village to capital city. In Sn Lanka
in Januarv 1992. in Botswana in June 1992. and in
Bangladesh in January 1993. villagers first con­
ducted and presented their own analyses in their
villages They were then invited as consultants to
present their maps, models, matrices, institutional
diagrams, well-being rankings, seasonal calendars
and other analyses to senior people in. respec­
tive!). Colombo. Gaborone and Dhaka In
Colombo and Dhaka, a v ideo of the v illage process
contributed to lhe impact on capital city skeptics
in Dhaka, the villagers, women and men. formed a
panel and answered searching questions with con
fidence and conv iction
— Throitph dissemination materials: Dissemina
non materials have played a big pan. especially
RRA Xotes (1-18 continuing) distributed free
by IIED. and a handful of videos, among which
M YR ADA's Garuda Kempanahulli A Partici­
pant v Dian of a PRA Exercise (1990). Michel
Pimben** Partu ipatnn Research with Women
Partners t J99J j. and lhe Sn Lanka Self-Help
Suppon Programme's Wr Could Do What Be
Xt ver Thmaihi We Could have been influential
The multiplication and distnbution of slides has
also been significant The visual nature of much
PRA analysis has lent itself to visual forms of dis­
semination
There remains the question why PRA. despite lhe
changes in behj\ lor and attitudes entailed, has devel­
oped and spread so fast Among many factors, some
stand out As communications have improved in much
of the world, new wjss of doing things have been
learned about more quickly. The sort of open institu­
tional culture in which PRA has evolved and thrived
has become commoner among NGOs Openended-

I

I’ARIirn’Alom Rl’RAl AH'KAISAI

4

ncx** has encouraged rapid innox anon The praclical
il) of applications has contnbuled lo the momentum
ERA. has. moreover usualK proved enjoyable and
generated rapport The information and insights
which flow from it base often been diverse, detailed,
complex, accurate, interesting and useful, and shared
in a short time Again and again. PR A has prosed both
powerful and popular With all these factors opera!
mg. it is less surprising that its spread has been rapid

3 DEALING WITH DANGERS
Rapid spread has brought dangers Like an) other
newl) labeled approach to development. PR A faces
dangers and is vulnerable
In an earlier draft of this article, the first danger
ua- listed as rejection, especially by academics But
professional attitudes are changing rapidly. Social
anthropologists, for example, have been increasing!)
open to adopting and adapting PRA methods. Perhaps
some academics who are firmly uedded lo conven­
tional questionnaire surveys will not wish to change
horses in the midstream of their teaching and research
careers, but. to mix the metaphors, the student tail may
wag the teacher dog. as students demand to use RRA
and PRA methods for their research
Four dangers remain as concerns expressed by
practitioners and trainers ? They stem not from rejec­
tion but from rapid or ngid adoption
The first is "instant fashion ’’ As happened at one
stage with farming systems research. RRA and PRA
are vulnerable to discrediting by overrapid promotion
and adoption, followed by misuse, and by sticking on
labels without substance. The hardened development
professional who knows how to vary vocabulary to fit
fashion will replace questionnaires or “RRA" in pro­
ject documents with "PRA." but may not know or care
about what it entails. "PRA" may be used to legitimate
the very approaches and methods PRA practitioners
ha\e sought to replace. The PRA label has been stuck
on questionnaires: a recent publication on rapid urban
environmental assessment (Leitman. 1993) opens its
section on methodology with the words: "In the same
spini as rapid and participatory rural appraisal
an
urban environmental indicators questionnaire was
designed
Yet conventional questionnaires arc one
of the methods which RRA and PRA have sought to
avoid and improve on. In early 1994. the warning
signs of instant fashion are evident demand for tram
mg which exceeds the small cadre of competent train­
ers requirements that consultants who were once to
use RRA" now "use PRA"; consultants who say they
u ill do so. when they lack the expenence and onenta
non. the belief that good RRA or PRA are simple and
easy, quick fixes, which they are not; and a failure to
recognize that most of the expenenced and skilled
practitioners are from the South and in the South, not

1441

from the Nonh oi in the North The practical implied
non is a caveat to donors and policy makers lo proceed
in a measured mannci. not to request or require PRA
immediately and everywhere, and lo recruit expertise
in the South
A second danger is rushing The word "rapid was
needed in the late 1970s and early 1980s lo offset the
long drawn-out learning of iraditional social anlhro
pologv and counter that of large-scale questionnaire
surveys But by the laic 1980s "rapid" had become a
liability It has been used to legitimize brash and
biased rural development tounsm (the bnef rural visit
bv the urban-based professional) Humed rural visits,
insensitivity to social context, and lack of commit
ment compound errors, and can mean that the poorest
are. once again, neither seen, listened to. nor learnt
from Misleading findings then follow Pottier’s cri­
tique (1992) of humed farmer interview s conducted in
Northern Zambia warns of such error. Van Steijn s
review (1991) of RRAs conducted by NGOs in th?
Philippines similarly points to quite w idespread prac­
tices of low quality Rapid often means wrong
To offset this danger has been found to require
care, patience and planning to have plenty of time
Much of the rationale for RR A/PRA has been to make
time to find the poorest, to learn from them, and lo
empower them Sensitive behavior and treating time
as plentiful have proved to be crucial It has been sug
gested that the first R of RRA and the middle R of
PRA would better be "relaxed" than "rapid "
A third danger is formalism. In the long term, this
may prove the most difficult problem. With any inno­
vation. there is an urge to standardize and codify,
often in the name of quality . Manuals are called for
and composed They can indeed be useful as compila­
tions of ideas and expenence. as handbooks that
widen choice of methods and applications, and as
sources of ups and techniques, both for field practi­
tioners and for trainers But manuals also inhibit and
intimidate With any new approach or method, they are
short to start with but grow fast. Paragraphs proliferate
as intelligent authors seek to cater for every condition
and connngency Some fanning systems research gave
nse to manuals the weights and volume of w hich was
itself a problem The four volumes of Farming Systems
Support Project Manuals (FSSP. 1987) weigh approx­
imately 3 6 kg The dangers are evident As the text
lengthens, training is prolonged. More lime is spent in
the classroom leaching the theory and less in the field
learning the practice Spontaneity is lost and spread
slowed, slopped or reversed
The lesson has been for practitioners to learn in the
field, through expenence, feeling free to start taking
responsibility for what they do. making mistakes, and
learning on the run. It has been not books of instruc­
tions. but personal commitment, critical awareness,
and informed improvisation, which have best assured
quality and creativity.

144?

4

WORLD DL VBLOTMENT

A final danger is routmisaiion and nils With acai
mg up and spread, rcpelilion leads praclilioners and
trainers into regular habits There arc man) different
ways of doing pamcipatory mapping and modeling,
transects, walks, seasonal analysis, group interviews,
ranking and sconng. identifying special groups of peo
pie. and the like But practitioners in any organization,
or even region, have shown signs of slipping into un
vary ing standard practices, overlooking other options
Some routinization and repetition are inevitable,
even desirable For example, there is a logic in certain
sequences of methods for specific purposes But
experimenting, inventing, testing, adapting and con
stantly Irving to improve have been part of the
strength of PR A That spinl has been nurtured through
exchanges of trainers and practitioners between orga
mzations. countnes and continents, and through open
sharing of method , experiences, and ideas, especially
'H together, these four dangers threaten the quality of
PRA as it spreads As PRA becomes more wide

spread, so it may degenerate In strategic discussions
about PRA the question has been raised whether qual
its can be assured by stressing changes in behavior.
• handing over the stick” (passing the initiative to vil­
lagers). • the) can do it" (having confidence that vil
lagers can map. model, rank, score and so on),
•‘embracing error" (welcoming and sharing mistakes
a. opportunities for learning), and "using your own
best ludgement at all times" (stressing persona'
responsibiht) ) The working hypothesis has been th;
if these are part of the "genes" of PRA as it spreads,
then where it is adopted, practice should improve
Good performance w ould come then not from external
and through personal critical awareness, trying to do
better

4 POTENTIALS AND CHALLENGES

Poiennals and challenges presented b> PR A can be
considered under seven heads

(a) Be\ondfarming systems research IFSR)
Farming s\ stems research faces problems because
ot the diversit), complexity and uncontrollability of
many farming systems, especially ramfed farming in
the South Participatory approaches known variously
us farmer-back-to-farmer (Rhoades and Booth. 1982).
farmer participatory research (Famngton. 1988.
Farrington and Martin. 1988) participatory technol­
ogy development (ILEIA. 1991) and farmer first
(Chambers. Pacey and Thrupp. 1989) have moved
toward invoking fanners to undertake their own
analysis This is potentially parsimonious in the use of

xcientiMs’ lime (Chambers and Jiggins. 19801 bui its
methods are still in an early Mage of development
Pioneenng work by many of those working in
India (see eg . Mascircnhas rt al. 1991). and by
Jacqueline Ashby of Cl Al. Clive Lightfoot ol
ICLARM. the Sustainable Agriculture Programme
Team al ilED. and others has shown that farmers have
greater capabilities for diagramming and analysis than
has been normal professional belief (see e g Ashby.
Quiros and Rivers. 1989. Lightfoot rt al.. 1989.
Mascarenhas ft al. 1991. Guijt and Pretty. 1992.
Palimswams rial. 1992. V.jayraghasan et al. 199..
Cornwall.Guijt and Welboum. 1993) In Bangladesh
Ghana. India. Malawi, and Pakistan farmers have pre
sented and analyzed nutrient flows and other linkages
m then fanning systems by diagramming on the
ground and on paper (Lightfoot and Minnick. 1991.
Guijt and Pretty. 1992. Lightfoot and Noble. 199V
Ofon et al. 1993) In Zambia in 1991. matrix sconng
01 millet
"J'1''1 was
* the core of a process in
for varieties of
.............................
• session, all present, farmers
which
b) the end of the
[nd rescarchen., had learned a great deal more about
finger millet than the) knew at the beginning
(Dnnkwater. 1993. p. 241 In Pakistan >n earh 1992 m
(1
\ field training exercise, women and men. non
e as well as literate, drew flow and linkage dia
gru...s for their farms and livelihoods (Guijt and
Pretty. 1992) In Tamil Nadu. India, in 1992 PRA
methods, including matrix sconng. led scientists to
learn farmers’ preference for red over white rice, and
to change their research pnonties (Manoharan.
Velavudham and Shunmugavalli. 1993) In India and
Botswana in 1992. matnx sconng for vaneties of a
crop was developed by asking analysis to add a "w ish

them (Chambers. 1993b. p 95) Pamc.patcry map
ping and modeling, seasonal calendars, and treno and
change diagramming have also been facilitated to
enable farmers to conduct their own analysis The rate
of innovation has been rapid, and much that has taken
place has probably remained unreported
The challenge now is to further develop and dis­
seminate such approaches and methods to help farm
ers do their own analysis and make their own needv
and pnonties known to scientists. If such efforts con
tmue to be successful, the implications for activities,
procedures training, rewards and institutional cul­
tures in agricultural education, research and extension
will be little short of revolutionary (Pretty and
Chambers. 1993)

(b) Participatory alternatives to questionnaire
survess
Despite repeated exposure and criticism of their
often high costs, errors, delays and other defects (see

I

PARTK IPA1OR> RI RAI APPRAISAI

eg. Mon*. 1970. Campbell. Shreslha and Stone.
1979. Hill 1986 Bieck 1987. Duane. 1987. Ingh*.

4

|90| |992.C»ill. I99t|. I.irpc scale quotionnaiic mu
vcy*. whclhci loi one-oil a<l
investigation* oi loi
longitudinal studic*. remain one of the mo*t wide
spread and Mi*tjmable of rural Industrie* Among the
large*! customer* have been donor agcncie* requiring
baseline surveys for project*, in the hope that later
progre** can be monitored and evaluated Evidence i*

scarce that such ba*eline survey* have been useful or
worth the co*t The rea*on* include the difficullic*.
often unforeseen or underestimated at the time of the
ba*eline. of quality control, of ensuring comparabilitv
in sub*equen! *urvcy*. ot a**essing the counterlac
tural (what would have happened without the project),
of finding comparable control areas, and of disentan­
gling and weighing multiple causality (Chamber*.

144 A

condihonx ’ I
jI people nonlilcratc a\ well
lilei
ale. haw used latds lo rceofd household infonnalion.
including assets The National Council ol Applied
I■ronomie Research, probabl) the largest sur\c\ orga
m/ation in India apan from the National Sample
Sum’), has undertaken a research project lo lest
RRATRA methods as an alternative or complement
to a consentional sample survey using questionnaires
(Chaudhan. 1993. NCAIR. 1993) NCAER staff
were trained b) Joseph in RRA/PRA methods These

uerc then found to generate valid and reliable quanti­
tative as well as qualitative data al the village level,
and also some fairlv good ratio estimates for the state
(Maharashtra) level for some, but not all. variables
The sample surve) with questionnaires covered 120
villages as against onlv 10 with the RRA/PRA meth
ods The report concluded (NCAER. 1993. p 92)

1978) Nevertheless, such survey* persist Moreover,
for some professional* still, rural research is question

naire survey*
The sustainability of large questionnaire survey*
as mode of investigation is not difficult to explain

Academic*, official*. re*earchers. consultant* and
donor* find in them a common language and under­
standing They reliably feed commensurable number*

to central computer* They protect those senior staff
for whom too intimate exposure to the field would be
less than congenial They provide continuing work
and salanes for the field investigators who have been
employed for years on temporary terms by research

institutes Above all. until recently, they have lacked
senou* competition
The evidence is accumulating that participatory
metnoos now present alternatives in two dimensions
The first dimension is in depth, nchness and real­

ism of information and analysis Questionnaires are
only a single, peculiarly fallible, method, m their
application, both iocal people and enumerators tend to
be poorly motivated, and complex causality can be but
dimly discerned, if at all PRA approaches and meth­
od*. in contrast, present a plurality of methods, with
triangulation and crosschecking: and local analyst*
are usually committed lo getting detail complete and

accurate, and can from their personal experience inter­
pret change and causality
The second dimension has been the generation of
numbers From India. Nepal. Bangladesh. Pakistan
and Nigeria come evidence and examples of censuses

It is perhaps conceivable that an appreciable increase
in rhe number ot RRATRA villages can provide a da'a
set for generation of regional/state level parameters uith
relatoelv smaller sample than normall) required in the
the (sample survev) approach

Participatory method* have been used increasing!)
instead of questionnaires to identify target group*
well being ranking ha* been used for thi* purpose by
M3 RADA and Action Aid in India to identify the
poorer with whom they seek lo work, in Pakistan.
ActionAid staff have facilitated well-being ranking of
38.000 people for this purpose (Humera Malik, per­
sonal communication) In Bangladesh. BRAC has

tested participatory mapping as an alternative way to
identify target groups for a nonformal education pro
gram (Khan. 1993) in India again. IFPR1 and
1CRISAT have been developing and testing proce­
dures. schedules and routines for facilitating and
recording v isual analyses by villagers, using mapping,
chans for food and women s activities (time use. and
energy use), and seasonal calendars, as pan of a pro­
ject on alternative approaches to locating the food and
nutntion insecure (Haddad. Chung and Devi. 1993).
Panicipatory methods have also been used as alter­
native* to questionnaires in monitoring and evalua
non ir. some AKRSP villages in Gujarat, village vol­
unteers have retained the maps made by villagers and
used them for monitonng soil and water conservation
measures and yields (Shah. Bhardwaj and Ambastha.
1991b. Shah. 1993a) In Nepal, in September 1991.

and survey* based upon PRA methods such a* par­

ActionAid staff (ActionAid. 1992) facilitated partici­

ticipatory mapping and well-being ranking
In India, a leading PRA practitioner and trainer.
Sam Joseph of ActionAid. Bangalore, was able when
cnallenged to specify an alternative PRA method for
obtaining all the item* of data in a standard baseline
survey In practice, participatory maps made on the
ground have been used to present demographic data,
using different seed*, colours, stones, vegetables or
other sy mbols to present different sorts of people and

patory mapping as a basic method for a utilization sur­
vey for services Problems were encountered but maps
were reponed made in about 130 villages, giving
information covering the whole population of each
village This presented a differentiated census, and
information including utilization of service* for edu
canon and health, the use of pit latrines, adoption of
various agricultural practices, and participation in
group activities The information was collated by the

WORI D PI VI1 OPMt N1

Action Aid learns and presented in conventional
tables In Bangladesh, participatory mapping has been
facilitated similarly by CARI to enable women to
present and assess changes resulting from a Women s
Development Project (Vigoda. 1993)
Also in

Bangladesh. Inals were conducted in 1993 as pan of a
joint project of BR AC and the International Centre for

4

Diarrhoeal Disease Research to lest and develop par
ncipatory methods to assess change in health and
women’s lives in Matlab Thana (Adams, Roy and

Mahbub. 1993)
In Nigena. the late Selina Adjebeng-Asem of
Obafemi Awolowo University. Ife-lfc. reponed (per
sonal communication. July 1992) on the application of
PRA methods in momtonng a soyabean project
I trained the
Soy abean project group in the use of
PRA for momtonng of the project impact in five states of
the Federation i e Kaduna. Niger. Enugu. Anambra and
Oyo States of Nigena The group of 16 researchers were
amazed about how much easier it is to obtain indepth
information through participatory mapping in addition to
other RRA techniques they have already known We
were able through mapping to obtain all relevant socio
demographic information we required for the project, for
example, the number of households in a village, house­
holds involved in soyabean production, gendei issues in
soyabean production, utilization of soyabean, and prefer­
ence rankings of various soyabean diets
Wc gathered
an incredible amount of information w ithin an hour and a
halt visit to the village
The researchers have been beg
ging me to give more training in PRA

In cases such as this. PR A methods, used well, ha\e
proved not only more cost-effective than question­

naire surveys; lhev have also proved more popular

with all concerned, researchers and local people alike;
ano repeated!) villagers have said that the) had not
realized they could make such maps, that they have

the only means of generating quantified stx ial d.it.i In
many contexts, for the data gathering purposes of out
siders. participatory methods now provide substitutes
or complements to them, using various piolocols
or schedules for recording and standardization
Participatory mapping, seasonal calendars, trend and
change analysis, well being ranking, matrix scoring,

impact diagramming, and innovations such as visual
interactive questionnaires (Shah. 1993b) present alter
natives to questionnaires On the evidence available
by early 1994, such participatory methods have show n

advantages When well facilitated, they have so far
proved cheaper and quicker in their comparison of a
questionnaire survey approach to identifying eco
nomic status in a community of 412 households w uh a

participatory wealth ranking approach, a team in
South India found the questionnaire cost seven times
as much (7.1)1 rupees against 1.011 rupees I and took
eight times as much staff time (77b hours to 96 hours).
besides giving less valid results (Rajaratnam ci al..

1993. pp 20. 36) Participatory mapping can also
eliminate laborious household and respondent sam­
pling and sampling errors by covering the whole pop

ulation of a community

Participatory methods have

improved accuracy through cumulative presentation,
crosschecking and analysis They have entailed shar

mg rather than straight extraction of data, and to v ary
mg degrees fun. interest, learning and empowerment

Given the precondition of trained and suitable facihta
tors. PRA methods have proved so far to be generally
cheaper, quicker, more accurate and more insightful
To what extent PRA methods can and should
replace questionnaire surveys requires further investi­

gation. Issues include the feasibility and cost of train
ing fieldworkers in PRA methods and the validity of
data for generalization at higher levels It is also prac­
tical now for local people to use PRA methods to gen­

learned from the process, and that they now see things
differently
There remains the problem of comparability The
central need for commensurabilny can conflict with
local diversity: this was faced by the Action Aid teams

erate and use their own numbers, conducting their
own censuses, appraisal, baseline surveys, momtonng

in Nepal, who had to invest time and effort in ’ gap fill­
ing" after central analy sis had taken place, concluding
that analysis itself would be better decentralized
Comparability of information shared in different

< c» Emptnitnncni mid t quif\

contexts may become a big question in the 1990s
Decentralized and democratic processes lend to gen
erate disparate data which central planners cannot
then easily add up or compare More remains to be
learned about how and how well PRA methods can
generate commensurable data (for example demo

graphic, health and agncultural information) from di!
ferent places, and to what extent central planners and
officials can tolerate and manage incommensurabil
ity. and variability in the form of locally shared infer
mation and locally generated plans
Conventional questionnaire surveys are then not

and evaluation

In practice, much PRA has been found to
empower Those who. through u PR A process express
and share what they already know, also learn through
that expression and sharing Those who investigate
and observe add to their knowledge Those who ana­
lyze become yet more aware and reach new under­
standing Those who plan and then implement what
they have planned lake command, and further learn
through the experience of action
Whether empowerment is equitable depends on
who is empowered There is a danger (stressed by
Scoones and Thompson. 1993)of a naive populism in
which participation is regarded as good regardless of
who participates or who gams It those who partici-

L

I’ARIK

RVRAI AH’RAISAI

p.itc and gain arc only a kval male elite, the p<»or and
dis.uhani.igcd max end up worse oil The "natural

tendenev is lor those who arc empowered to be men
rather than women, the belter oft rather than the worse
oil and those ol higher status groups rather than those
ol lower status The challenge is then so to introduce
and ire PRA that the weaker arc identified and

ll

empowered and equity is served
fortunately, the tools available suit this task
Sequences such as participatory mapping leading to
household listing to well being ranking and then to
hvclihood analysis, can identify groups distinguished

according to l('cal values Focus group discussions
can then be convened to enable different categories of
people, including and especially the disadvantaged, to
identify their priorities and interests The contrasts can
be sharp Draw mg on applications of PRA techniques
in Sierra Leone. Ghana. Malawi and Bangladesh.
Wclboum (I9MI )has shown significant differences by
ethnic group, age. gender and economic status, and
combinations of these With pastoralists in Kenya.
Sw ift and Umar (1991. p 56) found marked and sink­
ing differences m the identification of pnorily prob
Icms out of a possible maximum of 100. livestock
managemenrwas scored 87 by focus groups of the

rich, but only seven by those of lhe pwt. and lack o!
livestock zero by the nch but 4^ by lhe poor
Differentiating by groups, interests and gender can
empower the pvrorer and women in several ways, it
can give them collective awareness and confidence to
confront others and argue their case: Youth for
Action, an NGO based in South India, worked at first

in some v illagesonly w ith Hanjans (Untouchables) so
that thev gain in confidence and capability first, before
later extending their work to the rest of the village
AKRSP (India) convenes separate groups of women
and of men to choose the numbers of trees of different
sorts they want in their nursery, and then helps them
negotiate a consensus Differentiation through wealth
or w ell-bemg ranking can help an outside organization
select and deselect those with whom.it will work:
ActionAid and MYRADA. both in South India, and
ActionAid in Pakistan, have used PRA methods
to identify the poorer people with whom they then

work
PRA methods such as diagramming can also be
brought into play to clarify and resolve conflicts
Agroecosystem diagramming was used in lhe
Philippines to make explicit lhe differences of intere-ts between groups after lhe construction of a

small dam at Lake Buhi and to achieve consensus
jbnut priorities (Conway. Sajise and Knowland.
1989. Conway. 1989) In the approach of the
Neighbourhood Initiatives Foundation in lhe United
Kingdom, a large model of a neighborhood allows

people to address conflicts by pulling down sugges­
tions. and using markers to agree or disagree without
needing to identify themselves This "depersonalises

|44''

conflicts and introduces informality where consensus
iv more easilv reached (Gibson. 1991)
The identification, expression and resolution ol

conflicts of interest remain a frontier for participatory
methods Diagrams are promising as a means to
defuse tension by making agreed fad visible and drf
ferences explicit, focusing public debat^ on physical
thing* rather than on individual people There remain
both potential and need for new and better partictpa
lory methods for negotiation and equitable conflict

resolution

(d> Ln al people as lacihlaiors and trainers
A commonplace of PRA experience is that rural

people can do much that outsiders have thought thc\

could not do. and often that they themselves ha\e not
known the> could do One by one the dominoes have
fallen as they have shown that they can map. model,
rank, score, estimate, diagram and analyze more and
belter than expected Often, too. they have done these

better than outsiders The working rule has become to
assume that local people are capable of something

until it is proved otherwise
One challenge then becomes the development and
spread of participators approaches and methods b>
local people ihemsehes Farmers' oun extension has
a long history Deliberate training of farmers as exten
sionisls may be more recent. As one example, in lhe
1980s in Ceniral Amenca. World Neighbours trained
volunteer exiensiomsls and gradually handed over
responsibilities for expenmenls and extension to them
(Bunch. 1985). In India, both MYRADA and
SPEECH have invited villagers who had already
gained experience of PRA to take part in PRA activi­

ties in other villages
The Aga Khan Rural Support Programme
(AKRSP) (India) has taken this further, through the
training of village 'olunteers as PRA facilitators
(Shah and Shah. 1994). In lhe late 1980s. it developed
village extension volunteers as an approach in which
villagers were trained in PRA both for their own and
for other villages. These village volunteers were not
just exiensiomsls. but facilitators of lhe PRA approach
and methods (Shah. Bharadwaj and Ambastha.

199 lai They formed teams to conduct PRA exercises
in other villages. involving mapping, transect dia

grammmg. interviewing, group discussions, prioriti­
sation and preparation of a village natural resources
management plan II is observed that they enjoy the
process. .(pp 87-88). In February 1992. a team of
village volunteers from other villagers demonstrated
their skills as facilitators to an international group of
visitors in Kabnpalhar village. Bharuch District.
Gujarat In one day. the village volunteers enabled vil­

lages to map their degraded forest, count and measure

I
i

WORl P PI VE1 OPMI N1

1446

rootstock in five quadrats on the ground, and assess
numbers of nursery plants needed
One question is whether spread through village
volunteers can become self sustaining and self
improving Villagers experienced in PRA may facili
talc appraisal and analysis in neighboring villages on a
voluntary basis AKRSP has incentive systems for
volunteers with payment by results, rewarding good
performance Some new villages have also been pre
pared to pay for the services of village volunteers as
consultants Were this to become common, with
market incentives for gixxi performance, what began
as a program initiated from outside, might become
self-spreading, self-sustaining and self-improving
Organizations such as AKRSP could then foster
spread with a light touch by training volunteers and
encouraging them to form teams that provide serv ices,
whether voluntarily or for a fee
Finally. AKRSP has trained and enabled village
volunteers to be trainers for NGO staff The latest
domino to fall then, is the reversal of villagers becom
mg PRA trainers for outsider professionals, with the
potential that they will develop and invent their own
training approaches and methods The challenge is to
accept that through such reversals there are new rela­
tive competences and roles, and that outsiders become
not just facilitators but learners and trainees

(Cl Polic\ rescart h and change

Policy insights have been gained through RRA and
PRA as specific examples from Zimbabwe. Tanzania.
Chad and Nepal illustrate.
In Zimbabwe m November 1991. RRA and PRA
methods were used i investigate the effects on agri­
culture of structural djustment policies RRAs were
conducted by a team of researchers over two weeks in
two Communal Areas Their findings and recommen­
dations. in a report (FSRU. 1991) completed immedi­
ately after the fieldwork, provided immediate feed­
back from the field concerning marketing, transport,
input supply, pnees. food security, and fanners’ atti­
tudes toward agricultural structural adjustment poli­
cies. and provided policy makers with insight into the
farmers’ viewpoint and their intentions
In 1991 a survey was undertaken in Chad on a
national scale using RRA techniques to try and under
stand how people perceived their food secunty prob
lems. and what solutions they proposed (Buchanan
Smith et al* 1993) Thirteen survey enumerators
worked in 55 representative villages, spending about a
day in each village A group iniei view with a checklist
as gu«de was followed by household interviews, par
ocularly onented toward women (who were rarely
represented in the group interview) Three years of
different weather conditions were used as reference
points Organizing and analy zing the mass of data was

achieved despite difficulties, and lessons were Icaml
for improving this son of survey Three categories of
administrative areas were found, each with a distinc­
tive household food security strategy. The results
challenged the conventional thinking in N djamena
which held that the key to raising production uas pro
moling free market systems for agricultural produce
The sunev showed that more was needed than mar
keting alone, local people knew methods and tech
nologies to increase production but were constrained
by lack of credit for ploughs, oxen, improved seeds,
and more efficient irrigation
Another example is provided by land policy in
Tanzania (Idns Kikula. personal communication.
Johansson and Hoben. 1992). As a contribution to a
government reassessment of land policies, the
Institute of Resource Assessment at the University of
Par es Salaam organized four RRAs for mid-level
policy makers Four villages were chosen to represent
a range of conditions Four teams were formed, and
each spent five days in one of the villages. Through
the direct learning of the RRAs they concluded that
the government’s top-down approach was wrong, that
communities and people were already doing land use
planning, that imposing a land use map was mis­
guided. and that new participatory approaches were
needed They presented their findings to a seminar
with high-level policy makers The resulting recommendation> from the seminar implied major changes
of policy, and seemed "to indicate just how great an
impression such a short visit to a rural area can have
and how effective an RRA can be in providing rele­
vant insights for policy makers and planners"
(Johansson and Hoben.'1992. p 30).
These three examples were one-off efforts A pro­
totype for a more permanent facility has been being
tested in Nepal There, eight small Rapid Deploy­
ment Teams have been trained in basic PRA methods
and are m place at different locations in the itrai (low land) They have simultaneously used PRA methods
to investigate and report on aspects of policy and con­
ditions. providing comparative insight for policy mak­
ers (Gerard Gill, personal communication), demon­
strating a model which might be applied in other
countnes The evidence to date suggests that policy
makers could now. through improved RRA and PRA
approaches and methods, receive information and
insights which were more up-to-date, reliable and
credible, than those through official channels
(Chambers. 1992)
A more general application of PRA methods for
policy purposes is in the Country Poverty Assess­
ments sponsored by the World Bank Most of these
have been conducted in a conventional manner, using
poverty line and similar entena In 1993 Participatory
Poverty Assessments using PRA methods were pilot
tested in Ghana. Guatemala and Zambia National
teams of facilitators were first trained in PRA They
i

I

pariicipakwy rurai appraisai
then lacilnaicd ItHal people s own appraisal and
.in.ihsis id ihcii life, condilions. and livelihood Mralc
giev. eliciting their concepts of well being and wealth,
their needs their distinctions between types and
degrees of deprivation, and their differences of pci
cephon bv gcndci The resulting insights into poor
people’s conditions, values and priorities were

alrcadv in earlv I9M4 be ing used in polic) analysis

J

(1 > Pt r

1447

(Shah. II) Scope and need remain for more such
methods
The policy and personal potentials of RRA/PRA
interlock Then scope has scarcely begun io be
lapped The frontier here is to see how to scale up. how
to enable many more policy makers, as well as others

I

at the local level, personally to gam direct learning
experience in the field from and with rural people,
enabling them to fit policy and action more lo local
conditions and priorities and to the needs of the pmu.

bt'luixKw. aiitiudc* and learning

Senior officials, scientists and academics who pro
nouncc and prescribe on rural development often lack
recent direct knowledge, and base their analysis and
action on ignorance or on personal experience from

(g) FRA in t)rf>ani:alton\

earlier decades Top down, center-outward presenp

Perhaps the biggest challenge is the establishment
of PR A as a w ay of operating, affecting the culture of
organizations Normal bureaucratic tendencies to

non follow s
Il is not a new idea that rural development would
gam if senior officials and policy makers were able lo
spend time unofficially living and learning in rural

standardize, centralize, and impose lop down targets
impede or prevent the open-endedness, flexibility,
creativity and diversity of good PRA To establish
PRA as the norm in an organization usually therefore

conditions, but little appears to have been done An
exception is the Exposure and Dialogue Programme
of the German Commission of Justice and Peace

requires reversals and a change of culture More resis­
tance lo its adoption and spread has been found in
organizations with strong top-down authonty and
hierarchy, evaluative and punitive styles, and repeti­
tive routines and actions Conversely, the most rapid
and effective adoption and development of PRA has
been in organizations with democratic management,
lateral communication, and flexible and adaptive
modes of operation This is show n by the experience
w ith the three mam tv pes of organization w hich has e
been involved with PRA NGOs. government field

which for some years has been enabling senior out­
siders to learn the life stones of village people
i Kochendorfer-Lucius and Osner. 1991. Osner et al.
1992) In a less structured manner, senior officials in
India have appreciated the opportunities to spend time

incognito in villages, with their interactions uncon
strained by official protocol At a personal level, the
methods of PRA offer new scope, and make mini
sabbaticals easier to envisage PRA approaches and
methods have prov ided ways in which officials, scien­
tists and academics have come face-to-face with local
people in an informal and nonthreatening mode which
both sides have found rewarding, providing expenence and learning which have been intellectually

exciting, practically relevant, and often enjoyable.
Much needs to be learned about how. in the local
and especially rural context io facilitate changes in
outsiders’ behav ior and attitudes. Some methods have
already been devised, such as Anil Shah’s “shoulder
tapping ’ He has written that, taking Distnct Officers
in Gujarat on a transect walk to see the problems of
soil erosion

I told them in advance that a transect in Participatory
Rural Appraisal (PRA) is for observation and to under
>(and the knowledge and perception of the fanners We
do not ad\ ise. but ask — ask open-ended questions with
out implied adv ice 1 told them that this was very difficult
tor educated people, more so for those in authonty
Therefore, when 1 heard anvone giving advice or asking
questions with implicit advice. I would tap his shoulder
and if necessary offer my services to rephrase the advice
nr query into an open-ended question
R the end of half a day. and several laps, a lot had
Ken learned that would otherwise have been missed

organizations and universities and training institutes
Initially. PRA has been evolved and spread largely
by NGOs This is not surprising, since their orgamza
tional cultures are quite often more panicipatory than
most Some have simply adopted PRA without
attempting to disseminate it. Others have defined or
redefined their roles to include training for others in
PRA These include the Sustainable Agriculture
Programme of I1ED in the United Kingdom; Action
Aid. AKRSP. MYRADA. OUTREACH. Seva
Bharati. and SPEECH in India; the Self-Help Suppon

Programme in Sn Lanka, and Suppon Panicipatory
Organisations in Pakistan Those international NGOs
and foundations which have taken upPRA suppon and
training on a wider scale in several countnes include
ActionAid. CARE, the Ford Foundation. Jntercooperation. the Near East Foundation and OXFAM

Adoption and use in government field orgamza
tions has been more difficult Given the scale of gov­
ernment operations, it is also potentially more impor
tant In India, several state forestry depanments have
adopted PRA. and the movement for Joint Forest
Management is designed to be implemented in a PRA
mode (SPWD. 1992) MYRADA has undertaken
PRA training on a large scale for government orgam
zations and staff Behavior and attitudes have proved

i

I

I
I

»»r vti A WMtN I

a key problem, and attempts to achieve change have
included mandatory overnights in villages, with
senior officials expected to set an example by refusing
special comforts (Fernandez and Mascarrnhas. 1993)

The introduction of PRA into the work of the State
Watershed Development Cell of the Government of
Karnataka, facilitated by M YR ADA. raised problems
of conflict between community level PRA and profes
sional norms and government procedures (Bhat and

4

Satish. 1993) In Kenya, the Soil and Water
Conservation Branch of the Ministry of Agriculture,
following training workshops conducted with IIED
(Pretty. 1990) adopted PRA as policy in over 40 dis
tncts. and some initial successes have been revealed
through participatory momtonng and evaluation
(Pretty and Thompson. 1993) The problems and

opportunities for PRA in government field orgamu
lions require sensitive research to add to understand

mg of reasons for resistance and distortion, and to pro\ ide the basis for a realistic assessment of potentials
Universities and training institutes were at first
slow to notice or adopt PRA Given that PRA is con
cemed with learning rather than leaching, and with the

ol an inMitution has not on its own proved enough,

noi. on its own. has repeated training Training at
lower field levels without higher level understanding
and commitment has proved ineffective II appears
critical for adoption that the middle level managerial
staff in an> organization genuine!), and not just ver
bally, uishes to use or support PRA If the staff docs
not. there arc mans ways in which its lack of support
can undermine and Finally eliminate the participatory

spirit and practices of PRA
The bottom line in organizations has been, hou
escr. individual .choice and freedom Much has
depended on facilitators who were both committed
and free of line responsibilities The organizational
challenge ano opportunity for PRA can then be seen as
enabling such people to be identified and then pro

tected from line duties, freeing them to devote lime to
the spread ol participators approaches and methods,
and contribute to cultural change in their own and
other organizations

5 THE PARADIGMATIC SIGNIFICANCE OF
PRA

field rather than the classroom, this is perhaps not sur­
prising From modest beginnings in the early 1990s.

however, interest in PRA approaches and applications
on the pan of individuals and groups in universities
and training institutes has grow n quickly. and by early

1994 included at least 25 countries The Indian expe­
rience is instructive In some cases PRA was adopted

quicklv for the fieldwork of students, as with probanonersat the Lal Bahadur Shashtn National Academy
of Administration In other cases, sequences of work­

shops. field expcnences. and training have been pan
of a patient process facilitated by an NGO or NGOs
which have led to gradual incorporation of PRA
approaches and methods into curricula, fieldwork and

research, as w ith the Gujarat Agricultural University
(Shah and Mane. 1993). the Tamil Nadu Agricultural
Universilv (Paliniswamy el al.. 1992; Vijayraghavan
ct al.. 1992.Manoharanf/o/.. 1993). and several other
agricultural universities In other universities.the cul­
ture of learning (as opposed to the more usual teach­

ing) resonates with PRA. as in Australia (Bawden e/
al 1984. Ampt and Ison. 1988. 1989. Dunn. 1991;

Dunn and McMillan. 1991; PRA Team. 1991J espe
_--t only Hawkesbury Agricultural College
cially but not <
.
_
_
of Western Sydney)
The chai
(now the
t..^ University
—
lenge presented bv PRA modes to traditional unrerMty teaching remains largely unrecognized
To summarize experience to early 1994. those
organizations which have embraced and developed
PRA have shared four characteristics The leadership
has been stable and committed to participatory
approaches, a substantial proportion of staff have per
xonally wished to use PRA. there has been little rent
seeking activity by staff, and there has been recurrent
reinforcement Commitment of a director or principal

One contribution to be sought from universities is
a better understanding of under!) mg theory In

Australia. RRA has been linked with soft systems
theory (Checkland. 1981) and contextual science
(Russell and Ison. 19911 In making these links.
Australian researchers have begun to explore further
the paradigmatic significance of RRA and PRA The
word -paradigm" is used here to mean a coherent and

mutually

supporting pattern of concepts, values,

methods and action, amenable to wide application.
In his paper (Jamieson. 1987) ‘’The paradigmatic
significance of RRA." delivered at the International

Conference on Rapid Rural Appraisal at Khon Kaen
in 1985. Neil Jamieson argued that RRA. with its

rapid learning, fitted and supported a new and emerg
ing paradigm of development Despite ideological

conflicts. Marxists, socialists and capitalists had
shared evolutionary, umlmeal. universalistic. posi­
tivistic and utilitarian assumptions, and a fervent
belief in progress Another view of development, he
evolution as problem solving
wrote. wa< of
v. human
.
.
as
adaptive
change This fitted better
under pressure,
with a cybernetic systems approach, which included

the concepts of feedback, of lead time (the time
between receipt of information and when it is too late
to use it), and of lag time (the time between receipt of
information and the completion of action based on it)
(sec also Joseph. 1991 ) Jamieson presented the case

that change had accelerated and unpredictability had
increased, making accurate and timely feedback more

than ever vital for effective adaptive change
Much that Jamieson wrote applies with even more
force in 1994 than it did in 1985 At a theoretical level.

I’ARIK II‘A1<»R> Rl’RAI AITRAISAI

ch.ios thcotv h.r led t” a vlcau i umlml.indinf th.it

pattens and diieclions <>l chanpe can be xcnxiliu- to
small dillerences in xlartinp conditions (Gleick.
|9K7). stressinf the impinanic ol quick, accurate
learning and action At the empirical level, changes in
global and local conditions - ecological, social and
political
appear to be accelerating In conditions of

faster change and of increasing unpredic labilit) it .s
even n^orc important than before to have timcl> feed
back, prompt learning, and rapid adaptive responses
uhich will differ to fit local contexts This learning
and need is encapsulated in the title — ’ More diver
sitv for more certaintv- - ol the last chapter ol
Pevr/opuirnr in Prmiuf (Porter. Allen and
Thompson. 1991. pp 197-213). which analyses and
desenbes a development project in Kenya PR A
approaches and methods, through local analysis,
^provization and action, appear suited to the under­

standing and expression of local diversity, and to
enabling local people to assess, analyze, cope with,
adapt to. and exploit accelerating change

Bevond these aspects. PR A as it is emerging is
experiential, not metaphysical Theory has been
induced from practice, from what is found to work,
not deduced from propositions Good performance
has been sought through empiricism, diversitv.
jmprov ization and personal responsibility
It is sinking that parallel shifts of paradigm can be

I J4»>

ici than on the lhciMCtic.il iinplkaliens <»f then cvpeii
cnee Rm posiinmlcrn iheoty post Neutoni.in s<k i.il

science, and the cxpcnciuc ol PRA are mutually icm
forcing i'n common ground lor all affirm and cde
brale multiple icahiies and local diversity
In the natural sciences, conventional approaches
using hard systems and reductionist assumptions and

methods, are in crisis when laced with main of out
important pioblenis (Mearas. 1991. Applcyaid

1992) Scienlifit method is not competent to predict oi

prescribe foi the complex open systems which mattei
most Global environmental issues involve huge
uncertainties and demand what Puntovvicz and Ravel/
(1990) call a second order science" in which judge
mem plays a more recognized pan Precise under
standing, prediction and prescription for local agro
eco-social sy stems can be similarly elusive This is not
a new discovery leremy Swift wrote in 1981
a mator World Bank livestock development project in
Mali is based for crucial calculations of sustainable gra/
mg pressure, or ihe report of a highly competent ecolo
gist m 1972. the calculations were redone in 1977/78 bv
a different equally well-qualified ecologist who hac.ed
the earlier carrying capacity Nobody is to blame, the sc.
ence is inexact But the consequences could be disastmu'
for the project, and more so for the pastoralist' involved
(Swift. 1981. p 4S'i

itself
In the social sciences, postmodernism (eg
Harvey. 1990. Rosenau. 1992) asserts philosophical

Perhap' no one was to blame then But now we know
more about what is not knowable using the standard
meihvxjs of proft'sional disciplines When so much is
so unknowable and so unpredictable, it seems right to
seek solutions through methodological pluralism,
through flexible and continuous learning and adapta
tion. and through the exercise of judgement, again all

relativism and multiple realities Interpreting the view
of affirmative postmodernists. Rosenau writes.

elements in the practice of PRA
In business management, the parallel shift has

noted m tour other major domains of human experi­

ence in the social sciences in the natural sciences, in
business management: and m developing thinking

The absence of truth
yields intellectual humility and
tolerance They see truth as personal and community
specific although it may be
U relauve. it is not arbnrar>
Some of them substitute a substantive focus on the
local on daily life, and on traditional nanative for the
hegemonic theory of mainstream social science

• Rosenau 1992. p 22)

(. phoffs 11992) study of participation in Sn Lanka

and hr post-Newtoman social science” combine to
challenge reducnonism and mechanistic models, to
recognize and rehabilitate altruism and cooperation,
und to stress positive sums and the potentials of * social
cncrgv
which is manifest when individuals and
croup' work for some common purpose. Postm<»dcmism. I phoffs analysis, and PRA have differ­
ent 'tuning points postmodernism tends to start with a
Kcnain theoretical pluralism. Uphoff Starts w ith empiri. jl experience which then informs and interlinks with
theory and PRA is found to suck largely with the
a. >ion u uh dispersed practitioners subject to the disci­
pline of W hat works, reflecting more on how to do bet-

been from the values and strategies of mass produc­

tion to those of flexible specialization (see e g
Harvey. 1990. pp 125-188; Kaplmsky. 1991. p 7i
Standardization has been replaced by variety and
rapid response, hierarchical supervision by trust, and
punitive quality control by personal quality assurance
at source A highly successful Brazilian manager,
w hen he took over a company, abolished norms, man­

uals rules and regulations, and put the company s
emplovees ‘ in the demanding position of using their
own judgement’ tSender. 1989. p 79) Much in Tom

Peters’s book of advice to US business managers.
Thriving on Chao< Handbook for u Mana^mcm
Revolution (1987). is found equally in PRA He advo­

cates. for example, achieving flexibility by empower
mg people, learning to love change, becoming
obsessed w uh listening, and deferring to the front line
The theme of local knowledge and action is also
strong In The Fifth Discipline. The Art and Prat tu e
of the Learning Organization (1990. p 228) Senge

wntes

WORLD DI VHOPMI N1
Lncalness •> especially Mill in limes of rapid change
Lot al actors often have more current information on cus
lomcr preferences competitor actions and mariet
trends, they are in a better position to manage the contm
uous adaptation that change demands (Sengc. 1992 p
22K)

l)

Strikingly, writers on management stress paradox,
reversals, and what to a lineat reductionist thinker
must appear irrationality Charles Handy wnies of
The Age of Unreason (1990) with the ’ Un" empha
sized in the original, and "An Upside dow n Society "
In Thnvinf: on Chaos. Peters wrote about "building
systems for a world turned upside down " His best
seller Liberation Manaftemen: (1993) is subtitled
Necessan Disorganization for the Nanosecond
Nineties (my emphasis)
It has been the discipline of the market and oppor
tunitirs from new technology which have driven and
draw n business management to decentralized fiexibil
ity. to diversification, and to finding and exploiting
transient niche markets. For PRA and related
approaches, it has been the discipline of w hat works
with people and communities, and the opportunities
opened up by the new approaches and methods, which
have driven and drawn In both business managemeni
and PRA. value has been placed on decentralization,
open communications and shanng knowledge,
empowerment, diversity, and rapid change So it is
that the philosophy and approaches of PRA can be
seen as one expression of a wider paradigm for effec­
tive action in the contemporary world
In development thinking, normative theones of
universal economic growth as the main means to a
belter life are no longer tenable (see e g . Ekins. 1992.
Sachs. 1992) As economic grow th ceases to be a sim­
ple. universal objective, as it is recognized as environmentally harmful among the richer, and as economic
resources are recognized as finite, so there is a search
for alternative normative paradigms, for more sustain­
able ways to enhance the quality of life. For the rich,
the question is how to be belter off with less; for the
poor, it is how to gam more and be better off without
repealing the errors of the nch One w ay to serve these
objectives is to enable local people to identify. express
and achieve more of their own priorities In line with
this, the emergent paradigm for liv mg on and w ith the
Earth bongs together decentralization, democracy and
diversity What is local, and what is different, is val­
ued The trends toward centralization, authooianan
ism, and homogenization are opposed Reduciiocism.
linear thinking, and standard solutions give way to an

inclusive holism, open systems thinking, and diverse
options and actions
RRA and more so PR A can then be recognized as
part of a more general paradigm shift tn the social anti
natural sciences, in business management, and in
development thinking, and as pan of a new ptofes
sionalism (Pretty and Chambers. 1993) PRA.ssanic
ulated by its practitioners, has an emerging normative
theory-and-practice This includes practical engage
ment with local communities and people, openness to
complexity and diversity, a principle of decentraliza
lion and empt'ucrmeni — "handing over the stick,
and shanng and lateral learning and spread It mam
fests and supports methodological pluralism, rapid
adaptive change, the analysis and expression of kK.»l
people’s priorities, and democratic local diversity
Much of ns distinctive, if modest, contribution to this
shift of paradigm lies in evolving ways to change pro
fessionals’ behavior and to enhance and support
analysis and action by local people, empowering those
who are peripheral and weak
The most sinking insight from the expenence of
PR A is the pnmacy of the personal This is easy to
overlook Responsibility rests not in written rules, reg
ulations and procedures but in individual judgement
The one-sentence manual for PR A ’Use your own
best judgement at all times" (KCA'K. 1991) onginatcs
•n North Amencan business management (Peters.
1987. p 378) In this mode, every PRA expenence can
be seen to be different, the outcome of local conditions
and improvised personal performance by local people
and facilitators Authonty and responsibility reside
then not m a bible or manual, nor in a sequence of
observances or procedures, but in personal interac­
tions, judgement and choice
The future of the philosophy, approaches and
methods known as PRA cannot be foreseen. Dangers
and promise coexist What happens depends on deci­
sions and actions by individuals, especially profes­
sionals in NGOs. government services, training and
research institutes, universities, and donor agencies
To describe these decisions and actions as polarized
between closed and open, conservative and radical,
reductionist and pluralist, and timid and bold, as in an
earlier version of this article, is to load the antitheses
as if of bad against good Pluralism itself demands a
balance A more securely empirical conclusion is that
PRA approaches and methods have opened up a new
range of practical choices for local research and action
which seem increasingly to fit the priorities of the
1990s

NOTES

I
For comments on earlier versions of this paper I am
grateful to many people, including Tony Dunn. James
Mascarenhas. Jules Pretty and luo anonymous referees

Responsibility for errors omissions and opinions is mine
alone

4

I’AKIK II’AIORY KI'RAI AIVKAISAI

?
lhese points uric stressed in the South South I’K A
I wchanpr U oik shop hosted in India in September I9*H m
uhnh panuip.ints ucic li.iincf/pra* ntioncis from I? toun
Ines in the South

MM

t
In .m jll u«wm-n ' I’K X m S«mih Indu xcllnu « ih lr*
uctc pl.hc»l J"mml h«Mi'ch>’KU whctc hu\b.in»l\ uric thunk
.ml\ anj thilhfx uric umkI Io icpicxcnt tuo m.inupc’.
iShcclu I uiu
pcison.il»oinmuni* .iiion)

KI 11 Rl NCI S

ActionAid I'tHlii 1, 'iiiot \ Rural Appitiiuil I 'uh.alum
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> Khinmil. Farming S)*iems Support Project,
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Institute U
Florida
(Gainesville. FL FSSP. December
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l> * Non™* •nO I w""h
..... .......... ^rr......... I MM'K-

lkv<.1..r,„<n, I’ap.. No
N.' «■
Ikpannv-m ol Apmuh-Ml I..dal.
I niveisiiv lQMh
Gill (kraal J <>A Hu
li'" h' W
1
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(

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A p.itiii ip.itofx cxpt'ii

JiHtuhil f<'' f tinniHi:

nu'iii in xuM.im.iblv j|’iit ulliiiv

I lIM'H) pp

S\\h m\ Kt miN li/l ih fiwn \ <»l 4 No

Implication*

Meanis. K
I mitomnciii.il
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jnJ I)

I .iihk'i liixt qujlitjtivr

Mmnuk

Multi sub|Cc( tann sunevs ri'ccmsidrivd

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meth«nN Ijnnci* dupruinx lot impiming methods of

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O de (»ui.i Ji

I lehttoot (

Alinun. jnd I

A

(Kudo.

St stents dufi.mis io help lamtcts decide in on farm

leseaivh.

in R Chambeis

Paecv and I

A

lltrupp

iilion iiru! Ajjru ul

(Ids ) I a unit fu\t / nfintr

(i'in/ur<»iii

of

StuJx

Siimpli

November 1991)

Olc’n. Joseph Mark Piein. Frank I enmn Dav id Ou usu .mJ
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(I d • Riipid Huhil Appiiiuiil. //>.S Hiillcim.

l.i>ni>mm

7 riii!

t>n

7/.<

Atiihi<tp<ili'^inil him for ii PioM utn»n (Cambndge
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II I IA

Dntlopmcnt
Ih it lcpmfiu

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SuMiiiihiblt April ulfnrc (Leusden. The
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Forestn

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and

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for

PKA. Rural

in

Netherlands

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Kommission

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Rexearih

(Coimbatore

Department of Agricultural Eccinom.es

Paixur.

at

Tamil

\adu

Con\rnfn>ntil

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Development

Tamil Nadu Agricultural I niversitv and London Intc'
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Harvesting local forestrx knowledge A com

Peters. Torr Thmtni: «•/; Cha, ■» Handbook for a Ma'-.ae,

Paper

(London

14c

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1992'

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School

(Ssdnev

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PID and NFS.

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III I \

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Netuork

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l\-\i lnpincnt

Polls

tin,I

i Nc'vc

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Clive | ighiloot

Vol 12. No 4 (IMS 11

I .ist

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Rural Apt'raixul Methoiloloeu '

Parii, ijKitorx

PKQi pp Ml |(M>

I onehutsi R

the

Confcieiur

April 4. 1970)

(Dai C' S.u.iam March 1|
NCAI R

Pape* lot

Agric uhural l eonomics Socictv

mrul Ki \ciinh (1 ondon Intermediate leehnologx Pub

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Sucntilu McthmK
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\alltx Cornmunits September 1991. compiled

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ment New South Wales Agriculture. School of Agncul
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Agents .Soles on the 1990 Kern ho Training Workshop
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Agriculture
1990)

Programme

(London

IIED.

November

MM

WORI P PFVnorMI N1

I rr(tv. Jules, and Robert ( hambeis. louard* a learning
Shah Panncxh. (iinsh Bharadwaj and Ran|ii AmbaMh
Paradigm
Piofessionahym and Institution* for
"F atnxrx a\ anah
and fai'iliiator> in pamcipalor) mt
Agri, ulture. IDS Discussion Papci No 114 (Brighton
apptaixal and planning RRA R'airi. No 11 (19VI a), p
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h4 Q4
December 1991)
Shah Parmcxh. Ginxh Bharadwaj, and Ranjit AmbaMh
Rajaratnam Jollv. ( (iamesan. Helen Thasian. Navamom
"Panii ipaton impat l momionng of a toil and waici 4 01
Babu and Abel Rajaratnam \dhdating the
-h
ten anon programme b) farmrrx. eatrnsion xoluntre
Ranking of FRA and formal Sune* in Identifying 'ic
andAkRSP. RAM Aiver. No H (1991b). pp 127 |1
Rural Pm’r (lamil Nadu
Rl'HSA Depanni. nt
Shanci U U p | Philipp and U R Schmchl. himun
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Swtmn Rf\ear<h and Ihirlapmrnt (imdrhnr\ f<
Rhoades. R I . and R Booth. "I armer bai k-lo farmei A
Ik^rl.Ting (<mntric\ (Boulder. CO UeMticu Prcx
model for generating acceptable agricultural lechnol
IVS2i
ogv. Agri, ultural .Administration Vol II (I98-') pp
Sheelu and Prxarai. Pann ipahm Rural Appranal tPRA,
127 117
An Inifhitinn m Jamil Xadii f ipcrirnt f Shoring (lami
Rosenau. Pauline Mane. Post M<>J< mi*m and the So, nil
Nadu India ActiMMx tor SrKial Ahcmanxrx. 1992)
Science* Insights. Inro<id* and Intrusion* (Pnnceto:i
Slim Hugo, and Paul Thompson lixtrninf for a Chan/ic
NJ Pnnceton I niversitv Press 1992)
Ora. h\nmori\ and Or iclopmrnt (London Pano
RRA Notes 1-18 and continuing (London Sustainable
Publuanonx. 199.1»
Agriculture Programme. International Institute lor I n
SPUD. Jami forru Manaitrmfnt hrld Method* Manua
vironment and Development)
\oi I Diaitnoitu 7<>(»/» for Supporting Joint Torr\
Russell. David B . and Raymond I Ison. "The research
Management Swtern*. and Vol 2 Community fore*
development relationship in rangelands An opportunity
Pconom* and lye Pattemt Participatory Ru^a.
lor contextual science.’ Plenary Paper for fourth
Appraisal tPRA ) Method* in South Gujarat India (Nev
International
Rangehind*
Congress
(France
Delhi Sex-iet) for the Promotion of WaMelands Devel
Montpellier. Apnl 22-26. 1991)
opment. 1992)
Sachs. W . The Development Dictionary A Guide to Know
Swift. J "Rapid appraisal and coM-effectoe research in
ledge as Po*er (London Zed Books. 1992)
Uest Africa. Agricultural Administration. Vol X
Scoones. Ian. and John Thompson. Challenging the Populist
(November b. 1981). pp 485-492
Perspective Rural People * Knonlcdgt Agricultural
Suit!. Jeremv. and Abdi Noor Cmar. Partmpah
Re*' ar, h and f vtensior: pro, ti, e. IDS Discussion Paper
IXit lopment in hiolo l)i\trnt
Sot io n onomn
1.12 (Bnghton Institute of Development Studies
m iht hiolo Lot'yfock Development Proie^t
I niversity of Sussex. December |99.1j
(l*iolo Kenv.i ImoIo I ivextock Development Proiect
Semler. R
Managing without managers.’ H,ir\,od
|WU| ,
Business Revieu (September-October 1989). pp 7b-M
Theis. J . and H Grads. Participatory Rapid Appraisal tor
Senaratne. S P F . "A program of micro-level studies m
Ci'trmunif. Dt vtloprnrnt .4 Training Manual Ru*td on
rural Sn Lanka.’ Mimeo (I976«
Lyperiemes malic Middle Last and Sorth Africa
Senge. Peter M . The Fifth Discipline The Art and Prtn m t
(London Save (he Children and I1ED. 1991)
of the Learning Organisation (London Ceniurx
I phoft. Norman. Learning from Gal O\a Possibilities for
Business 1992)
Parm ipatory Development and Post-Nev*toman Social
Shah. Anil C "Shoulder lapping A technique of training in
S. icn. t (Ithaca Cornell L'niversitv Press. 1992)
participatory rural appraisal." f or, a* Tree* and Peoph
van Sieijn T. "Rapid rural appraisal in the Philippines
Newsletter. No 14 (October 1991 j pp 14-15
Report of a studv on the application of RRA bv
Shah. Parmesh "Participatory wj’ershed management pro
Philippines NGOs. GOs and 'jniversitv institutes
grammes m India reversing our roles and revising our
(Quezon Citv. The Philippines Council for People s
lheones. in Rural Peoph \ knowledgt Agri,ultural
Development.Julv i99l 1
Researih and Ettension Prat tn e. Asia Papery. IIED
5 igoda Marc>. "Panicipaton rural appraisal in a women’s
Research Senes. Vol I. No 1( 1991a)
health education project in Bangladesh (Dhaka CAREShah. Parmesh "Questionnaires participatory, reliable and
Bangljdesh. Januan 199.11
interesting ’ Note prepared for the IIED/iDS workshop
Vijavraghavan R S R Subramanian. Jules N Prett) and K
on ’Alternative* to questionnaire- survevs’ (Bnyhton
( John (Eds) Partmpatory Rural Appraisal for
Institute of Development Studies, t'niversity ot Sussex
Aitm ultural Rrvearch at Aruppidottai Tamil Nadu
October I991bi
(Tam. *tjdu Department of Agricultural Economics.
Shah. Parmesh Concept of people s participation in the
Centrk for Agricultural and Rural Development Studies.
watershed development —
extension volunteer
Tamil Nadu Agricultural I niversity. Coimbatore, and
approach (Ahmedabud India Aga Khan Rural Support
London International Institute for Environment and
Programme. June 19X9)
Development (1992)
Shah. Parmesh and Meera Shah. Training of xil.'agc ana
Welboum Alice "RRA and the anal) sis of difference.' RR.4
lysts From PR A methods t( pr-Kess.’ RRA Note* 1 forth
A</Zr» No 14 (December 1991) pp 14-21
coming 1
The vs omen or Sangams Pastapur. Medak. Andhra Pradesh
Shah. Parmesh. and P M Mane. The Aga Khan rural \up
and Muhel Pimben. "Farmer participation in on-farm
port programme and participatory approaches to agncul
vanetal tnaK Multilocafional testing under resource
turul training ’ m J FamngtonandD Lew is (Eds ). ,Vo/i
poor tonditions RRA Nuti v No 10 (February 1991).
fj<vemmrntul Organisation* and the State in Asia
PP I”
(London Routledge 1991). pp 169 177

I

X

34

PA* HCIPATORY RESEARCH

AND EVALUATION

evador'/0'1' °f 'he Chall<:nges of P’f'icipatory research and
Jh i
p
C°Un‘ry- By lheir very nature lhey
macroa^ engrt’ ?U‘ *' Detd 10 deal Wi,h lhem b0,h at 'he macro
and mrc.-o-level through a combination of research and action
armed at empowering the marginalised sections of our society

USAID - PVOH - II
WORKSHOP ON PARTICIPATORY DEVELOPMENT

May 6- 10, 1996

i'J'ori<
LpazEixLifiaho’iy

'e.s.za’iafiDn

q.2, ^ugliPafzaljad. flndihulionaf. c^f-n-E-a,

- 110 062

1
Participatory Evaluation and
Research: Main Concepts and Issues'
Rujesh Taiklon

from the days in the I93O> when the VnivcrMtx of Bombay first

introduced a poxl-gradu.itc <oursc in socflogs. to our days,
there has been a •• adnr.l change to p'efesstonalisalion of the
social sciences Wnh profcssional-salton came specialisation and

its acceptance as a science that can be considered objective by
creating a distance between the researcher and the‘object’of

stud) i.c., the people studied —actr rs in the social setting.
What is forgotten in this classical mode of research is that
this erv for objediviis i\ a result of the post-renaissance
developments in the West, the evolu'ionars ‘ thinking of the late
nineteenth and 'he ration.'list schools of the carls

twentieth

centuries, when ‘modermst' thought considered the world as
chaos The work of the social scientist was to create order out of

this ‘chaos’ b\ remaining outside the sxstem and taking an
observer stance His work was to anal\sc the behaviour of man
and understand the sxstem in a ‘scientific wa;.

Looking a( the uorld .is chaox led toiiher io the model
of man where subsistence and survival were hspothcsised as
‘Thu paper has borrowed extensively from ’wo other papers of the
same author, the first presented at the Adult Education Research Seminar
held at Kungalv. Sweden. June 25-27. 1979 and the second presented at
the PariKi''at .ry Research Meumg held m New Delhi. India. Fehr....ty

7-9, 1979.

16

PARTICIPATORY RESEARCH AND FVA

TION

the prime driving forces In order further to gam some
control over the chaos it was
)------necessar)
--------- x ‘to~ generate a construci of social order demanding compliance 2
The classical research approach m social sellings has, therefore,
implicitly borrowed the method of inquiry used in the natural
sciences. This has led io a distorted emphasis on ‘objectivity’
and researcher-object differentiation. This approach in social
sellings has placed primac) on developing research designs (both
in the laboratory and in lhe field) that attempt to maintain the
separation between the researcher and individuals in lhe social
syatem under study Such an emphasis will seem misdirected if
we examine the three distinctive characteristics of inquiry in
social settings
(i) Social research means a study of individuals, groups and
organisations in a social setting,
(n) The researcher shares his essential humanity with the
individuals in the social selling under study,
(ni) The very act of inquiry tends to have some impact On
lhe social system under study.
One can clearly notice the differences that emanate from these
u^atinctive characteristics of social research and inquiry in the
natural sciences. To that exlent, it is doubtful if social research
can utilise a methodology that is implicitly based on the assump­
tions of natural science inquiry.
Another major influence of natural sciences on social inquiry
is in terms of the acceptable purpose of research. In the natural
sciences it is solely aimed at increased understanding of, and
knowledge about, natural phenomena. The utilisation of this
new knowledge has been the task of the technologist. Social
science researchers have assigned similar roles to themselves.
Social change based on the enhanced understanding of the social
system and phenomena is not seen as an integral part of their
role. In the absence of social technologists, the utilisation of
new knowledge has been neglected.

Thf Huiorical Context
One mav ask why social technologists have not ‘arrived’ in spite
•SushxDla Baoerxc. ‘PartiCipAtory RticMcb: Eihic or Logic,’ in Rajcah
Tandon (cd.), Participatory Research in Asia (Canberra, Centre for ContiQuusg Education—Australian National Umvenity. 1980), p. 26.

MAIH CONCEPTS ANO ISSUES

17

of this effort at ‘objectivity’. The reasons should probably be
found in the historical context in which the social sciences grew.
The search for objectivity that finds its best example in Durkheim is the result of the interaction of the early twentieth
century social thinkers with the natural scientists. Their pre­
occupation was to show that sociology and anthropology were
sciences i.e., objective like the natural sciences? They had thus
to be shown as studying an object that was outside man.
Durkheim declared that the object of study was a social fact
which is external to man ‘every way of acting which is general
through a given society, while at the same time existing in its
own right independent of its individual manifestations.*4
If Durkheim’s prc-occupation was to show that sociology was
different from psychology and philosophy, Weber had to show
its psychological linkages which were essentially individualistic.

The main intellectual influences in which Weber’s work is
steeped are as predominantly German as those which shaped
Durkheim’s writings are French. Moreover, Durkheim’s
early studies are rather abstract and philosophical in character. -Webcr’s first works on the other hand, are detailed
historical studies, and it was from within the context of
specific problems brought to light primarily by the German
historical school that Weber went on to expand the range
of his writings to embrace questions of a general theoretical
nature?
Moreover, in all the classics including Marx, an evolutionistic
trend is clear. In the nineteenth and early twentieth centuries
this was also a colonial context since it made a distinction be­
tween ‘primitive* and ‘advanced’societies—the former belonging
to the colonies and the latter to the colonising countries.
Though Indian sociologists gave it a ‘national’ interpretation by
making the anthropologists study the ‘primitive* tribes of India
David Walah, 'Sociology and the Social World,* in Paul Fiimcr. Nr*
Directions tn Sociological Theory (London: Collier*Macmillan Publiahcn,
1972). pp. 16-18.
•Emile Durkbeim, The Rules of Sociological Method (New York: The
Free Preas, 19M), p 13
• Anthony Giddens, Capitalism and Modern Social Theory—An Analysis
of the Writings of Marx , Durkhelm and Max Weber (London. Cambridge
UniwTiiiy Preaa, Reprint 1*74), pp. 119-120.

18

P AkTlClPA r()R'» KL.L.'RCH AND LVALUATION

and the sos.iuiocisls studying India's ’advanced’

original intention of the colonialist
own society

societies,6 the

trying to understand his

by going back to the origin of’primitive civilisa­

19

MAIN CONCEPTS AND ISSUIS

knowledge generated by social research is its lack of applica­

bility

m

particular

settings.

As

the director of the

Amul

cooperative said recently,

tions’, or trying to know more about the colonies in order to

better control them, has to be borne in mind.

Technocratic approaches to improve productivity in our
villages cannot put the tools of improved productivity into
the hand', ol our poor, lural majority. Thus, increasingly,
in our search for a key to rural development, we leave aside
the conventional economists and technocrats and we turn to
the sociologists. Then we encounter a paradox: the profes­
sional sociologist is very good at describing a social struc­
ture, at measuring attitudes to change, at diagnosing male/
female roles and so on ..But all these sociological exercises
do not seem to be of much help, when it comes to putting
some equality into (he power structure, or modernising
attitudes to ch ’nge, or freeing women from the bondage of
traditional i.lcis -bout men's and women’s roles.8

It is in this context of evolutionism and its colonial past that

the present should

be examined

This is especially important

if one bears in mind that in spite of thirty years of independence,
our intellectuals are. by and large, dependent for their status
□ nd acceptance on their links with the West.

From among the members of the second generation and of
the third generation (if sociologists) some went to the
Umtcd States and some to Britain after independence...All
these person> formed a caiegor> and did influence sociological
tradition in India, by introducing the new trends. For
academic posit ton a foreign degree, or even a stay abroad
without any degree, was considered more acceptable by the
universities and they filled unmany positions in the univer
sity departments. Tlii* nev trend was reinforced by the
visit of the foreigner', to Inuia, again a very large number
from the United States and a smaller number from Britain.7

To that extent, those interested

in social change in a parh

cnlar setting need to move away from this type of professional­

ism and initiate their own research process in that setting. It
h

because classical social research has neglected the issue of

change of social systems except as one more subject of study.

Classical Methodology

This methodology was more and more quantitative in character
and assumed the universality of social principles. In other words,
methodologies developed in the West under a totally different
social, cultural, economic and political situation were absolut-

ised and transferred to India and other Third World countries.
These methodologies that look the principles of natural sciences
for granted, did not make allowance fur the distinctive nature
of social science inquiry. If ac assume that it is impossible to
control all the ..purious interference'* in social research (and
this is an increaMngly doubtful assumption), then it might
be d.liiudl to ijlk ab* ul ‘reproducibility’ and consequent
geiicralisalH'ii Vv e only develop u pailial understanding of a
social phenomenon a.id this seriously limits oui ability to
generalise Therefore, a major argument against the utilisation of
• 1 P. Dcui, Crrti of Sociology m India —An Aulobiocraphical Pers­
pective,’ Economic ii'iil Pfhiicul ITeekiy. 16 (n 8 Lcb.uary 14, 1981)
pp 247-248,
’ /W p. 246

It has not only been indifferent to this issue but also actively
punished (hose who attempted to combine the two purposes of
understanding and change by labelling their efforts ‘unscientific’.
Another argument against researchers’ involvement in social

change is premised on the misconception that research is valuefree. Since all change, especially social change, is based on a
normative vision of the ’desired' and since the researcher’s task is
io be objective and value-free in pursuit of his inquiry, how can
one expect him to combine the process of inquiry with the
process of change?
The underlying fallacy in this argument is the naive assump­
tion that inquiry is value-free. Neither social research, nor even
inquiry in the nadir.ii sciences is value-free. The researcher not
only believes that (he natural phenomena are orderly and theref .ire cm be researched, but he also adopts a framework in order

•V Kuncn, ProJucimit iniJ Rumi Development— Some Economic,
Technical .md Soa..' C>mM.leruiion\ (N<w Delhi. National Productivity
Council. 22nd I uund.Hiun Day Lecture, I ebruary 1980 )

MAIN CONCEPTS

20

PARTICIPATORY RESEARCH AND I

SSUES

21

^CATION

Flgwt I: Control over Knowledge-Generation and Elaboration

to collect observations. These frameworks are as much normative
m those held by social researchers.
Moreover, the myths of value-free inquiry and the nonnorrnatiyg role of the researcher have led to the dehumanising
and catastrophic utilisation of knowledge. The overwhelming
obsession of researchers with ‘objectivity* and ‘neutrality’ has
resulted in the development of nuclear missiles, biological poisons
and psychological brainwashing. Other studies have shown how
the standards of professionalism in the social sciences set by
foreigners, have infact led to a colonial control of inslitutionsand
knowledge?
Finally, there is an ethical issue that has been largely neglected
in classical social research. The practice of classical social
research resulted in complete and exclusive control of the process
and outcome of research by professional researchers. The
researcher develops knowledge based on data collected from
individuals, groups and organisations in a social setting. Those
individuals, groups and organisations do not have any control
over the knowledge generated from the data obtained from them.
They are only the ‘objects’ of research.
And the researcher is neither accountable to them nor respon­
sible for the use of knowledge thus generated. A researcher can
do that in the natural sciences without any ethical considerations
because the subject-matter is natural phenomena. Can we follow
the same argument for inquiry in social phenomena?

Participatory Research

In the light of the above frustrations with classical research, it
may be valuable to analyse the issue of control a little more in
depth. In various types of research approaches, what is chosen
and who chooses? Figure I can give us some idea, (see next page)
As Figure I shows, classical research emphasises professional
control over the generation, utilisation and elaboration of
knowledge —hence the need for new approacnes. Participatory
research and evaluation maintain that the actors in the situation
are not merely objects of someone else’s study but are actively

•Zafirullxh Chowdhury. •Research-A Method of Coloniaation,’ m
RAjcab Taodon. op clt.. pp 16-25

Prace it

Clajsteal Research

Participatory Research

Professional
Researcher

Actors
(Subject!)

/

Social
Setting

\
Actora
(Objects)

Z
Social
Setting

Reacarcbcr

influencing the process of knowledge-generation and elaboration.
To that extent, the participatory approach is an effort to check
the present trends of (a) professionalisation and centralisation of
knowledge in its generation and utilisation since it can be used
to manipulate the actors of a social setting without their having
any control over it; (b) the neglect of the actors in the situation
not only as sources of knowledge but also as its legitimate owners.
Is this an ethical issue or ideological confusion? Probably it
is a combination of both Whatever be the case, it is obvious
that if the actors in the social setting become the owners of
knowledge the) generate, the process of this elaboration can
itself become an important step in awareness-building and social
change among the oppressed.
If we broadly classify research types into the three cate­
gories shown in figure II (see next page), then it is easy to
understand how participatory research approach differs in some
very fundamental ways. Academic research is what most pro­
fessional researchers are engaged in and what most research
institutes icward and encourage. Policy/evaluation research has
become increasingly popular over the last two decades. An
administrator, policy-maker or government agency commissions
a research study in order to satisfy some of the administrative
needs. This client is, by and large, outside the problem or area
he wants researched by a professional researcher.
Participatory research has been set against these two types on
the three key steps in a research act: choice of the problem,
choice of the methodology and choice of the outcome. Figure II
highlights, somewhat dramatically, this issue of control in
research Academic research has emphasises unilateral control
by the professional researcher on all steps of a research act.

8

9

1

^ecaderr.ic
Kr„,,,'l,

Steps In
Research

Policy, Lvaluulion Rr scar th
(Co.mm^nr.l)

Participator» Research

Choice based on client's
administrative needs

Choice based on immediate
problem situation

Client (who is outside the
problem area)

Jointly by the actors in the
problem situation and professional researcher

Quasi-expenmcntal field
research designs, use of
<
reliable instruments,
s’, tistical analysis
Professional researcher

Consensual-validity-based
research designs, use of em­
pathic instruments, multiple
anahsis methods
Jointb bv the actors and the
profc'Sional researcher

CHOICE OF PROBLEM
Choice based on the interest
and discipline of the pro­
fessional researcher

What°

Professional researcher

Who?

?. CHOICE OF
What0

methdology
Experimental research dcsigns, use of reliable instru­
ments, statistical analysis

ProfesMonal researcher

Who0
3 CHOICE OF OUTCOME
What0

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Client (primarih)

Professional researcher

p
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— Chances m the situation
— Increased knowledge base
— Increased capacity among
actors to inquire into and
change their situations
Jointly by the actors and the
professional researcher

— Report (to the Client)
-Publication (if the
researcher negotiates)

Publications (Presentations
in •learned’ seminars)

Who?

K>

>yr<~' •>< Re"a"l. I .ocr,,

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24

PARTICIPATORY KLSLARCH and evaluation

meihoJolog) in idcniif) mg the records of people whose land
was illegally alieniatcJ from them.11 Another well-known case
is (he Chipko movement in Uttar Pradesh where, as a rcrull of
the people's reflection on the causes of the 1970 floods, defores­
tation caused by some industriali-is, the forest department’s
refusal to let the local poor use the Ash trees fur their needs
and the permission they granted to commercial contractors and
induslralists, the people organised themselves into a resistance
group. A community forestry scheme ba?.cd on the right of the
local people to the foiesl produce and the maintenance of its
environment was born out of it.12
The relevance of this chararteristic of a participatory approach
is not merely to recognise that, while the label is new, the
approach has existed over the years, but also to accept the
fact that while labelling of concepts is an activity of pro­
fessional researchers, ordinary people somehow do not see their
approaches in similar conceptual frameworks. Participatory
research is, therefore, a new approach for professionals and a
pragmatic one for those in the field.
This poses significant questions for the development of a
participatory method For example, do we have a single, welldefined and well-articulated approach? Are we clear that the
range represented by those engaged in participatory research and
evaluation (from professional researchers located in universities
to semi-liierate field workers in the village) necessarily implies
tensions which need to be addressed in an inclusive manner?
Wc do not as yet have clear-cut answers to all these questions
but can only think of tentative steps Figure III is an attempt
to chart the steps of an ‘ideal’ participatory approach.
One major clement missing in this ’ideal’ model is the
ideological/normative stance. To the extent that participatory
approach is an attempt to break away from unidirectional control
of the professional researcher, it has to be consistent in its
definition of‘actors n the problem situation’. Therefore, partici­
patory approach is sulely in response to and for the fulfilment
of the needs of the less powerful, weaker segments of a social
selling and is part of a process of their growth into consciousness.
“‘The Siory of Shramik Sangaihan Howl(n. 1 June, 1978), pp. 24-28.
“Gopa Joihi, ‘Afforeuatioo of Deforuted Hiooalayaa.’ Howt 4 (n. 4,
. 1981) pp. n-u.

main concepts and issues

25

At all stages of tncir liberation, the oppressed must sec
themselves as men engaged ,n the ontological and historical
vocation of becoming more fully human. Reflection and
action become imperative when one does not erroneously
attempt to create a dichotomy between the content of huma­
nity and its historical forms. 1 he insistence that the oppressed
engage in reflection on tbeir concrete situation is not a call
to armchair revolution. On the contrary, reflection—true
reflection—leads to action. On the other hand, when the
situation calls for action, that action will canstitutc an authen­
tic praxis only if its consequences become the object of
critical reflection.”
Figure III: Sltps in on ‘Idtai Pai.iapatory Rtitarch Approach

REQUEST
from the
actora in the
problem
ailuatiou

Joint agree­
ment between
researcher and
actors in the
situation

Small group
responsible
for research
cycle

Joint design
of research

Dcvclopracni
of
Change-plans

Sharing with
actora in the
problem
situation

Joint data
analysis

Joint data
collection

Implementation I

| Ccnaolidatioo
of
I
Learn in|

ChaDge-plam

______ I

Some comments related to Figure III are needed here:
(i) The initial request in an ideal participatory process may
come from the powerful actors in the situation. But in reality,
this may not be so. The request may come from someone power­
ful within the situation, or outside it. Yet, the researcher can
transform it into a participatory process by following some later
steps, provided his ideological stance is explicit.

‘•Psulo Fraire. Ptdagogy of tho Opprtuta (London: Frngum Books,
HcpcuU 1910), p. 41.

26

participatory research and evaluation

(ii) Various steps outlined in Figure III appear to be one-shot,
fixed ones. In reality, a participatory process has to be cyclical
and iterative. For example, joint agreement may need to be
worked and re-worked many times, over the entire cycle.
(iii) As presented here, various steps in the participatory
process assume the involvement of an outside researcher. In
reality, groups of actors in a particular setting may go through
the entire process without any assistance from the outsider. In
fact, effeciive participatory process must have the increased
capacity of the actors in the situation to inquire into and change
their situation as a valued outcome. To that extent, an outside
researcher will become redundant soon.14
(iv) As presented in figure 111, the participatory process may
appear identical to Action Research. However, there are two
significant ways in which participatory research is different.
First, the ideological stance and emphasis on making the
researcher’s value-premises explicit are generally not mentioned
in die action research approach. Second, action research can be,
and is being, underUken without the participation and control
of the actors in the situation. In essence, then, action research
becomes another method in the exclusive control of the pro­
fessional researcher.
The Pariicipanis
A related characteristic that deserves meulion here is the range
of people and their diverse motivations to enter into the partici­
patory process. We can see the participants at two levels i.e,
professionals and the common man, especially the oppressed.
At the professional level, in the Indian context, there are at
least three sets of people and motivations. One set comprises
those who have been trained professionally in the empiricist
paradigm of traditional social science research. They have moved
into participatory research due to frustration with the existing
form* of research. For this set, the reality has remained
untouched and unchanged despite tremendous development in
research technology. They notice that despite the increased volume
“l or more on n see, ’The Activist's Credo’ (Excerpts from the Report
. i ilu Warkslup on The Training and Methodology of Training for
Au. »isn prepared by Kami a Bhasm and Va.m Palahtkar Lakahnu Rao),
I.
t..') t</.. n, 2J (n. 5, December 19-U), pp. 249-251.

MAIN CONCEPTS AND ISSUES

27

if printed material, the life of ordinar) people has remained
unchanged. Morco'er. the institutionalisation of research in the
universities and other such institutes has led to a monopolistic
control over research, on the one hand, and a distance of research
from ordinary people on the other. For this set of researchers,
such irrelevance of social science research is intolerable in the
context of a poor soviet) like ours.
For the second set, motivation is related to the need to
redirect the processes of development in the country. The failure
of existing programmes and models of development is being well
established. These are the activists and field workers who have
experienced frustration and anger over the misdirection of our
developmental strategics. For them, participator research is a
possible alternative to provide momentum to decentralised alter­
native models of deveh-j mint- development cf the people with
their active participation. They aie engaged in localised expeiiments in a participatory pioce^s to try out these alternative
models of development
Education as a means of social transformation is the under­
lying moi'vation of the third set. For this set of people, research
is a learning and educational experience and therefore, should
be attempted in a manner mat facilitates societal level change.
Unless research contributes to learning and unless that learning
is widespread enough to include those who arc part of that set­
ting, it is a meaningless activity To that extent, participatory
research has been found to be a relevant approach to education
and learning.
At the level of the oppressed sections, the participants arc
predominantly rural. The size of the rural population in India
and in other Asian countries, as well as the complexities of
developmental dynamics, have contributed to the overwhelming
rural context of participatory research in this country, or for that
matter, in the Third World as a whole. The best examples of
this process are, in fact, from rural areas. As examples we may
mention the Joint Irrigation S)stcm among tribals in Southern
Rajasthan, Gram Vikas in the Ganjam district of Orissa or
Bhumi Sena in the Thane district of Maharashtra.
This rural context has contributed to a much bettei under­
standing of the prouessc-' involved than would have been possible
in an urban profcssion.il atmosphere. Moreover, Indian activists

MAIN CONCEPTS AND .

/ES

29

participatory research and evaluation

28

and researchers have bee^ ?bie to learn from similar experiments
in other countries of Asia, Africa and Latin America and have
been able to contribute to learning in these continents. In that
sense, it is considerably different from similar experiments in
Europe and North America and can at best compliment them
since they are, by and large, urban in character.
SGML IMPLICATIONS

It should be clear from what has been said above that the
participatory approach is oot \alue-neutral but is ideologically
committed to the weakest sections. It has a necessary relation­
ship with social transformation and action while classical social
science research has conspicuously avoided any active involve­
ment. It is this close linkage between social action and its
political implications mat has scared many professional research­
ers from adopting a participatory approach. These professionals
work on the assumption that research should be value-neutral.
However, one can question the validity of such an assump­
tion.Though scholars may consider themselves objective, the
system within which they work cannot be politically neutral.
Research in social settings has always been political and either
maintains, explains or justifies the status quo or prosides data
to those who want to question, examine or transform it. More­
over, studies have shown that many apparently Charitable
Foundations such as Ford, Carnegie and Rockefeller have in
fact been used as tools of American foreign policy though the
scholars concerned may not have been aware of it. The decision­
making process, the nature of funding and the type of institutions
they helped io build up all indicate a definite policy.15 What
Las been said about the above foundations can be said also
about many national institutions and the funding policies of
many other countries.
On the other hand, participatory research and evaluation
cannot be considered merely one more mode of community
development. In the Indian context and in the Third World as

uRubert F. Arnovc, •Foundation* and the Transfer of KnowledgeUnpliGaiion* for India,‘ Social Action, 31 (n 2 Apnl*June, 1981), pp
1U-173.

a whole, the participatory approach is inaeasingly becoming
synonymous with the processes of liberation of people. The
involvement of poor, marginal farmers and landless agricultural
labourers in the twin processes of participatory evaluation and
social action have resulted in enhancing their self-confidence and
ability to take collective initiatives in their common interest.
While it is different from the classical community development
approach, participatory evaluation can contribute towards the
liberation of people only if it is associated w ith some form of
participatory social action. The challenge to researchers as wel
as activists is ‘arc we prepared to accept this as an operational
definition of the participatory approach?’ The researcher who
accepts this definition has to commit himself to an approach that
1S closely linked with action. One cannot demarcate separate identi­
ties of participatory research and community development with­
out asserting the elements of participatory social action.
To the extent that participatory research is invariably associated
with some form of social action, it has very clear political implica­
tions. To use the participatory approach in identifying land aliena­
tion with the organisation of landless tubal labourers .s to link
.nquiry with the political dynamics of the setting. To join with the
farmers to engage m the soc.al analysis of their ex.slmg situation
is to raise political pressures about the existing structure. To
develop an alternative health care system which favours the rural
poor is to enter mto direct conflict with those whose interests
are challenged. It is so because the process of social control is a

political process.

Differences in the ability to make rules and apply them to
other people arc essentially power differentia s (either legal
or extra-legal). Those groups whose social position gives
them weapons and power are best able to
r“le$o
D.stmctions of age. sex. ethmcily and class are all related to
differences in power, which accounts for
« for
degree to winch groups so distinguished can make rules tor
others
The participator) approach, therefore, by its commitment to
the underprivileged as well as to social action, enters into a

••Howard S Becker. OutUderi-Studlct In the Sociology of
(New York: The Free Preu. 1973), pp 17-18.

30

PARTICIPATORY research and evaluation

political arena where questions of method and validity become
nphstic. It is because the rural Indian, for that matter the
»n and Third World context, is primarily unorganised. The
underprivileged, whether landless labourers or urban slumu vellers or women, are primarily unorganised. In a large
measure, their state of poverty, exploitation and helplessness
are related to this non-organisation.
To initiate a participatory process with such underprivileged
groups means to initiate the process of organisation-building.
Unless this process leads to genuine organisation, one cannot
think of a genuine participatory approach. In fact, in the absence
of an organisation, the participatory research efforts can become
tools of unilateral manipulation by an outsider. To that extent,
initiating participatory research efforts with unorganised groups
requires an initial effort in developing a rudimentary form of
their organisation.
If there is this initial effort, many instances have shown that
the participatory research effort itself contributes to the building
of an organisation of the people with whom this process is
started. By the sheer process of attempting to bring a group of
small marginal farmers to analyse their own situation, temporary

Rajasthan. In other words, this poses some questions about the
methodology of the participatory approach. To the extent that
Indian and Third World societies are unorganised in comparison
with more developed countries of the West, any participatory
research effort in the poor nations has to be simultaneously
an effort at building organisations. This is not necessarily the
situation in the rich countries.
Development of Knowledge
Another question that arises from the above discussion is: how
to develop authentic, valid knowledge? The participatory process
tends to lay emphasis on authenticity as opposed to validity.
The concept of validity as defined by the classical research
paradigm ;$ inappropriate for several reasons. First of all, know­
ledge about a social setting is not equivalent to information
obtained from it. The meaning attached to that information is
more important. Any representation of social reality is contin­
gent upon such meanings that actors attach to their reality.

MAIN CONCEPTS AND ISSUES

31

Secondly, the impact of historical contingency on knowledge
derived from social settings is too critical to apply to universal
constructs of validity Existing criteria of validity are concerned
with the generalisability of the outcome of research.
Participatory research, on the contrary, is potentially an
attempt to generalise a process of research, instead of its out­
come. To that extent, the criteria of validity need to focus on
the external generalisability and internal consistency of the
research process itself. What can be some initial elements of
such a concept of validity? One can enumerate the following
among many other possibilities:

(i) Relevance: Histor.cal, temporal and spatial.
(ii) Researcher calibration Sensitivity of the researcher,
emphasis on the calibration and reliability of the researcher as
opposed to an instrument or a method.
(iii) Convergence. Emphasis on consensus of issues, multipli­
city of methods and congruence between processes and outcome.
(iv) inclusion: Context, actors and researcher. Emphasis on
looking at the research approach as a social process and managin; the confluence between the aspects of the setting, actors tn
the setting and the researcher
How can we build an alternative concept of validity based on
the stance that participatory research and evaluation emphasise
generalisability of the research process itself? This is one question that still needs to be studied, because though many groups
in the field are involved in' the participatory process, not
sufficient work has been dore at the macro-level.
Moreover, if the generalisability of the research process ts
emphasised in the participatory approach, what is the outcome
of research itself’ It can be at different levels:
(i) Immediate social action and change is one such outcome.
The actors in the research process engage in a common effort
to transform their situation since they become aware of the
causes of the present state and their own potential to be agents

of change.
(n) Increased knowledge about the particular social setting n
another outcome. Unhke in the classical system where the out­
side researcher has the monopoly of knowledge, in the.partcipatory approach it is available both wnh the researcher and the

participatory research and ev

32

*

main concepts and issues

'.cation

that .»■
the present
b ,hl
of
research is in fact a reproduction
repro uc i
decision-makers control the rest
move away

a

population that
Aassical methods and
■nd

““i,““.te „i or UK »<« »ir-Co»IU«n« UK,
s.

7 (Tnrt at aclion Persons who were till then considered

occurs in the process.
. fa participatory approach,
If these are th.* potential outcomes of
of
Viewed from a
what happens to enhancement cf knowledge?
k:
not be increased
classical researcher's point of view, there may
knowledge smee in this sy stem the cnd-product is a professional
d:£rereni kind
rxf W » •V.7 - •. ’
eed

.tor
i;
nation.
• rjssi.h enhancement

since they constder it a politic P
hM nol
wants to find an alternative to
led to any S0C,al
K we get involved in
he makes Ins Geological sta
P
f , d
weak, the
research efforts that asstsl h Mess powe
so-called research process becomes P^^
panicipBlory
However, those who shy <
y;mnhcations do not seem to
approach because of ns pobeen pohtica!. U
realise that research in socia se
h^
Qt queili0B8
either maintains, explains o j
_ ^ke an acUve part in changit. though the researcher may
lhe political aspects of our
ing it. We may not be aware
lhaV our inquiry was
research efforts because w
idc0i0gical stance explicit.
normative or we never made ou
S
requires some basic
A transition to lhe part.c.pa
PP
lhe reseatcher or the
attitudes on the part of the
parlic,pafion in his own
activist, as the case may .
able (0 facilitate
pa^/patioTo?ihe°people in -'‘^^X’^iaf^son^ty of

. -.•■-nessicnal researcher?

CONCLUSION

, .w

This paper has
ous points of v iew. There are
professional researchers from va^
of lh£ pledge generthe ideological issues of
n^lnr<- as objects of stud>
ated. the ethical issues of
i(j lhe hands of .he proand leaving the contr
. usc lhal is madc of
fessicnals, and the political issues
h programme. It
this knowledge by those who fund the research p g
,.;3, XUral D^lopmtni and Social
»’ J.M Hcredcro
Siucanon (New Ddbi: Msnohar Book Service.
In NoM-ForMJ/ J—
pp. 12-iS.

underprivileged.
researchers have to be in
In other words, the va u
parlicipatory approach. He
congruence with lhe va ue
;hs of the people and has to
has to believe in the basic
of th£ wfm Tbe
cherish democratic values m th P
suslain part.cipabehavioural sk.lls rc^‘dnX" ed by ‘he researchers. These
uon of people must be possew
of th. focus on

the participation of such secuons.

i i

\

/oX-

•A

o-[pQjMhS I’y

4^ Wov^'r^
vxeJfdrrfe <T

OfDop o/>

orjan/
e/
can? -sevvices “jn

Z\re<V3

*.y/M'-X*

G U 'U 'i* S '1

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’ -M-K--M-X-K K A •kX-K-X- X-X * *

i

CHLVm
IntroC.i. f ■

/

1

2

5

6

-I-

II.

D.jl iVir.'i't.i >ih:; of tho

in.

FiudiuCs of the

IV.

Ik.’Cc>in)’icii<ln.t iouu

Uorl: in" <lr«']'

Vforkir-g Group

7 - 17
18 -

19

20 -

21

• 22 -

2J

1
i

I.

Lot tor of Wl. Secy. & ^oni'issianer
, Ministxy of Health
.
Nev/ Delhi, constituting the working
Group.

II.

Present Pattern and Scale of Services
in Family Welfare Centres.

III.

Minutes ol the First Meeting
ojid Quonti. rnaire issued.

IV.

Jib into: j ei ;ho

v.

Agenda Note for the Oonforonoo
of Chief Executive Officers
of Mimic in al Corporations.

VI.

I.Hr.uW c»f the

VI.

Miriiitc<3 of the Fourth Meut^iiC

w

:

Gocond WjotiiiC

Third Mooting

*-«■***

i

J

24 -■ 5°

31 - 46

47 - 54

55 -

6o

69 -

72

V

1

C !r A P 'J? ?3 Tt

A-'-xwHr.r; tn th?
ec’i.-ju.s,
cf CrMp.-J pop?i><u?
r ’ • • — -•• i t.re?.;3e
Xiiis c wo to over ]>7 i’ij.’ion
-•■‘’•j h,.;;,n;i i -'j 1 . h'y.y ;:y;..fern in rm rcehmi rre-’.,

cr4

1 •;

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- in I jcj.j (
l.'-Ci

>,<i/,H ;tf; rd; ho-. -iunlj / dJ;.; 'j'SJrr.'i'je/ Cii
*-•
*
• • •*-

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I

I

J ,9
i i:.<. ji,

f,

Governirnnt, State er Centralj

0

b‘n Lc:il»uL Glirj,(Jr, i.j >]./?(,.7!l Ct.-iajUcviJ j

<0

p
aa Cnnlr.'J. Govern..wt Health Sc1iq;;:q,
■’r :i.(‘fT utate I'lJtvrcuico Corperntion, Induntrial
1 iu z'x..anh; ;; caul Volrait^f Or,ro2iisatia;isj raid.
Private ind.iv?'i'ials /bodies (nursing homes/clinics, etc0)

;7.
:r,9} C
1...lLr.;<.:
’nlly attaohod
••■ .1fJ
•U hr
Ci;.it.
<•.;<: ••re USt
USUrilly
attached to
to
• '
G ■•,vli X cy; ,L x i1 jiii:
^o'/orir/H|.t/i
|j •
| ‘.b.u.b:
. . Li
... el
-.f'Ciiios/Voluntary
c
lo'irjjod jn
institutions
3 o1\those
.u
'^-■L-J'-.-lv_j are prodominaatly
'•
‘ I t
1 ; < f;r
.
OL\rOor •’nJ loi-er Uii-Ulo class
t‘;° irrjt;kutl^iu do not have proper I
outreach unrv?.(’cr ■ h V
soxrziee^’-.rot I-ril-ry
5 j/' -. ’ T,' •'■'.3 4
110 1’amily p lann ing advic e/
—-1 g^cq. Gorviues tond to jet left out,,
f
4?tl Urba
U.i *uan
,
n a>'( • . ■*. i.
j£L'^
eLOd? d^10 ^tPEE, Poor and
-—* d] aoTT

I

.

,; i ‘ ' iJ

TT'•!>■ J’’.:n

L'T X'ir»

---------

, - I ■ J

■

plpop, thq envirorifnjYtni

>

---- tCrr-thewF

^po^u is 4iiT^opo:eg pnQ^^_
caroThe^itt;
tcrc
'■y
'•■pre.:.J ol disc-GT^;
Ut‘

I

'

LUMUrto
Un^le to rJiord costly
130stJ.Y inadequate, iTyPP------

9

1.4
' ■k? ^^ard to Family Vlr.^
present otwoturo in
iu and Prl-naxy Health Coro tho
jTAiTtn o I?, -—
-Led
. r,Qric Qr less entirely hospital/
prJL. Pol?
there is a
ive purposes inTarger cities, ”—‘
Q- liistrict
sorewhat on t he- same lines as
•Gopc-.idjh’g an the si%Q of the city
9
-i oar.abxxrjhed mostly r~
- adjunct
—•
cis an
-re amtre to fthera is
th®
^-.Lroa
r
,.
0
C
„'®
ZO5:
depopulation.
Most
^La^vig-ec

I

;^n33^E5?s^TS,ggT‘:. p“
.•i’ :hjch ';l'-o_Urban Pcniw VMpai'r

Oi f®am
hospitals
^octoJiQ Enjntain

■

,lum,

—«r<*

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.

-

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i

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|

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,

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■

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.

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/

■

I
’
•
1<5
Primary
Wealth
Care
facilities
in
urban
areas especially
. *
in tbieMy populntod pockets, slums or areas inhabited by
vubtpr i!« i<|j i1He
th
5’”-M
j.j'Jii of
OC
cjul
LXv uru,
ai’uu, thus,
I' .h'ii
oI suulLty
.juiluty
bhiiDj almout
ulmout alsunt
uLijunt ci-id
^1.
~ gc^j-cQG in. a <ciV taad tg bo largely curo^oyientod throc^h
hospitals and clinic a.
-—

1 ii
■

>

-.

'I'

-he need to remedy the existing situation ."nd to improv^

the

r'- < |.,i

urban , slums Ayas 'discussed at th Cmfav-arioo of •
n i*::;/;UtlVo UJfloors of Mmicipal Corpornticxu held in
s’ <:ttI
Ap^id»1902. Tlie Confer unco intor*-alia

m

OT“P t0 80 ““ «* varl0“3

i

1
;3
\
u Hgfc.']/
,

.

out-raach.services in urban
x-cvtj.ow~6r^thu exist'iii^ 'n6fms7~f or cJEablisli in^
N’elfru^o Centre^, Settiji/j
_ __ _ up of Family Ublforo
”?». _Qto, ^7,ccordlngly'tIi^MiTictfy~bT
:-1’’ Hoalth TJiT" | '..
l...HJJ,y Ull aro 1JOt hp/
r . ’^. Croup
u_,„r to (/;o
w into tliis question vido
xott^r Ho. h„ )';.):iyi/u2-l>ly.' ^atodI 22.4«02 (Annoxuxu I )
cons mt m,'; ol , .
ill]

1

1.

.
";r-

.■] -■'

..

■■■' ' ■ ■ :

J
. Ij':

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i1
.. . X- ] • .

4.
5.
"6.

,l:

Health Secretary^ Govern meat of. Maharashtra*
Health Secretary, Government of Uttar Pradesh
i

’ "'i

'

Sliri R JTatarajan,
iJoirt C
w
9
_ '.ret
_ » ary f
f Mini st
UJL^y
Sec
xy
of Health & Family b’elfare 9
GoTOmmont of India.

•

.,..

:

Cr

“VTKI vr./-w-.4*

—- X*

*1"

1 _• _

;

■

.

I

••

.

Bio Health.Secrctariec of the above States were also
n
reQt^^Gci to associate- one or two representatives <
__ _
*
pal'Corporations
of the Munich.
i of their States^
!. •
■.■.,■■

—~

ia

- \

!

.

.

. I, .-Jh
/ •] fl

i ,/

norms for establiWelfare PuroanE;
/

.q^UuM
'

■ ®i

I

*

l

Ini-ri v.^!Q10?QiCinp'
of the above Group wore to po
and nuulQv'rfX< l’C-^T’On’j rolnttoc to toprqyfaff the cut-roach
■ 1~'--y 01 1 ^^oly^Qlfoto and FrS^rTgaFeF^m^

■

.

j - Kp- OtO; :

■
■

■

J'-;/

•• •

»

j-i

Health Secretary, Govemnent of Gujarat*
o k w vajujt

■

<

Govcmiiait of Ifeat Bon/jrJ.

i 2‘'' Health Soorctray, Government of Tamil Nadu,

■■

!S

I

Health Socfatary

------- n

1

.1.

3
_C_ II A P T B B ~ II_

DALUIKIL'.TKHIS Ob’-'r.'lM ..OlflCHUI GROUP
2. '
The Croup had ita first mootin.- in Na/ Sol’ii on 6th kr?r,
’J902. Shri J .3. Baijo.l, Addl. Secretory Cowiauioncr k
Ministry of Health & F.W., briefly described thej.-e.-iconc x<u
nottia;; up the Workint; Croup end emphasised, that the eroup tiioa
Co into oil aspect□ of tho problems ni\cl
|
.v. liionn ..which. vouXd form the basis of the hoaltjic^Y^^^
[
P hi the next 20 years.
Sir’i S^V .l<risbr',n, thotum i-oll. 4.a •
' Socr.)l;nry
S.^roUry, Heal th ?c
Wont BavrJ, was im ••..\u.ioaGly
x'oquQctad to bo tho Ohairuw. of the Gro'ipe iSltri Baijol -cqii'.•G’o
thq Group to corploto its report by the end of July, 19°2*
Ghairnian, Ehri Krishnenl suggested that, in order to have an
•
indepth study of the problems, the Group might i^ot in the different^
Staton^ *

2<1
A copy of the minutes of the first meeting is at hmexure US*
^f-Lor discvuuixu^ tho problems, of the States represented
represent cd in tho
the
Group* it \ms decided to evolve a format seeking detailed information
cm the existing facilities in respect of health structure rnl thb
the
After
^itin^y^Tru^ in tho States rep-• esented in the Group, if—detailed
---- —
dice’mt ions, a fomiat appended to Annoxuro IH was drafted aaid
oirciilatod to tho Lh uber- St at es along./ith tho minutes of the
mooting snd tho nor bore were roauestodt o s end the information
</ell before the next coeting of the Group.
The particular infer- ? ^^■9n.._??^_4__for in the proforma related to urban population
1 ^particularly in slums" ) , existing programmes for pwyiding f't?.
c
\ 1
X,-l&kl aria, Fi jar4a^Lepyosy, T, School Health,
\ \
at.istios.*,Intensity_£f coverage. Health education, *
\ \tvallubility of buds, etc.
*

i

I
\ ^*2
On the roconu-ondution of tho QhaiMncn that there sliould
be a Senior Statistician in tho Group, Shri S.S< Hair,-Director
t
(^valuation ) Ltinistry of Health & F.W., Doptt. of Family Welfare,
v/us Co-opted as Un;Der of the Group.

<•3
rfho Group had its second meeting in Madras on *26.5 •82«
no list of oil leers who attended the mooting aid the minutes
cl the -meetin•; is at Annexuro IV.

^GG^ccions at the Madras meeting v/oro mainly on tho
^’•cri.al aupplied by certain State Govts, on the proformp.
Circulated to them.
Tho Participants fcvelt at.laigth on the
\
providing—jEha. minimum-needed primary health care*
I
ic e s, w at er supply, disposal of ni5it soil,
well as family
\
X'-re—GoryicQs, supplies and advice at the door-steps of the"
I ^?I?13•
Gb^gGnsun emerging z mj^it provide tho basic health*
\
Llir^cntiye, proP-otivHZfcicl.eum-tiyc) 'and the F.W.
’
~a.placejipitJphLli..waihitig distance of about "IfTTminutoc
_ur ea.
The various aspects of creat in g aw arene s s
Z-GUi of these disnvjx-

ions-iaas th5.+, .XLaolififfia, should. ^>e bo davisacl as

Ji

i:
■

4 -

!

i

■ ■

■

,

■

•

'

i '

ainangst the people living inf0*?ltd M.T.t.services
" small family norm” and
Y Various motivational
wore also discussed in great detai^.
-ri us
f
strategies, audio-visual techniques and incentives
and benefic.iarios wore also discussed.

'L .

. r

C
\ j'i ■

.

G-oup then discussed the suggestions
Ministiy of Hen ch. & ^u.dly Uelf^o ta the Agend^^'.icipsl
the Caiierence of Chief Lixecutive
„x
jq,-, out inn of.
Corporations on 7th April, 1982
J•
of the Jointly. ^for.^re^n^f a2Lrf
ponTtb cover_ajppulution not excoji^^"^voman )
,c4;^5h-ErEKrblun aroas-aid^appoint
f g~g£3jagfiL-P£—yil 1
Health Guides
Ud to define
\ . oraSFt^live due cansido»ation ^.^i'^^Xuired and the
' ’
the norm for areas to he covered the staff
it v/a3
xmco or ooroiooo noodod tteouah out-nash
tt
decided that Dr.
Saigal md Dr. 4 A. Cantra^or
. 8acrot.-iry, Government of Tamil Nadu, °hould,pro^vanL.1icoo
giving specific suggestions regarding the out-reS orjilsutionul set up for the consideration at the ne-t
,

...

.

‘

I
.

f •

r-

Iho Third meeting of the gwup was held at

'
■ :
•

.

>

-

•
Hj

j

’

•

.

?i

1

Mf
.f.

The discussions.revolved mainly on the definition g
slums and areas inhabited by weaker section
society an
-TTT^Tnfrn-r'.triie.tiiro proposed in the paper.
o pay^pn.

At’’

I.

I.
f ■

•

i this mctlxg’srnt. Avabai B.Uadia, President, Family
. Association of India and Dr. Indumati Parikh were
^ted
to obtain their views on how voluntary organisations couLd
. participate in this prograimo.
The
^fra^bructurs’'
paper ontitlec’ "out-reach services with uUgGestoa iQi
pyieparod by I*r..
Saigal#
|

^iTSitW'v/brkbrar^^
at~tlie~'health'posts aiQi-pforral centres were alSohliacuqsQd '.
at length#

’'

W'

=* Another important aspect, discussed was about the
agency whether Goygcnment or local hojy or voluntar^g|aiim ■
which should primarily bo rosponsibile for organising x_
|
services.
It was decided that the entiro-matter should be
discussed in more detail in the next meeting on the basis of
views exo res sod. in this meeting®
I

I

■ A-

5

•i •

■'

•

.

5 rn;

.■

•

• i

v/- the
-A j group was hulci in ITctj Lcn..ii
I 2.6
Eio fourth’meting of
on 12th July, 1982.
'Tho rdxiutes 'jf the rrooth.g are at *^nnexa??o VH.
Tn thin meting, concrete shape v/ae given to the paper on nnut~
roaclx sexT/iccu in urban sl*imsn which wre redrafted on the Ilvjj
Tiio group dik JUS-.-ed
of sag-<antions nade at the Loi.lay meeting,
/b:
i’l u[ ucir.Jc term the utatus of proposed f ie: ’..\b--.ri-.)j (iu A.udi'i.*
q
’ •nrn.i:iriQi/h(c:r1ratiun ) and range of services io Lo proVAbd
ritual
x(
‘•nt each level.
As jj was difficult to identify the
sluins, it was decided that the proposed UIu;.lth l oatl—should--^yQr an area v,Lose population hail at leapt /}^i?
tn 1
crAiluj) 3
fxr(
y/Hh pro-dnulh.unL.ly wimIluj1 insetiunP+
^UCtMxtional nsnocto of the scJieno word LllJo discuseod-in—
111 ip Knoting* • ""
* l“~
"
-___

^•7
^here was a considerable discussion on the question
y Croat ion of slipervisciy and coordinating levels and agencies
to be ontrui/tHd vrith. the task cf i^lomoiting the programme.

Tp8 + +^? ^^o^ncndations of* the group are given in dhapter HI*
ie tentative recorjendations made by the group were placed \
kth Joint Canference of Central 'Councils of Health &
hold frori if/th to f.Oth Auguet, 1962.
Tlie Cenforoncd
1%2.
rr’/bi
l V I I <) W ll L g LU ‘ >Qii .L! 1VJ] i <1l X lul LU I-

w
li

• ■'

s/wTho. Cuvornnont have1 already roco.giisod the need for
■i-'evar.*ping emd restructuring tho Kriiaary Health Caro
rtia 1 amiiy Pluming out-roach services for urban
^roruj, pru.'tlcuJ.urly uruim ulimia and congestod
ouclitiofj inhabited by under privileged sections
tt- l-hc^ pocpla*
reaoctxiGndaiiixis of .tho Task
constituted for this purpose v/ero generally
opV/Qa
that these rocoinmndations
MV ba processed urgently and given effect tn as
^peqaliy as ponsible, with provision of additional
^uiy □ made x>art of the fajaily welfare progranae
aadt th^rofor^^OD^^dsral^ funded^11 i

. ] _ ■ P^l/CU, L </ ^

U

\ uu

vjXAK^
LuA

^cA

Ajxt/vos
1 zlvt

f

; J .

li
■

h"'

■

I
~ 6 Q H A P TE R

- III

FUmUTGS OF THE WORKING GROUP
■

gAMIX PI2MMIKG Alffi PRBiJg H-’ALTH
SWICKS fl EM 'suto
■

■

Considering the need of Family Pl?n.;iu.;, J.j.C.-I* end

L

[ \ - •-< Health Care in Urban Slunis, the follow tig cut-re*'.ch n.uvi’ea
-

; ■> i uro considered nocoscaryi-

1,
I

V
I

r

put-roach services

30

Pqj.)U1 at ion ^duc at ion •
11) InfoiTi;vt ion, mot ivat ion about
Pamily Planning methods md Il^TeP.
•Hi) Hfialth lllucntion
Unv i ronriontal| s an it at ion •
P ere oi i al Hyg icne «
^owunicahle diseases*
JTytrition*
..
and E*P*I.
,
ij./.l,

j prevent Xvq Sarvicos /0
A

, ...

^Immunisation^ I

ul) Ante-natal, post *41at al and infrant carp*
iii)
lv)

Prophylaxis againpt anaemia.
Prophylaxis against Vit.fAt deficiency*

•v)

Presumptive treatiaent of ml aria*
Identification of suspected cases of
tuberculosis and leprosy*
Pilariasis*
Infant feeding* •

Vi)

(■

vii)
j.

5.

. I
!
♦

ffi.arui jng Sorvicen*J

N irndh, other com anti«ial
contraneptives and oral pills*
^i) I *U JI * In sort ion*

I)
•) -

I

■

I iii) Sterilisation and M*T*P* services either
(—through referral hospital or while vans provided
. undorROJ.ll Scheme or through identified
institutions nearby existing or created*

4.

SAj^at ivn

1)

■

■ 'H-

Flint aid during accidonts and omcrgoncioQ
TreaUiient of sinpla_ailnmtsi.

7
■

■

7
.

^apppitivo services (Referral).)

?♦

All the out-reach services must be backedup by institutional
services particularly in respect of

.

V<t)

High risk maternity cases•

vii)

Sterilisation and.
biatnosis and treatment
tuberculosis
leprosy.
Laboratory Dowicco for diagnosis of malaria r'tbor
requiring -doctors services/hospitalisution,

•A
^iv)

I

I

*

(Reports and Records Jaxticulaxly Ln respect, ojE^s.

■

Prevent ive Services •
Frii;;i3.y Plarminc; Acceptors^

Vf)
Mj)

V i t; il ova it u J
' Morl}j ;l ity anSSfoyt pl it?/ / p art ic ularly
ularly in respect
Qi' (a) Ahiaria (b) luboruuloJis kc)) Loprosy
(d.) diarrhoeal disoasoa*

kZv)

i-e.-binoQ gf Faiaily cards or resiste£_
lor population covered^
__ J
t

pronant fanili,t joe
1

jprosunt there is no otoiidard staffing pattern for

the delivery of out-roach services in

urban family welfare aontrjjs^

urban, areas except the

1

The ulufL’lng pattern of those

»

Urban Family Welfare Gent res was so revised as to ensure

for family planning and

roach and clinic services

I

out-*

M£JH«

However, experience has shown that those centres have not

Stuff of these centres

succeeded in either of those functions,

hardly visit the field and clinical services (sterilisation

\

& I2PP ) are provided mostly by the attached or nearby hospital,

<*3 • Rrogrumne wherever

•X •

<ne medical officer, one
^—11

» —• —

1

jripleinented in urban areas provided

LHV and

AHlis and one Anganwadi

•••-—-

ofox every

-

1000

population for

I ■——^1,

—,

„

.—

-------------------------------- J-

.

-

II I

t

NOH Services to cover

about ono laVh population.

>

■A
-

:

I
;

■ I’

'I

!

.A^

•

0

Hio other out-reach services are provided by the locj.
2.
The quality and
body ctnff depending on their availability,
quantity of such Horvicoo vary from urea to ugoa and ;.;ono rally
\ arc considered inadequate toi meet the requirements. In most
\ of those aroau some workers to look after environmental saiii-

? ■' Ia
. ’ }-'* /;r'a ', «• ’

’

tation, ^*P*I

-I '

fuid Malaria programmes

are also available.

HI. Strucutr? siry-ested for slum areas,

No doubt many of the health problems of. rural..areas

1.

/

and urban slums are similar. Yot there are many diffeygicos
between the two areas which need to be taken into consideration,
while suG/jestins the health infrastructure for urban

*

slums.

Some of the major differences are «-

i)

Uhile rural axoas have a mixed population of upper
middle class, middle class and poor people, iwban---- -

sl^population^febfilnncs to pogg^^
clans and

i

>

!

I

morbidity and mortality.

io.)

Eniviranmental conditions are much the worst in
• . areas and as such
u5>an slums corparod to L
-rural
slum population is moro exposed to illness•

lii)

Rural ijopulation is mostly farmers and can be

-

■ ' l!
:

as such have c< iinparatively higher

'

••

■fr-K

J*"'

■’

-

contacted any time either at their houses or
farms, while urban population mostly belanso to

'J '

, labour and services class and__as such only oojdailL

perocntnb'O of adults can be oontacted at any

particular sivon time*

■rf:

■A V

H'"'
I •

I.

f

' M; ■
I

5

X
■ ■

1

"I

9Vi)

Jh mcht of the cases, the whole family i.e. mor.,

women uid grown-up children, do some work nvl
tribute to the income cf tho family.

Under those

circumstances, it nicy often be difficult to get a
purely voluntary health worker in the slum areas
from the residents of tho areas.

However, such

workers may be available on payment of soma .
honorarium.
v)

1

«

UnlikGt tho rural, population, the alum population
io canoentratcd in coxtain localitioo of tho tov/n
and. are, therefore, easily appro achable# KKeeping all these con silerat ions in v lev/, it is

suggested that there should be a, Health Post for every slum
area lopatod ii the slum area itself.
In the infra­
1
structure suggested below, the nurse/ midivife forms the
4pE5>loyoe.
back-bone of the out-reach services and must be a full time/,
In case of
can be Appointed by paying’certain fixed amount as retainers
other, fulltime
staff suggested ^eQ ^ud the other payments can be made according to the
. part-time staff dcrvices rendered.
The number of such part-time staff and

the retainers fee to be paid would depend on tho number of
hours such staff is prepared to devote to the work.

Hoiebver,

the total expenditure on appointmont of part-time workers

I

should not exceed the expenditure which otherwise would have
been incurred on providing full time staff.

ConsIdering the needs of urban slums, they- should,
be given the hipest priority in re-orealisation of the services

as sug/sostod. belQW«

For the purposes of determining the

infrastructure to be provided, (according to the types of
unit given below ) the population to be covered should
have atleost 4^/® population living

in the slums including
1

I

iff '

.

1

-.' 'i:

10 -

■

slum like areas or have predominantly weaker
f

j;

sectims.

In

a

course of time, the’above percenta/d reauirorwt may bo.

•

progressively lowered,

and the orgsnisational pattern

■

extended

in a phased manner to cover the whole urban

population*

Va) For. ar on w it h npj2Ulat ion

•

•

T

J

i.'.
tftp ;;

■

■

i

Two*'

ii) Voluntary Women Health-Workers

.

:j.h

J/W i

Nurse -midwife

i)

/•

Ijl |

/

Pi

til) Tiie health post would bo an extension
of services of the appropriate
liospital selected for the purpo00* '
It would provide nil the back-up
(referral sorvicos and supervision) •

fc'

;t: • •<

b) For area with population bctwoori 5000 "IQ-ifipO

jl
:■

.

1

...
| \/i) N urso-mid-v if o
Aim A basically trainedjnalo
Worker
? /.ii) Voluntary* women health workers ano .
w
for every 20tX) population. As it is
difficult to (jot such workers from
the residents of the slum area Wx-li—
out any payment, it is sucrostod that
tlicy may bo paid an honorarium of
Hs 100/- per month.
The volunteers
would be local residents®
iv)

r

One J

The Health lost would be an extension
of services of the appropriate hospital
selectod for th({) purpose.
It world
provide all the »back-up1 (referral)
services and supervision.

a population between,

o)

io,ouo-25tooo
Tii<! i'/iiio orrruiiunt.tmal not-up r.s rocommonded for
h0G0-10,Gu0 population with the following additiaui*

i) Nurse -midwife

s«. | One

ii) Male

*■. .

i

Ii

h-'-'H.di

One

i r

• -4
«» ; •

u to too
111) ■ Supervision and. supportive servicoo
u—
provided as in the case of oab'....'oJJ W.

i -ono i’or
Voluntary v/onion liaalth v/oikpru
/ JQ (/V\AA^
ovary 2,000 popiilaticn.
- j/etweon A
d) For ^xoa covorin^ a 3P
2^ ,€00 - 50,000■

.

.

•J

■

■

■

■

'

One

e

Ono

Lady Doctor

u.)

Public Health Nurse

ill)
iv)
v)
Vi)
vii)

Nurse Mid-wives .
Male MeP, Workers
Class T7 (Woman)
Comput or-cum-clerk

v ii 1)

laboratory
aterilisaticn
3 tor ills at irn and
and MTP services to be provided
by the. mobile van provided under HOIvE or_axy
other programme. Other services like !• • •>
Vaaoctoiry etc, would bo provided at the
oontro itsolf,

J:
i

•••

1)

ir)

Voluntary woman health
v/orkora

:k t-

'*

*

One
• •4

•••

One
One for
ervezy 2000
pqpulaticn

n) For, area covering population of moro.thnn

Areas should bo divided into sectors of 50,000 and
provided facilities given under (a.), (b) and (c) above,
according to the population to be covered.

In order to ensure that prompt services are provided
to all cacos referred for tubectory and M,T,P., the post partum
progrcjrio/st jrilisation Beds Scheme v/ould be strengthened in

the rrj£<n?rc.l inctit '.it iono whorovcr noodod.

v/r;.

I

H^latjonphip with thp exi^tinfl facilities
1

Thio available personnel at present serving the slum
1.
Utcauij including the staff provided in Urban P^U, Centres should

I

Do re-distributed amongst the Health Posts,

2a
Wherever there are dispensaries near the slum areas,
they should continue to function for providing curactive
l

servicea« is Health Posts would_be mainly

j

r

Mgl

J

■ JE
s
■

!

'llliS!
• ' '

i
B

. '.

'

■' ■ I
12

s
I -.■ ii ■1
I
■

s' '' I

■,

; • '’•jV

■ Bi ■'

?

■■: •» ;

!

■ 1S :

■i;4r'kis5?A!.<

•ffl

h ■ 1

■

-

pixMiw’tlvo uorvlooa, it would not desirable to convert
i

...

_ .' ____

it ""
w-iU.d
dif’flouli
thonn ; rtlnyonnnrl.on
134,.. HunlUU
’Putu’’ ’nu.......
'■ '
5
r.~ bo
'
to
existing pattern of functi.jndnj, with tho hitfx
dojj.'And for curative • services.* • Any sucli efforts afo r.ioro likely
to adversely affect tho preventive and promotivo health and
F*P. functi.,»•’r;, which are proposed for the Health Posts*
Separate l^Jcjransnes for opening more dispensaries shoifld.,
thereforef be inplemontod| whorovor noodod*

1^,. "
’

v« ^ky.dtn/i.Jor. the Hcv?q.tli. P<;>sts>
i " ' |
i ImIi t ’
For the effective funotiendng of the Health Posts,
■

>

,

f!

i1

1

it
J? if

theyL.aXQ_.located in the slunarpa itself*

As suitable buildings are not likely to be available in slt^n

aroas, it is desirable to construct functional buildings of
i j 4]theqe
Health Pests*

I
' 1•
'

'

:

.

■

ibo Sixth If'ivo Yq;w llttfi h.-B X’ixod Uy tho target for

ji.ijirovoiiKint of ijluins oovorlng a popnJat ion pf ton milljm.

-■

i

■

■

CnorcUnnti.rgi •■•Hth other,hiyilth yolnto^ pTpnmtnwo,

.

is,!.

'■

Iho Progranmo oovorod under thio Bcheno includoo wator supply,
jrafaago oj wus';o watQr7~paving of otroats, canstructlm of

community latriieu and street lighting.~~^n~e^a7c[itur3--of
Re ^0/~ per capita han boon providoTfor thiZjpurposQ.

<■

It is, suggested that the facilities for health and I family

planning and primary health oaro should be coordinated with '
I / this programo whorovor it is being implomontoda
I
• -------------------------------- --------- ... .................
It should bo fuitlier dooiroblu if the sohotios of
^""

i'-: . ..

■

I

......

•

runjjy tho Dopartmont of Social Lb]faro and

?31lc5?._o:C noiv-formal education for adult a iniplomontod
by tho Deptt» of IMudation arc also ir^)l^mqniQd in thoso
areas
sp that a OQordinatod. packoco of SQrviceooaxi bo
rendered.

^i-/

' W’-

* ~

:

r. !

■.'■f

■

h.

' ;p > ' ■ '

. .

e

..

■■■

O!
• ■■r

■

I

.

•J ■. < teH

I.

-

■ t-in-r.

'-■•!

i

"■

f
•

■

•

’*.

i

u -

■

• 7

;-!■

I1’

'

——got
al numb er of units of different cateporte.n jn
____________
•
I QB with population, of one lakh and, above., .

■ ' •

■ 'r
The Dotting up of a rovisod typo of health infra-otructuro
-r- < I Htrvjcture
has boon visualised for the following population

' I! :j

groups, in urban areas•

.

Q.f,t eroty -a

( less than 5000 papal at iai)

( 5000 to 10,000 papulation )
.

.

*

Ontorrnry „ Q

( 10,000 to 25 9 ^00 population)

2;;

(25,000 to 50,(ajO population )

-d
-X . • tJeCi’

Unit coat

Gato^oty
v5 ,OC(k-5o>tjQC^
Oatocoxy
>10t0CGw25 ,000)
O^tosczy
■ v >000,10,0)00)
jategoxy
(lens than Jcno)

1

Ifjh.

t;

1878

Rs 35,000

Ru 1,50,000

73

Rs 15,000

Rs

®, COO

28

Rs 3,000

Rs

30,000

32

Rs 5,000

Rs

16,000

i^b-'ibbVVi

I

>

Total

2011

I

7111 • aaasAaLXaJAaiai3 (Botnl l
■

FV’Vb
1
M

lb
J
W-

' ’; V’.'U •

C.33 not •'take into, account the existing facilities 1
■

mi0

.taking

- add.itional cost should be v/oriced
‘“isting nen.pCT.vos’ as available.
■

K entree uming
tin Rj.lakhs)

!

a^Q(Joiye4
^ota^oryw)

^^QGory^

j

H

•I

1870

. X°.S»5

5s

!

.

2.24
1.5J

Recurring
(in Rs .lakhs)

2817.0

47-15
8.4
__ 5_.28
2078.73

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• 'Ju

lilt
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I-.

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■

- 14 Bie above cost does not include the cost of hiring/

B

it

-

;

construction of th<^ suitable accormodatiati for the health units,
f which have to be located either in
in the
the siun
slum areas
areas or
or at
at their
tlioir
periphorioo*
.
I
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■■

*

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.

’

Jho cost requirement pccordinc to the, present pattern •
coiaos to Rs 1548.14 lakhs per annum. .But as all the Urban F.i?;
Centres required have not yot been established, the present

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expenditure .on infra-structure in urban areas is Rs.350.00 lakhst

,
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Planning Bureaux

City

...,r

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•

In yiew of the suggested changes in the'
organisation
in urban areas for the delivery of Family Planning
, JOI and
i
Primary Health,Caro services, it would be'necessary
to modify

¥

1
'1i

!' ■ b- Jqs the pattern of city family welfare bureau, as follows!
■-

—h.

Hi
>

5j
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:

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.■

h® ®

Mie towns having population of less than 5 lakhs'

/hl - J

Hi.'

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II —< •

need not be provided any separate set up for

■

ii ■ ' ' I.
if

■ '

I" '

coordination, and supervisiai.
The existing
district level organisations shoul'd be able
to look after the.activities of the health

It

: .

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' ’ ' ‘ i: 7

1■

.

I;

I

...

.4

>

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ff0** towns
‘
?lgjiaving
population between 5"16 lakhn
---- —a.

if ■. IS

•
i, ■

•■••U i.

posts in urban areas.

SB

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nonulaticn

. I
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a)

For towns having population of betv/oon 5 to 10

■

l.-ikhs and located 'in th0 districts having total

'"'h - L S
■■ (I

! M'! J'

population of less than 20 lakhs no
“ separate
City Family Velfqre Bureau would7 bo
r j required.*

r-

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; fS

existing district 7level organisation should.
bo able to coordinate the activities
ai
-------- and.

provide the requisite supervision.
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b) For towns having population betwoen 5 to 10 lakhs
located in the districts having population over
20 lalchs, the following additional staff should bo

p rov ide d to th o o rg an is at ion of th e. 1 oc al b o dy or

the District Chief Medical Officer for Qooriinc..tio&.x

and supervision of the urban area orgs;-isation*
1.

Coordinator (equivalent to deputy district
Extension Media Officer )
Senior Public Horlth Nursot

J 0

4.
5.
6.

St at ist io e CL A a s i st ant t
L >0 e_c uotyp ist •

Attendant
Contingenc ies

- Rs 10,000 PtAc

iii) _For tarns with populatim between 30.15
5

1,
2.

3.
4;
5.
6.
7.
0.

iv)

Coordinator
ibctaasicn Educator
Public Health Nurse
Statistical Assistant
Collator
U^.C^-cuiii-StorQ keeper
A *1}«C e im>-t yp ist

Attendant
C or.t ingonc ie s

\

••

Rs 15,CC0 PeA.

'.i - towns between 15 to 25 lakhs
Ear’.o

(ill) above.with the following

lor

additions/ Lxidificatians 9

I

1*

boputy Chief Modiaal Officer

2.

CoKputor

1 (additional)

3.
4*

L.b.Cc

- 1 (additional)

Attendant

•* 1 (additional)

Two wheel vehicle
1J.O.L

ha 5,CW/-

1\1..

Cent infancies Ila 2O,CUO/- P.A,
<

1

0Q
. 1
0 0 •

‘

.

...

.f* !
■

- 15
1

v) ?or towns above

iii ■

lakhs population

The nuixibcr of towns abovo 25 lakhs population arc

•I* ■

Their population varies from 25^15 lakhs
Eieir
in JQmedahad to over 91 lakho in Calcutta0
nr-'

only covon.

roquirGMonts should bo worked out coxarutoly»

■■

■

i

It io

further suggested that for Bombay and Calcutta*
’

th;no should bo $-4 area organisations

/

j‘'' ■■

ai the

pattern of (iv) above and an overall ceil for

hi^ior Iqvol co ordinal ion#

r .

d

Total ntunber of Gj.ty Bureaiyc
reqaired

did1
■

(ii)

24 (population 5*10 lakhs )

Catogoxy (iii)

2 (population 10-15 lakhs )

Category (iv)

2 (population 15-25 lakhs )

Categoiy

di

V^Categoiy (v)

7 (population above 25 lakhs)

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17
C JI A _P_T S R

'

^PJ.^niMTICNS,
The broad recaiuixndi/.tions of th.?

grdu.} are as

f C>1 lo\73t -

An integrated area sub-centre approach, with

1,

suitable out-reach service is essential in the
to provide for promotive and preventivo

rudiment ary

health care,

a.T.ticiliary treatment and for advice as well

as suppiios to family planning .acceptors;

referral from those centres to the
for

h

urban areas

Tnore will bo

nearest hospital

3 in ion.3 reid apocial 1st norvic es t
The modules of service delivery as presented in

P,

Hie /nfiinaiiiundutioiii; are considered suitable to achieve

that olijactive.

5.

Thin_• nodule □Qi’vioo nhould bo achiovod by

JuloGraticui md rG-or{;ruiioat ion whoro nooessoxy

existing servicos end staff strength*

To tho oxtont

possible additionality for staff should be

avoided as

'-x.iating staff available for

services

providing ‘the

should be fully deployed w ithout

stauf requested in tho
staff tn discharge

I

the

model is the nucleus

the minimum workload.

service□ are progressively

taken up by

centres, the staffing pattern

for the utr/oral

dupl is at im_«

schemes co

The
pore

As more
these

as admissible

i

taken up by them

should also bo made available to these centres.
■ I

4»

The centres may be operated by the

Sb ate

directly or the municipal bodies or by voluntary
_
.
ujcnclun., as the case may be. For effectjve inrplomen.**

tat.ion of the programme,

I

a system of

payment by

I

1

4

■

■

W

>.. (V- J'1-..

i'':
■

results nrd use of

’ .fiA-

part-*ti}ne functionaries

paid

accord : nr; t > per for; icnce, is buc :osted*
1

■' '

is applicable tn all ur-jm

areas, to start with priority attention needs tn bo

I

paid to slum areas or areas

■

t

V/hilo the module

5>

gr

-

;

inhabited by undey-privi-

leged sections of the society*
For this purpose,
which have at least 40/i people living in slum areas
or in congested areas

would v

taken

I

up for coverage

curing the current plan period, the percentage being

pro/jjcaf.ivoly lowered until all urban areas are covered

J

I- •

I

in duo coui’rio*
C.

Thorn is nood for a suecial approach tn the

urban □'Lira populatim by evolving a suitable institutional
and mans publicity strategy in order to mobilise
p art ic ipat ion for full ut il is at ion of the

peoples1

f ac il it ie s

offered under the programme*

Similarly, there should be

a scheme of incentives for the

beneficiaries

as well

as for the staff engaged in family welfare, so that
payment by results is •

7.

encouraged.

Difficult! finaneipl ■ implications

of the proposals

r-.ro difficult to work nut precisely at. this st age •
' the l.road financial

Only

implications for the diCferent typos

the various urban areas •
T^e programme has to be lOO^o
have been indicated*

of modules to cover

centrally financed*
8*

City Family V/alfare Ikireau >— In vIjw of the

indented c’kW'es in the

or ganisation in ur -an areas

for the dolivoiy of Fnriily Pl Annin,';,

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JOi and Prirnaxy

+

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- 19

Health Caro

services, it Would
would

Iho p it' orn '<d‘
■h

bo nocOaSurj: tr fuodl/.y

Citi' Pamlly Woliaro

hiv.m.

Thu CH.lip

huu roc nun.,undo d add it ianal ntaff for tovnio ai the
bauis nt’ their popujptioa uiao, uo hi Chrvptur III.

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20
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Letter pf^Addl *. Secy * & Commissioner (FW)
Ministry of_a^Health FL\ New Delhi
consulting the Working

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Copy of D.O. letter No/

I5

19Qll/l/82-ily, dated

April 22, 1982 friw. Addle Secretary & Commissi aver (?W)

Ministry of Health <3; Family Welfare, New Delhi, addressed

to the Health Secretaries of Maharashtra, Tamil Nadu,

West Bengal, Gujarat and Uttar Pradesh*

¥

In the Conference of

Municipal Corporations held in New Delhi on the 7^^ April,
1QB2, in which your Government was also represented,
there was a good deal of dispassion an drawing of strategies

i

••

:

Chief Executive Officers of

'

■

to improve the out-reach of Family V/blfere

services in the

urban slur.? and to re-organiso the existing infrastructure

j

if necessary»

As announced in the

Conference, a Working

Group comprising of the following has been sot up to go
■

into various suggestions relating to improving the

I*;:'

out- ' i :
■reach and quality of Family Welfare services in the urban
areas, including review of the existing norms for establishing
Urban Family Welfare Centres, City Family Wolfare Bureaux
etc *
,
1)
2)

i..' - .

' —I

I'
j

I ■ , ft

I

3)
4)
5)
I'

C)

Health Secretary, Govt • of Tamil Nadu
Health Secretary, Govt. of Maharashtra
Health Secretary, Govt e of Vest Bengal
Health Secretary, Govt t of Uttar Pradesh
Health Seer’tary,. Govt * of Gujarat
Shirt R^LTatarajan, Joint Secretary,
• 'Ministry of Health and
Fa.nily WeLfaxe

t
\ V

21

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i’'d

--- ------------ J-1
If you desire, you may also select one;Mun^cip^al'/^-jv.: '
I

r-iJ5imLsaion.er (Chief Executive of .a Municipal .‘Qpoperation)."

T®
Etate to be a member of the Group.RespectiVe mi.
State Governments and Municipal Cor potation s '^ill .feuar. toe
expenditure towards T.l./D. A.
i

.'J'?' ''

' ;i''*
•

"■

J

S The

feting of the Working Group will be held on 6th May>
at 11.3q A.M • in Room No«2497A, Nirmun Bhavan, Now
•

I'Q1 hi ( Counni 111

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.

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< '

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•

Room) < I will be grateful if you can

make it ------ ’

—

convenient tQ..also inform

o ‘^y^ieipa.i Commissioner selected by you about the
/ acting.
x ■ ’
...K
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■ . ^ ke. grateful for a line in confirmation
•

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22 j'

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Annexure -II
£8ESENT_lp4TTERN

& SCALE OF SERVICES
' ^L^MTliXdjELFARE CENTRES.

I

■

Present
Ratos,(fa)

I* ^a^-teaX_Wolfaru Bureau

'

■■

a) Replacomen”t of furniture
anS equipment;

2000 per annum

■fessu ruroit”°

2000 per annum

r

b) Fu^ni^r! & Equipment, ;;
I
0) Storlllsatlon
1
for mobiir^<*?
units» U? sot3 1i-

•

Revised
Rates (Rat)

48,000
■ ■ i iv

20,000
■''

'■

■'I-

1' ■'

Urban F.W. Centres

£-(10,000 to 25,000 population)
■

1) 3,0!
equipment &

•

'
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.

*

ll)-S1„^c^!;s0?■r<;“rrlnc,
b) jype-II (25000

-

•*-

1) Equipment &

1 4)^uSnofe-roourrln8>
■

-

;

..

5000

500

2000 par annum

to 50000 population)

■

*■

-

.■

2000

-

• C) >■

7500

1000

4000 per annum

6500

I5099

1000
200

4000
500

1500

On as requ­
ired basis.

|

—(50000 and above)

Equipment, Furniture,
.[ Educational Aids and
9^rgical equipment
1 l^n-recurring)
'll) C^tingencies.
^Placement of surgical

. V)

3000

..

%

' 1500

I

j.A..
4

•: •
f

4
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IV.

23

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Ci>y Family Welfare Bureau

Revised
RatesCfc)

Present
RatesCSs) ,

a) Typo I (Dotv/cs;n T lakhs to 5 lakhs
IWytilaiJ on)
i) Furniture, Equipment and
Educational Aids.
ii) Contingencies (per annum)

10,000

10,000

3,790

6,000

Typ0 II (Between 5 lakhs to
lakhs population)"

••

Equipment, Furniture & J
Educational Aids.
J
ii) Jeep and Trailer.
J
iii)Contingencies (per annum)
i)

*

V
..

25,000

35,000
5,690 .

@

/

8,000

tyP° 111 CBetween 7,5 lakhs to
10 lakhs pppujationy
~

Equipment,Furniture, Building
Q?p+:?-rs & Educational Aids,
station Wagon-1
I
Contingencies Cper annum)

■ 1) ,
HA
iij
iii)

•Vi

V.

50,000
7,000

-

@

■ 10,000

Rural FyW. Centres at PECs.
allowance for Computer
and Health Assistant. P
ii) Conveyance allowance for zlNM
"I

.

1)

Equipment & Furniture

HhS6?1 for the Building,

Rs.4 p.M.

■

.Rural Sub-centres

' 1 J

30,000

ill)Maintenance cost of
1 a yans^-storiscd sets,
IV) Fixed conveyance allowance
to A.N.M.

J ! i-l

■ T.A. & D.A. ■
as per State
Rules,

■

J

2,900
1,000
' Rs.25/por annuo,
Rs.4/t per
month.

3,500
1,000

As per
State Govt.
Rules.

Ho provision is needed, as these units have been
Htblishod,

Actual cost of vehicle to bo provided.

i <
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24
’.I

/JJNEXiniE-III

K

' 4

2^ the First Meeting
5?u^^tionrxairu issued<

OROSATION OF FZJ-KLY
ogg-gn ,9N..PE-~ HLlALTH
ShIftVTCE5"II< URB/JJ

AKhiRb
- Uh
1 lfa1' The busj'i'i^o' Held' 'in to.1
iTH
^
'LHl "UN bTH Mp7“IVBSj. - ---------------------------------

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¥

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WelfnrpTtQ forking Group sot up by tho Ministry of Health and Family
nuaiitv
r° 7’?to tiw question of improving out-reach and
;tho urban
Welfare and Primary Health Services coverage in
in the rhnmhJ^3 inclu<iing review of the existing norms etc., mot
(FW) in Hou rT-iff ° 11-i J’0.Baijal.Additional Secretary andlCommissioner
at the end^ Dulhl 011 Gtl‘ Muy, 19^“ The list of participants is given

thnuph in n2+^ls inauE11Tal address, Shri Baijal stated that even
and fnoii i + fot?Wris there is more of literacy, awareness
’ are not within +ho Family Welfare services, still such services Jf
areas inr°ach of the masses- especially in slum areaV
emnhnsiqAa
Ey weaker sections of society. He, therefore,..

"• dxsr,™
’
?^:3soboieni
Wars
in this togard .in urban areas in the next 20
renort hv +h^the? d®sired that the Group.might finalise its
the fn-pf»r.ah+ a^3 of July» I-!82. It could hold its meetings in
will eiver+h3 rnat^i The Ministry of Health & Family Welfare
&
he Committee the requisite secretarial assistance.

idrii
Ba*-3al also suggested that Shri S.V.Krishnan,
Vest Roni i Secretary and Health Secretary to Government of
'ihSlmouIlJ SSd?6 thQ Chairman of the Group* T*113
u-x
4*' ^he Chairman suggested that the Group should in the first
itriXctSVlvni 1'nhi oa:Ji? dat,a c°ll0cte|d relating to the infra•rv
&Vailat)lc and programmes as now implemented in respect
hl tiS Welfare,
E.P.I., Malaria, T.B. and Leprosy as
tlo iini\pr?blems arQ t0 b0 tackled in an intensive manner in
“ore backward urban areas. He suggested that a questionnaire
'■‘nT n.,r+4 oe prepared, detailing the relevant points on which
nJ+AM i+?
Be needed, which may bo circulated to the
tlug State Governments for compilation of the data which
1'rm tho '?ti!34 Qred in\ the coming meetings of the Committee and
rm the eaals for its recommendations.

!•

25
6.rq^S
K
a^ovo suggestion of the Chairman and on the
UUS18 Of the detailed discussion in the meeting, it uas decided
to incindic the iollowing items in the proposed questionnaire i-

r

*)

Urban population - City/Town-vJiso showing the
population in slum areas, separately within each
city/town.

■“’l Details of eaisting prograiamos for providing health
JiTni?!3 Tfor Family Welfare,
B.P.I., Malaria,
q .
a» Leprosy, T.B., School Health (upto primary.
snnnQ^^GVC^^ ’ TLis should be classified by the
Hail ij°ririfta5ency viz*
Government (including
Sector
T
n+Ce\E,/’I,C-’ P & T Loptt.,Public
(o\ vni^0' leS c10’)’ Cb) Local Authorities and
ic) Voluntary Organisations.

•

Intensity
StAt?«i?y,ofxcoverago Of the above programmes of coverapeatnU+hPO+Uiation COV(ired and percentage
at4 (scwitn f?0 totai Population in the urban
ovaiiabiu^ 1 figuros for slum areas wherever

1VV ^lu?athioVifvn clas3ifi0d under the broad Heads »
Dispinsarie/^Vddl^’ + u°meopathic “
number of
a yeart 1
and th° total Pationts treated in
«)

<vl)

ails of health statistics mortality and morbidity.

Provision of health education facilities.

Mi) Man- P

er in position for the different programmes*

vUi) Availabliit

iv

I

their ratioytnf+inds/K0ct0rs/nursos at a11 levels and
xapio to the urban population.
^hS^oJJice centiSili^°f Famlly Welfare and
Jo to 15 minutes fJom
a walkine distance of
the slumsin benpfi
++
> theofpopulation
Sanctioned
aefittGd
an^ thearoas
pattern
man-power
.uacuioncd in these service facilities.

bop^atlonSin°twatGr and the percentagePuree's, and pniimQ ^ban area covered by-such’
ana gallons per capita per day.

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26

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i 6.

Bascdon the above points, it was decided that a

3y°stionnaire
minutes"n
+ "+h,niay +?! prepared and sent along with the

meeting
t
m
^ting to the parti_.ipating°States
participating States for
followthe^extamaeting
^ept?J;
1OW
7
U
?
l
aC
w
ion
’
It
was also decided that
’of ?
Madras at in
*he Working ^oup will be held in
'
J A.M. on the 26th May, 1282.
uaaras at lo.oO
^ALTn^^^^Mrr!-lT-Y W?1LFARB AND .PRIMARY
*
- QUESTIONNAIRE
•

I.

kame of

II.

Total population
according to 1<?81

III.
:

•

CfJUiiUiJ.

Rural
Urban

Distribution cl
of cities/
towns by the size of
•
urban population

.■

(a)

:
’

b

.

? (If ■-iv.

!
■?

(a)
|(b/
I

,

■ Q)

j

No. of clties/towng

"■i

Less than 25,000
25,000 to 50,000

,-i I r •' '

sojooo to One l^kh
l^kfa

1

1 lakh to 3 lakhs
3 lakhs to 5 lakhs
Jd:.
$
5 lakhs to’lO^lakhs
over 10 lakhs
■J population,
r
Number of Health and
i
medical service centres with beds
and indoor facilities available
u
showing thorn separately
under the following heads .1 *•
..•>‘j./
■
,
j. ■
&tate Local
'Vol.
Private
Govt. Autho- Agenritios. cies.

!?■))
0
)

I

General Hospitals
Maternity Homes
Specialised Hospitals.
Family Welfare Centres '
(particularly those
whore facilities toi'Orilisation, abortion
a 'implicated maternity
cases nro available).

■■

I

■ i

■ 'I-

V.

Position of
of out-patient
out-patient facilities already available
U.P.ts.
(including dispensaries, M.G.H., Conti'us and
treatco
in
and thu number of patients
in hospitals
1
• the last year)
Private
Vol.
State Lo cal
Govt. Author­ Organiautions.
ities.

Allopathic
Ayurved ic/Unani
homoeopathic

(a)
(b)
Cc)

VI

Coverage 'of Family Welfare, and- M. C.H. Cuntl’cs
available in/or n.ar the sluin areas
<z V W A

• **

'**

**

<-4»« •••*»

I (a) Population of the sluia
of Family Welfai'o/MCil Contres functioning
Cb) IJi.nabur
in/or near the slum.

(c) Details of'slaff sanctioned/in position.
No,qf posts sanctioned / filled
Filled on
Sanctioned
31,12.81
on Pi 1,12,81 •

i) Medical Office
ii) Lady iUalth Visitor
iii) .Auxiliary burse
Midwife,

• ,

iv) Family WelfareWorker (male)
v) Any other post.
■: Vll .

percentage of population"covered in each urban area
undur the following health programmes
■
By Voluntary
By Local
By Gov jru’iat
Organisations/
Authorities.
institutions
Private Institution~
(including
> .nilu ays.Defon co,
K.S.I.. Public..
3■••ctur' - tc. )

ia) Family V.'-1 fare
(u..L rdoo -s)

tb' M.C.'d. .

I
7
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Cd) Malaria
(e) Filaria
Cf) Leprosy
(g) l.B.
Ch) School Health
(upto Pri/ary School level)
(i) Any other major healthnrogramme.
I

VIII. Intensity of the coverage of the above programme in
alum areas
ai'cas :

By Govt. Instts.
Cincluding hall­
ways, Defence,
ESI, public
Sector etc. )

By Local
Authorifr
ties.

By Voluntary
Organisations/
Private
Institutions.

Ca) Family Welfare
(all modes)
Cb) n.C,H.
c c) H,P,I.
Cd) Malaria
Co) Filaria
Cf) I.B.
(c) Leprosy
Ch) School Health

(upto primary
school level)

g -

(i) Any othor major
health programme ■

IX,

Health Statistics ■

Mortality and morbidity figures in the last yoaf
for each urban area relating to major enmmunicable
diseases.
X,

Health Education
ilontion existing extent of population.covored by
health education programme.

: | ...

. . 1'1

29.

i

XI.

s-

Ratio of beds/doctors/nurses

to the

(.ii) Total urban population
(b). ratio to the total
population under the si tin
‘iTea ( wnerever available).

I

Any other medical <
or health facilities
available
.-’-IJ exclusively in"the

-- —; slun areas.

XIII.

drinking water
°f th" P?P“latlon in

U)

S'ifT>
arGa ^avinE access to
or ni^}nklnt7 watur showing spot
piped source of water available.

Cj3)

of abovu covered by
chlorinated water supply,

tC>

??_drinking water
(ballons per capita per day in
each municipal area ).

. Night sou (collection & disposal) ' '

suc^facilitieF^nM{j^ing access to
soak pits etc.)
ncluding mechanical,• manual,

\ I

g™ °F WORKING r.BOnp QB
WMLFARB and PRIMER HEALTH"
^VICES la irRBAKi
3
11
HELD
INHiNEW
ON~~g
-~
AR&Ab 11 h^ld ih Hew del
or DHL
6tHHlmay
71982.

WQggfa1?!!

jfeyuc

Designation

1.

Shri J.S.Baijal

2.

‘Sliri 3. V.Krishnan

3.

Shri R.Natarajan

4w

Shri K.Lakshai■ 'kanthan Bharati.

.\

Additional Secretary and
CommissionerCFW), Ministry of
Health & Family Welfare. .
Additional Chief Secretary &
Health Secretary, Government of
West Bengal.
Joint Secretary, Ministry of Health
and Family Welfare.
Coomissioner & Secretary, Health
& Family Welfare, Govt.of Tami1 Nadu.

i

30

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Resignation

i

5. ■ but. Lata bine

Health Secretary, Govt, of
Uttar Pradesh.

6.

Lr. U.p.Gupta

Director, Health, Medical Services
Medical Education, Government
of Gujarat.

7.

Dr. S.K.Deb

Joint Director of Health & FW and
State Family Welfare Officer, Govt,
of West Bengal.

!
8. ■

Dr. (Mrs.)II.Balachandran.

Distt, Family Welfare Medical
Officer, Corporation of Madras

f’

Dr. N. R. Chaud bur y

Special Officer, Health Project,
Corporation of Calcutta.

10. Dr.D.N.Pai

Special Officer Incharge,
Family Welfare, Bombay
Municipal Corporation.

11. bhri If. 8. Chopra

Administrator,
.
Municipal Corporation, Agra.

12. Dr. K.K. Shariaa

Health Officer,

• Agra Municipal Corporation.
!

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CENTI i .'Ju COVEL CliLlENT OFFI GERS

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13. Dr. H.D.Saigal

Deputy Director. General (RHS),

14. Shri H.W.T.Syiem

Deputy Secretary (Policy)

15. Shri Vijay Bhushan

Deputy Secretary (^HS)•

16. Shri S. Jha

Under Secretary 1KHS).

17. Shri O.P.Khatri

Research Office1*•

18. Shri K.S.Mathur

Desk Officer (policy).

-i

31 »-

AlWjgUPE - IV

ilinutosof tn.. Firs £ Jl^ting,
■ MINUTES OF DISCUSSIONS OF WORK. 1TG ' ItOllF UN F^ilLY
PLANNING held ui .-I.ibT.hS UN THE 26'1'n n.'A’, 1Fo28--

Present
1.

Sliri S.V.Krishnan,
Iddl. Chief Secretary .and
Secretarv, Iicalth &. FW,
Governnuht of West Bengal.

2.

bnri R.lUtnrnjan,
Joint Sucratnry,
Ministry of Hoalth

Chaiman •

>

FW.

3.

Shri V.Srinivasan,
Secretary, Health & FW,
Maharashtra.

4.

Suit. Lata Singh,
Secretary, Health i; FW,
Uttar Pradesh,

5.

Shri K.Lakshaikanthan Bharti,
Secretary, Health & FW,
Toiail Nadu.

6.

Dr. A. A. Contractor,
Government of Gujarat.

7.

Shri H.W.T-; Syici.i,
Deputy Secretary,
Ministry of Health & FW.

\

\

\

•»

Dr.M.D.Saigal, D.B.G CRHS),
Dte. Cunoral of Health Services.
9e

Shri S.S.Nair, Director iEvaluation>
Ministry of Health & FW.

10.

Son!or Official of Madras

11.

Dr. D.N.Pai,
Special Officer InchargeJW,
Bombay Municipal Corporations

12,

•i

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Shri N.S.Chopra, Administrator,
Agra Municipal Corporation^

t
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32

I*

The
The Chairman
Chairman welcomed
v; cl coined the
the rwabers at the LiuOtis.nc of
^osecond
Su”™i“J:“^o3*rorin^3TEr51o?5n have bjua rurniahad
prudent ^^ting^
nnd tli-s-; rc-juix'^ to be cxnrninuaC
^xmainod. In the prusone
noting
ho sought the vi.Ais of the othoi1 neabui-s whetherit should
b„ confined
___ — ______________________
_
_____
_ "
"
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bo
to information
concerning
water
supply?
disposal
'
----of night soil, treatuont 'facilities fox- MalariaL? Filaria and
covemgu for 'i‘»-l3» no .also requestud the views of the Group
as to whotner infor.n'.tion given was sufficient or whether
rxoi 3 should bo asked for.
2. bhri K.Nnt.ar.ajnn stated the uain purpose? for sotting
■up the Working urpuji. ..V.^'o »j.

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To look at public healthy„
■ care iiT~slunZ5fwSs/'br areasTIrtKWlL^3AZ5S^^
cally viilnora^le_^cEoa£-Q^=^
ufbKn'Tx-eaSj> The affluent.-Calfiggr7 had bo^lgf_
MifTecauso theyJiav^^^UA^r^^J^f^^^iTes
facilities-To avai^J
pr o v id dd': uhd
available including those from^rn^Unil^^
home, "odeters etc•

ii)

To review the existing structure
welfare services for necessary
tho people
The services should be taken clo
services
rather than confined to ^sP^^f^^raryTIuKs,

tehirciubs etc, should

Tor~~better offcctx__VoIu£tft^y
—hq su'ggtswd’
% * ^eric^-gcaZSZM^^
•Ehnt these ideas-should be kgP----- ----------------a’TBcussTonsof~the Workin g_SX_Pioj.p the suggestions of
iii) Thu Chairman, while endorses
s of th0 other
Shri Natarajan, requested
questionnaire
members of the Group as to
btain Qore information
should bo more wido-ba^od to obtain
as suggested by him oarlio •
blii’i Lirinivasan, Health Segetaryj Ms^^ ^
iv) stated that the questionhail e
Gr
Was
honsive. The genesis
vis-a-vis slum
to consider out-reach tacii
. COUparison
areas which wore at a d^a^a"hoSruraL tuxas. Thu
to thu yurvicus avaiiahiu in
_ tJjQ biasing
Task Force should uxamine wi■• f cilitioS through
links in providing oui'"rtafa cove/ these slum areas,
urban health care centres w cover

■ 'I

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33

I*

■ I1
perhaps it nay be worthwhile to obtain information
on corporations which perform thuso out-reach work. Tho data
available on tho fo?_owing would’ bo helpful
(a) Number of Workers actually doing .out-reach.
soi views j and
(b) huziljor of workers formally d-ployed .in out­
reach sarviqus.

I.

V)

The Chairman stated that such information is
probably not available* in most cases. In view of
the shortage of time since the Working Group .has
to submit its report by July, 1£‘82, it will not
bo possible to wait for this information.

vi)

Shri Natarajan stated that what is equally
important is the availability of primary healt/J
care near slum areas. Hence co1.8 may be anenyGd
since in the earlier meeting it had been mepCionod
that hospital facilities which may be avaiJ<aD-Lfl
within a walking distance of about 15
from the slum area would be a sufficient iacJ-x ey
for such areas. :
.; ;■ .

vii) The Chairman agreed and suggested that
the shortage of time, the inforniation
regard for the ’ two biggest corporate * / • • ruState nay bo furnished. The State this
Secretaries were asked to maleo a noV
. y «
. and furnish the information to the
r
•JL-inTt.h
___ 4-i
4»___ >
Health anc] n
Family'Welfare.

viii) Shri Srinivasan, Secretary,

. .’
ix)

the question as to whether actual
in big
bo made of people' who go from do/*
He felt
city corporations for immunisat*0^J^naation,
that if this cannot be done, V10 **
would not bo accurate. Tho Cbai^^T gvailablc.
that this may be furnished if it a.
b^tar Pradesh .
Smt. Lata Singh, Health Secretary»«.
tho
•
stated that information as askdd. '^specifically,
proforma is not available for si^Qr^-the Gorpo--Such information can bo furnish^
within
ration as a whole which cover ftr n including
the jurisdiction of the CorporA1
1 .
elitl areas.
’

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34

Shu ale;- iu: ticn -d thrt services rendered in
Priunry iionltn C'.ntrus in the area should be linked
tc the requirw.icntg of the people, if they are to
be nuaningful. In ether words, such services should
be av.'tilabla <it the required time. This has to be
nssesscG acc-.rding to the routine habits of the
inhabitants „f the area. Simply providing health [
cai'u facilities during day~tiuu7~Ti>ill nut achieve
th0" puifpuse~lt~is~~rfeant~fl'r~If^th<F~pooplo aru- busy
vTitli i..'taor v .rk and cannot avail such facilities. '
It was also necessary to nonitur the prograQQQ
STu s ely. ~
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X)

On tho question of water supply, she stated that
the information given is for the corporation as a
whole. She also raised the question whether the
supply of safe drinking water was the criterion
for wateiJ supply or whether water needed fur theso
purposes may also be taken into account.

Xi) Tho Chairman replied that the information sought

for-' safe drinking water only, as this was a norm fixed
uxoa
as a bas^c minimum need. Other'data on water for
washing etc. can be given if the information is
available.
xii) Shri Natarajan then stressed that thobasic questiion is:
\
<•

(a) What is the ba^ic minimum water-supply needed per
capita in a sluu and
(b) liow Liu ch is actually available to the Sinn dwellers
tlirough street taps, etc.
----- * <roni State
iii) The Chairman replied that, these nora^vary
be~useful
z
to
ha>'e infonaation
to State. It would perhaps
per hap] L for t-he consideration
of the
h' States
on norms fixed by the
Working Group..
xiv) Shri Srinivasan then mentioned'about ^/’garvicos
Municipal Corporations as an indicate^
while the
provided under the Health Care Progr^’, it is
stress is moro towards preventive freal
>
the
a most common feature to see that 't^?h'3^Tr.Q as rm
budget is provided for curative health oa •
example, he cited the case■of Bombay Municipal
Corporation which has a Budget of as.bo
health care and of which only R*’.*0 aores was
provided for the preventive gide>

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xv)

The Health 'boci'Ctary, Tamil Nadu, stated that
the budget will fidt reflect gervico out-ruach
fur urban - slums. Be^caUsc thuTbudget covers the.
city as a whole. Securely, he stated that any, .
increase m expend.l~cu".u' does not necessarily^
mSan tnat'more facilities, have been provided
Eq.net- mucITo’f tho increase goes to meeting rising
bo st of salbriesi drugs, etc. As such, figures do
not 1und tu any conslusicn. bri Contractor
TGuTJarat) observed that as pt-i’ the proforma only
family welfare out-reach services have been
askud for and not other services. This may lead
to under estimating out-reach services in other
areas like malaria etc.

xvi)

The Chairman felt that the following issues are
also tu bo looked into j-

>

vta) Motivation aspects - use of mass media etc,
v-(b) Incentiv.es aspects -

xv ii)
■

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>

;'7,

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' . 1

to motivate adoption
of a small family*

Thu strategy so far had been confined to mesa
media techniques and publicity for methodso
Family Planning. The approach now shoi^a
to- soli the concept of the size of
_tc bo decided by th a. parents theme
inus,
wo should concentrate on educating_th%P_ ^7
Especially the semi~literate and
5e“rmt'_thoy'_cah thihlTTor thems^^.<^Z^_j££

^CT--orEho---ramlly-'tW~wahTr^^
^Tn'centiv es~~et/cr^-------

I

xviii. 1 • Use >f nudif>~visual technig^es> }-L^2-^j^S--,7,„^f-^*?
/ cartoons .otc, should be~ r^orT^J7.ii7._-n—.
A or tho view that such filns and car^eun^ay b
.
of 5 minutes length. Some State
Sif] to 3
have done something in this linG;rtJZh*rH thu

> advantage fur the Working Group to^J
experiences of Maharashtra and ? Jestod that ;
a pioneer of these methods, he
.
.■.
at the next meeting the Health r
.. Maharashtra may give a short r^P
experiences.

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that’motivation c old be-viewed from two aspects

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(a) Flow of information and knowledge ; and

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and
onri.
’aj'u.’, u-Jinu
Joint Secretary
Duu-winv, intervened <^
xm stated
Shri Avn^PU.
Natarajao

XX)

O
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(b) Rato of incentives and disincentives - the, .: ni] ;l
.......................................

41 '

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,
xyi)
■

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4.

* ***

'•

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bhri Srinivasan then raised a question of typo of staffing
in the slum areas. He stated that a cadre o£
iS—
the sluri£__§
gwwer rtS the MuTtl-purpose Workers in the nurax
Areas* The Multi-purppse Worker '
EducaioKand" (b) a Salesman on
.
piTFTrrrpiiorHe als~stated that a caareyor stairsy
should not be paid salaries but be PB1Acj
| gdrTafian w hi ch should be JlhKed
ont
I ZTsystem of chocks should also2^QT_d_eyi^^ZZ^12£2-------■

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Government of Ihdia.Mas examining the whole
Hones
question of incentives and disincentives* l--~
he stated that the Working Group should confine
its rocommendation only to the flow oi information
and knowledge to the target groups.
,

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carinu-. I...
be* n-iv ids a.

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then
onri; Srinivasan,
Mrxnivaaan. Health Secretary, Maharashtra, v
Shrii
iicnti u: .<] that tneugh yotivntien was an oxtrcicwly’' fejffl
the
inpcrtnnt part of the fanily planning prugraiauo. _uuw
Task Feres :.iay be expanding its area of action if it
deals with u >tivr.tion. Thu Chairuan replied that is
sc far as thu sluti pr;igra..iuu is con owned, Motivation

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Tho Health Secretary,' Tanil Nadu,
Slum areas
care
SlUu
nruas primary
priaary health caro
practically non-oxi stent. These^houlo xi
started.

i/xxii)
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xxiii)

xxiv)

The Health eccrotary, Uttar pracKshi stated that
, ' '* 1 ■'. •’j:■’ pi-’ti -n given, tli • infra-structui u
i..i
vices in th.; slikis was po^r. When the’
W-.rking Group rucoujends the in fra-structure, it
should Camino ca< o fully as t/ the type that
Wuu.xd be su?.table. 8hc supported the suggestion
of the Health Secretary, U-.narashtra.
The Chairman agreed and requested Health Secretary
Mahaiashtra, t,
---------- a- paper for
- -•t, ]prepare
the next meeting.

■ Institutional sot-up
XXV

The Chairman stated that in the Working paper
prepared by the Ministry of Health & Family
Wuifurc smio gcotf suggestions had been made.
Certain issues, now over, have to bo examined
closoly •-

Cu)
V

*

I

hjcruituunt and training of honorary workers*
In this connection whether the norn of
uno Health Guido for every 1000 should bo
followed for the] slura areas or whether this
should bo changed.

I

Difference of range of services between
health centres in rural areas and urban areas.
Can the pattern as existing in the rural
areas sh.uld be followed in the sluns.

I

xxvi)

bhri Srinivasan stated that as a starting point
the note from the Union Health Ministry prepared
for the meeting of Municipal Corporations nay be
circulated.

xxvii)

Dr. Saigal, D.D.G(RHS), observed that the Health
Guide in the rural areas cover all strata of
society. In the urban slums, the conditions were
vastly different, ffe.. therefore, doubted whether
Health Guides with’'tne saiae level of education
c/Uld be obtained.

•

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Dr.C.ntractor of Gujarat fclx tho need of an
intogratod approach to lock into the existing
staff ano structure of the primary health services.
It will also be necessary to l^ok into the
working .>f tho existing staff and the institutions
in the urban aioas.

xx lx)

The lionlth Secretary, Uttar Pradesh, while
supporting this ebsorved that the out-reach in
urban sluns has to bo assessed, iron a saiiplu
survey dene Uy the Agra Municipal Corporation,
only ITO -f the people in tho alsu sima areas
have been sterilised. She suggested that the
approach should also include the following »-

; I

Cb)

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xxv ii i)

(a)
'( : -( ■

38

XX x)

s.1'*

xxxi)

Ontinuia
Qptiiiuia services
services should be nado available
ti slums;
The motivation sch|ei3O should bo undo quito
attractive particularly to win won on; nnd
The payment of salary/honorariuui bo tho
examined. on
Tbd^
Health Guidos should be
th
present
remuneration
of
UD V X
’UUUUUJ. ttUXMlA VA
I .<*P fyeas.
nT’r'/lS.
may not bo
be attractive in ths
the sl^
slua a^
As per tho pattern, the Health].^,/ nflH
+.
services are supposed to voluntary
. toan^,
■--7
part-tino. It nay not be possibl
. obtain
suitable persons under thosa parametros.

The Health Secrotary, Tamil Radu, obaorvod^that
it is clear by and large what typ
1
urban
services should be made available
Oj.ganisatlon
slums. What is more important is xn
basic
of the prugraimo. As part of this,
gramme,
question was who is going to tuna eastud that
As regards the organisation, he
vach State may give its own. vie>.
t services needed
It was agreed that the range o> anr-vices require,,
in urban slums through put-roach .
d<d<G(rhs)
to bo spelt out carefully. Dr*t“ list theso
and Dr • Con tr a ctor v or e requester
Tanil Nadu„
out in consultation with the

!

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xrxii)

In rc. ai\ v ff-.ile btej’ilisati'on operation, Shri
Ngtarajan saggo
g:s’ ed thax the Orissa pattern should
be ].i eked into carefully, where the necessity of
h-.s-ita.lisn ion is avuiacd. Operations is Orissa
in cau,Eamind.-^tl^t^^tTjjj^pTiflirEart
j.c
<-- V- This technique could be applicq noro
in Lhj urban
The Chairman rplied^
■
experiencc-in Calcutta, the surgeons
.are h<ig.itant, to adopt the Orissa technique
'
because of ; ’’
:----------------------- (a)

Inherent caution. ; ..

Cb)

Unhygienic conditions prevailing in the hones
of the
thv patients if they have to return to
their huues immediately after the operation
and suffer infection j; and
a. i- - _? _

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Complications fron| the

operation,

Shri f
’
NataraJan
replied that iron results so far

achieved the purfcruance in Orissa has been vex-y
gOs>d and cases of infection/coiaplications
infection/cotiplications hav/
hav/'
hardly occurred. Moreover, with an effective
foilov-up systuu through Health Guides, M.PtWs.
effective nonitoring of the patients is achieved.
It was felt that each State should consult its
Liructor of Health Services in this matter.
I

xxxiii)

Voluntary organisations like F.P.A.I, ua/ alr’° be
consulted before the recommendations of the Working
Group are submitted,

xxxiv}

A meeting nay be held’ with Ministry of Finance s-nd
Planning Commission before the report is-finalised.

xxxv)

Before the next ueeting Dr., Sqigal and f^n'i Srinivasan
Health Secretary, Maharashtra would jv-spa-re a j>aper
setting out issues to be included
fina«i
report.

xxxvi)

The next netting of the Working Group has beat
fixed on 21st June, 1982 at 1O.-PJ AM at BonW«
All participants wore ruquostud to coimhunieato
their prugranuo to Shri Srinivasan, Seci>^ary,
Health, Maharashtra, separately.

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‘•AMILY PL^M'h- ;j<Ij Phil.’ JIY

Til TJi3JT bLtTilb

Cunsic^ring -the need of Family Planning, MCH and
Primary Health Caru in urban slums, the follow*ng out-reach
services -nr« c-.nsio-red necessary. :
1, Qut-reach Services

i)

Information, motivation about Family
Planning methods and M.T.P.

i i) Health_Education

aJ^-Environmental sanitation
b) Xpeysonal Hygiene
c) •✓Co. muni cable diseases.
d/) Nutrition.
o) M. C.H ana E.P.I.

V

2. Preventive services,
$
fb]

(c)
Cd)
{ej
(f)

Ante-natal",npost-natal and infant care
prophylaxis against anaeuia
Prophylaxis against Vit.Adeficiency,
prosuaptivo treatment of Malaria
Identification of suspected cases ox
T.B. ana Leprosy.

(g) Filariasis.
Ch) Infant feeding.

3. Fanily Planning Service_s
"2_ i'i} other conventional contraceptivof1
Ca) ‘Nirodh,
and
pills•
U-_ Oral
Ch) I.U.D. Insertion.
aithej''
Cc) Sterilisation and' MTP services <
through referral hospitals or mo
•r
vans provided under ROME Schaaf
4. Curative
id ^rgancies.
(n) First Aid
/Lid during accidents
acciacuuo and
^ia,J
(b) Trcatuent of siuplo ailnents.

-;

5.

41

Supportive Svrvic.b (Referral)

All the .ut-ruach services aust be backed up by
instituti .nal scrvic'-s particularly in respect of
i) II: t, orr ? ty cn. s o s

ii)
zuiu
iii) BirigiiMsia ;uig tr-al.iunt of J

tuberculosis and leprosy.
iv) Laboratory services for
diagnosis of Mal.-wia,
v) Illness requiring doctors
scrvicus/hospitaisation.
6.

i
J
5
J

Only.in siua-living
population of less
than 25,000.

Reports and records ■> particularly in respect of

a)
b)
c)
d)

|

prcventivu servi cos
Faraily Planning Acceptors.
Vital events
Morbidity and mortality particularly
in respect of ’(i)
Malaria
Tuberculosis
(ii)
Leprosy
(iii)
Diarrheoal diseases.
(iv)

II, Present Facilities

...................

• ‘ • I

pattern for
1./ At present there is no standard staffing pattern

■A

I

tlio doITvery of out-reach services in urban areas except
u ur b~an~-f au 11 y v el f ar c c en tr c s_,_ The staffing patt ern
of"tlTu U/F.W. centres.v^as so devised as to ensure qutYe^ch .-uid clinic services for family plannin^_and^jT *
lloWevex*. —expericnee has shuvjp
FaiTcd' hr botlFtEFsOungi^Er^^ of those c^^cs
hardly visit’the field and clinical services
sation r>nd M.T.p.) are provided mostly by th" ^OUOnted
or nearby hospital. I CDS prograLine ^hgreye;— P
,
in urban areas provifresZo&rneajZal^^
ahd"5-6 MJMs for MGH services to cover a^O
lakh population.
; ,
[■
'
¥Jed by tho
tho2. The other out-roach services are provide
nvailability.
/local body staff depending on their
/The quality and quantity ;of such serxiceb vui/
from area to area and generally are *ons^ F
inadequate to meet the requirement*
virQnthose areas some workers to look after
v nnQS
mental sanitation, E.p.l. and malaria
ar e al so av ai 1 abl e.

V

42

■ r/V

I

III.

, , n7

Ko co: in uncled Nurr is.

1,1 rurrli

rucuauunaua

ijrUoWuo^^oE1oratioa
■■•■cc-nPr' v th,-x PbPulnti?n« These recoLiraundati^ns were
. cc^pUd u.v the Guvurm.iunt, During the Bixth ?*an formulation
nor... have k,41 , uvla.d f.,r\rlbnl
HUy
tar -Vurw Snon
?n“ fi,n!'l0 Marker has boon rocemaodod
xor every JOOO pujjulntion.
2. No rocoumunaation regarding the health ..inf
rtmir^cturv in-Urban areas woTj^ads
wby" the' Cduaittee''on
However, Min
MTnTstfF
istry of Health.
-bas op served
Family Planning
.
par

IV.

Infra-structure suggested for slum areas :

LiiicrcnGC3 between the two areas which need to be taken
c+LG consideration, while suggesting the health infra­
structure for urban slums. Some of the major dil'ferences
ar <* ■
(ji> While rur.ol nr das havu a iaixud population of
upper miaclo class, midclo class and poor
people, urban slum population nostlj^bolorig5 II
•
class and as_sU£iL±aviL^
||
higher morbidity and mortality,

KEnvironmental conditiuhs aro much wor^
urban
slums than in rural arleas, and as sued slum
■population more exposed to illnesses;.
Rural population is mostly faiTiar$..a&- -eaO^
contacted any- time* eithci’ at their Rouses or
farms, while urban population mostly ti^Idhjs
to labourers and service^class and' as'^irch can
be contacted in the morn mgs-and' ev^ning-s—only.

‘1

iv) In Liogi. 01' the Criers; whole fn;'.iily , wan, wordan and ‘.-row up

children do•aono work and contribute to the incone of tho

Zanily ,

Under these circumstances, it is difficult to get

a voluntary health worker in the slum areas from tho

residents of the areas*
J

Unlike the rurnl population, the slum population io concentra­

ted in cc ?tnj„n loc-'litles of the town and are easily
^ptr.-nnc^Vil ■ly *

2.
r

r

Koerinr all these, considex^ations in view, it is suggested

that thc.‘f: should be a Health Post for every slum area located
in the slun a^a itSrlf with the following staff:

a) For__slum'area with population between 5000-10000

i)

Nurse-midwife - on©

ii) A basically trained, male M.P.W, worker - one
iii) Voluntary women health workers - two.

As it is drifi'icu-^t

to get such workers from the residents of the slum ar^a withA
out any payment, it i3 suggested that they may be p^d an hono­
rarium of Rs, SApor day,

ovary month,

^he volunteers would b^ changed

it i3 felt that while working in the health post,

th«se volunteers will pick up knowledge about environmental
I

M

saiiitction, personal hygiene, F.P,, care of th/, mothers and

childreqTpreventive and promotive aspects

a1 health.

This

would help them in improving their own Hying cuoditlona and

to act ap Health and Family Planning guide for others.

Changing

voluntary worke-s every month will help in fpreading this.
persons living in

educational processes t0 Q large number

slum ar pas,

iv) The Health post would be an extension

■ --

.

servicao Of the nearest

hospital and under ita administrative'^ technical control,
I ■

■

would provide all the 'break up«(referral)services & ejipprvlslon.

b)

I

.

For slum areas coyr-rlnp a population betWgenJ^QQQ-J-^OflQ; -

I
*44*
The sane or^r..nl jntional oct up as recom?nd?d for 5*10
thousand population with the following additions:
»*

1) Nurse nid-wlfe
7 * One
• ’ ■'
{
ii Male’M.P.W,
- One
ill Supervisloual and Supportive services to be provided

□□ in -he case of category (a)
7erGQp coyorlry: n population Jbetweon 2^t.OjX) *50,OOP»

i) Lady doctor - one
11) Public Health Nurse «• one
ill) ITurae KiidvivtiF)

iv) Halo M,P.Ws - throe to four
v) Claaa TV - one (woman)
vi) One cor.!puter-cum-clerk
vii) Women Health Volunteers - three to~four
viii) Immediate sup^iwiaion t0 he provided by the Lady Doctor
and Public Health Nurse.
'
^/Ix) Stcrf11 nation and M.T.P, nervices to be provided
thei
’f* mobile
'
van provided ......................................
under! ROME, gchme and the staff
provided either by the- referral hospital or by. the Po.at
partun-centre attached to the nearest medical college.
F.°y slums covering population of more than 50^000.
\
I

’.Ur'!

Area should be divided into sectors' of SO^pOOO and
■

provided facilities given under (a), (b) and (c) above^
according to the population to be covered.

I

V.

Overall Supervision

'

Ov^’ all supervision of the Health posts would be the responslbilicy of the Health Officer of the Cor-poratpn, who would be

assisted in this work by the Asstt.^Dy. Health °fficcr .(FPj)

a4d other staff provided under the city F>W* Bur^au*
*2•

One or more (depending on the glum popul?^01^

■

■

-

.

~

'■

■

I

covered)
,

mobile van provided under the ROME SchoEie woi>d be placed at
the disposal of Health of the Corporation

providing supportive

and surgical F>P> Services on the spot to the
I<■

population^

<

.Contd.••••

1

I

/r.:v-Pri:APPr ^,rkQf:L\V:/LJ?>Q

VI •

I’m rv.iilaLl- pcrpnmrl at pv-ssont s^rv.tnj thn slun

!•

arena, including thn otnff provided in Urban F.v'. C.nti»ra
should bo r^distributed amongst
5^'

i'w

chd Health Pontn«

■’ ’W bo coho diupcniKU.ino nou£

they should continue to function for pi’oviding. curative
v__1————------------- ;

service a,

—

...

-----------------------

---. -

“ '■

~~

■

7*

..a health pont3 would bo. mainly providing pge-

yentive and promotlvc services, it would_not be desirable
to convert these disponsaries into Health Postsj as it

muld be difficult to change theft existing pattern of
C.

■■— w

--------------------------------------------------------------------------------------------------- - -------- -JX_______________________________ —:-------------UJ------------------- —

' -

functioning, with the high demand p.ndzfor curative services

Any such efforts are nore likely to adversely affect the
preventive and promotive health and_FP functions, which arc
propopod for the Health Posts,

szVII, Building for the Health Po3t3

For the effective functioning of the Health Posts,
it 5.3.eso.nntlal that they aro located in. the slum areas
l^nelf.

As such buildings arc not likely to be availble

in slum ureas, it 1$ desirable to construct functionpl/|
building-j of these Health Posts.
'

VIII,

Coordination with other Health related Programme

Tho Sixth Live Year Plan'has fixed up the target for
improving of slums covering a population of tenmillion.

The programme covered

under this scheme iiviudo water
1/

ouPply> drainage of wanto

water, paving

■■

■

*■

■

atrocta,
I

Conti.. •..46.

i

■■I

•

-46cnantruction of coinnunity latox’ineo and oti'i. t lightt-ng.

An expend''.tn.'c< of Rs. 150 per. capita has be i provided

for this purpose.

It is suggested that the facilities

for h'-nlhi and family planning and pi'itaary hc.olth care

nry bo cxt<indi.d during this plan prrJ.od duly to those
10 pillion population vzhich io being. cov> red undta
4

the
1!

!

inprovomit of urban slum ochcJae.

It would ba further desirable, if the scheme of
.

supplementary STTP run by the Department:_ofj^ooial_WpJJ'aro
I aid the scheme of non-formal education for adul^vhich

is implemented by the Department of Education arc also
\ implemented in these nreas, so that an overall ^Pnckag^

* of services can be rendc-red.
•

•

' '' ’' **’

1

•

*

r

IX, Financing, thn ‘Scheme
Ill general it is suggested that the various

t

componehts of ths scheme should have more or I®3s the

some pattern of financing, as under the Rur^ Health
f

Scrvici-s.

This would mean all three,

o/ India

Statg Gov-rnnonts and Municipal Corpbrp^ions vroyid havp
'

/

.

to shave the expenditure, though not in equal jroportionp.

• •;

'

f

,

<

■

/' '
, V

.

• .

v .C
A.

'

•

•

5

Ann, xurc V » •

Aqcndn BToto for the Conference of Chief Executive Officem
of Municipal Corporation^*

Ministry of Health & Family Welfare

Meeting of Chief Exocutive Officers of Municipal CorporationsNew Delhi.
7th April, 1982.
gAJlI^Y XTOLFARE AND PRIMARY HEALTH CARE

According to the 1981 Census, 23$ of Indiels population

. of 634 millions live in urban areas.

people.

This la over 157 million

Granting that in urban areas, there is a higher

fp nting pon.ii rtfon cenninfting of single mon and therefore^

the numb'--?1 of eligible couples will be somewhat less per
/

1000 population, such couples nay be at. least 23 millions

(at ig't of the population).
2.

The Health delivery system of an urban area particularly

i

in large citl.’s, consists of hoepitcl/dlsPfinnitries/MCII
centres run by'j
r

n) Government, state or Central;
b) Municipal Corporationo/Town Conmitteeo;
x
c)
Orpanloatiorxa such as Central Government Health
2cn'-me, Employcgo* state Insurance Corporation,
industrial undertakings and voluntary organisations;
cl) etcy11^'0
(nursing homcs/cllnico;
Urban I'amily Welfare Centres cvro usually attached to
institution □ run by the Govornraent/I4unicipal Bofllca/Voluntary

Ovgrnlso.tton, ..
1

,x
cnesc institutions
AoU tjopv
m-t oi
of thcoc
inotitutiono are
eye predominantly

!|-t i l ar-.m v/hd’n u-^u.-.
vy ux
denoity
of xowor
lower middle
nlddle class
oleso and
and poor

’Wh?-1
low and as such institutions do not j ■
toidJlcs io nory
oor.r.wh
;.t low,

f .

(

ii
I' M.

5

I
s

h.v«. p.' 'P'-- ^ub'c-cch services, the people moot needing family
plr-KVng advlc /n rvi.eeo or Pvlmary H- alth cai’o services seem

to be senewhat 1< ft nut.

■y

I

1

I11

I •

-48--•. tain classic syraptonst Poor and
All
urban
areas
have
ce
O 9
highly uiiliyaienic
lower middle olrus people aro crovzdod
otlinr crovzdnd,
envi-• oriental conditions, in slum areas or
In these places, the. environmental sanil . tion is poor or .tn

T

the case of slums, totally lacking; water supply is inadequate
absent; waste disposal is improper; people are poo- and
or
to af ort costly medical care; health.facilities are
unable
These conditions provide a fertile
either few or not available,
The need of the ho ur is
ground for spread of diseases,
to
. thot h^lth .vid raMiy «ir«. odnooti™ .. well a-fl

Borvicoa ond suppl?p3 •’

well organiapd Tiian’',^v ao

4.

In regard

o TAnde available to thaao people.

Q

clone to their homes an poasiblo.
Welfare'and Primary Health Care the

FamJ-ly

t is mre or less entirely
present structure in urban areas
administrative purpose, in
hospital/clinic oriented. For u
Welfare Bureau somewhat
larger cities, there is a City Family
■ Welfare Bureau*.
4n the same lines as_a District family
V^ifa-re Centres
Depending on the siec of the city, Ik ban la
y
■to existing cu-inloo/
have been established mostly as an adjunit
pJoi’e tli al one
hospitals. In larger cities, there would he
jlatiorf* '£h0
Urban Family Welfare Centre to cover the pope­
Genres ?nd
pattern of provision of Urban Family Wolfer
t Appendix I.
facilities available in them are shown a*
only to provide supplies
Urban Family Welfare Centres are equipf^
For stPrAisation
MCH services and som-times IUD insertions.
cl ir> cs/ho spit al s
opei-ntlons, S«vlc-3 hav. to bo availed of
attaehA.
urban
to uhloh too o-.baa Family Wolfavo Centro Is t
registers &
i
fn
maintain-co upl0{3
Family Welfare Centres ai e to
provide door to door motivation which is

health cr/ a
seated
that
p-imary
It has iiready been

«. i a

that Health Services
?1' ioot
^.cilities are- ?-- absn.it pnu
orientfid through hospitals pM
city tend to te la:?g^ly cu ••e

cl i.nic s •
situation and to improve
6,
In orej:’-'’ to
Lr5 remedy the exist. ,ig
.,R and family welfare.services
the ou.treach of primary health c
inhabited by poor peoP1^ 1:110
in the urban slums, aid places
thought of in future:following strategies can be
, ■••
rr-»vrn. for provision of
greater
attention
npfus
l
o
_>■
/poorer
1)
4h,.l e.prv-'CPS to lower income/pooier
.
outreach and 'Hsitue’ serv-C
,„nliate
s-ctloao ot the soclaty. (other poopl" have . ■
faolUtl- ocoeaathlo to them for M. Purpoee and ore

ii)

ueuelly foown to pvaotice faMly
In thio cootezt, aoeas or sections predominan

•
.

in each urban area and mapped out.
lifltlng 'th613

Ill) Baumeaatlon ot all eligible couplee and
in family registers should be carried ouU
Igoalees to these Woao ebU be mode

Iv)
natter of education, information and mo

‘

0<ne3 for
*

I
7.

of supplies, K® servioos and
WD insertlon/sterl ,
coifiinon ailment
should also bn made available in on accep

.

ble manno-’'.

'in tils

The following suggestions niay

X' gard:-

,

be consl4^,e4

A

.

4

0°”1' ’

. ■
a)
An MCH centre-cumJV n'1th Post may be ea ?
10,000 p®s™3>°ha population not exoeeding 5,000 or
<1 n 11 e d
h y
be m & n
These
centres
will

II

-□0One Adxiliary Hur sc Midwife or an equivale it c.
'

well as a male motivator.

go. y

n

In addition, not exceeding two

volunteers, preferably females, may be selected in each

area to provide support in the some manner a Village Heal tn
A

Guide Provides' support in rural areas.

These pa^ns should

either live in the area or in a place closely and must attend
to work in the area dtr ing regular hours.
b) These centres will b< responsible for ante-natal, natal,
post-natal, infant and child care; immunisation of mo he

and children; nutrition education and supplementary feeding
of children; provision of prophylaxis against anaemia and

Vit.’A’ deficiencies; carrying out certain basic enviioim

sanitation work; treatment for common ailments; maintenance
of eligible couples’ registers; listing of biiths dca

and marriages; family planning advice and motivation,

,

.

predominantly to men an-d woyicn through group gather

supply of conventional
conventional contraceptives,
contraceptives, such
such as
as ore- F
‘
4
nr tud insertion, vasectomy
NIRODH,, etc. arrange for services of
and tub ctorny, in

I

designated

Slums c:in also have suitable

clinics, etc.
Health Committees.

a
di Every 1,00,000 population could be covered
IUD InecrtloO) vas|rCt'3mJ
delivery point essentially for
W el<h«
°n 4 ,5“"P-'
and tubectomy. Such_points Can
- -vaUnt,
ibasis such as in a temporary shed or
. outpost (dlepon.eary/ollnlo)
or any existing service delivery
aoal^ta/ for delivering
near the area may be allocated or
41sWOeB m oitit services to the area concerned. As
avese, and
much shorter than in rural
arc
arc av**,11 able,
transportation
facilities
better
Con id... SV-

-51,a service delivery point, <4 or 5 kws. away would not po&

problems.

In these service delivery points, additional staff

and faclli-s way be. added as way bn neCGSoavy.

If It is a

cawp approach, an existing dispensary/clinic should be given

extra staff to do the comp work*
e) In the case of tubrctomy operations, especially othoiv than

laparoscopic operations,} thn
the women a?,
aree usually kept in anA| 1
institution for rao??e than two or three deys after the opcj?|fc
However, a I’ninilap1 operation does not require pro- *

tlon*

longed stay in the hospital^ eape.c.tally if the woman can be
*

easily roachrd by, or can easily roach mcdicsil facilities

quickly, in the even of complications developing, It should,
therefore , be possible to release the woman even after a
Winilap operation on the same day to go to her home in the

cit-j/ tovm. area.

Proper follow up can be done in such cases

ty the MCH centres as distances are very short Pnd population

ia usually confined to a very small area.

Thio way, t|ie

existing service delivery points can do wore out turn of work.

^°r amending t0 this work, a machinery by way of a ’cell’

,

,

v /'

|

J11 00011 ’corporotion’or 'municipality' may be set up tp cocn—
donate the activities of all organisations, covering the

target groups.
J^ag_tp be cohered may be earmarked for coverage according

to

gaographical jurlstdiction by voluntary organisations who

°

to undertake aid carry on this work.

‘

No

pa-^rn nohe developed io:.’ such voluntary organisations,

--- L-j^l^Ppdy^-Prpvislon. may be made to mate them do the work
wh^ci. a^y be apocifted, .

Co.'itd

52.

i

1

-52-

•

|

h) As an alternative to (g) above, and/0? to facilitate
Corporations may be ask^d to redistribute the existing Urban
Family Welfare Centres (including those amalgamated with

Post-partun centres), both in regard "to their jursdiction and
location, so as to cover the now terget groups and they may

also l>e allowed to marginally add on to these numb ar s, as way
*

be necessary•

•

taking into account the growth in population

since 1971 on the basis of which the existing^entres

have

been sanctioned.

. i) In orartllpj* towns, eithr? voluntary organisations or existing
dispensaries or imedical facilitteo may be allotted the task#
I ’81

-hese matters m 'y be considered and commented upon in
■

-•»

-W— •

Regard to the fol?owing issues?-

a) ^at is the p??esent status of oiitreach services for health and
family 'welfare to proper sections of society in the urban
V.

co?€as?\

xb) What approaches can be followed in the future without creating

'ny new infrastructure, but by utilising-the existing

machinery

reorienting or reorganising the same to do these tahks?

4

'

c ) 1(3

^cre any need for any pilot study to be conducted on

Qortaln models ?.

1

■ I

•• •••
i

•. -53-

e

Arnynxiyo to Afjinda Itninn tJo« I,

' g-AFF QAncglOriED AT VAR TOP S LmLS' n'lDTm FAMILY WELFUB PBOGRAMfr
. >1,. u^anj?j\mily J'WJtwij?. a^rriTO";
A. Type I (fox' a papulation or 10,OCO to^.SSjOOCi^
1. Auxtlij-ry Murae Midwife
1
2. Fiunily Planning Field Wo; knr (McJ-r)
1
Typo II
a population of 25,000 to 50,000)

I

1. Fn) ?■• ■ Planning Extension EduantOi’/
lad,. .. ..lull Viuikrx’
3. Audiliary Nur no 1-Iidwi f o
3. Family Planning Field Worker(Malo)

1

1
1

U. Type_JXX_(..X°JL°f 50,000 an^,above)
I 1. Medical Officer
1
2. Lady Health Vinitor
1
3. ^Auxiliary NurW; Midwife
2
1. Family Planning Field Worker (Male)
1
Store keeper-cum-Acctt.-cura-Clcrk
1
' 11 SliXXXXi WELFARE BUREAU
I

r

J ‘ J ........................ ....

k' ?XE£.JLJXlZ_a.J?.oj?ulation between 2 to_ 5 lakhs)

1. Family Planning Medical Officer

1

2, Clerk-cun-typigt .
2, Peon-ew.7-,Qhowkidai’

]_
1

^^L^Xog^-PPPulation between 5 to 7.5 lakhs)
k Family Planning Medical Officer
2* ^tension Educator

3* Clerk-cum-lSypiat
Projectionist

J * ? 6r^-num-Cho wkld ar

1
1

1

1
1

Contd....54.

I

-54jV« Type ni, (foy a popiyl a.t^on between 7«5. lakhn to 10 lakh;?)
Family Planning Medical Officer

1

2* kxten.nion Educator (1 male and 1 female)

2

- 3. Statistical Assistant

1

4# U,D,C. -cum- Store Kceprr-cum-Typist

1

5. Projectionist
6* Drivcx --cum-Mcichanic-cum-cIcntnfa’

1

?• Pe*on-cum-Chowkldar.

1

**«

more than 10 laMig)
^ho pattern io the same as per the Diotrict Family

Welfare Bureau*
i

I

-55-

Anaexuye VI

Minute3 of the Third Meeting.
MIIIUTES OF THE MEETING OF the WORKING GROUP on reorganisation
OF FAMILY WELFiTE Al® PRIMARY HEALTH CARE SERVICES IN URBAN
*aREAS .HELD AT IKAISAY ON 2Xst JUNE, 1982._____________
-—

The third meeting of the Workding Group was hold at

Bombay on 21.6.82.

The following officers were present:

1. Shri S.V. Krishnan. Addl. Chief Secretary & Health Secretary,
West Bengal, Calcutta*
...
2 Mr* R* Huturnjw, Joint Secretary, Health & Family Welfare
* Government of India, New Delhie .
3. Mro* Lata Singh, Health Sacretary, Uttar Pradesh, Lucknow#
4* Mr* N*S* Chop^'a, Administrator, Municipal Corporation, Agra (UP)*

5* Mr* K.L.K* Bharati, Commissioner & Spcretary, Health &
Family Welfare, Tamil Nadu*
6# Mr* N*C* Matarwala, A*C* and C_*B«, Govt, of Gujarat*
7# Dr'. A*M* Barot, Medical Officer of Health Municipal
Corporation, Ahmedabad*
8> Dr. S.S* Sabnis, Deputy Executive Health Officer, Bombay
Municipal Corporation, Bombay*
9* Dr, S*5* Mair, Director (Evaluation),
Ministry of Health & FW. Govt* of Inula, New^Dolhi*
W# Dr* (Mrs) H ema Bal chandr an, District Family Welfare Medical
Officer, Corporation of Madras.

lit.Dr• Indira Kapoor, Offlcer*-in-iharge, Family Welfare,
I & R.C* , Bombay *

4

12* Dr# A*A* Contractor, State Family Welfare Officer, Ahmedabad.

13. Dr. M.D* Salgal, DDG(RHS), Govt.-of India, New Delhi. M/o H&FW
M. Shri V. Srinivasan, Secretary (Public Health) Maharashtra,
. Government, Bombay. . .
.. .
• > —■
Dr. G*A* Pause, Joint Director of Health Services, Bombay.
■ ?•

16. Dr* D.N* Pai,7 Special Officer, ;F.W., Municipal Corporation,
Bombay.
17*tMr* Prpvin Kamdar, Dy. Municipal ■Commissioner, Bombay,
k Municipal Corporation, Bombay..

I

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Contd.••.SSe

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-5C-_

The Chairman welcomed the members to the meeting and
stated that in tho last meeting it was decided, that background
papers on the following subjects will be prepared and submitted
for discussion:i) Motivational aspects. Media Approach a and
communication strategy,
ii) Out-Tea'ch services to be provided in urban slums and
suc'eastcd infrastructure.
■

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■

I

2.

A3 the paper on motivational strategy was hot available,

tho Chairman (Rcidad that the paper W be diocussed in *lie
i k

next meeting to bo held in Delhi on 12th July, 1982• The paper
on 'Out—reach1 services with suggested infrastructure1 prepared

by Dr* MJ), Saigal, Deputy Director General, of Health Servicos>

Govt, of India’} in consultation with Dr#

Contractor, Dye

Director of Health. Services} Gujarat, had been made available to

the members and should be discussed in this meeting* '
•

,3.

-j

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»■ •

likg Chairman doaired that while diucuaolng thia pupor. he

would like to have the viewa of the partioipanta particularly
with regard to i-

' ;

'

1) whethcr' the infrastructure' suggested should cover the
whole urban urea or only urban slums.

li) In case it is felt that initially only the urban slums
should be covered then how the urban slums should be
defined. Whether urban slums wb'uld’mean areas where
total population is in slums oi’ the
areas which
i ha-ye a mixed population but'majority of the population
. io in urban slums.
$
iii. What role can bo played by the voluntary organisations
■n implementation of this type of programme. It is ft
/infUEAtry to discuss the voluntary organisations role in
£■-'"-I. This in important particularly in view of the
t'nat most of the voluntary organisations today are
wormy,on^y for Qomg component of the package.

Contd..,.57.

I

-57During the

■were given

°n
primary Heaith

)

the following

discussion

comcnta/ougSGatiqna

haoicground pn.p0r on

family Pluming ana
Care Services in urban
1) Among the <
^t-rouch services under
family planning
information
-b and motiyat<on
, Population education
should also
be included,
11} Xt ha3 been
thaf th0 “Mllnntion/HCH
'
^floee^w.mn be provldai
trough ruturra! h,.^^
“>tlle vane provide
■Mor the HOKE ^umo. Ihe
Provision to
Provide the
M qOT10'!s ‘taobEh WmtlfIM
institutions nearby,
1U) "
“? be poeelh! ®i^isting oy eroatea, may b(J
e for the
’•efen-al ln,tituti0n8
* Provide raollltiee
for the institutional delivery

■

of nil fctormty 0a3ea-

^ttUtlee ehould bo

Howevtep> the inatitutionai

Eiade ovallable for
eternity caaea.
1V> Partl*P»t3 euggeeted that he to
1 '

Acords indicated i
c^s or regist ‘ *

!
•

•

h?usehoid. °

j’

. I',^her,Q waQ iot

'
3 h°
° bacK"roi’nd P

reports and
Paperj the fa^^y

ra Sh°Uld 3130 b0 maintained
1 for each

01' d’-oou-ton on the haeie 01
s^Uot^
e has been
-^estod & tee f„110wIns ■ or .vhiah. the .infto.
out;.

is mt ^J-vzay a

-r

'■

.■

•v y ■

Polntg were brought

correct tl0 aay
'lums ia
_ _• Pop U1 a t i o n
b-JESlsUytj^
°f urban
gfey-poos.
latir
are tw0 typ
■
" rEoWI
"E in
■.^ng
in the
thfj elan,
es of popy..
^Ut
>
Pda
who
are not reillly
■^Ot n«nrt to have
ei\h
a hattop
"coo.nmodatton
to
— “■'‘'nvallabinty
exa^la
or high,. COgtt Tn ‘t'h-f
_L_r£±s_£Pgar(i
. — P2*?^trt_nal(i t.
^o be the
with V;
^^Lolur1 in AaiT~
t)PPulatiOn op
........... -—- --._JL±alcii a

Conid.

.1

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-Nl '■ i

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i

-53-

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■

and It waa Ejtated that mid or no definition of poverty all

■

..

;

!’■ ’

b) While the presumption that mogt of the population in urbah

l.

■i ' i : ■1>'l

!

the population living in Dharwi can-be aaid tp'bo poor*
*

•

• ■

- ■

’ ■

alums are either labourers or in service and cannot be
contacted in day time

I

i3 to a certain extent correct,

nearly 25$ of the adult population in the alum arcapis

always available and can be contacted any time, .
I fih'ft c) lhe
presumption made in the background paper that pure
voluntary workers cannot be avilable from the residence
• .

I

■of the slums is not wholly correct.

The experience of

• the organisations •working in slum areas of Bombay indicates

w

(that such volunteers can be available provided they arc

paid.an honorarium of about Rs, 75/- per month,

IM

6, The Chairman ddsired that in the light of these observations,
the background paper should bo suitably modified.

7. Other views expressed were:- ;

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. i

a) The background paper suggested the smallest pnlt with

Minimum 5,000 population, with the stipulationtthat slum

.■

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i

areas iblth a population below 5,000 can be. takpnecare of with
the existing, infrastructure. However, the jconsensus was'that ik

♦

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'•

the existing facilities cannot provide the out-reach services

I

suggested and as such the structure should also be suggested
for the unitn cov ring the population of less than 5,000,

An area inhabited by low income groups, including a slum-CQVw
ering

a population of 5)000 people of

}east_4Q$_liV0

in slums could be covered by a unit mBant for .5,000 paoplet

Contd...,
I

1

" }[ ''
Il I
:

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j

59
b)

o£ the participate WGTO nf the viw that tha
structure suggested f or the urban sluias should
bo cn the same idhes as approved for rural areas.
TCiile the other participants were of the view that

in view of the fact that the Urbm population iB
concent rated and can be appmached easily' ana as
such the population staff norms shaulc bo difficult
fr’f urban slums.

-

c)

Part io ip ents wore of the view that units covering
population more than 25,000 should also have laboratory
facilities f(?r
routine examination for the urine

examination of pregnant women and single investigation
rociirod for diagiosing the oases of malaria, leprosy
tuberculosis.
*

» Tne group devoted considerable time in
discussing the
.-inrit^j^d do-..o-.-ts of having fulljtimojvoifcoth,
It was felt
tivr
th° QiltiUMtan003 -uld bo'varying'from plate to place

\

I.

'■ ‘2 :11,0
of piV1 tn h”° °ltllOr fnl1 tl"“a ’'“*-opo OI to hsvo nunbol

P^t t“° '

’Ith “

an't’^t'al—~ 0QP

B0rViCe3’ nujIlbQr «f cases provided with

“ ««<«*«

niado “
an h° h“ls o1'
In thir
somoes tondoroa.
xug’ird,
ttinno woLT
1’ it
“>
th“‘ t,w
PWrt to
IT
-9= J^PPPt^ oj

'

1

port t,

"at-a_3°CTiCM^“
obuara, sottfag
“
al“ rSTtW-tKXuri.or

P « t^ TOIkoM Ofn vajy
■'.i-

I

H»z:ToTtdOTOto te

md

~ —•

ithese pU f - ' 31 0XrjQndltlirQ
Priding retainers foes for
' Ikich would Xi.J w
Bh0Uld T 8,8,004 thQ QXp°n<iitllro
tine workers.

I

I •

'

Mlirrod other-wise on. employing whole-

■

4

iiact. ■

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i •

.
■

-.rd.--

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■r'-d P

- 60

I

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The Chaixwn had also invited Dr, Awabai B, Ifadia
9
I of Family Planning Ansneiation of India and Dr. Induinati

;3'

Parikh to know their views on how voluntary or^misatifxis

Dr, Av/abai B, Wadia was

ian paitioipato hi this programmo#

I: V . ■
■■;

<

pf th|o viow that if it is desirable that the package of health, '
family planning and NCH services are to be delivered, it must

1

/

®

be ensured that while doing so, the ejiiphasis on faraily planning

■J-...-'

■■■■».

I

-

.1

■ - ■

v/ork iu not reduced,

„

-

.

--

—

-

'

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■

■

Sho aluo onrphauiuod that for the- dolivoxy

. t)f package services, part of the'fluids should come from the

i

• other progrrurvjies and the limited funds available for the family
planning programme should not be utilised for the delivery of

health servicesj, Sio was of the view that it would not be

ft

. difficult for the voluntary organisations to take up these

Preets on aroa specific ( basis, provided adequate
assistance is provided by the Government, Dr. Indumati Parikh _

r

informed the participants that her organisation is working in
* slum area of Bombay covering_a population of 6^000^

they are not prnvidhig: qll jtho_out«r
services as suggested,
I ’thsy havo’boon able to covjor 65% of the eligible couples with
I one or the other typo of contraceptive methods. vL Qho organisa­

:

■

tion has only one doctor, one nurse and four social workers
.•

i

as whole time employees. Remaining specialist doctors and
other work on honorarium basis.
The main structure for

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.

, ■ d’1 •■■■'■
.

!

•

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!

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educational and field work consists of 25 women volunteers
I-

ES i-

■

who aro paid Rs 75/- per month as honorarium and one group
leader for evexy J to 4 volunteer workers who is paid an
honorarium of Rs 150/- per month. Dr. Parikh was of the view t

that ft would be possible
■'

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■:

package of services on an area specific basis, provided the
financial support from the Government for this purpose is I

■

'
L:'.
.
J
‘ ? r »■:

available^

IP
)■

•

'-■K'

for her orgaiisaticn^to provide ;

she was of the view that it would bo

easier

rob
i ’■

jii" •
'r- ■ :

PW

Lr

I

11
r

■•(!

■

-it

- 61

I

I

-

for the voluntary orgrniant Lonu Lor rendering thin ty[O

of servioo, as ovm to her present
pmcramr.TO, no sorviQjgs
are free and nominal chargos are tfiknn from thg.todividnal-

beneficiaries for tho services rundorod, -X
that
During discussicn, it was
’^as also felt
lelt taxau

10.

whila.

primarily tho roaponsibility to organiPgJho_B8Xvi05P
to"urban/ slums shdtld'bo of^^Jh^loc^bo^j^ro^ould
bo no rigid oonjlitionii about it,

Tho roDp<.ilOib.llity

of

organising, suporvisii'-g and_ adratoistobtog uuoh__ ssrvioos
^an taso’be’er.trusted t,7the_ Statajovpjnment or voluntary
organisations depundtog on the local oircumatmoais•— —
Chairman desired that Dr.J£r^Sa^^^oul£r®?’i?e_.^2.
background p'-por on tho Itoos of discussiona. He farther^
iequ'ested. Shri Srinivasan, Health Commissimer, Maharashtra

. tVprepare the paper on »Mot iv at ion al
upprouohon ’

aspect£gnd^gdia

which inny bo tnkui up for discussion to the

next meeting of the group»

11«
The Chairman thanked the CommieBinner and Deputy
| Commiaoinner of Bombay Corporat: irji for errcnging the n^etin#
Jlf of the pw/tioipants
••x and for their hospitality on .boh
It
?*nd adjourned the meeting.
1- was decided that the next
»

J^ting would bo held on the 12th July, 1902, in Siw Bhavan,

.

4

i
I

62 Fondly
FAKTTTY PLANNING AND PR'INAKf HEALTH SERyiCES
IN URBAN SLUMS Clt^iSd^^
'•

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■■

•

‘

ConBidoring the need of Family Planning, MDB and

Primary Health Care in urban elans, the following out-reaoh

Dorvices are considered neo os saiy !■*
lw Out -reach Services
i) Population 'Education
il)’ Infornhim/totivation about Family
Planning Methods and M«TePe
; iii) Health Education
a. i Enviranmental sanitation*
■b( I' Personal Hygiene!*
o I ^onmunicabje disk asos*
d I Nutrition
Q, I MCH & EPI*

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•.

1

£• Preventive Servicog •

'■
1.
'

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;. . •

II

«

■

«

ii.

.

-

Innun is at ion*
Ante-natal, post-natal and infant care
Prophylaxis against anaemia
Prophylaxis against V it J A< deficiency.
Presumptivo treatment ,of malaria.

! iiij
iv.
v)
vi)

■

■■

<■■

£

*

■

Identification of suspected oases of tuberculosis
and leprosyo

•:

•

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. ... ..

<- •
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♦

Filariasis*
Infant feeding c.

; t vii)
Viii)
:

/'

'•

i.,

•

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■ ■

■’

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"i'
:

•

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>

>

i'

Nirodh, other conventional contraceptives
and Oral Pills.
if) IUD Insertion*
Aj
'
iii) Sterilisation & MEP services either, through
referral hospital or mobile vans provided under
ROME Scherne or thro ugh ident if ie d inst itut ions
nearby existing or created.
4x. Curative
1 First aid during accidents and emergencies*
ii; treatment of simple ailments*
1)

5 • ^ipportive Services (Referral)

I

a

j:

',irv

5* Family Planning Services
•

iir ■

-

, ‘

I
V

'

All the out-reach services must be backed up by
institutional services particularly in respect of i
t)
iJ.)
ill/

iv)

High risk maternity cases*
St aril is txt ion & M.T.F.
liiugnosis and treatment of tuberculosis
and leprosy*
.Laboratory services for diagnosis of malaria
matters requiring doctors service ^hospitalisation,'

:±
i

6$

6. Reports and Records - Portioularly in roDooct
■■S1

ij
id.
iii
iv,

v)

Preventive services*
Family Planning aoceptors*
Vital events*
Morbidity and mortality particularly Jn
respect of
Malaria (b) tuberculosis (o) leprosy
(d) diarrhoeal diseases*
Maintenance qf family cards or registers
for population covered*
.

present Facilities
11

’-I

.

t

1#
At present, thero is no standard staffing pattern
for the delivery of out-reach services in urban areas except
in the urban family welfare centres*
The staffpijg pattern of

‘i

these U*F*W* Centres was so devised as to ensure out-reach and
conical services for family planning and
However,
experience has shov/n that these centres have failed in both

i

these functions* Staff of these centres hardly y is it the
^Iqld and clinical services (sterilisation and M*T*P*) are

’ , provided mostly by th.e attached nr nearby hospital*

I*O*D*S*

Programme wherever implemented in urban areas provides one
’ medical officer, one LHV and 4-6 ^NMs end me Anganwadi worker
for every 1000 population for JOI services to cover about
eno lakh, population.
, •
■

M

’•

2.
Ihe other out-reach services are provided by the local
body staff depending on their availability*
The quality and

J
.r

•

;■

. quantity of such services vary from area to area, and generally

^re- Considered inadequate to moot the requirement*

-■

■

•

tt

In most

4

these areas some workers to look after mvironmsntal
?■

I

Sanitation, E.P.I and Malaria programme are also available*
Hl. ■^eQomr:iend.Qd. Norms

Coifliaittoo cm ’ Multi-purposo Workers* (Kurtar Singh.

y

) considering the extent of out-roach servicos to be
rendered i\ rujrai areas had roonmiaended one male and one female

Worker ^or uvery J,000

-5,5000 population and has further
.•

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f

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4

64

r

■■

□tated that as it would
■

Mox-kotii for «• prooon

J„A0t3

^le pnlt^^e
oa

populrtlt'.

n-’““4 f"*

<’“X JJU. »^»

Those xwonmndatlona sera weep o
the 6th tl. foliation, these »™-

I

“

”rla “ "

trllal »d urny
ho. hem »-.« '■»

2,

OT1Md for ■

■

’■00°

„» xeoo^xddtt™, roSa^'S

to urw «« ««» “*■

-’»» ^£“*

other Oorolttoe.
1 waver,
eooeslons that
end ■Plonnins “o-iwlnn have otsoev.a » t»w
tios

fox provide hoadth f^ pl—=’
axhsh el«» weald ho treated at pat .«»

■«

r;,

of rural aroas
UO to-bt uuuv of the health problem,is
dlfforonoQO
' .
. „ .,luVvl nT.o oornnm, yet ihore are many
onnui<loEatiant
“
V <eh need to bo taliai into
Letween the two oreae which need t
kith ' ewioottas the health dhfrwttuetaxo for urban slumOt

X

Sono of the major differences are»d) V.,110 parol ataos have n wired pepalatlax of upper
I

hX «, riddle
“b“ ’1“‘. a,
Xt l« kstll telws. to pof - m-e
-

each have eowsrativ.ly h^ee wrhld.lty and mrtallty.
Environmental

conditions are much worse in urban

clunio tkiFjn in rural uioan

.end as such slum population is

•nore axpnuGi to illnosooQ*

Uljltaa. populate 1. wrtly t™1’ ®a o"

oraltX w tl- althaa at t^

populate, aoatly flow »” !•»»«“ “*i “
01esa aA a» auf «ly oettata

’

contacted at my pa-ztlcular elven time.

••

•I

!

c-fj

iv) In most of the cases, whole fiuaily, men, women i\nd
grown—up- children do some work and Contribute to the income of
tho fpjoily.
Under thjuo circiuastmces, it is difficult to got
a purely voluntary health worker in th0 slum areas from tho

residents of the areas.

However, such workers can be available

on payment of some honorarium.

r

Unlike the rural population, the slum population is
concentrated-in certain locr.litiec oi the town and are easily

U,
SO

approachable.
2,

Keopiiv; all these considerationa in view, it is DUggOotod

that there should be a Health Post for every slum area located
in the slum areas itself,
In the infra—structure suggested #
below the nurse-r.idwifo forms the back-bone of the out-reach II

services and

I J

i.iuat bo u full time omplcyoo.

In case of other

'full time staff sug.:astodt part-time staff can bo appointed
—i— --------- • '
---------------------------------- -----by paying certain fixed amount as retainers fee and the other

•I

jiaymarts can bo made according to tho services rendered,
The
number of such part-time staff end tho retainers fee to be paid
I
'
'
would depend on tho number of hours such staff is prepared
• to devote to the work.
However, the total expenditure on
appointment of part-time workers should not exceed the expenditure,

which otherwise would have been incurred on providing

full

time staff.
Considering the needs of urban slums, they should be

given the hi’jhobt priority in ro-o£ganiuatim of tho
M suggested below.

001*71000

For tho purposes of determining the

infra-structuro to bo provided (according to the types

of unit

given below ) tho population to be covered should draw at
least 4-C^ population living in the slums.
Subsequently, the

organisation,

as per patternj may bo extended in phased

manner to cover the whole urban population,
I

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r

GG
^ nr pnpultvt ion.

j.- 000

N urso -rn idw if o -one
Voluntary Health Workers one tn two*
Tho Health post would bo an extension cf services

i)

ii)

iii)

of tho appropriate hospital selected by tho Inoal
body. It wnuld provide all the back up. (referral)
11

’1 ;H>!|

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services and supervision•

0

.

b) For
.

■

i)

I

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ii)

.

iii)

N ur se -midw if o •• on$
A basically trained male M.P.W* wnxker ~ one*
• - mo
—3 for every 2000
Voluntary women health workers
As it
is difficult to get such workers
populaticn.
—- —
from tho ronidonto of the slum area without any
suggested that they nay be paid an H;J
payment, it is
lhe volunteers
honorariurn of Rs 5/*- pc2-' day*
It is felt that
would be chongod every month*

./

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52PPriP.°22.

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while working in the health post, these volunteers
will pink up knowledge about onviraimental
;

H

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sen it at ion, personal hygiene, F*P* care of tho
mothers and children and other preventive and

■

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’

pronotive aspects of health*
Kiis would help
them in improving their own living conditions and
/■

to act as health and family planning guido for
others.
Changing voluntary worker every month

hi

f

/
I

will help in spreading this educational processes

to largo number of workers living in the

slum

t areas.

iv ). Tho'Health post would lie an extensim of services
of the opprorpriate hospital selected by the local
It would provide all the back-up (referral)
bodyt
services and suporvisi^ie

lb'or

I

botv/oon 10,000 to
Tho srjne orr'aiiiaa'tian.EiJ. sat up as raconunonded.
for 5-10 thousand, popul&ticn with the following
u'ldit inns j ~

!) Nurse -midwife
-One
it/ Jfcle IA.P.W.
-One
iii) aipcrvisirn and suppoirtinG services tn be provided.
an In the case of cotogoiy (a)
j

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*:

67

i-

1V)

Women health volunteer - Ono fox- every 2000 population

d)

For slug areas covering; a population between 25,000 to 50,000

Lady Doctor
1
Public Health Nurse
1
iii) Nurse Midwives
3-4
iv)
Male Multi-purpose Workers
3-4
v)
Class-IV
1 (woman)
vi)
Coniputorclerk
1
vii) Women Health Volunteers
1 for every 2000 population
viii) Laboratory
^5)
Lady Doctor and PtH.N.
i
x)
Sterilisation and MTp services to be .provided by
mobile van provided under ROME scheme and the
staff provided cither by the referral hospital or
by the Post Partum Centre attached to the nearest
Mcd i cal Col 1 u g es.

Ji)

e)

*

For slums covering population more than 50,000
Areas should be divided into sectors of 50,000 and
provided facilities given under (a), Cb) and C c)
above^ according to.the population to be covered.

V.

overall supervision

t. Overall supervision of the health posts Would be the
w^P2n^^iiity Of
llGalth Officers of the Corporation,
+
^e assisted in this work by the Assistant/
D puty Health Officer (Fp) and other staff provided under
the:
City Faiaily Welfare Bureau*

2:. One or more (depending on the slum population to be
covered) mobile van provided under the ROME scheme
Would be placed at the disposal of Health Officers '
J'0EP0F?t,:i-2? £°r providing supprotive and
sirgical Family Planning Services on the spot to the
slum population. '
’
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VI.

RELATIONSHIP WITH THE EXISTING FACILITIES.

The available personnel at present serving the slum
jjas including the staff provided in urban family
S
H
+aHuUld bd ^distributed amongst 7
Hua^th Posts,

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There uay be sone
u” tor pr^ldieg
2.
areas, they should ““JiJJth Posts ituld bo
ld
curative serviees.
. nro.arjtive services, it would
providing prevenxivc and proae
diSponsaries into
not be desirable to conv r
difficuit to change thoir
Health posts, as It uould be
„ tl)0 hl6h aenand
existing pattern of functlu
K>
offorts are more
and for curative S^°U“T £g, preventive and pronotive
likely to adversely affoCt tnep
which ar0 prjp03ed
health, and faxaily planning iuncb±u
for tho Health posts.

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711

I building for THE health posts
For the effective functioning

^^^he^iun area^
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t^ailh Posts.
no^ntwioi,
The Sixth Five Vear Ug^a^opulSlon^o^ten
improving of slums c°y,e^fredpu£der this scheme
million. The programme °°Xa%Tf waste water paving
Includes water supply, di aiaas
latrinbs and
of streets. construc^°n
oj Rs.lSO/- per capita
street lighting. An exP^d
r
Q
i8 suggested
oas been provided for this PV?P . family planning
that the facilities for health ^%^$nPt9d With
uls'pXU^ihore^er it is being implemented.

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It *ould be further desirable, if l^lQgf^i^elfare
and 3.N.P. run by the ^P^^^^cati oriCfor adults
a-4 tne scheme of
^Department of Education
whi\h is implemented by
Depar
so that ^n
are ^so implemente<i ^n
®J^be rendered.
overall, packugo
services c

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69
AIiNKKURa -■ VII

Uinutes of the Fourth Meeting

minutes of the meeting OF THE WORKING GROUP OH " REORGANISATION
of family welfare AND PRIMARY HEALTH CARE SERVICES IN URBAN

AREAS"

HELD IN NEW DELHI ON 12.7.82.

the Working Group was held
in Newpresent
Delhi On,ltjth July> of
1082.
The following officers
were

1.

^iJ-V-Krishanan» Addl.Chief
Addl.Chief Secretary
Secretary &
& Health
Health
Secretary, Govt, of West Bengal, Calcutta.

2.

Mini3tr^?/r\Jialh'?rtdl:^Q};ary and Commissioner CFW)
“inijtiy q[ Health and FW, New Delhi,
3«l Shri R.Natyr..,^, v
mjan, Joint Secretary, Ministry of Health
.and Family Woifai-e,, New Delhi.

4.

Lata Singh, Health Secretary, Govt, of Uttar
I-Pradesh
--a, Lucknow.

%

Dr. A’ofnTon
Govt
fr11tractor
U^CT°rUStat'0 Faraily Welfare Officer,
oi Gujarat, Ahmcdabad.
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-hri N.C.Matarwala, Under Secretary, Govt, of Gujarat.

Shri P.V.Bhatt, Municipal Commissioner, Ahmedabad.
8.

^poratlOT;SBonb^.0ffi°<“' tFW)’ B°“‘ba>' Municipal

.

;S.l;'“a°Fra’ Mulnlstrator, Municipal Corporalion

1C,' Ho^“’tay§^6S)'Eoihl°t0r Ot;n<iral CWiS)> Mlulslry or
U'^tb’4^,#5rS3g: Evaluation, Ministry of

Evaluation, Ministry of

.

12’ H»\th’i’F^yNX’DShl!0“'atary <Ply) ’ Minlstry bf .

’ «?rH8llPh“aFwi’lISSDgg.0£rl<:Or (FWB>' Ministry
|>4. Shri R.S.fathur
New’ D^lhi^^^031*
I \ Health 6c

. 4

Ministry of

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Shri S.V.Krishnan, Chairman of the Group welcomed the
members to the meeting and stated that the Committee would
dis'cusg in this meeting the revised note on ' Out-i uach
Services to be provided in Urban Slums' pprepared by Dr.Saigal.
~ '
Mo-tivational
The Chairman also stated that the papei’ on 'i
'
1 aspects,
Media) approaches and Communications strategy' which was toi be
submittedi by Shri V.Srinivasan, Health Secretary, Govt.' of|
Maharashtjra may be discussed in the next meeting. E
1 . 1Ho desired
that this paper may be circulated well in advance by Shri
Srinivasan.

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2w The first item discussed related tq
to the staffing
pattern suggested in the revised note on ’Out-reach Services
in
in Urban
Urban Slums
Lilums*1•. The
The Chairman
Chairman desired
desired that
that the
the range
range of
of the
the
■
• staff suggested heeds to be spelt out* It is also to boi

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examined whether the staff has to be positioned in the 'Health
posts' by re-distribution of the existing personnel from the
existing F.W. Centres or they are to be recruited afresh. In
the latter even, their service benefits will have to bo kept
In mind. The needs for construction of buildings should be
examined by the State Govts., as per the availability position
in each'town/city. The Central Govt, would, however, provide
funds, whenever construction is inescapable.
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.3, The Chairman pointed out that the support for
supervision of the proposed 'Health posts' Which
was left
out in the minutes of tho last meeting needs careful consideration.
It was the consensus that a 1bypcrvisory Coll', should bo
.located at the Directoratei or Government ley el.. This Cell
should consist of staff for supervision and collection of
Statistical data., It was decided that iJhri $.S.Nair, Director
(Evaluation) and Dr.Saigal, DDG CRHS) should'work out the
financial implications on the various inputs proposed for
'Health Posts and the Supervisory Cell'.,
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4’ The
Chairman suggested that the criteriaas
■petitioned in para-2 on page 3~of jthe revised note should be
unended to read as ’The population to be covered should draw
least 4055 population Jiving in- the slum or including
slim-like areas or predominantly weaker sections’ instead of
! 4^ population living in the slums' /' Accordingly, the
headings appearing on page 4 of the 'note' should road as
'areas with population'between
’ » The wards for
'slun^t should be deleted.'These suggestions were agreed.
4

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On the question of. payment of honorarium of
RsiS/- pe^ day to the Voluntary Woman' Health Workers, there
Has a considerable discussion.' It was the general feeling
that it may not be practicable to appoint women volunteers on
dally basis and It would be only appropriate to appoint them
on a monthly honorarium of Rs.100/-.
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Rs•50/- is of,1000 and the Volunteer In th
that In Gral areas population
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covers a
---as will cover 2000 population♦

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---- e taken
Tiie following .further decisions
were
--- in this recards-

(a) The voluntary vjomen health workers must be
local residents.

Xi-

(b) The volunteer;i should not be changed yniess
their performance is found to be unsatislactory.

( e) The following sentence may I
bej substituted in Item. CX)
nf
Vai’on rare 4 of the note. "Sterilisation
aJdPK? Uriieas to be provided, by tbe^oblle Van
um.-t KOiU ocheao or any other rrocrauM. otresb
may be laid on the camps based approach ano
augmentation of the Post partum Prograiamo .

I

Secretary, Ministry of Health
6. > Shri R.Natarajai), Joint
and Family Welfare, suggested that the staff available under
I.C.D.S. Programme should bes absorbed in the new set UP*
it was'decided
thatices
evenin
This suggestion, was
i-ri- J
was annreciated
appiuciau
u and
u
out_r3ach sOrV
ot’hdr Programmes aimed at improving the
sluns
be fitted in this nucleus.
siuns jeouid
|__
-ingh,
Sinrh liJkth
liehlth secretary,
Secretary, Uttar
Uttar ?radesh,
Pradesh, ..
J 7# Lmt, Lata trainJd
Dais should bo Jily ieyoived in the
suggested
that
the
ten^®'
<foi-V
ante-natal/p'ost-natal^care
uServices^bho^also
»Maternity
suggested that the proposed
Homes’ f
... - ...
services but also M«T.P• and
n c \» d i**,’•
“• ■ — ~—
basie ma^jtrnity services*
There was a detailed ,<scussion on both the above points.

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.dais1 bhri
On the suggestion relating to 1 trained
that because of more
.. y.S.Baijal, ADdCtFW), was of the view
bareness Imongst the urban p^Opl^x^onl^afoW-^auO^^
-^j-XTKcfuOTng slums)..
iiMled by tranltional Dais ihjurban aru&S~
separat
there-Tippears to be np need t- have
n» ?, a the
scope of the
HoweverV*i^in g pro grammu for
for this
----- purpose.
*
4
for
training
of the
can be e:iten4®d to provide
P^Msticlr^ Dais in urban are^s>
Maternity Homes’ it t0was fl
On\ha
............ .. ’suggestion
___ regarding ’Maternity J^s
ii4Yin
+
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nrpqnnt,
*
Huai
th
.posts should c
Reeling t'y^t°tho present
risk
cases «should
be
i if fy.
My
wviws am mlahleb risk casos
—■»«*,
* '
Ttferre
?
t
0
regular
Hospitals/Dispensarius
which
could
be
rcferr'4
Hospitals/Dlspensarius t--- -i
nafle rei ral centres* ”*.....
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'Shri Baijal suggested thuu tho u/isting rosv Fai tum -Unti .both in the Institutions ana Hospitals could be expanded to
provide for F;p., M.'i’.P., Maternity and MCH services to tau
referral cases of Health posts. In other words, these could bo
utilisecj^as referral centre for health posts.
.'V .. 8. Dr.D.N.Pai suggested that for bigger slues (over 1■
population), there, should be a higher level sex,
de clarified that birr er nlu.nb can have 2 or 3 po~ts do pp^opoSd p««rn. icUvor, If tbsra a> o Pfcial probluub oi a
particular |city like Bombay, the btatu Govt, can make a specif
■ proposal,
9. There wfl;; n suggest ion that thui e should be co-ordination
in- the activities to bl curri.u out by the various agencies, ouch
/^supervisory unit can be either under the btatu Govt.Aocal
—Rsxlyjd openiding uno’’; thu1 conditions* Tho sot up pro via vd
.•
City y./ .bureaux which arc functioning in cor al a
States undur tho Local bodius may also bp rovisud keeping 1
Wl View t-he lob functions of this Unit.
It W8.S
vias consiciered
that for i
t’\i nn
F^tnilV Card • It
(---- -—
Family
‘oTihe area tlu? health1 posts should hayu a family
___ all
-i
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u
4n
1 2_,’>y»tr und.or
nnh at the
*
Ca’d for
the
families
living
jurisdiction of
;1 y
<
Post
1
whiiCh
wil
1
in
club
o
inforuiation
in
regard
to
’’"■ 'Post' vihich will inelueo information
re.gar.d..J1/1 f
.feconqai^ntuo
past inedi
cal ’rL
rucdroZutiU^tion
^serv
i cos.
l^^eBunoNLic
status,, ’ pust
medical
?cQfbZutil’isation oof _
T.
,
v-^unds inay also bo provided. In the pattern^.fQr...£vtyinG--iilo.,
n* !1*:
f^^JLCard jrintucL.
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decided that a separate
-SW'li; Training
of .personnel
personnel t* Jt
It
was
2__ " '
of
- - -*
+vm4 M-int? a nd Q0ST.
Cnapter
oh
’
training
needs'
as
woll.
.as.
i?l
ode
Jor_training^^
.;
ier on ’
nuods' i
’
also'
bo
prepared
for
1 of-training needed for the beneme may
.' .dls^slonTlb
discussion .in the next ^bting.
meeting. ,■ '
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, DDC(RHS) and DirectorCE) were requ^stca to work out xne ...
tfiiis
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details in
la this regard.
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t-u
financial
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13> Financial Implications ; ••Thu Overall
pi
may
bo
;
worked
out
and
during
■
lotPlications of the- revised sat upip total, coverage nueaed may
&•,;sixth Elan,
. tht
klan .ally 1/3 rd of th?
v be committed.

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Dt’iCRilS) and Director (E) were requested, to prepare a
paper c^.this aspect.
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13. it was decided that the next meeting may be
so°n .
J" after the meeting of the Joint Council oi Health 6. FW, which
t is scheduled to be held on 18th to 2Cth August,
1
was also decided that in the next meeting, Adviser Planning
i
1' Commission and Finicial Adviser, Ministry of Health 6c FW may
. also be invited.
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■pEw -M .
COLUMN

Choices on the streets
For many of Delhi's homeless people, the city's night shelters are their only stable anchor. Closing
them down leaves the destitute with no home and no protection.
HARSH MANDER

unsteady and tenuous rest, amidst the unre­
lenting glare of the street lights, the diesel
fumes, the dust raised by trucks and the
constant danger of speeding drunken car
drivers.
It is on these pavements that Vijay has
grown from a runaway teenager to a mid­
dle-aged man, with a wiry, strong frame,
intelligent and alert eyes, black, close­
cropped hair and a ready smile. Resolutely
without self-pity, as he talks about his life,
he returns over and over again to his
dreams and ambitions, which he describes

endearingly using the English word
‘choice’: “Yeh mera choice tha”.
1T OR the greater part of two decades, the
Vijay Singh grew up in a village close
1 only home that Vijay Singh has known
to Gwalior city. His ‘choice’ was above all
in Delhi has been the dusty pavements near
to educate himself, but circumstances did
the Old Delhi railway station. Most nights
not allow him to study beyond the second
he has spent under a starless grey sky dulled
standard. His father was murdered under
by smog and harsh city lights. It is this pro­
mysterious circumstances, when Vijay was
foundly lonely public space around which
a boy of 12, his sister five years younger
has built his life these many years, a space
and his brother an infant in his mother’s
.c he shares with more than a hundred
arms. Their agricultural land was acquired
thousand anonymous homeless men and
to build the Gwalior airport. He looked
women, boys and girls who live their lives
for work, at the airport construction site,
out on the streets of India’s
and at factories, but he was
capital city.
.|o turned away as being too
The
congested
young. His widowed mothmedieval walled city of
er struggled to bring up her
Delhi, spanned by six his­
children by cleaning the
torical gates, accommodates
dishes and sweeping homes
within its aging alleys, crum­
in Gwalior city.
bling footpaths and over­
Young Vijay abangrown parks, more than 30
doned forever his dreams of
per cent of Delhi’s homeless
books and reading. He
people. It is a vibrant eco­
replaced them with anoth­
nomic hub ofthe city, which
er ‘choice’ - to go to the big
never sleeps. For homeless'
city of Delhi, to earn
workers like Vijay, wage
money, to establish a busi­
work as hammaals — porters
ness, and to provide for his
— is available mainly at
impoverished family in
night, when the dense and
Gwalior. His mother
feverish daytime throng of
should not have to slave, his
haws and cars, travellers
sister should marry well, his
shoppers give way after
brother should have the
$ chance to study that Vijay
darkness settles, to trucks
r
and hand-carts for loading
himself had missed. These
and unloading merchandise
were Vijay Singh’s ‘new
in its burgeoning wholesale
choices’, which led him to
markets. The railway station
the streets of Delhi.
handles 188 passenger trains
But this journey was to
through day and night - a
begin first in Bombay. One
larger number than any
day, some two years after
other railway station in the <
’i# his father’s death, Vijay
world. Nigh t is therefore the without taking leave of his
time for work, but also the [•
HE family left with a friend for
only time available for a few p
Bombay. His companion
hours of sleep, when small k
was a couple of years older
stretches of the footpath or
B than Vijay, and had trav­
•
Sy.
the central verge ofthe high­
elled to Bombay earlier.
way are silently occupied by I'
Life on the road. More than a hundred thousand men and women,
They had money only for
legions of tired bodies boys and girls, live their lives out on the streets of Delhi. The 14
railway tickets to Vadodara
stretched out precariously, night shelters run by the government house just 3 per cent of the
(Baroda), and there they
to steal a few hours of city’s homeless people.
emerged at the railway staFRONTLINE, APRIL 26, 2002

91

0

tion. They were sleeping in a public park,
when a policeman caught them and
locked them up for three days. It was the
first time both had seen the inside of a
police station. When they were released,
Vijay’s shaken companion decided to
return to the village. But Vijay was <deter’
mined to go on to Bombay. He begged a
small hotel owner to buy his watch, and
with some seventy five rupees that he paid
Vijay, he set out for Bombay.
For two days, he scoured the city, on
foot or ticketless on a local train, in search
of work and a place to live. In the end,
desperate with loneliness, he spotted two
young boys sleeping on the pavement out­
side Dadar station. He told them his
story, and asked for their help to find
work. “We clean the windscreens of cars
and taxis at road crossings,” they told him,
“and ask the drivers for money.” They
gave him a piece ofyellow cloth and invit­
ed him to join them. He began work the
next day, and money started coming in.
He rarely stayed in one place or with
one group of boys. Instead he moved1
compulsively around the metro|ipolis, and
when he had extra money, he visited Film
City, saw movies, and explored all the
tourist locations and markets of the city.
“The days were fine,” Vijay recalls, “but
at night as I lay on the pavements, a pain
would grow within my chest. Is this any
kind of life? To wash cars, eat, sleep on
the streets? There are days when the rain
does not stop in Bombay for three days in
a row, four days, even a week. I recall sit­
ting once in an abandoned tempo vehicle
for four days, soaked, cold, alone, miser­
able without food. From time to time, the
police would catch us and lock us up in
the police station. The lock-up would be
closed from all sides, so many of us crowded in a tiny space, no windows, beaten by
police sticks, released after several days.”

' I "WO years xpassed, and Vijay decided
1 that Bombay was not the city for him.
He took a train to Delhi, to begin life all
over again. Within days of his arrival in
Delhi, he found work in a dhaba, a mod­
est iroadside eatery for railway passengers
near the Old Delhi station. He worked
through the day, and slept at night in the
dhaba itself, on the floor below the wood­
en tables.
He saved money, about five thousand
rupees gathered over a period of six
months, and decided to visit, after more
than three years, his family in Gwalior. It
was a sentimental moment, the memories
ofwhich he still treasures. His mother was
overjoyed to see him again, and the entire
92

village gathered to meet him. His moth­
er begged him to stay back, but he rea­
soned with her. What would they eat?
How would they live? He was earning
enough now to send money home regu­
larly. She would have enough money to
bring up his brother and sister. He did
not want her to struggle any more.
His mother let him go.
Back in Delhi, the owner of the dhaba
where he worked died, and his family sold
the shop to a transport company. A whole
string of transport and travel companies
sprang up alongside, replacing the food
stalls. Vijay found work\ as a porter, load­
ing merchandise on the trucks and baggage
on to passenger buses. He continues this
work until today, earns well enough to eat,
and regularly saves money to send home a few thousand rupees every six months.
But following the sale of the dhaba he
on the streets. If he hired
was onceagain
;o
a room to live in, he would have to spend
monev on rent and travel to work. There
money
would be nothing left for him to send to
his mother in Gwalior. So it was to be the
pavements outside the Old Delhi station
instead that he would make his only home
in Delhi,

A TIJAY’S ‘choice’ of a dwelling on the
V streets for the sake of his family in the
village, resonates with the choices of thousands ofothers who sleep on the pavements
of Delhi each night. A survey of homeless
people in Delhi in 2000 by Ashray Adhikar
Abhiyan, a dedicated group of young peopie working for the rights ofhomeless peopie, confirmed that contrary to what many
people assume, no more than 4 per cent of
the homeless adults in Delhi are ('destitute
and unemployed. More than 70 per cent
of them migrate to the city from the countryside in search of work because of desperate poverty. About 26 per cent find
casual wage work as loaders and porters,
33 per cent ply rickshaws and handcarts,
and 7 per cent work in food stalls. Three
out ofevery four homeless persons in Delhi
maintain links, like Vijay, with their fam­
ilies in the villages and towns, and almost
60 per cent save money and send it home,
So, like Vijay, they choose homelessness,
in order that their families survive in the
lands of their birth.
Close to where Vijay loads merchandisc and baggage on to trucks and buses,
is a night shelter run by the government,
For over a hundred thousand homeless
people, the Delhi government runs over
14 night shelters, with a maximum capacity of2,937 people. In other words, night
shelters provide a roof for not more than

3 per cent of all homeless people in the \
city. There are none for women, or
migrant families. Ofthe government shel­
ters, the largest is the one near the Old
Delhi railway station, in the vicinity of
which Vijay works. Started in 1964, it was
the first night shelter to be opened by the
government. In winter and during the
rains, its four large halls are crowded well
beyond its official capacity of 514 persons.
The facilities are rudimentary. For a fee of
six rupees a night, bare common mats are
spread out on the floors, on which men
sleep, body against body. Blankets are pro­
vided for the winter, and there are com­
mon toilets and bathing places, erratically
cleaned but always in demand.
Vijay uses the toilets and baths, but
otherwise prefers the independence of
sleeping under the open sky. Outside the
shelters, private contractors, called th:
and plastic she
Jjawalahs, rent out quilts
.
for five rupees a night. Iron cots are lined
un in the corridors outside shops, for a
up
rent of fifteen rupees a night.
However, the blaze of the street lights,
and the clamour oftraffic and loaders working through the night, are unremitting. It
is ganja that gives Vijay the peace he needs
for a few hours of sleep. But this is often
disturbed by policemen, who routinely beat
on their feet and shins the men, women and
children sleeping on the streets,
Even as we spoke together for many
hours, Vijay admitted that he was intoxicated with ganja. “I have smoked ganja
for so many years, the time has come when
I do not know whether I am sober or
high,” he says. “I need the ganja because
it alone brings me solitude. There is no
place I can go to in order to escape the
din, the hordes, where I can be by myself.
Where I can think, be at peace, be at r
Only when I smoke my ganja, ’I can ,
alone even in a crowd.”
The Old Delhi night shelter remained
for several years the one stable anchor in
Vijay’s life i in Delhi. When winter was
vengeful with bleak and icy winds, or the
streets were awash with the monsoon
sludge and garbage, he always had the
night shelter to return to. Besides, he used
the shelter
shelter’s’s bathrooms
bathrooms and
and toilets
toilets
the
throughouttheyear. And many men, who
worked as truck-loaders, rickshaw-pullers,
casual workers, or railway porters, had
lived in the shelter for several years. Street
boys whom Vijay would take under his
wing from time to time always had the
assurance of a roof over their heads at the
night shelter. One hall was reserved for
street boys. The shelter, decrepit, unclean,
I basic, crowded, dirty, still became to Vijay
FRONTLINE, APRIL 26, 2002

and so mamly who lived in and around it, bering men and boys on any given night. :and he can stay as long as he likes. It is
the closest they had in Delhi to a home.
For Vijay and the Beghar Sangharsh often that Vijay takes> care of young boys
Then suddenly, without warning or Samiti there is a quiet sense of triumph, who start life on the streets in the way th;iat
notice, in July 2000, exactly 36 yearsafter
;
They are determined to keep it alive to ’he ’himself
*
had• two decades earlier.
it was opened, the night shelter was closed secure a better life for the homeless work­
down. It was converted into a detention ers and street children who live within the
ESPITE his ‘choice’ for his brother
centre for ‘illegal’ Bangladeshi refugees. walled city.
, They
, now xpropose
x
to ask the JLVRaju, and the money that he sent
For the 500 to 1,000 meni and boys who government to handI over
over the
the managemanage- home regularly, Raju grew up unschooled
had slept every night on a few
I
square feet ment of the night shelter to the homeless in Gwalior. Afraid that Jaju too would end
each of its floors, as their only defence people themselves, so that they can con- up like him on the footpaths, Vijay brought
atgainst
L ’
the cold and rain, it was like being vert it into a place of dignity and rest.
him to Delhi. He arranged for him to learn
rendered
—more profoundly homeless all
Vijay pays the policemen a daily bribe work at a garage at Kingsway Camp. Raju
over again. They spilled back on to the sur- of Rs.20 in order to run a small cigarette 1has learnt
’
' of~ a car mechanic and
the trade
rounnding
’
n ’ pavements, where
’
'
overflowing
stall" under a tree close
to the night shelter, Vijay hopes to set up a garage for him. His
they passed a bitterly cold
sister was married a few years
winter in 2000.
o ago. They found decent peoThis was not the only
pie, who agreed to take no
night shelter to be closed
dowry. He is still able to send
down. In May 2001, a night
money home regularly for his
‘Mter at Turkman Gate was
aging mother.
;ed down. A few months
Vijay remains virtually
later, in September 2001, a
unlettered, yet he has
shelter at Meena Bazaar near
emerged as a reluctant leader
Jama Masjid was also shut, as
of other homeless men. He
part ofwhat was described by
speaks like a philosopher of
the authorities as a ‘beautifi­
the streets, acutely observant,
cation’ drive.
analytical, caring but careful­
The activists of Aashray
ly unsentimental. He has
Adhikar Abhiyan slowly gal­
views that are entirely his own
vanised Vijay Singh and his
about everything - politics,
friends to fight this injustice.
the state of the city and the
They came together on a
country, the Prime Minister’s
platform for the first time,
performance, ethics, religion.
No more than 4 per cent of the homeless adults in Delhi are
which they called the Beghar
Vijay refuses to complain
destitute and unemployed. However, thousands of them choose
Sangharsh
Samiti
(Home. ­ to sleep on the pavements at night to save money on rent.
about his life, and says that he
r.
, ,
e
less
People’s
Struggle
has no grievance against God.
Committee). Another group that gave which he operates in addition to casual “He has given me a healthy body, two eyes,
itself the name Yuva
Yuva Ekta
Ekta Manch
Manch wage
wage work,
work, the
the staple
staple of
ofhis
his income.
income. Over
Over two hands, two feet, a good mind, what
(Homeless Youth Group) came up at the
theyears
years he
hehas
has run
run through
through many
manytrades,
trades, more can I ask for?” he says.
Jama Masj id. These motley. groups
ofdis- sometimes selling tea or snacks or chapatis,
~
,
,
But he is uncompromising on the
possessed men metto
todiscuss
discusshow
howto
todeal
deal but
buteach
eachtime,
time,despite
despitehis
hisdaily
dailyallurements
allurements resolve that he will never marry or raise a
h the closure
even the
the new
new legal
legal to
t the men in khaki, and the municipal family. “I cannot let my child have a life
-----of
5 even
^r^ces that the government had conferred staff at least two or three times a month, it like the one that I have led,” he says qui­
on homeless people. On September 19, invariably comes to pass that his wares are etly. “I cannot. I am content instead to
2001, they decided to organise a demon- confiscated by the municipal office. He has see my brother have a family, and a home.
stration. A group of 70 homeless people befriended a lawyer, who is uncompro- This is enough for me,” he adds.
marched to Rajghat, and took a pledge of mising about his fees (Rs. 200 a hearing)
Does he think that he will continue
non-violent resistance. Among them was but is otherwise supportive and effective. to live the same way that he does now on
Vijay.
2001,. Vijay had
to the streets of Delhi? “Twenty years have
. . The -group
. then
.
.proceeded to the The last time,. in June
J
-----office of the Municipal Corporation of pay
payRs.
Rs.950
950asasfine
finetotothe
themunicipal
municipalauthorauthor­ passed,” he says. “Who knows what the
Delhi where they sat in a dharna. In terms i ties
itiesafter
afterthe
theexertions
exertionsof
ofthe
thelawyer,
lawyer,totoget
get next 20 years have in store for me? My
of scale and participation, it was a mod- his
hiscigarette
cigarettestall
stallreleased.
released.But
Butby
bythe
thetime
time father
fatherleft
leftaasmall
smallpiece
pieceof
ofland
landininmy
myname
est protest. But for the homeless people he regained possession of it, the money in the village. Ittwas
was the
the only
onlypart
partof
ofour
who joined in it, it was the first time they from
fromsales
saleshad
haddisappeared
disappearedand
andthe
thematemate- property that was
was not
not acquired for the
felt able to demand their rights from the rials
Gwalior airport. Maybe I will be able to
rialshad
hadbeen
beenpartly
partlydestroyed.
destroyed.
stateOn the night that we spoke together, return to it one day. Maybe I will be able
Less than a week after the agitation,, the cigarette stall, under the itree, was to build on it my home. Maybe that is
but months after its abrupt closure, the doing good business, even tthough
’
it was where, with my mother, I will spend my
government relented and the night shel- almost dawn. Instead of Vijay,
' \ , a young last days. Under a roof, within walls that
ter was restored. In the winter of2001, the boy sat at the stall. “He has come from I can call my own. May be.” H
doors of the night shelter at the Old Delhi Bengal,” Vijay told me. He has no one to
railway station were reopened, and once take care of him, so I asked him to sit at Harsh Mander is the country director
again teems with several hundred slum- the stall. Whatever he earns he can keep, ofAction Aid India.
FRONTLINE, APRIL 26, 2002

93

■ TRADE POLICY

Protecting Indian exports
The new Exim policy attempts to mitigate the problems of Indian exporters by improving
the infrastructural endowments in certain export enclaves.
eligible for official assistance under a
newly announced Market Access
Initiative (MAI), which could enable
A AARGH 31 has in the last two years
IVlbeen a day in the international
them to set up common showrooms,, con­
duct
surveys
<’
y and promote their brands in
limelight for the Union Commerce
markets. Common service
prospective
Ministry. March 31, 2000, represented a
providers> in these industrial clusters
crucial threshold in India’s decade-long
would be entitled to import equipment
process of integration into the global
under the Export Promotion Cap’ll
economy, when the process of disman­
Goods (EPCG) scheme, which wr
tling quantitative restrictions (QRs) on
conceivably give them - and derivatively,
imports in line with World Trade
the exporting units - better economies of
Organisation (WTO) norms was sharply
operation.
accelerated. The process was concluded
This is one among the Commerce
on March 31, 2001, with the announce­
' " ‘ ,’....................
Ministry
s initiatives» to address an
ment of a series of amendments to the
<endemic problem of the Indian export
1997 Export-Import Policy.
effort. Poor infrastructure normally
Alongside this, on March 31 last year
entails higher costs of operation for
Commerce Minister Murasoli Maran
exporters. Estimates by industry associa­
inaugurated a new phase of export pro­
tions put the magnitude of the cost dismotion with the announcement of a
advantage that Indian exporters suffer on
scheme to set up a number of Special
account of higher power, transportation.
transportation,
Economic Zones (SEZS) which would
finance and other infra­
function under a different
structural costs, at between
set of regulatory norms and
10 and 15 per cent. The
laws than the rest of the
new Exim Policy seeks to
country. With all these
mitigate this problem by
foregoing developments,
focussing its attention on
when the time came to
improving the infrastruc­
review and renew the Exim
tural endowments in cer­
Policy norms on March 31
tain export enclaves.
this year, there must have
One of the propose J
been a serious shortage of
to initiate a programme
practically useful measures
known by the rather attrac­
that could be conceived of.
tive acronym ofASIDE, or
One half of the regula­
assistance to States for
tory agenda effectively van­
infrastructure
develop­
ished with the removal of
ment for exports. This pro­
QRs on imports, which
gramme builds upon
meant that tariffs fixed by
certain schemes that were
the Finance Ministry
announced in 2000 to
would be the only measure
encourage the participa­
of control. As a practically
tion of States in the export
useful set of measures, the
effort. Ofthe Rs.330 crores
Exim Policy was saved
that has been allocated for
from obsolescence by the
ASIDE in 2002-03, as
specific conditions that
much as 80 per cent will be
prevail in the world econo­
divided in accordance with
my today. After a period of
the two criteria of the total
fairly buoyant growth Commerce Minister Murasoli Maran releasing the Exim Policy
quantum and the rate of
through much of the last document in New Delhi on March 31. By his own admission, here
growth of exports originat­
decade, the world economy he is disinclined to risk any policy changes that might unsettle
ing in the respective States.
lurched into a recession as the export sector at a time of acute uncertainty.

the last fiscal year wore on. India’s dollar
rate of export growth tumbled from a
robust 19.6 per cent in 2000-01 to a paltry 0.6 per cent in the first six months of
2001-02. In framing his Exim Policy proposals, Maran was guided by the understanding that the modest growth persisted
well beyond the first six months of the
year.
His response has been to provide a
further impetus to the concept of the
SEZs, and to try and extend the princi­
ples involved to other sectors of the econ­
omy. Although Tirupur, Panipat and
Ludhiana may not feature in the list of
SEZs, the Commerce Minister has5 now
designated them as “towns of export
excellence”, focussing respectively on
their traditional capabilities in cotton
hosiery, woollen blankets and woollen
knitwear. Recognised associations of
exporting units in these towns would be

SUKUMAR MURALIDHARAN

* 1

94

FRONTLINE, APRIL 26, 2002

I URBAN ISSUES

Shelters for slum dwellers
The Global Campaign for Secure Tenure aimed at providing houses to slum dwellers, which has been
launched in Mumbai, highlights the long-term sustainability of such a programme as opposed to the
temporary measure of eviction of illegal dwellings.
LYLA BAVADAM
in Mumbai

/AN July 16, the United Nations
VV Centre for Human Settlements
(UNCHS) launched in Mumbai the
Global Campaign for Secure Tenure in
partnership with the National Slum
vellers Federation (NSDF), the

Brihanmumbai Municipal Corporation
(BMC), the Government of Maharashtra
and the Government of India. The cam­
paign comes in the context of the grow­
ing realisation around rhe world that a
solution needs to be found to the prob­
lem of homelessness among the poor.
Governments, international agencies,
non-governmental
organisations

(NGOs) and community-based organisa­
tions representing the urban poor have
been engaged in the search for solutions.
Absence of secure tenure, particularly in
the urban areas, has been identified as one
of the key areas of concern.
At the UNCHS’ Habitat-II confer­
ence in Istanbul in 1996, formal recogni­
tion was accorded to the necessity of

Along P. D’Mello Road, one of the busiest roads in Mumbai. These families are due to be resettled soon. (Facing page) Slum
colonies along Central Railway tracks. The resettlement and rehabilitation of these dwellers is an integral part of Mumbai
Urban Transport Project-11.
PUNIT PARANJPE

TN Till

. -T W

94

FRONTLINE, SEPTEMBER 15, 2000

Lessons from a survey
al and economic parameters.
The survey was conducted and the
data scrutinised and analysed in accor­
dance with rigorous statistical principles.
An advisory committee of sociologists,
economists and statisticians was con­
sulted in designing the schedules to make
it as objective as possible. As caste is a
sensitive issue, the respondents were
assured that the primary data would not
be given to the government and that they
would not be forced to respond (statistical techniques were used to deal with
non-response). Although Rs.40 lakhs
was budgeted, only Rs.30.42 lakhs was
spent.
A pilot survey was done in
November 1994 and the formal survey
was launched in January 1995. The
report was submitted to the "
BC
Commission in April 1998. It is, how­
ever, yet to see the light of day.
► What was the survey design?
The survey was done scientifically. I
adopted a stratified random sampling
method. We
adopted
the1 sample
survey
I
\
1 1
t
(and not the Census) method because of
its advantage as, apart from saving on
time and cost, it has been proved that a
rigorous and scientific survey is much
better than even a Census. This was
established by the late P.C. Mahalanobis
more than 60 years ago, after which was
set up the Central Statistical
Organisation (CSO), the National
Sample Survey Organisation (NSSO)
and the State Statistical Bureaux.
The survey covered all the 23 districts from which 3,600 urban enumerator blocks and 2,000 villages were
statistically chosen. Out of these, 50,000
rural households and 25,000 urban
households were statistically shortlisted.
The choice of even the ultimate sam­
pling unit, that is, a household, was
made, and not left to field personnel.
personnel,
Care was ttaken to include, as far as possible, castes with small numbers.
Nearly 90 parameters on 1housing,
education, occupation, income, expen­
diture, assets, family size and so on, were
collected and scrutinised, and an Index
of Forwardness (or Backwardness)
worked out.
A novel concept to measure the coefficient offriendship (between castes) was
also included. Both qualitative and
quantitative data were collected. Each of

FRONTLINE, SEPTEMBER 15, 2000

the qualitative classification was graded,
For instance, ‘structure of the house’ had
five classifications, each superior to its
successor; ‘location of the house’, four
and so on. All the qualitative variables
were then indexed using well-proven sta­
tistical techniques with coefficients
ranging from 0 (most backward) to 1
(most forward).
Broadly, four basic indices (ofsocial,
education and economic status and of
political empowerment) were worked
out to calculate the: Index of
Forwardness.
The Index of Social Status is a
weighted average of such indices as qual­
ity of housing, ownership of agricultur­
al
land
and
equipment
and
gender-specific job security and job levels. The relative status of women mea­
sures the progress towards gender
equality.
Each of these components has subcomponents. For instance, the ‘quality
of housing’ has nine <components, eight
qualitative,
with 10 per
x 0 cent weight
c' each,,
r
and a quantitative parameter (structure
of the house) with a weight of 20 per
cent.
Finally, each component index is
normalised over castes to make it comparable and then assigned weight;:s to
obtain the weighted average. This is the
Index of Social Status, which gives the
relative rank of each caste in the overall
social status.
Similar is the calculation of the Index
of Education Status (computed from six
components, including adult male and
female literacy and indices of schoolgoing children). An Index of Economic
Status was computed from five compo­
nents including ownership of assets, per
capita income, value of consumer
durables and proportion of expenditure
on non-food items. An Index of Political
Empowerment was computed from an
‘auxiliary sample’ ofhouseholds ofmem­
bers of randomly chosen elected bodies,
such as gram panchayats, municipalities
and corporations, mandal praja
parishadsandzillaparishads,andthedistrict cooperative central banks. A statistical measure using grades of elected
bodies and designations gives the index.
► What were the results ofthe survey?
The Index of Forwardness was calc '
culated with 40 per cent weight for social

status, 30 per cent for education status,
20 per cent for economic status and 10
per cent for political empowerment.
This value, normalised for various castes,
gives the composite Index of
Forwardness, ‘F’, which like other
indices, falls between 0 and 1. For each
of the five indices, the castes are ranked
in the descending order. Ranks are given
bypassing the non-Telugu population.
The ‘F’ distribution is divided into
five: Central 25 per cent average castes;
25 per cent on either side, forward and
backward; and 12.5 per cent on either
end, most forward and most backward
castes. This is only a guide and if need
be the scale can be divided into seven.
There were 369 castes listed in the
households. In the sample there were no
households for 63 castes, 104 had less
than 10 households; and 30 castes had
non-Telugu households. Ultimately,
172 castes/caste-groups
x ; were identified
and studied in detail. The tables were
prepared in alphabetical order and the
castes iranked according to the index and
populateion percentage. The index
ranged between 0 and 1.
This index apart, we also worked out
the coefficient of friendship. At the end
of the schedule, we asked each respon­
dent to name their five closest friends.
Castes were grouped into 25 broad categories of single caste or homogeneous
groups of castes and a 25x25 matrix was
worked out, which was used to obtain
the index coefficient which, if closer to
1 denotes high inter-caste friendship.
Interestingly, the lower and higher castes
were found to mix well.
► Why is the report not being discussed
or usedi
The report, in all probability, has
some embarrassing and difficult results
for the Andhra Pradesh government. It
may have to derecognise some castes that
are now in the B.C. list. For instance,
converted Christians are ranked 34th
(out of 172) and have 81 per cent of the
population below them. How can they
Ibe called backward? Similarly, the
Kappu community, which has 77 per
cent of the population below them, can­
not be called backward. The B.C.
Commission wants me to provide the
primary data. I will not give them as I
have____
made a commitment to my respondents. H

93

’ providing people secure tenure. India, a
participant at the conference, was a sig­
natory to the final document, which
included recommendations for the grant
of land tenure to the poor.
At rhe function on July 16, the BMC,
the Slum Rehabilitation Authority of the
State governmen t, a private developer and
the NSDF/SPARC signed a memoran­
dum of understanding (MoU) to relocate
3,000 pavement families. Chief Minister
Vilasarao Deshmukh symbolically hand­
ed over the keys of their new homes to
some pavement families. The recipients,
like several others, will soon receive hous­
es measuring 250 square feet and consist­
ing of a room, kitchen and toilet and the
facilities of running water and electricity.
Each family will make a deposit of
Rs.5,000 towards a maintenance fund
and also bear the monthly outgo for their
ter and electricity charges. The new
uuildings are located in areas that are well
connected by road and rail. The idea is to
put the people on their own feet, remove
their insecurities about displacement and

then let them contribute to the develop­
ment of the city like any other citizen.
The programme is not just about pro­
viding shelter but integrating and build­
ing the self-respect of the poor. William
Cobbett, who heads Shelter at the
UNCHS (Habitat), said: “The message
we want to send out is that only by recog­
nising the permanence of the urban poor
do we have a chance for sustainable urban
development.”
The launch of the campaign was time­
ly. Every monsoon Mumbai witnesses
two phenomena-one, oflandslips caused
by poorly constructed houses on the hilly
areas, and two, eviction of slum dwellers
who live alongside rhe railway tracks of
the Western Railway and Central Railway
lines. In the northern suburb of
Ghatkopar more than 50 people living in
hillside slums were killed in a landslip
recently. The BMC and the railway
authorities carried out a series of demoli­
tions of trackside slums ahead oftlie mon­
soon.
The authorities have always respond­

ed to encroachers of the city’s pavements
and squatters on public or private land
with
demolitions
and
evictions.
Recognising the futility of such an
approach, the NGOs convinced the
authorities about the need to evolve a
more balanced and long-term solution to
the problem.
(Moreover, the demolitions of hous­
es and evictions have come to be recog­
nised as significant violations of human
rights when these are not accompanied by
resettlement and rehabilitation.)
Habitat and the UNCHS are address­
ing the problem of shelter for the home­
less at a global level. To address the issue
of a secure shelter and infrastructure,
slum-dwellers from 12 countries have
formed a network of their national feder­
ations called the Shack Dwellers
International. They work out ways to
negotiate with their respective govern­
ments on the issue of homelessness. In the
process, they have created powerful exam­
ples that show that partnerships between
the state and communities are viable.
PUNIT PARANJPE

T PARANJPE

U.'.J

Wfi

I

J

fry ill

•

313

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I 1
•
•4

TX__
4a^s^'
IT

FRONTLINE, SEPTEMBER 15, 2000

hi? .

95

Countries involved with the
infrastructure are key to the secu-'
Shack Dwellers International
rity ofthe urban poor. We do not
use savings and credit apart from
believe any more that solutions
creating information as a basis to
will be handled by the state.
There is a need for the participa­
organise poor communities. The
Q ECURE tenure describes an agreement involving an
0 individual or group to land and residential proper­
tion of the citizens. Pavement
belief is that money and infor­
mation are powerful tools.
dwellers and railway track-side
ty, which is governed and regulated by a legal and
In India, the NSDF, which
dwellers have devised their own
administrative framework. The security derives from
was formed in 1975, has along
the fact that the right of access to and use of the land is
solutions. These are the starting
with Mahila Milan mobilised
points for exploring further sus­
underwritten by a known set of rules and that this right
communities through an exten­
is justiciable. The tenure can be effected in a variety of
tainable solutions. In the next 20
sive savings and credit pro­
ways. People can be said to have secure tenure when
years, urbanisation will go from
gramme and through a
they are protected from involuntary removal from their
the current 30 per cent to 55 per
community information-gath­
cent. So there is no questioning
land or residence except in exceptional circumstances
ering process of mapping settle­
the need for new community
and then only by a legal procedure.
ments. These processes have
partnerships. There should be a
The rationale behind secure tenure does not pre­
created an authentic and popu­
rethink on the myths impeding
sume to resolving the world’s housing crisis. Granting
lar knowledge base and are pow­
of secure tenure is a step in the right direction of
the development of cities.”
erful tools in the hands of the
acknowledging the permanence of the urban poor and
Jockin said: “The days of the
communities. The NSDF,
1970s when we said ‘We will not
ofcreating the right conditions for them to exercise their
which has a membership of 2.3
rights and discharge their obligations as urban citizens.
move from the land we 113'^
lakh families living in 32 cities,
The urban poor are already providing for themselves
squatted on’ are gone. We
has successfully negotiated with
albeit often in illegal ways. The Campaign for Secure
longer want to live on pave­
various State governments and
Tenure believes that, at a minimal cost, the same facil­
ments. We want decent housing.
city authorities to achieve solu­
Now, 80 per cent of the pave­
ities can be provided legally. ■
tions to the issues of land and
ment dwellers save money to buy
housing and have sought to
houses. We have also changed
prove that the poor are an asset, a resource en by the Campaign will be a programme our attitudes. We want to organise our­
that the city can bank upon, and not a lia­ to remove all discriminatory legislation selves. We do not want to beg for any­
bility.
against women in respect of access to thing. The plan is to rehouse 14,000
The Society for the Promotion of property title as well as inheritance families in two years from their present
Area Resource Centers (SPARC), an rights.)
location along the Central and Western
NGO that plays a supporting role to the
railway tracks. The urban poor have the
NSDF and the Mahila Milan, was start­ f | ’HE State government plans to table a seeds ofa solution. They just need the cor­
JL Bill in the current session of the rect framework.”
ed in 1984 to bridge the gap between gov­
ernments, professionals and poor Vidhan Sabha providing a cut-off date of
communities. These organisations are January 1, 1995 for resettlement. Slum T TSING the salt land available in and
committed to work towards security of dwellers who entered the city after this date
around the city is seen as a possible
land tenure and infrastructure for poor will not be eligible for housing and other solution to the issue of identifying land
communities.
facilities. Explaining the rationale of the for resettlement. According to Jockin,
During the last two decades, there has proposed Bill, the Chief Minister said: there are more than 70,000 acres of salt
also been the realisation that the role of “There are 12 million people in Mumbai, land in the Mumbai Metropolitan
state agencies as providers of housing for Those who have settled here before January Region. But the Centre and the State
the poor is limited as they are constrained 1,1995 will get full protection, civic ameni- locked in a debate over the rights to th
by limited budgets and less than perfect ties and housing. We take no responsibililands. The Centre has claimed rights over
delivery systems. Consequently, a con- ty for those who have come after this date,
these tracts of land, whereas the State has
sensus has emerged that the role of the In another two months photo passes will
suggested a compromise solution in
state should be that of an enabler and a have been issued to all the pre-1995 setders.
which 50 per cent of the land is given to
facilitator. Legislation making land avail- We realise that people have come to the city the State for resettling slum dwellers.
able for the poor, the provision of land with hope and it is our duty to help them
Bandaru Dattatreya, Union Minister of
tenure and housing finance have been but it must also be understood that
State for Urban Development and
Poverty Alleviation, is non-committal on
identified as key areas for state action. The Mumbai is an island city and there is a limit
the issue. What neither side is discussing
actual task of building houses should be to
towhat
what the
the land
landcan
can offer.”
left to the poor; they can do this through
The major concern, however, is about is the matter of the Coastal Regulation
their own organisations by mobilising re-encroachment. Sheela Patel, director Zone (CRZ). Salt land comes under the
communities and developing their capac- of SPARC and A. Jockin, president of the CRZ and no construction is allowed 500
ity to deal with the various aspects of this NSDF (see separate story) are confident metres inland from the high tide line.
challenge.
that pavements will not be occupied
The response to the campaign so far
William Cobbett emphasised the role again, but at the same time admit that cit- has been encouraging. Christopher
of women in urban development and izens groups and the local municipal ward Williams of UNCHS (Habitat) sums up
shelter issues saying “their involvement is officer should be “vigilant and not allow the project saying, “By U.N. standards
a key to the success of the programme”. encroachments to resume.”
the response (to the launch ceremony)
(A major initiative that will be undertakSheela Patel said: “Land security and was tremendous. To have about 80 per

On secure tenure

96

FRONTLINE, SEPTEMBER 15, 2000

Award for a fighter
LYLA BAVADAM

TN characteristic style Arputham
A Jockin, this year’s winner of the
Magsaysay Award, sums up the past and
the future of Mumbai’s 5.7 million
slum-dwellers, of whom he is one and
r whose rights he has been fighting for
^0 years.
A sprightly man with bright eyes
and a siimiling face, 53-year-old Jockin
was born and brought up in Kolar Gold
Fields, Karnataka, where his father
worked. Poverty made him leave for
Bangalore, where he trained as a car­
penter.
In 1963 Jockin came to Mumbai,
He rented a room in the Mankhurd
Janata Colony and earned a living as a
carpenter. “I love children and used to
play with them. I started a small coach­
ing class. On Sundays, I’d get the kids
together and we’d whitewash the toilets.
There was no ideology, no formed ideas
of giving back to the community... it
was all just spontaneous, but I suppose
it made me into something of a local
leader.”
His natural leadership qualities
adually made him the focal point of
the community. “My social work slow­
ly became radical,” he says, explaining
his tactics while demanding regular
water supply for the colony. He would
write a letter listing the demands of the
70,000 residents of the colony, wait for
45 days, and if no response was forth-

coming, break the municipal pipe and
take an illegal connection. This would
catch the attention of the authorities.
The retribution would invariably be
met by an audacious response from
Jockin: he would tell them that if they
had responded to his letter this drama
could have been averted. “My con­
tention was that we paid rent. Janata
Colony was a legal settlement of the
BMC (now the Brihanmumbai
Municipal Corporation) and yet we
never got water.”
His informal leadership of the
community was strengthened in 1964
when the Bhabha Atomic Research
Centre (BARC) was established in
Trombay, near the colony. Citing secu­
rity reasons, a determined effort was
made by the Central and State governments to evict its residents. They
responded by forming a committee,
which carried out an action plan of
organising morchas and bombarding
the government with petitions. “I
became so powerful,” recalls Jockin,
“that I was only arrested on paper. The
police would come to my house with
'
the
bail papers.”
However, backed by
Indira Gandhi’s gov­
ernment
at
the
Centre, the State
removed the residents
in 1976 to their present
location
of
Cheetah Camp. “I still
observe that day in
May as Black Day. It
was like Turkman
Gate,” he said, refer­
ring to the demolition
drive in Delhi during
the
Emergency.
“Around
“13,000
policemen came to
demolish
7,000

cent of the audience as slum dwellers is
unprecedented. This level of interaction
with grassroots NGOs is still only a subculture within the U.N. Programmes like
this are proving the efficiency and the suecess of interacting with groups who are in
direct touch with the government and the
people.”
Williams’ view raises an issue that has
been hanging fire for decades. While pro­

grammes like this are commendable and
required, they need to be more integrated
and have a holistic approach and tackle the
root of the problem simultaneously. In the
case of urban housing for the poor, the need
of the hour is as much to improve rural
opportunities as it is to house those who
migrate to the cities because of a dearth of
livelihood opportunities. There is no
known holistic approach in operation.

“We know how to steal electricity. We
know how to steal water. But we veput
all that behind us now. The days ofthe
1970s are over when we used to say ‘We
will not move (from the land we have
squatted on) ’. Now we say ‘We don't
want our children to grow up on the
pavements. We want decent homes and
were willing to pay for them."

FRONTLINE, SEPTEMBER 15, 2000

homes.” Jockin rallied slum dwellers
from all over Mumbai to form a united
front. His efforts crystalised in 1975 in
the form of the National Slum Dwellers
Federation.
Jockin has weathered many storms
since. He has been called a “slum lord”.
He says: “There was a lot of talking and
doing on my part... I got things done...
maybe they mean slum lord in that
sense... someone who has the respect of
others.” He is accused of unconven­
tional measures, such as luring munic­
ipal officers to the slum on the pretext
ofshowing them around and then push­
ing them into overflowing toilets just
“to give them a first hand experience”
of life in a slum. But more important is
the fact that Jockin has initiated a path
of action that is truly revolutionary.
Jockin believes that without the
involvement of women, poverty and
slums cannot be eradicated. Men drink,
sleep and are easily politicised. Women
have a knowledge of reality and the
desire to change their lives,” he explains.
Whether to organise a demonstration to
demand water supply, a gherao to
demand educational facilities or a cam­
paign to expose unscrupulous slum
lords, Jockin has always believed in and
w motivated women. He
z has announced that
“ the $50,000 (about
| Rs.22.5 lakhs) award
will go to Mahila
Milan, the women’s
organisation he helped
form.
Largely unaffected
by the latest changes in
his life, Jockin contin­
ues to live in Cheetah
Camp. He says it is
impossible for him to
live elsewhere. “This is
my university, this is
my motherland. I have
learnt
everything
here.” ■

The other fly in the ointment is the
matter of the cut-off date which extends
no security to other illegal settlers. While
the campaign strongly opposes forced
evictions, the government has stated in no
uncertain terms that it will “severely deal
with” illegal settlements after that date.
The resolution of this problem will deter­
mine the future of the campaign in

Mumbai. ■
97

I COLUMN

Lessons from the Kursk catastrophe
The submarine disaster underscores both appalling lack of safety in Russia's military, and generic
problems with nuclear submarines everywhere. To avert disaster, India must abandon its nuclear
weapons and submarine development programmes altogether.
f | ^HE world public will find it hard to by comparison with the far, far simpler arrested in February 1995 by the security
JL overcome the sheer horror of the last task of getting divers to break down the police and accused of grave charges,
moments of the 118 men who died gasp­ hatches - itself a complex operation which including espionage, which carry a death
ing and choking inside the Kursk subma­ demanded the forging of special tools.
sentence, although he had obtained all his
rine. If death could ever be totally cruel
Abandoning the submarine where it information from open sources. Nikitin
and merciless, undignified and sordid, lies would be even more dangerous. Its spent nine months in jail before trial. He
wanton and preventable, then this was body will decay, releasing huge amounts was prevented even from choosing his
that death. And yet, the
of potent toxins, contam­ lawyer. Recently, however, he was totally
accident was in some ways
inating marine life and acquitted of all charges.
only waiting to happen I interviewed Nikitin two months a&u
eventually endangering
BEYOND
in line with the 120-plus
human beings. Nuclear- in Stockholm. All his fears expressed since
“incidents”
involving
powered submarines con­ 1995 - when I started following his case
THE OBVIOUS
Soviet/Russian
sub­
tain a cocktail of poisons: - have come true. Nikitin, at one level,
marines since 1956. The
highly enriched (usually was glad to be exonerated of the trumpedKursk disaster holds many
90 per cent-plus) urani­ up charges. But at another, he was full of
lessons for the world, in
um, hundreds of radioiso- apprehension that under further, massive,
particular for India.
fission budget cuts, the Russian forces’ safety
topes
and
To start with, the cat- (
products, including plu­ standards would fall precipitously. Today,
astrophe is far from over.
tonium, and high chemi- Russia’s military runs on a budget $5 bilIndeed, the radiation dan- ,
cal explosives to boot, lion (compared to the U.S’$300 billion).
ger may only be beginning
Nuclear submarine opera- (This is even lower than India’s current
to unfold. According to the
tors follow patently unsafe $13 billion-plus defence budget.) More
Bellona Foundation, a
practices which would be than 70 per cent of Russian warships are
highly
regarded
totally impermissible in in a state of disrepair. Most soldiers earn
PRAFULBIDWAI
Norwegian environmental i
civilian facilities: for the equivalent of less than $ 100 a month,
group which has for years
example, storage of high Some do not get paid at all.
monitored Russian submarines, the explosives next to a nuclear reactor.
“Vast numbers of soldiers and sailors
Kursk is powered by two OK-650b reacThe Kursk is only one of 125 Russian moonlight,” Nikitin said. “This means
tors with an output of 380 MW. Their submarines which are still to be disman- they pay little attention to their job. Their
cores contain an estimated 1,200 kg of tied. (About 180 have been taken out of skills and qualifications have eroded. TUp
highly enriched uranium, most of it U- service since the end of the Cold War.)
armed forces are in a state of turmc
235. This has a half-life of a mind-boggling Two-thirds of these are in the north of quarter ofthem homeless, and most acute710 million years. This means that even Russia. In fact, Russia’s Northern Fleet ly demoralised and depressed.” Two years
with radioactive decay, 600 kg of the operates a fifth of the world’s nuclear reac­ ago, a young sailor went berserk on a sub­
material will still be present 710 million tors - in an unsafe and increasingly slop­ marine and held eight of his colleagues
yearsfrom now, and nearly 500 kg one bil­ py fashion. It also stores some 21,000 hostage at gunpoint. Some of the gener­
lion years later! The inventory of radioac­ nuclear fuel-assemblies and has a unique als who prosecuted the Chechnya war
tivity is likely to be 2.2 million inventory of hazardous materials. Any would routinely get drunk by 9 a.m. These
terrabecquerels - an awesome magnitude. day, any month, one or more of the 200- men are sitting on the world’s biggest
Even the short-run environmental plus nuclear reactors in this unsafe, poor­ nuclear arsenal, with 22,000 deployed
hazard is grave: the reactors probably shut ly guarded fleet was liable to experience a weapons.
Even before the USSR’s collapse in
down without adequate cooling (due to catastrophic accident. That has now haplack of power) and retain significant pened. It can happen again — so long as 1991, there were 121 accidents and “inciamounts of heat. It is also likely that they the subs exist.
dents” on board the country’s nuclear
Since 1994, Alexander Nikitin, then submarines. According to Greenpeace, at
were damaged in the explosions that sank
the Kursk. To haul the submarine to the a 44-year former submarine captain, has least 10 of the incidents involved serious
surface or otherwise remove the reactors been doing some whistle-blowing, docu­ damage to nuclear reactors. Meltdowns from its twin hulls will necessarily entail menting the Northern Fleet’s poor oper- the worst possible reactor accident huge radioactive exposure of personnel, ational and maintenance practices and occurred in 1979 and 1989. Since 1991,
The enormous difficulty is underscored warning of disaster. For this, Nikitin was under economic near-collapse, safety
98

FRONTLINE, SEPTEMBER 15. 2000

. government in the past 10 years. Laloo
Prasad is desperate to get rid of this image
and restore the people’s confidence in the
government. He has threatened to
launch an agitation against the Centre
which, according to him, is responsible
for Bihar’s backwardness. Laloo Prasad
told Frontline that the Centre’s econom­
ic policy had caused serious damage to
Bihar. “The Centre enjoys control over
the forest and mineral resources of Bihar
but refuses to extend any support for its
development. The Centre has not revised
the royalty for Bihar ever since 1966.
Had it been revised, the State would have
got Rs.4,000 crores more, which would
have helped improve its economy,” he
said.
A delegation of leaders from Bihar,
1 4 by Rabri Devi, met Prime Minister
J Behari Vajpayee on September 2 and
demanded a special aid of Rs.3,262 crores
for the State, which is ravaged by drought
and floods. According to Laloo Prasad,
Bihar, after it lost its mineral and forest
resources to the newly created Jharkhand,
is a fit case for being accorded special sta­
tus. “There will be no option left to us
other than taking to the streets if the
Centre fails to accord special status to the
State,” he said.
Laloo Prasad’s frustration in this
regard, which is shared by many people
in Bihar, is understandable. Of all the
States, Bihar has benefited the least from
developmental
activities
since
Independence. Even since the Third
Five-Year Plan, it has been getting the
lowest per capita outlay. Today it has the
dubious distinction of being the State
with the lowest per capita income. The
'isury is depleted and the State govv.jment has no substantive resources to
replenish it. It is in this context that Bihar
feels aggrieved that the Centre transfers
the State’s mineral wealth to other parts
of the country without adequate com­
pensation.
Laloo Prasad pointed out that Prime
Minister Rajiv Gandhi had announced a
Rs.5,000-crore development plan for
Bihar just before the Lok Sabha elections
of 1989. The package included an allo­
cation of Rs. 1,500 crores for the
Nabinagar Super Thermal Power Station
and Rs. 1,100 crores for a mini steel plant.
Laloo Prasad said that the State had not
received any funds for these projects and
that projects planned for Bihar had been
shifted to other States. For instance, the
project to build an integral coach factory
at Jamalpur had been shifted to a site in

Punjab. ■
50

I THE STATES

Pie in the sky
The S.S. Tinaikor Committee report exposes the truths about the
Shiv Sena-BJP government's scheme for the resettlement of
Mumbai's slum-dwellers.
PRAVEEN SWAMI

ments were ready for occupation, and
another 39,146 units were in various
stages of construction. The Committee
found that several projects had simply
been abandoned by builders. Of the
Rs.73 crores that the SPP handed over to
construction firms in the first two months
of its existence, over Rs. 50 crores is yet to
be repaid. Also, building regulations were
routinely violated. “Relaxation of guide­
lines were made,” the Tinaikar report
asserts. “Funds in excess ofthe actual need
were disbursed. Special favours to a few

A DAY before Deepavali last year, bullYAdozers knocked down Anj ana
Pandurang Nalawade’s slum home in the
upmarket Mumbai suburb of West
Andheri. The demolition was, officials
claimed, for her own good. Nalawade,
like the 700-odd families who live in the
D.N. Nagar slum, would be relocated
into spanking new one-room apart­
ments. The Shivshahi Purnasvasan
Prakalp (SPP), an ambitious slum reha­
bilitation
project
PICTURES: PRAVEEN SWAMI
launched by the Shiv
Sena-Bharatiya
Janata
Party alliance government
in December 1997, was to
have built 200,000 homes
by the end of 1999. Now
a year later, Nalwade and
her neighbours live in
makeshift shelters put
together with tarpaulin
and sack-cloth. And most
of the slum residents have
lost their means of liveli­
hood. Worst of all, the
new homes they were
promised are nowhere
near completion.
In August 2001, the
report of the S.S. Tinaikar
Committee on slum reha­
bilitation exposed the SPP
as nothing but a fraud,
designed
to
enrich
Mumbai’s powerful con­
struction lobby by rob­
bing both public assets
v|
and the urban poor. The
Committee, headed by
the
highly-regarded
bureaucrat S.S. Tinaikar,
who retired as Mumbai’s
Municipal
Commissioner a decade
ago, found that by the end Part of the D.N. Nagar slum in West Andheri, where
of March 2001, only the houses were demolished on the eve
7,461 rehabilitation tene- of last year’s Deepavali.

BB'

'

FRONTLINE, OCTOBER 12, 2001

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I

^3
The building that would house the slum’s residents, which is yet to be completed, and makeshift shelters outside it.

developers were made,” the report points
out.
The conceptual basis of the SPP was
simple. In return for building public
housing for the displaced, private developers would be allowed to undertake
commercial development on slum lands,
'here there was no land available for
.^mmercial construction, builders would
be granted an instrument called “development rights”, which would allow them
to construct an equivalent amount of
floor space elsewhere. In this case with
Shiv Sena chief Bal Thackeray personally committed to the project, the most
basic regulations governing slum rehabil­
itation were waived. For examnple,
Mumbai slum rehabilitation rules man­
dated that 70 per cent of a slum’s resi­
dents had to agree to a project before it
could be initiated. But the SPP was
exempted from such democratic niceties.
A new Slum Rehabilitation Authority
(SRA) was given the right to exercise all
legal powers related to land issues.
But from the outset, the Tinaikar
Committee report makes clear, the pro­
ject had all the makings of a huge scam.
For one, the bulk of the lands on which
FRONTLINE, OCTOBER 12, 2001

private builders were allowed to start projects
jects were
were public
public lands,
lands, handed
handed over
over at
at aa
pittance
pittanceof
ofbetween
between Rs.
Rs. 1,000
1,000 to
to Rs.4,000
Rs.4,000
per
persquare
squaremetre.
metre. ““The
Theprivate
privatebuilders,
builders,””
the report records on
on page 213, “picked
up premium lands of public authorities,
which had been grabbed by encroaching
slums, and got a quick clearance from
(the)
’ SRA. Clearance from the land-ownthe
ing government departments
Maharashtra Housing and Area
Development Authority (MHADA) or
the Municipal
Corporation of Greater
...
not a preconMumbai (MCGM) dition. It was to follow within 30 days of
the SRA approving the project of redevelopment. Lease or similar authority in
respect of land was not insisted (on) by
(the) SRA from the developer”. Of the
270 hectares of land covered by the SPP,
62 per cent was state-owned.

T TAVING taken control of public
11 land at rock-bottom prices - the
Tinaikar report says that prices were
charged “almost free” - developers
moved on to the next stage of the SPP
fraud. Until March 1999, SPP officials
tried to raise funds from the Housing and

Urban
Urban Development
Corporation
(HUDCO)
(HUDCO)
and
the
Housing
Development
Development Finance Corporation
(HDFC). However, both organisations
flatly refused to lend money to private
developers for slum rehabilitation pro­
jects. In the case of HUDCO, after
appraising 16 projects that were submitted, it refused to go through any more.
Without passing any judgment on the
financial credibility of the projects it had
assessed, HUDCO suggested that they be
passed on to the Investment and Credit
Rating Agency (ICRA). The SPP board
agreed. But then, suddenly it changed its
mind and allowed the SPP Managing
Director to choose any credit rating
organisation he wished.
At this time, Maharashtra’s new
Housing Secretary, Govind Swaroop,
had taken charge as Managing Director
of the SPP. Instead of ICRA, he appointed two obscure New Delhi-based organisations as appraisers. Within two
months, 51 projects were approved, and
Rs.73 crores released to 30 projects,, controlled by just 11 builders. The Tinaikar
Committee found that the appraisers’
reports were not subject to scrutiny by the

51

i

- ’ ;4W? 7'i J

I

4 z-''.

Anjana Nalawade with her destroyed masala-grinding unit, and (right) with her family outside her hut. Most of the residents
have lost their means of livelihood.

SPP, and rules obliging builders to contribute start-up funds were waived. The
Finance Secretary and SPP Director R.B.
Buddhiraja mounted a stoic rear-guard
action to block these flagrant violations,
but to little avail. Owing to such
unplanned disbursal of money, a cashstarved SPP began to default on payments
to contractors and incur penalties. Of the
Rs.408 crores that the MHADA and the
Maharashtra Metropolitan Region
Development Authority had given to the
State government to be invested as share
capital in the SPP, Rs. 105 crores had
already been committed when the
Democratic Front government took
power in October 1999 and stopped further spending.
Who were the beneficiaries of
Swaroop’s conduct? Consider the case of
Akruti Nirman, a construction company
which the Tinaikar report describes as
“the worst of all the cases this Committee
has observed”. Akruti’s owners, Vimal
Shah and Hemant Shah, were both offi­
cially associated with the setting up of the
SPP. Despite the objections that the SPP
52

General
General Manager
Manager inin charge
charge of
of Finance
Finance
raised
raised that
thatvery
verylarge
largeloans
loans to
todevelopers
developers
were
were risky,
risky, Swaroop
Swaroop made
made over
overaa Rs.30Rs.30crore
crore first
first instalment
instalment to
toAkruti
Akruti Nirman,
Nirman,
claiming
claiming to
to have
have the
the support
support of
of then
then
Chief
ChiefMinister
MinisterNarayan
Narayan Rane.
Rane. Similarly,
Similarly,
another
another construction
construction company,
company, S.D.
Corporation, was
was granted
granted over
over Rs. 18
crores overruling earlier demands that its
project - the largest single SPP enterprise
- be audited by 1CRA. Thus, three of the
30 builders who received loans, alone
accounted for
tor over 66 per
pc. cent of the total
L..T disbursed.
funds
1. While Akruti and S.D.
Corporation paid up, others did not.
Builder Kiran Hemani, for example, has
so far returned just Rs.2 crores out of
Rs.
Rs.13
13crores
croresdue.
due.
Since the SPP did not provide either
for a deadline for the completion of the
buildings or for any penalties, construeconstruc­
tion was delayed. With real estate prices
at low levels in Mumbai, developers have
an obvious interest in delaying construetion, so that they can sell the commercial
portion of projects at a higher price. “The
fate of buildings under construction,

many ofwhich have been left abandoned
or are showing very little progress,” the
report notes, “is at the mercy of developers.” More important, slum residents who
are the intended beneficiaries of rehabilitation
itation projects,
projects, have
have no rights over r'
tenements they have been allott
Although government organisations like
the MHADA and the MCGM had been
ordered to lease lands to private developers, in fact they did not do so. As a result,
the Tinaikar report says, “occupantshave
no
no title
title or
or rights
rights of
ofany
any type
typein
in respect
re;
of
property on
on which
which they
they are
are settled or
property
which they claim to have purchased.”

VV'THAT is most appalling about the
W SPP story is that the project had no
real chance of working in the first place.
As the Tinaikar report notes on page 236,
“it is well established, after 10 years’ expe­
rience, that utilising the agency of private
property developers for construction of
formal houses for slum dwellers in
replacement of hutments has failed mis­
erably.” “The size ofproblem,” the report
continues, “is of a magnitude with referFRONTLINE, OCTOBER 12, 2001

ence to which the achievement over the
last ten years of the slum rehabilitation
scheme is so minuscule; the gains derived
by some developers by grabbing premi­
um plots of public authorities for a song,
so high; and excessively liberal develop­
ment control rules to ‘facilitate’ the devel­
opers to make unlimited profit at the cost
of integrated development of (this) metro
city so brazen; that the continuation of
this policy... is bound to be disastrous.”
Consider the case of the D.N. Nagar
slum. In September 1999, just before the
Democratic Front government took
office, bulldozers moved in and demol­
ished at least 300 of the slum’s 905
homes. While an estimated 200 families
moved to a transit camp, the rest held out.
Their reasons were simple. “First, we were
~:''en no guarantees on when our houses
uld be complete, and what would be
done if the construction took too long,”
says car repair mechanic Dileep
Nalavade. “But more important,” he con­
tinues, “they will, at best, give us only a
one-room tenement. In the slum, I used
to run a workshop. That has been demol­
ished, but I will be given no space for busi­
ness in the building. How will I survive?”
Out of work since the company he

DY

worked for closed down five years ago,
Nalawade understands that the SPP will,
in effect, strip him of his last economic
asset.
Several others agree. Dileep’s moth­
er, Anjana Nalavade, used to earn
upwards of Rs. 100 a day from her spice
and dal grinding machines, run from the
space outside her slum hut. “The build­
ing they are constructing,” she says, “is
like a chawl (worker tenement). The cor­
ridor is very narrow, and there is no space
to do any work there. How will I make a
living?”
Others are resisting the project on
even more practical grounds. Sunita
More has lived in the D.N. Nagar slum
for over 15 years. Although her family has
a welter of legal documents testifying to
their residence, the SPP authorities claim
she is not entitled to a new home. “What
proof do they want,” she asks, “aren’t my
two children proof of how long I have
lived here?” she asks. Hard hit by unem­
ployment, some slum residents say they
just cannot afford the Rs.40,000 they will
have to pay for the new one-room flats,
whenever they are complete.
But holding out is proving tougher
than most people thought. Electricity

I

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connections have been cut off, and efforts
by residents to “rent” lines from neigh­
bouring shops and homes have been
blocked by authorities. Anjana Nalawade
lost her grinding machines when bull­
dozers, backed by policemen, moved in
for the second time before Deepavali.
Residents of the ten homes demolished
have moved court, but feel that this is an
expensive option. “My sons have to go at
least twice a week,” says Nalavade, “what
with the lawyer’s fees and so on, we’ve
spent thousands so far.” Although some
slum residents have made several rounds
of top politicians’ homes, including the
home of Deputy Chief Minister Chhagan
Bhujbal, others have stayed out of polit­
ical activity, fearing reprisals from the
police and builders. Sooner or later, most
people will accept the patently bad deal
that the SPP has to offer. The Tinaikar
report’s findings should have encouraged
the Democratic Front government to ini­
tiate action and put an end to people’s
suffering. Unfortunately, the State
Cabinet has showed a strange reluctance
to discuss, let alone act, on the report.
Whoever might be in office, it seems,
Mumbai’s poor will continue to pay for
its rich to get even richer. ■

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53

I FOOD SECURITY

Hunger and democracy
The political economy of food in Adivasi societies of the Koraput-Bolangir-Kalahandi region of Orissa.
ARCHANA PRASAD

indigenous varieties ofrice, has been busi­
ly engaged in the promotion of soyabean
as a crop with major potential for rise in
A STARK image, reflecting little glory
productivity. These changes have been
-Zion Indian democracy, was that of
prompted by the sharp rise in the price of
Orissa Chief Minister Navin Patnaik
soyabean in the world market. Facts such
asserting that the tribal people of the State
as these bear out Utsa Patnaik’s thesis that
were dying not because of starvation, but
liberalisation will lead to a shift to com­
because of their ignorant and backward
mercial crops and therefore a contraction
habit of eating poisonous mango kernels;
of the area under subsistence and food
that it was not the lack of food, but igno­
crops.
rance that was killing them. This attitude
These phenomena are not mereh
of Patnaik and his ministerial colleagues
result of the liberalisation process, but
brings into sharp focus the callousness of f I ^HE spectre of starvation in western also an impact of the Green Revolution
the rulers. But they have been unable to
1 Orissa has its roots in the rising on Adivasi areas. Because these areas pro­
shift public attention away from the inequalities within the agrarian regime. vided cheap land and labour, the shift to
grossly flawed food policies, whose worst Fundamental changes have plagued
th<ie cash crops also implied that big farmers
1
o
effects are now being
1
felt in Orissa. The Kalahandi-Bolangir-Koraput (KBK) belt came from outside, bought tribal land
media gave voice to tthis by advertising since the late colonial and early post-colo- and made the Adivasis work: on their
the fact that 40,000 tonnes of paddy was nial period. The first scarcity conditions farms as cheap labour. For instance, there
rotting in the godowns of the Food were seen as early as 1954-55 and there- was an influx of Punjabi landholders into
Corporation of India (FCI) while poor after there was hardly any decade with- the heavily forested area of Shivpuri in
farmers and Adivasis in western Orissa out a scarcity, the worst one being in western Madhya Pradesh. Some of these
were starving.
1965-66. But despite these conditions a farms (owned by prominent bureaucrats
While growing public outrage may report on paddy production in Orissa and freedom fighters) were built on land
compel the government to introduce recorded that Kalahandi had 118,731 bought from the Adivasis at throwaway
some short-term relief measures for the tonnes and Bolangir 66,036 tonnes of prices in the late 1960s, which then put
Adivasis, the problem of a dysfunctional surplus paddy. Between this period and the‘ same Adivasis to work as landless
food distribution system is only the tip of the 1990s, rice production in the KBK
labourers. Such a differentiation is also
the iceberg. It does not touch the core of area suffered while the production of evident in the KBK area where there was
the problem that lies in the structural oilseeds, along with pulses, reached a new
a sharp increase in the number of land­
changes in Adivasi society and economy high. These are points made in Bob
less labourers and small and marginal
in the last 50 years that have destroyed Currie’s The Politics ofHunger in India,
farmers. Between 1971 and 1991 tf
the food and livelihood security of these which also shows that paddy may have
number of marginal farmers with lair
regions. More recently, the crisis of been replaced by ragi, a subsistence crop
holdings of less thani one acre increased
Adivasi survival has been further deep- of Adivasis and other small farmers.
from approximately 17 per cent to 39 per
ened by the policies of structural adjust­
Changes in the cropping pattern cent of the total agricultural workforce,
ment adopted by the Union government within Adivasi areas are evident in whereas the number of large farmers
with the endorsement and support of a Chattisgarh also. In the post-1991 peri- (owning above 10 acres, or four hectares)
large part of the political and business od, an area, which has over 10,000 declined in the same period from 4.7 per
elite. Perhaps, that is why the media do
cent to 0.9 per cent. However, the most
Sundargarh “Jharkhand^-.
ynot seek the answer for inconvenient
stark trend was the decrease in the
questions. For instance, why does a rice
importance of the middle peasant (four
Mayurbhanj
surplus district like Kalahandi have
to 10 acres of land) from 30.4 per cent
Keonjhar Ba|a^fe~
<
Sambalpur
one of the highest mortality rates (140
to 9.9 per cent during the period. Since
Orissa Brahamani
per thousand) in the country and the
the number of small peasants (owning
iL,
.
Dhenkanal,
Bolangir
8
MahanadiR. •Cuttack^
most frequent instances of starvation?
one to four acres of land) did not
CD
Phulbani
52
Or why are predominantly tribal dis­
Bhubaneshwar
increase in the same proportion as the
— VPu’U
tricts, such as Sarguja in Chattisgarh or 5
Kalahandi
decline of the large and middle peas­
Ganjam
Mandla in Madhya Pradesh, vulnera­
antry, it can safely be assumed that
ble to chronic disease and malnutrition
Koraput
'
many of the medium farmers may have
despite their rich forest, mineral and
been reduced to landless peasants or
Bay of Bengal
Andhra
agricultural resources? The answers to
marginal farmers. In this context, the
Pradesh7
E3 The affected belt
these questions are disturbing for the
work of Currie as well as the fieldwork
sections that dominate Indian democrademocra­
cy. This is because any long-term reme­
dy for the situation would require the
reversal of the policies impacting on nat­
ural resource management and agricul­
ture, particularly the policies initiated
since the liberalisation process. In this
sense, the hunger of the Adivasi areas is a
phenomenon that has5 a systemic link
with the suicides of small farmers in
Maharashtra, Andhra Pradesh and
recently Karnataka.

f

54

FRONTLINE, OCTOBER 12, 2001

First National Confsrenco of Health Officers
of Municipal Corporations

And

Major Municipalities

o

A?

I

1937

2

A ; ■

LiSl/oJ

\ui\

/-/

\v*-\

.<2

a

'Ft

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^<2^-1 Mv
~

? kt y?

20th February 1987

Key note address by :
DR. V. RAMAKRISHNA,
REGIONAL DIRECTOR SOUTH EAST ASIA
REGIONAL BUREAU OF
INTERNATIONAL UNION FOR HEALTH EDUCATION

THEME

ROLE OF URBAN HEALTH ORGANISATION
IN
ACHIEVING HEALTH FOR ALL

i

I

1£

• <'
ROLE^OF URBAN HEALTH J?R GAN ISATlrNS

IN

ACHIEVING HEALTH_F£R_ALL
jDRr V ♦ Jl^AAKR ISHNA
I.

MRODUCT Wt

PEACE ANL PROSPERIT Y£

1B

In the ancient past, India at its zenith of civilization had
®an^ cities and town inhabited by most people in the Country.

They were

rekriowned world over as centres of excellencre in Art, Science, Philosophy,

culture and education.

These cities provided latest <ivic ameneties,

healthy places for work and recreation and an eir^iroi innt of peace and
harmony condusive for enjoying health, high quality of life and longivity.
thoir houses and neighbourhoods were models of beauty, cleanliness and
The way of life they load reflected high standard of

orderliness^

physical, mental, social and spiritual health resulting from tRo practice*

of principles and regimans prescribed by the science of longivity and

holistic health.

2. citxss nr declinei
Even in the recent past, before the onslaught invaders,
India, had many rich and prosperous cities and towns*
5 •

•’6th century A.*D*, a quarter of the population of the Country lived in

But, thoir very affluence, .exquisite merchandise and trust­

urban areas

■

As early as the

worthiness attracted waves of invading barbarian hordes to plunder, defile

and destroy cities and towns*

Those who came to trade not only stayed to

conquer, subjugate and govern, but also to impose their culture, values,

values, language and system of medicine*

Cities and town became centres

pf exploitation, channerls for exporting welath and raw materials and for
supplying manpower to serve of masters* < People,.-moved-away from cities
and town to places of safety and peace*
J '• I;';

3. umgRrrs pccr health »
In -|901, the Urban Population sank to. -|0.d/o of the total
population and did not rise till the dawn of independence*

Similarly,

status of health, quality of life and productivity of people reached
■one lowest levels*

The expectation of life at birth was as low as 22*6

years for male and 23*3* years for female during 190-f —1911 an! tho
birth and death rates were as high as 49*2 and 42*6 por jOOO population

f

respectively*
1

The infant mortality rate was more than 220 per i000
:»

live births*

...<2
:i-

fi..,.

-i .? *II. EJffLCSTVE URBAN POPULATION i

l)-

Independence ushered in rapid changes, many favourable and some

unfavourable.

Urban population gradually increased, but in the recent

years, migration tn cities and town became explosive 159 millions people
(23.3%) lived in urban areas in 1981 and
of them wore in 2l8cities
with a population of .more than a lakh.

- • n •.■

c;. Air

Twelve cities with a population

o.f more than ten lakhs contributed 26.^ of the Urban Population.
^^^®llZcrc0nt3S0. cf tha ur^n population lived in slums-about
in Bangalore, 38fo in Calcutta and 4^ in Bombay.

By 2OOO A.D., the

(

population is likely to be. Sjo million and slum dwellers in major cities
. will constitute $0^ or more of their population.

This forecasters

serious health hazards that will havG to be faced by Municipal/Corporation health administrations.

■

f
■J'

The Civic Bodies will be required not

■ only to provide basic facilities like safe water supply, drainage,

sanitation, shelter and other serves of primary health care, but also i

solve emerging health problems of urbanisation, industrialisation and
mcdernisa'tipnt

2)

In l97l itself Karnataka State had 24*31% Urban Population who

.when India had only i9.».

There were H cities and town having more
I

than One lakh population in 1981 and Bangalore City Urban Agglemaration
alone had s9 lakhs.

During the past few years, Bangalore City became the

fastest growing city in India.
,35 lakhs with 64 siubs.

At present, it has a population of about

This explosive growth of population has created

I;' L

serious shortage of essential civic services, pollution of air, water

and soil and demoralization of civic services*

■

-J

III.

NAT ICNAL J-IE/1LTH_WfirVES t

■ ■ ■

-j) During the past four d.ocaiesa

since independence, India has maid
• -tremendoug progreas in agriculture,, health , since and technology and in
many other fields.

The expectation of life at birth has

increased

from 3 2 years in 1951 to 55 yOars in 1982.

The birth, and death rates
have come down from 39»9 and 27"4 per i000 pBulaticn in 195! to 32 and
11.8 in 1982 to 115 in the same period- The scourge of Small po.nx is

*

no more.

Incidence of many communicable diseases has come down.
All
indicies of present health status .are more favourable in Urban areas

■I J

than in rural and urban slums.
' J

....3

-I 3 *~
£•

rme

The baby born in Urban Karnataka during ^98-f*-65 could expect

to live for 6-|»4 years i.e*, ^4 years more than an average Indian baby.
■>

• i-( ■

t

Those born in urban slums and rural Karnataka live fr>r shorter periods.

pie

Birth and Death rates were 24*0 (27*2 rural) and 7*8 (l2*5 rural) per

1000 population and infant mortality rate

s

•[J-

Lrif

live births in 1977*

j (,9l«1 rural) per -|000

Rates for urban slums will not be much different

from those of rural areas#

3-

By the end of March 1984

millions births aax had been

averted and total marital fertility rate had declined*

ios

India expects

' to have about 950 million people by. the 'year 2000 A*D., and is confident

. of aebdeving the goal of ’’HEALTH FOR. ALL. H” through effective implemen-

taticn of the National Health Policy as an integral Part of the total
development'plans ensuring ’’equality, social justice, solfreliance,

■ improved efficiency and producitivity”.

1

■■

J

IV. NATIPNAL HEALTH PCLlCYt
•• " f. • Equality, free don, justice and the dignity of the individual are
the foundations of Indian Constitution.

rhB

IA .directs the state to regard

the raising of the level of nutirition and standard of living of its

.rn

. people and the improvement of public health as among its primary duties

•u

th©
;rut

But, till 1982, India had no integrated, comprehensive and acceptable

National Health Policy (NHP).

• .

Such.a policy document discussed and

approved -by ths Parliament.,, jxcaK is now under implementation at various

ted

levels of National, State and local administrations*
« J

2#

: ;■

:

:

r,_ :

The policy reiterates Indias commitment to attain the aimsof

^Health sfor All ” by the year 2000 A*D* (HFA) through prevision of
universal comprehensive primary health care services.

It will cover

laid

the entire population either urban or rural and emphasise on all

in

aspects of total health care viz*,' promotion of health, prevention

In order to achieve

and treatment rf diseases’and rehabilitation.
"

■

.

■.

1 >?3

•

a)

3

.1

....

t

■

. ■

this goal it proposes to3

3

id

..

;j

n

:■ oi;

•

,

'■ •

meet the actual health needs and^priorities of the
community at a cost which the people can affordi

t) . involve community and voluntary organizations in a
fully integrated planning frame work!

• .. , i .

0)

integrate all plans for health, human development and
socio-economic development with stre s on co-ordination
and collaboration of all health related sectors *

d)

re-organise health services infrastructure> and

“ J

'

a

overhaul education and training of medical, health and
allied personnel*

v

4

4 i1

THg Natirnal Health Policy alar lays dr^n twelve guidelines rr

3*

bread approaches tc be followed ^te put ah end'to the existing alrrund
unsatisfactory situation by restructuring ourhent health Services
It.wants priority attention for oi^ht problems *- Nutirition

urgently11.

•

Prevention of ford adultfation and maintenance of the quality.of drugs,
• l' 'water supply and sanitation, environmental protection, immunization,
MCH sercices, schorl health programme and occupational health services,

schorl health programme and occupational health services and has selected
sevdnteen indicators fixing targets to be achieved for the years 1985,
(dnnexuro• (I^a/b).

1990 and 29°°
entire country.

Though these are applicable for the

States like Karnataka and especially

its urban areas

should be .^bla to reuch much higher levels of performance and attainment.

It is hoped that all the cities ahd'towns in India have formulated their

strategies, with define! objectives and' targets for the. priority.,health

they? . L; r

programmes and have., set up monitoring mechanism.

3MPL£MENTAT ICN £F_NAT ICNAL HEAT.TH^PoLICY INJJHBANJHEALTHI
CITIES LEAP a

1*
...

i; .

'Health administrations of cities and towns have a ifla J or” and

. .di ifi

y

-

!: '

t•

significant -rrleJ in aocellerating the progress towards the targets set in
;• the ULtibnal Health Policy.

Cities set the space for modernisation and

., tj-jocQUpy i’a position of 'influence and change.
,/.from: cities to villages.
■
'■ r£ '

r

L

C .-•

Urban way of life is infectious.

•••'■

• •

.

•

■

J2'

Generally, innovations spread

. REVIEW., CURRENT SYSTEM*

'

.

-

• •;

. *• ■■•
‘

• r

.V'vT'.,

■

'

i

*■

■ “■

a

h-v

•

•a

The on going'health programmes need to be examined immediately

i< the light of National Health Pqlicy and the WHOpSEARO "common F^ame
Work and Format’1 suitably modified to monitor the progress of implementatir

of the HFa strategies (hnnexure II).
answered

One of the important question to bw

is reviewing and adjustment..of existing health system including

its infrastructure and programmes to reflect the essential characteristics

of primary health care.

Similarly, answowto questions about - involving

communities, intersectoral action for health development and orienting and
training health workers

in planning and carrying out the strategy will

Apart from possessing the latest knowledge and adjust­

have to be found.

ment will required a thorough understanding of the concepts, approaches

and components of primary health care in addition t'o’HFA.

Though India

signed Alma Sta Declaration a decade ago and had subsequently several
exercises on HFa/PHC resulting in the National Health Policy for the first
time in 1982) there appears tc be an urgent need for clear understanding
i

■

.'>■

w...5

j-. '•

-1 5 1-

rr -

of HFa/PHC at the operatirnal levels*and confidence in moving towards

nd

the goal.

The urban health organisations have facilities to give a lead

and demonstrate that with determination and dedicated hard work, primary

t irn

"health care could be a reality.

3. PRESENT URBAN HEALTH_ORGANIZATICNS£
Most-,:Urban Health organisations like Ban^ilcre

98,

acted

5,
? the
aas

City Corpora­

tion Still function to provide traditional services like conservancy,
Sanitation, abatement of h^isances, Regulation of dangerous and offensive

X trades, prevention.and, suppression of epidemic and dahgerous diseases,
• - preventing, the .salefof unwholesome and adultrated food and drinks, regis­
Maternity Homes, MCH clinics1 , Dispen­

nent»

tration of■ births and deaths etc.

leir

saries and healtl^contres are also run by them.

The entire structure

and personnel are geared to undertake routine regulatory activities as

Perhaps, there is ho encouragement

required by the Act and Byelaws.

and :sufficient;inventiv.es for initiating and doing creative professional

work.

The health organization may not have key components like' planning

and evaluation, epidemiology and health intelligence,' training and

• ’jfttihliing,education, school health etc.

1

it in

Even some of the' National

Health Programmes may not^ find place in the annual programme of the
Municipality/Corporation.
'

and

>read

*

4..

bangalore c it y^health xWiNisTRATirNf

:

The Health Services in Bangalore, City Corporation area were

provided by 88 Officers and Supervisory staff besides - 834? executive

iely
ie

and ministerial staff at gn expenditure of Rs.858 lakhs (out of Rs.4{-j3
lakhs in 1984-85) i.e., about Rs. 25/“ Per capita excluding:Rs* 4t2 lakhs

.

spent on water supply.

r bw

. .

■ ,

...

-

ntat

;

,j

Licensing of traces was and is a major activity.

.

In 1984-85 as

ding

many as I842O licences were renewed and.2^96 new ones issued.

sties

samples pf food articles were analysed, 9^ fdund “adultrated,* but

ving

the court did not convict anyone in the past three years.

g and

,11

''

■

!

It is heartening to note that the

J.

•

'

1854

-

..

City with 3-5 million inhabit­

ust-

ants had in 1984-85 birth and death rates of 26,8 and 7.6 per i000 people;

es

infant mortality-rate of 36.4 per 1000 live births ,and,still’birth

ia

rate oif 26.7 per jCOO 'bir-ths.. Forty percent of the total births 74924
(1984-85) occur'ed in
Corporation Maternity .Hospitals. Nearly half

first

of the total deaths '^1334 (l984“85) were caused by respiratory diseases

ing

including tuberculosis, 'fevers, dysentry and diarrhoea,and accidents
in that order. ■■

< t

-

io

u -

....f

-3 6 a-.

5»; Task: FORCE FOR REVIEW I
•**

••

—*

<«*

«»*

Ban-alrre City Ccrpcia’ticn seem tn hav0 -already, achieved many

r

.

“

of the targets fixed in the National Health Policy statement for the
years 1990 and £000
satisfaction,

A.D.

while this should he a matier _,for ' great

'

it is necessary to review the progress critically with

a view to attain higher levels of health'dn-i' quality of life with
greater speed.

The best

w^y to initiate the review process is to'find

answers to fc.the questions posed in the WHO » a common frame work and
format" (hnnexurq Uli) and to examine current achievements in the light

of the global and national indicators proposed for mrnlti'ring the
implementation, of HFd strategios ( Annexuro la ahd I). Atel'ti'disci--

plinary task force of the health and development departments''of the

Corporation could undertake this critical examination in the first
instance.

The out cone of the review and recommendations thereon should

be considered by the St..nd,ing. Committee (Public Health) and the Corpo-

.ration Ccuncil for decisions and implementation.
•

?

6.
i I

‘

;

’

'■

•

t''-«
.

•

EXPEM^CCrmTTEB J?CRJIFA_STRATE-GYl ’

City Corporation and the State CovernmeriV'&h^Ul-^set up
an intersectoral multidisciplinary Expert' Committee to formulate urban

health strategy and the plan of action for "Healtli f6r‘ JJ!" in the light

of the findings of .the review by the task force..

The strategy will

involve development; of an urban health system'model for the primary
health.care approrpiate to different sections of the populations and
‘■‘'h • their,
onvironemnts.
their environemnts.

The. Expert Committee may‘alSn recrmmbnd additional

atid-higher targets- not only fc>r. physical health,-but also for human
dcvolcpmontsj quality rf life

7tu ,

prreluctivity.

'

CONTOTI INCJS-DUCAl Ir}j g

Recent-studies have clearly indicated the urgent need for

re-orlanthtion, -training and contuing education for the eniire health,
development .;nd Allied personnel in city and town Municipal

r

sations.

Major city

Organi­

Corporations like Bangalore should hav0 its own.

human resources development and involvement set up or centre which

continuously prepares all categories of personnel and cemmu,nity

'

••

•tJ. • ■

leaders to understand power ccncep-Ps, acquire .newer skills ^1 imbibe

desirable attitudes.

The existing training1 institutions and centres

in the States may not be able to take up this heavy training and
3u\'l

education load.

In order to practice "learning by doing" there should

be three filed practice, study-and demonstration areas of high, middle
I • ‘ •

-..7

••..4

-I

7

»-

a”*i Ifw srcio-oconomic sections of the City. Those areas' should serve
as dj^M'laboratory for applying and testing the principles of primary

nany

health oaTu like community involvement, intersectoral co—ordinati^n<
appropriate health technology, self-reliance, use of local cultural
and traditional resources etc.

;h

8.

CCMPREHENSWE SCHrCL_HEALTH PROfflJMMEl

’ind

The National Health Policy emphasises that School HealthProgramme should receive urgent priority attention. Unfortunatclyj

id

♦

there is no organised comprehensive school health programme ‘in the
C ity Corporation of Bangalore.

One third of the’ prpul'ition’belong

to the important school ags group and they io not get luo care.

Even

■•i

the 22329 students and their 751 teachers of the 8?

Corporation

Schools do not have primary health care. These students belong to the
low socio economic ^dctionS of the population which arc prone to many
health problems.
■
■ ■. ; ;
■*
lM ■

rul
ir—

■.. ^{•<v ‘

Municipal
up

Students. c.f primary schools (i),4>000) rtta’ by the Delhi
Corporatibri rhdeived schrol health services*

It-’r'^ig found

(1985) that as

g's 3V0 ‘And. 3$ Of the children had -dental and eye
defects resjiectWeiy. Suffering firm hutiri.tirn problems’like anaemia,

•an
ight

and avitaminosis was found in.20% of the children while 1(^> had intes­

tinal worm'"infe?tatime and another iC%;,ENT diseases. ' Early detection
and treatment./f* proper growth ani development ^of our future citizens,

this is an iAportant and legitimate responsibility of all 'urban organi­
rnal

sations.

■j

-

Tfaa/Renuka^Rgy... Committee on Schorl Health, Government of Iniia,

made V'Auhble.recrmmonlatirna in the "sixties to initiate realistic;
xteaoher central comprehensive school'health pro!^tomQ with minimum
additional cost. ;'.-It is high time that B,.ng;-ilrro City
h.

Corporatirn„and

other urban health .organisations initiate appropriate schrrl.-haalth

programme as,a Part of primary health care.
n

9.

KEABTH_EDUCATIO^_JS HlVrLVMENT OFJPEOPLEi
.£ J : ; \ v ••

•f

Tr?ditien^lly, Crrprr^ti^n health, services function 2s
e

Ji

prrviders rf s.?nit^tirn, medicrl Caro frr ccmmunic^blo'1 Uso^sos etc*,

<1X11 passive recipients of the services.

It is similar to d-ctor-patient

relationship in the bionnedioal model rf allopathy.

The tri .1 of

Id

primary health oaro is community involvement, in ter sector 71’T^r di­

lo

nation and appropriate health technelrgy#

Community involvement/

participation is the basis for the entire planning process of primary
j:
-.:'O -X' ,■

,

H.

.

'

-.to
“

1

1

' 1 :

■

■

.

. /

?

•

.

.
•

•

•

?<

—l
'!

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■

J?.'
•

■(

■

-

-

1

‘

■_

■

'i

’■.unlth ^aru .wherein, tho^ providers and people are equal partners.
Iraciticing equal Partnership calls for a radical change in the values

and attitudes of doctors> nurses and other health care providers.

This

.■ b the most difficult part of the re-orientation programme which requir

OS

unlearning of the previous concepts andfeelings before developing now
behaviciu
'
" '
’o

Research has shewn that invrlvement/participation of people is the

effeotive method of adult education.

Therefore, health eduoatirn is

equated with community invrlvOment/participatirn for hotter health?
.Planning, implementation and evaluation of health eiuba'tion reqqires

...knowledge, experience and skills of behavioural sciences, health sciences,
communication and media.

The City

Corporation of Bangalore and most

Urban health organisaticns have no sot-up to undertake this important
and complex sercices scientifically.

The National Health Policy stat’es"

. , "the recommended efforts on various fronts, would bear only marginal
...results, unless nation wide health education programmes, backed by appro­

priate, communication strategies are launched to provide

health 1 informa- ’

-....rtion in,?,asialy understandable form, to. motivate the development-’of

./J attitude fbr healthy

living".

Thu Corporation should establish an

appropriate soiontific
ic and technical organisation to provide leadership
in . informu tif^n,
Ji^uoatipn aspects of health, familywelfare and allied programmes. ■

1°.

OI^LCCALJlgSCURCESl

•■■CJ . J- (

cmmUnity involvement is the first step of mobilisation of local

: community resources.

The success of primary health care in urban.areas

largely depends in identifying available human resources, materials,
money, culture, experiences.,, talent etc.', and channel them for the benefit

of realising its objectives.

The local resources will include not only

what people have and could give, but also those of the Governmental and

non-Governmental Agencies functioning in the community.
.only way that Health for

This is the

All could be achieved by all through the

•..■ development of-health technoligies which could' prove effective in the
local cnvixonnioML. j i

.

,

■ ;:y.

J •

;

.

I-

....9

,

-

»•

-i 9 i-

The Municipal Ccrpora.tlcn rf Bjn:_lrre is fortunate tr. have an

lues

array rf Various local rosrurce^ of experts and leaders of Government and

This

and of non-Governmental Organisations.

squires

It has National Institutions like,

National Institute of Mental Health and Neuro Sct&ir&es*^ National Tuberculo—

icw

- sis Institute, --Kidwai Metivor-ial Institute of Oncology,five Medical Colleges

and rather professional institutions like, College of Nursings College of

• tha

Home Science and College of

.a

.planning, implementation and evaluation of urban primary health .care*

Social Work, which should fie involved in

Similar institutions may be functioning in major city Mun*

pal Corpo­

s

rations in the country and they should be mobilised fox’ providing Health

ienoes$

for All-

st

Primary Health Care in an area of about one Kilometre radius from the

nt

Todaiion of the institute.

tain-”

provide the services, which will also include the specialised services

1

of the institute concerned.

ppro-

reasearoh resource material utilising the problems, needs and resources

•'rma-

of‘the people

These instituions should be made responsible for the Urban
The C rporation and’the Institutes jointly
The area will also serve as teaching and

living in the area-

Similarly, the non-Governmental

Organisations functioning in the Corporation should also be involved along
with the pi*.cfGssicnal institutions. A seminar or a workshop may’bo hold

ship

involving all these agencies functioning in the Corporation area to orient

-y-

them solves with the basic of National Health Policy and to,,formulate an
action strategy for working together to realise HEA 2^00.

ENVIRCMENTAL HEALTH I
Sanitation is a way of life.

It has to groW from within the indivion
duals, as a part of the educational process going in the families, schools,

.1
938

work places and municipal facilities.
sanitary facilities

•onef it

Provision and maintenance of

and clean environment both physical and biological

requires' expertise in Public. Heal th and Environmental engineering.

nly

Doctors and Nurses are ill equipped to shoulder these responsiblities

and

and provide technical guidance and directions.

It is a pity that

Municipal Cor.ppra tions like Bangalore have no Public Health a nd* Environmental-Engineering Organi_sati on_to plan, provide and maintain Urban

e

Sanitary facilities and clean.environment for the citizens. ,A separate

Department with all the required'expertise should bo established and

all the Health Department to devote its full time for the taks related
• to x seven important components of primary health Care.

SAARC Conference paid high tributes

Dignatrrios of

to the cleanliness,’beauty and

serenity of Bangalore - this should apply to all areas and all people
of Bangalore and then only Corporation could achieve HtpA.

.Sjsn

I8^«b: "<-

• •*•-

,

J,

-* 10 l~

REFERENCES

1-

... .■*■ ■

■

’

■

'^4

•'

■

■

■

J • '■ C

■ I

3.'
,

•

•

/-

I*

1•

‘ .1
• >

a

'

’

■

1

■

‘

•

1 ■ .

■'

’health for All11 an Alternative Strategy” - Report of a .study group
set up Jc^intly by the Indian Council of. So di al Science Research and
the Indian' Council 8f Medical Research, New Delhi - 1980.

eI

C'

'■

’

■

.

■''.■ ■■ ■•-no.

rd

•’

Sl-Nc

.

"Annual Hep or t ■I984-85" , Ministry .of Health & Family Welfare,
Government of India, Ndw Delhi*
' ?
. ■
,

2*

In

. •>

,

•

"Natirnal Health Policy”, Ministry of Health & Family Welfare,
Government of Iniia., New Delhi - 1983*
■ .'■^4/‘ - v.
••

J

■

'

'f-

’"I

T-

’

4* . 'Unnua.l Report 1984-85'! f Health & Family Welfare Department,
Gcvorrime'nt of
cf Karnataka,
Karnatak
OovorrimGnt
Bangalore. .
>;■ v. •
.1•
■' (d

. 1 ; V.:

56.

i

2-

•’

"Administration Report -1984-85” - Cr'rpcrqtlr'n rf the City cf
Bangalore, B’loro.

J’

4-

"Hand Bock” of the Mysore State Department of Health by Dr.J.V.Karvo,
Director of Health, Government Press, Bangalore, 1933»

7.

"Year Book 498O-8-| ” - Health and Family. Welfare Services,, Karnataka,
Karnataka,
Offset Press, Directorate of Health & Family Welfare • Services,
Bangalore-j
982'' * '
Bangalcre-1982-

8.

’Monthly Bullatin of Health”, Vol,17, No.ji, Novemher 1985 -

5’

6*
7-

Bureau of Health Ihtellig nee, Municipal Corporation of Delhi,
Tcwn Hall? Delhi.

8.

9.

"Health for 1111" Series Nos. 1 to 8 - World Health frganisation,
Genova 19 78 - 198 2.

9.

19.

n Strategies for Health for All by the Year 2008” - Regional and
National Strategies, SHO, South East Asia Regional Office, New Delhi
1980.

10.

"Monitoring Progress in implementing Strategies for Health for 4L1 hj
the year gOOO" - W.H.0. South East Asia .Regional' Office, New elhi,

12*

1 1.

1983.
i.

•

• l-1F2.

11«

13.

’
U- . ;
.
4? '
Wintersectoral linkages and Health Development” Case Studies in
3ntia , Jamaica, Norway, Srilanka & Thailand - V/.H.O., Geneva 1984.

13.

’’Primary Health Care in Industrialised Na ti r nsn ’-Edited by Craig D»
Burrell and Cecil G.Sheps, the New York Academy of Sciences,
New York 1978«

14#

’’Health Sector PolicyPaper” Feb. 1980,
D-C. 20433, USA.

15-

"AlterMative Approached (to meeting basic health MeelsJ indeveloping Countries - A Joint UNICEF/wHO Study - WHO Geneva 1975-

iVorldBank, Washington,

r

■ ?
-:'1

.i.

t

:.?

■ki

"■

:>
j'.i . ; - ZJ

‘

14.

■

-

■

*

' ANNESUhE - la

■

.

.

.

p

-■

■■

-

...

.

....

national
health
— — — — —
-------- — —policy
— ------ -

4'.

Indica tors__and__Target.s_i<l k0_a£^iQ~Gi
~

SI-No.

e,

------- ---------- Indicator

y grrup
arch and

Infant mortality rate

Rural 136 ^1978)

Urban 70 <19 78,
Total 1 25 ( 1978
6-

Perinatal mortality

2000

4

5

6

12®
60
1O6

8/

Below 60
30.35

12

■|0./l

9<0

(i.976

Crude death rate

Ar cund 14

3•

Pro-schrcl child
(l-5 yrs ) mortal it y

24( 1976-7?)

20-24

15“2O

|0

Maternal mortality .
’
rate

4-5(1976)

3-4

2-3

Below 2.

Male 52.6(1976-81
Life expectancy of
hirth (yrs)
Female 51*6(1976-81

55*1
54*3

57*6
57*1

64
64

Babies with birth weight
■below 2500
age)

50

25

18

10

Around 35

31

27*0

21*0

4- - 5^

rnataka,
es,

1990

2j’

•V.Karve,

1985

3

or 2
1*

targets

Current level

6«

7*

Crude birth rate

Ihi,

8.

Effective couple
protection(percentage) 23* (»(March’82)

27.®

42.0

60.0

ion,

9-

Net Reproduction Rate
(nrr)

1.48 (1981)

1*34

1-17

1-0

and
New Delhi)

10.

Growth rate (annual)

2® 24 (l97l"8l)

1*90

1 • 66

1-20

11®

Family size

4*4 ( 1975)

3.8

’or AL1 by
w elhij

12*

Pregnant mothers receiving
ante-natal care(^)
40.5O
care(%)

13®

Deliveries hy trained
■birth attendants(%)

is in
iVa 1984*

14®

50. ^0

60-75

100

30-35

50

80

100

20

60

100

100

40

100

100

<0

100

100

immunisation status
(0 coverage)

Cra1g D®

TT (for pregnant wromn

5,

TT (for school children)
10 Years

'n,

2*3

20

2

1975-

>r

ii ’

-f

1

2 i-

2

3

4

5

6.

DPT (children belcw 3 years)

25

70

85

85

Polio (infants)

5

50

70

85

65'

' 70‘

■80

, 85

“HD(new schorl □htrahis 5*6 yeafs)

20

80

85 1

85

Typhoid (new schorl entrants 5*6 yrs)

2

70

85

85

15* Aoprrsy - per cents'g^..r.£ disease
arrested cases rut ef those ‘detected 20

40

- 60

80

Oc-r^’

•.

■

...

DC.0 (infantd'5

/'

1

16.
17.

’

60

Blindness * Incidence' of (%) ‘

1

___ ___

• : v.

•

.

7'-. *

■

Indi

Indi

TB * percentage'of diseases
' ‘
arrested cases cut of those detected 50
■

Indi

1*
4

.'i .

75

90

0.7

0.3

Indi

"i/ .

Indi
c

).

Indi
c t

f'

IHdi

"• -7

Ind.
..

0

■

o,.y

Ind.

a

Xndi'
r- ff
Indi*
Indi

•

‘o
j

•

J

/ ANKEXURE -lb/

H.F.A. STRATEGIES
A short list cf Indicators to Monitor Progress at ths
Global level (modified for Corporation/_Munioipalities)

-- --------------------------------- ---- ~

~

J ” ”

~

■

.no

'■

All has.reoeivpd.endorsement as Policy at the

Indioator 1. Health for
Ccrporation/Munioipal level.

...... r

r-..

Indicator 2. Mechanism fn involving people in the. implementation of
strategies have heoh-’formed or strengthened and are
actually functioning.
■'onc
Corporatien/41unicipality budget

.Indicator 3- Percentage of ■ the ..total
Indicator 3- ^Percentage
"'spent on health*1

■' , total health expenditure devoted to
Indicator 4« The percentage of“ the
' urban Primary Health Care.
'

. •

’ ■■•■I
-

'

<...i

•

.

‘-l

■ ■

' T

Indicator 5< Resources are equitably distributed-

■xne pv^tegy
The
Strategy for
for Health
Health for
for AH has been accompanied byexplicit'Resources’allocation and in receiving sustained
resources support from the State, Centre and other
Supporting Agencies*
J’j

Inoioator
’

Iridioator 7- Thd i>rcportirn cf the- population for whom Ur.ban Primary
+h Ho-na
liable i
1
.
?'• 1 :
'* Health
Care is aaVfl
valiablei
Indicator 8. The Nutirition status of children is adequate.
infant mortality rates for all in de nt if ia Me sub-groups.

Indicator 9*

Indicator 10* Life extfodtanoy at birth.
..

'

.

.-’j

■

•

... i:':

’

■.

-zi'T-.v:

'

■

Indicator 11. The Adult literacy rate for both men; & women.
Indicator 12» The gross national product per head.
J J r•

ri

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f-Ln: f ■
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i i

J

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•)

0

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J

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'3
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M I

'SX'/Q- - Ji

4WXURE II

S^^’SOJHiTEGlES
Mf,NM^RnjG_THE_PH'6GHES3 IMPLEMENT Al ICN
- -

QUESTIONS TO_BE ANSWERED"*
Questionf-.

~

“' "

“

--------- ----------

'

Sle^n^to8^6 ^r^ra^on>»iolPality Health policies
V Se year X?
^-Health for All

A,

11? 3J05' ^tlry^°iPallty strategy for Health for

Simulated? an

” f'r lniPlonontati^n toing

,

.,,3-

Does *he CorporationAunioipality-Heai^strategy . . )
fcrm
an integral part
Hovolopmelt^an?
1'’^ rf
’’ the G"P^f«tion/Municipality

4*

^alth sys teni'being ’reviewed and ad just!
ments made to reflect the essential characterIstibs.. of
JaseS on primary health oare, including
ne essary health programmes;,and infrast^ub^ure?

;i i
.'i

r

aP

5»

!

'

.

Has progress booh achieved!in
-i in implementing the strategy
and the’ plan of act ion?

'J

’•

’•••..•

•,

*

/..

’ J ' }•*•
’'
v

I

■

:

■

6.

Has progress boon mads 'in'
involving oemmunities in f1
planning and carrying nut', the
CcrporationAunicipal •'
Health strategy?

7.

Has progress been made in orienting and tr., iqipg. health
worker to fulfill their rcle j_n piannfng an(j- carrying
out the strategy?

rr- -. 'i •<..

•* .. ,1’I.-;.

LI ' •

8.

Have all possible material
- - - - and financial resources'teen
mobilised?
• f'•
'■...................

4

‘

9.

. .1
: W; oil rj:
Has progress been i
made in ensuring better .co-ordination
within the :hoalt|i Sector?
SQ0t?r7
.
’ •

10.

Has the inecessary,
—
intersectoral action fop health
development .been . initiated among those sectors concerned?

11-

Has progress been achieved in
* 1incorporating a health
component in the development’projects?"

12.

Has your Corporatirn/ilunicipality co-op9rat0d with other
orpora ons/iiunicipalities in connection with the
implementation of the strategy for Health for all, and/or

mX’SX;” tae“ <’ff8raa tr rth"
13.

Have you requested the VWIO to provide you with the
have you recoivod. suoh support?

VM/#

Sy

nd

a

jasa.

r

?

ANN&OJRE TO TIIE GO VERT' MISNT ORDER NO.IIFW. 80.FPE. 05
daTisojuoth march

looe"

C,

'pg\/ 4-*

.= -=,

..

No .p . 13C 29/4/ 85—RHD
z
Government of India
. Ministry of Health and Family Welfare,
Rural'Health Division, New Delhi, dts 9th/17th May 8$
t

To

Health secretaries.
of all states and Union Territories.

SUBJECT:- Family Welfare programme-setting up of Additional
Sub-Centres for the ytear 19-35-86 according to the '
norm of 1 sub-centre for 5CC0 population ( 3000 in
Tribal and hilly areas).
++++++++XXXX++++++++

I am directed to convey the sanction of the Government of
India to the establishment of 5634: additional sub-centres as per
p attern at Annexure-Ui . The sub-centres should be established
in accordance with the guidelines mentioned in Annexure-IH • a
list of equipment and furniture to be purchased out of the funds
provided
or non-recurring^at annexure IV»/ is
• • •
II. Bpfore establishing the additional sub-centres following
guidelines may please be strictly followed.

ta) Filling up the. vacant posts of a.N.Ms in sub-centres located
.
inp.H.Cs covered under Area projects, I.C.D.S Blocks, Tribal
Inp.H.Cs
H-iand hilly.areas.
:v. .7’ ’

' .7:

( b) Filling up the vacant posts of A.N.Ms in existing sub-centres
in other;areas •
<<
’
•
;(c) proportionate number of new sub-centres in p.H. Cs in areas
project, I.C.D. s Hocks, tribal and hilly areas.
(Ill)O.ne of the Female MPWs posted at pHCs is supposed to coy er .the
population equal to a sub-centres, as such this fact should be taken
into account, while indicating the number, of shbeentres functioning.
For exanple if there arc 3,CcO sub-centres and 325 PHCs, the total
number .of sub-centre^functioning would be 3325, for this purpose only
nunlber fof primary Health Cenfcresfbnctioning as on 1.4.1980 should be
taken lnto account, as pattern of new PHCs opened after 1.4.1980 do
noy.provide a post of female mpw for this purpose.

IV. In the revised pattern of inputs sanctioned for sub-cent res
(appendix II), an amount of Rs.2CC0/-per sub-centres 'per annum has
been provided for drugs. In order to eliminate the difficulties
faced, by the stat es/UTs government in t imely pro cur ement and supply
of medicines to sub-centres, it has now been d ecided that instead of
providing cash grant to the states/UTs, the Gnvernmerit of India would
supply the medicines in kind every' quart er• It is further decided
that the medicine for sub-centres to be supplied Would be-mainly
those requ ir.ed for MCH services and would be supplied to all sub­
centres ( the list of medicines is enclosed) including those to whom
1

j

'■

■

\

r j ' . •?.’

...Lt G

1' •

2

SiAA.A
p

i-.

■

centres and the funds available with the states for providing m
cipes at the rate of RS.2CCC/-. rier annum per sub-cent re op ened before 1.4.1031 should be utilised for providing these medicines to
all the sub-cent res.
V. In the revised pattern of inputs, a non-recurring assistance

:)

X
4 ru^
and wrniLure,

he£

.re_TV. The state Government may arrange to
those, or equlpmtnt, furniture-mentioned In ^ejira-IV whloh
can be pmcurred within the non-recurring assistance of RS.32CC/
I*’ am accordingly to request you to initiate necessary action
establishment of tgesta.'dittonal .stib-otri:res to be estaU
1 Ished during lOH-OS. The
fetter Un.
establlsHirent of sub-centres, sn^tlon.d vide this °>
d
p 13CK»/2/34-RHD, dated 11-h-IdBl may also .Kinaxy
x
onbeentres
this Ministry informed about the progress mad a
efore 1.4.1^35,
e = netioned during 1931-05 could not be established Dgiore i.^.x
steps may be. taken to establish them also during K

VI

'I

VII? From the year 193S-pe-, it has ^^rvis^the1^rk°of ^(si?) subFeTOl o HecAlth Assistant (L .Ih )
+■ nr prent
Therefore additional
centres instead of 4
“sanef lo«dthe
vef?6 It Is r'SesteS th’t'ti work tot the yenale Health Assist ant
f/^'v/renuired @l-6 and the Head quarter of F.H. A. may be at pHC
"ihlchUveSs 30,CCC population. ««..
.

?:g:lp‘^St^atoi^^h?s Ministry' for Sanctioning addl, ticnal Post ..'o.f Female Health-Assistants.
-..y
''VIll.' It 13, .suggested that at least 1< ^pj.^^ty1 should*be given

”lbnl ‘"f

■■ ^preconstruction1 of'

’ , 5 ch^dul^d c^ste ba sties.

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(uhplgsurc-s tg^ Jotter No. (M 12012/4/80 - -FWB,. dated 14.7.80)/*.

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•• _

J'/' . • _

. Qet-ails of‘Staff-.and :.Qth^r expenditure to - be incurred on
i 4
aT 1 -F r>
C
1 .nfr- r .Q Hnr-i
nn.
1
. c&t'^blish
’mant ^.4:
olT‘ lTv-A\-A
Urbin T?-, rv.-i ly IWulfn.rq
Centres
during'
' 1990-ei on. 1971 Census, popul.^ion. -

'»

/'*•
,/

■
■

i

' A

• ’s

• I; ^lOj OOP ‘to '/.i- populat ion) :

' ’
■

•

»

■•,

.’.Non-recurring ;
. .-■’T— ------------ --—'■—-

.

,t •

(is. 2000

1 .Equipment. and' furniture

■

Occurring:

J-|
■•.I,'.:.

/.

•

1

1. ANM
... 1
‘ 2. Family Welfare Worker ... 1

. ’

Contingencies ' .

‘
•.

■

■./

■

per States sc^le
of pay an<i allowances.

..I
. /Rs.SOQ^per, annum.

' ,

•'

■

—-:•
---------- T ,

■

/.

r ..., • \

•'/••

•

jLOOC_t o_50c000_po2U_. ^tlon),:

■

■

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i
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'•'/

• -A w

Non-recurring.;

<•’-

*»

.

'

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---------

■:

©qui.pmjjnt .^rid' furniture

-I,

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'Recurring..: ■

■' ■'

iv; L.H.V. . ’-r
■. '•v
< 2 . A.N.M. ■
3. Family Welfare ■
t
Worker (Male)' ■■

•

‘

■V,

•.

./j
-

•. ;

‘

•

•

'

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•.

- :

*.•

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-1

•

•

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i

As per Sta,t qS
scale of ‘ pay and
al^Q^ancq^,. 1 / ■
? • •

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>
' •

' V
‘

■

<-

Contingencies,;
■

Rs. 3,000

. r.

..

Rs. 1 <000 per annum-

•••
...

Rs. 3000

—”T~’---------------~

■<

'rY£ E_III^^50cOOO^nd_aboVe)_2.

• '

■

X

1.vFurniture and equipment
, 2. Surgical, equipment.
'v:.
Recurring: . .
. ■

■ 1

V '

•

■;

'

■

.

/

Rs. 3 500

•

1. Medical Officer (preferably
female)
’
1 ;
Lady Health Visitors
•*
1 ;
2
’’./.•e Midwives
2:
■ 3. Auxiliary ‘'Nu^
; 4,. ’’ Family-Welfare Worker (Male) 11
15.
V-S’vJSt’orc-rkeoper-cum-Clerk

;

>

.

'

As’ per States /
scale of pay
a-nd/ allowances •

Contingencies; ,
'. . ‘ ’
1. General contingent expenditure ‘ Rs.1OOO per annum -

:

;2\ ■Replacement of "Surgical
.
;
. instruments and appliances
...
Rs. ?Q0 per annum
3, .Rent for the. building admi, ■ ssibie if • the centre is
located, in -a rented building
RsJ30O0 per annum
rMaximum ceiling)
----

/ cop/V
■

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■
' for

\\ te
X?. JeilTH e F ‘ SAX’-,
•

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' MPP1JNDIX II

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■

X1 j

7

''

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J,, dated ' 14 ♦ 7.80)/
:(c-n91o^urQS tp.'"(Letter No. M 1201 2/4/80 r‘FWB,.
‘A/'"-

,

■■

•.

.

■

■ ■

.

\ ,, ;'-/C

•/><?.<•-b. :TYPE I

.

x ■

Jk .

. . ? •

25,000
-■ y .
(10,000 to-^/ population) :.

..;

- )v'

- .J\; ^.Non-recurring^ .

':

.

• i' ©jhipment. and’ f nraitVpc , ' _ ’

O

,r

/' •

-^tourring:

•

V1''. Cont ingundies ' .

■

\\;

.

' *

*

. /?/'’ . •/■ •
ANM ;
- • •• 1 '
J . '.
k / * ,. //
2 . . Family W elf are- Worker. ..

■

•. ■)

Rs. 2000

•

■

■

i

‘■'

’

'I

■■■■1--/ ■;

.-i:

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'

Pc-t-Vils of .staff'.3nd':ath<.r expenditure to-be incurred on
..'ust'nbl-ish'mcnt of Urbln,Family Wc-lfnrq Centres pdring'"■>1980-^31 on. 1971 Census., population.
'' '

■

■

{.

*•.......................

ife

,

■ PkS per States sc^lc
) . of p^y •.^nd ril low incus *

1

Rs. 500 ^.per, annum.

. -j

; 'r?!

' :;<•

TYP-tlll.X^B^OOO^to^SO^OOO^eopu j. ation)_:

/(

)

Non-recurring;
J 'l.Equipment. .^rid
£arhiture

•, 'U

•
■ ■-i-..

i

-sy • ■■

''

■ \ ‘ 'Recurring.: -

• ' : :

1., L.H.V.
■ 2. A.N.M. .
3. F-imlly Wulf Arc- •'
Worker (Male) '

.: ’V

>

Rs. 3,0.00

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1
.1

’■i
;

•
/

\s per States
scale of pay■and
allowancea^ 1 -<
'

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‘

■1

Rs.1,000 per -annum.

Contingencies

TYPE III (50, 000- and above) :
—

.

—

-

-

’

Non-recurring:
Rs.3000
Rs. 3 500

1•'Furniture and equipment
2. Surgical eqiiipment .

\

Recurring:
. • ■
-. )
•
• Medical Officer (preferably
■: female) • .< ■ . . _ _. . .
1j ; . ^s‘ per Stit es / z ■
i .
u
2. Lady Health Visitors
scile of pay .
2 !
3.. ZUixiliiry
/Auxiliary ‘‘Nupse
Nurse Midwives
Midwives
.^nd; allow inc u-s.
(Mile)lj
. , 4.. ’Family-W elf are Worker //'
■ ; ' \ / 5 - St'orQ-7-keepor-cum-Clerk
. ' / contingencies ; ,
M> VMB — MV

'•
•: ?r:
i-.

■ Rs'.lOOO per .annum
!• General contingent expenditure
e
. ,'2^ Replacement of. Surgical
- instruments and appliances
. . . ' Rs. ?00 per annum
3 / .Rent for the. building' admi. , • ssibie if •the centre is '•
,
located, in a rented building^
(Maximum ceiling)
---

. , ;
L

■

Rspooo-.per nnnum

; / copyV
' for D
‘

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rdTH 0. r; 3\.<’

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'X

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■ -''•s

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1

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'•-rt-

X

•■ aj
» tax'. the
bxiu '^luuvts
x’i-j xujl^ u a uh 9 . *t ho b'.iu n't "t 11 o pitj't'ta Futnl.ly VolimTuo "
After
<above ■relaxation
Surgaux qxigts’in rospect,,. of tho following catogorios of posts:,

v;

x

tA:1-:rky^qierkf. '</
z 2/, Apstt. ApQbuntant, .
’ ''''x’
ahier. - ■' ' '■•' , ’■
-. ■'
‘V.:’?7?,'4.^fU..p,Q'lQrks(st6r.e)'
‘
ClcirJ^cum-typist. . . s
. ■' '4. • '• 6./Sfc'epo-tynlst .’<■ v X• d ‘ * «
y’v;.:;

I.

.

■)

I

T.

,'7.rwitbr. x /•/':?.;X7

•

9? ;4?ti^7T9urp-phptQgraphex’f
.*’-7/9#:. Cleaner/p’oon/'Chowpkidar,

.

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-

A'? ; ’.',

P‘VN9Yvacarit: :pp'3t/:of . the .!ahovo7catogo.ry be filled, in case it is' (
/ lying .yd paint for, more than 12 /months as. onyi-saged in -pa^a! 7 of this . .
‘• Ministry’s letter No;M.120/22/8/,78 FWB dated 15-5-1980, ..
. •.

• !•

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.

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•

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■

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,

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■■■■..

■ IV.' SPATE PAMILY
BUHEAUX- . * •
x- -,•/
x7*"VX"”- - X,.
/
..
‘ 1’ •’Deputy Director’(Mass Education and Information Officer)
*>; ^^Admipistrative .Officer, • .' .
■<
*-,y ■r
! ?|,:StXre Officer.,; . ■ X;‘ ••./■,.
\ , ' /
•
; . : .4; Acqoyints Officer,.
' • . ,
■
.5>zPemparapherf. x’> -xx r
’6/.Inventigator (Statistics)•• 7,Z^ditpr/Assigtant.Editor.•
8? Statistician,
x ‘
X-.,
„
..
,.,T
1 9< Statistical Asst.t/Family Welfare Field and
' X''’ Evaluation Worker, * "
■ x
? t ’ • ;*■
/ .. *
10. Driver. ’ - x X: . ...x;’ '• / '
’•
■

■■■'.

.

■. ■

<•

..
: ,

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•

.

The relaxation of ban in respect of Posts mentioned' 'ijninst item
I 7 tO'lpVfx, Editor/Assistnnt,-Editor, Statistician, Statistical .
AQSistantXmily.'W^lfniq Field--and Evaluation worker and Drivers is
a'.'’'.-'.sublet to .the. follo^i-’g'.conditions,
'
-.’-Xx'X ' ’ ■, , x" X X'
•; ’ -. ,
•
" • • • ’ .
1) ^ditor/ABsistaht- Editor. ■
• ■
■ r
According to bhe pattern, orio post;Of Editor and pne post•of - ;
Assistant Editor.has boon, sanctioned for each state family Welfare , .
’■ Burqnu^-.Yln view of need for economy due ■ to-financial .constraints
■_ ’it 'has "be.cn ‘docidod that" tx Ma; may bo relaxed only ?n respect of
those states whei’O' both the posts arc vacant and Sta.tcv Qovornmont• '
m4y.■ ffll\?d pp . jnly onezof the 'Hto posts. On-the basis of .informatvm
.‘recoiv^d from the State Cov/rnmontp far Annual Plan 1930-61, it is'
X
.seen tha -’ both, the posts are lying vacant in Orissa and Utt xr Pradesh. .
'7- - As siichj’-'thu State Governments of Orissa and Uttar Pradosh only uro
/ permitted to'fill ^no of.thos, two posts.

'- '7. 7>

:• ; 7 - •

. 4/-

i

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■'

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'/•v

'■

■•■•A '

,r

'*?■ f;•■'

•

1 v’

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4 ■

A

•. 14-):ptAistician; ’
pittprn provide f.or,.tue posts.of St at istician at. D&E 7C0II.-in _

; ,

y.

the Statp Family Welfare* Bur.onuA td view of financial cohO^raiTltsr*
7/Ait Kak been.decided’that the Mn .may bo relaxed only.for those
.
•'.,;75t..-Tft;)s7_whbru- botft. the pp^ts are’ lying vacant so that: tnpro. may bo
atToast' one statistician available at ouch' DccE Coll.- On; ^ho-.ba^as.
l
; of'i4f^rmab.i?n hvailablo^ both th a posts are lying-vjc^nt
■•.7 .;•
• 'States of .’iTarnmu and Kashmir nd Orissa. As such Abo;, Staten ..■ ' Governments ’pf 'J&K and .Orissa ire allowed to filV.one. post;
• 7 Statistician, for the D^E-Coll,
,
-.a.
• < • u... ?•.:/'

A The' piti;ern;:pf-.'.staffx .apnr iyud f or th; D&E Cell Provide ••forgone post1■ ‘ of'Sfu^istichli'AhsistcnUhnd; posts-of Field.and 'Eya^pht ion.. Workers 1
.
oncAper twoCdis" riots; in the State. Keeping in view- the. needier ccon...my-,
it ’lias’ boon •decided''.that tliu-ban,'coy be relaxed in ■ such a • manner that
"■' . 'there’.should be'one 'statistical Assistant in each D&E Qc 11 and there
• should'be Field and •Eya-luntiori Worker -nt one for 3 Districts instead^
' ore for two districts. On the basis of the, detailed infarnntion recoi‘ ■'< vd ''from thd'States for Annual Plan 19^0-31, it -is-found that the.
■. .
ijndermentionod..additional.sf .rustical Assist^nt/Fanlly’ Planning
.
•
and Evaluation ^pricers’ ar e .•nejdpd to/bo appoiiitod on. the •basis of
.
,/
• •■••r prised, norm.. ■ 'A ?• ■ ‘ ;r '
/
*•■' •:'*
’' ■
' '
“ ' No.
li?A^w- e .
o-, of Posts
Pasts to,
to. be
bc^ fi
fillc-d^

',
."■

5 '•’• "

7-v Himachal Pradesh,

k & k-\

■.6..'

\

fl,9.samr
Haryana;-

; .7

Karnataka •
■ 7, Ma dh ya ’ P pa d 0 s h.

• V

■

'

'■• •.’ / **1 ’
.5 .
4

6
• < 14
.
5 '
1*

•••;■’-7
.?. .■• ' J?

•'
‘

‘ ■
I’

'l

c v
,, Maharashtra..
i
Orissa. '■
•
?r:'
' 5 .
' - Punjab. ’ z.
2 >
-'Rajasthani
10
<
Uttar Pradesh.
5
.
*■
.s-. •■'
•
■
West Bengal.
' .
. The State • Covernmojjtu. of the ab.'vo states may fill up the above•• v mbntloncd-past,s....
‘ ' 7. ‘'•■ '• 7'7

1 '.V

‘iVt Drivers.,
j vehicles up__________
xTp th
0 extent nodded '.to keep th? aviilabl.^aod^worthy
while-■
’
filling
up this
•vin/A/cc'f.Hficpto; to this ’of feet will, b ? piven while;' A’’
1
...»
.
•» •
n
• _ - '
-UlS* .
-v* r» /A
'
•
post that ?. vchicio _is.; ■ on tHp road. .
’■ /•; •
' • :.
.2. Tfco
Tbo relaxation '^ivon
givon/in'rospoct
iiL rospoct-•of District Fhnily<Wolfnro
Ftmily-Welfare Bureau ■
i.
_■
x
,t ’ _ _
■
-i __ j ._■»». „«4- />-P 4-H ■> an ' otlt.’S i
'■ .'••and Stdte
Family
.Welfare
Bureau .ayo ...only
in’ respect. of th a sc ^tat^s.1. • - -- - J
#3
*v4 al*
rara n
-where
/
.Where full
lull’ fledged
110a goa •Bur'inus
W j tuts tovd
u-ww boon
a.... .
uki .Pmt- •
‘ 1 stai
stafff for the-state;
the• stateua.nily
-i-> h licnblo to
Statu where selected
a.mily woix
- vr^.
ot

■ I

Fanily. Volfarc Bureaux have boon sanctlonoc.
Bureau or the Mini District
A---^Thc State Governments, of these states arc roquusteci' to exininc th?ir
. • ‘roquj.renients.-of additi rial posts nrod -d in the light, of above rolaxiti^n
*" .and wend detailed proposals to this Dcpartnunt for oxaninatier, and
‘ shnetibn.
• - . .5/-

I

;? /I

A

n

>

I

u. ’.

Y// _

in aoine ' of; the States\, tho
.
rposts mentionod above have not yet
. boon-created in. the oxist^g units.’ As such, sanctioned is also
to create the posts, , .
■ y,‘ ‘
. accorded to/the •Stptd^ Gow lamentsj concerned
r
. dtv • ■•’A ’
>.
...i li—- u*4 t i
•
■ who re vor no pessary ,• and.thon fi-11 them up.
. . ,

,
••

/
■

■

;
"In order thaVtho'persons appointed to these posts possess tho
■•’^requisite' -qualification and expedience and there,-may .ho avenues for
■•^■promotion for\ persons working at tho lower levels under Family
' 1 ■' f /
• Welfare 1 Pro graoviiie. \ Qual if ic at ions and job functions hove alruady
been laid down. It is therefore, requested that the- posts may be
J ■ s • • filled-up by duly qualified and competent persons^as per recruitment
’ . rules already laid down by the State Governments,so that they are
. able to deliver the goods and push up tho programme. The instruc'r; •• tions in pa rd 5 & 4 of this • Ministry's letter No, 14.1 2012/8/78- '
I
, .• : FO dated, 1.5th .May 1979, may also be kept in view vhilc^filling
up the. posts of/Deputy Mass Mdubation and Media .Officer at the
. n ' ; a District Family v/elfare Bureau and Deputy Director (Mass Education,
.-.artf. Infomiationj at tho State' Family i/elfaro Bureau.

5. ThS oxpondituro involved' on croation of now posts,whorovcr
nocossary and’ filling up of vacant pouts’ may bo mot from tho
' ....allocation intimated for 1980-81 vid a this'■ Ministry' s latter ;
No.H. 12015/29/80-FW datod 5-9r1980 and 'ropbrtod to thb popart-.
,'i.'
.mont through thdy quarterly report of oxpondituro undor ^ho
f
•
appropriate head. ;
...
f

.’ , 6. As the relaxation now given has beam approved after keeping in
■t - - ’ view the urgent requirements of programme and also keeping in view
. <tho need for oennopy in expenditure, it is requested that full
utilisation'of the -staff already available and additional to bo
’ appointed as_a result, off nbo^e relaxation may bo' planned and
requested* for further iu lax at ion .nay bo avoided.ns it may not
. be possible to agree for any other further relaxation during the
purrent year/
*

J

f- .

7. This sanction issues with the concurrence of Planning Commission
vide their O.M.No. HLH/3( 10)/80-Fv/ dat ed J 9-8-80 and1 Finance
Division vide their Dy,No.2641-FIN,l/80 dated 50-8-80.

I

8. ' It ,may please be ensured tha't the staff-appointed oqt of
Family Welfare Fund is utilised for the iaplomeritation of this
’'programme only, and'not diverted for some other. programme. The'
State Accountant Generals are- being informed so that when tho
■ qmounts are reimbursed this fact is kept in mind.
■r'

■

.

I

f.■f

..

•

'

—

•

.

9. » ■ The receipt of this letter may please be acknowledged and
early steps' may bo
to fill up tho vacant’post s. .

?:' •

■

Yours faithfully,
SD/(' J. §. SANDHU)
siry to tho Uovornmcnt
ctf| India.

J I ,

*
(
« ‘I ,

for DiroatWx
<j * .• *
V\Kl.

Zfloalth a F.W.Soryicos,

/

I

f

-

;

■ M.-O' ■; ■'
■■

,.z-

't W£’ d<< letter' n7 M ■ ;i 2012/1 /©O-FWBdate di

f

-■•'W Hedltii & FWCceptt. of.FW), New uein?.,.

,

,

u

,

'

Welfare Programme .n relaxation thPteof

feS '■

■

'■

■W;/

- letter' No.3-89/^2-PB

’-l am directed to"refer' t°^t^iQ.Mi"17cntioned’ahove and to. say
,
, on
the suoj^cu
«. was
(Vol?Il)': dated 26th.May, x1975,'
on
7cant
post
s
'
imposod
during
1973
was
the vacant post imposed, during 973
. that the ban on filling up of the vacant post
F
■ n^ith Visitors .
?l
ruraxe'd
in
’
roapppt
of
Auxiliary
Nura
u
.
*
5/2/74-PB,
10th May,
■ ' iSigl 4«asRduring 1974(vidQ letter
^^tpLily dated
Alfaro;/
.

■
'

" 1974)?and 3t^te:Fa®i^y/w^^ar‘',°ffiH
M <2o 15/2/74-PB, d^tod 4th Juno . k.
officer'in June, -1-974 (vide letter No. M
.fare^entros .

' -

t
• I •
t

and'nid for -oconomy, it ..had not been . .
ne'iZunit s. approved

,.... p.9sts

JJ

-n

.1979-86. tM

■

'| 1..-

' some of those posts.
In order
' Sater need; fbr person to

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-5^or
t and proper mohitonng of
sUo^of r laStion 0 f ban was

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' and’ Finanqe .Division>

'.' up'oVl;^ upderobn^ipried.categories 0 P
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itVi effect .from

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;'i•RURA1 ■ Wi,IV V^PARi.C^NTR^5 AT I,HC S: “ 1 COMPUTO, . . ,
<»» r-\ A ’

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the ec'ro/following
ban at^Rpralfamily
■■■< ■' : ./'. /'■'■?> With the .relaxation now ap?rfved rasp
categories .
•
/
3
l^vcl
now
1
exists
only
in
rv-spec
o
,' ■•; •' ■ ■ Welfare .Centres level now. .exists
m r-sp
^ , . . . .
.
j_

' pf- p 9 sit 9 p-'h
;.-4 7)? Family Alfaro.Health assistant ,/ . ;. ■
ii).- stprO-Keoper-cum-Clerk.

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popp-ldtion)

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b) Type-II Sd nt re (25.000 to
50,000 i>opul4tion.'

\

Family Welfare Worker
(male)
'

1. LHV/frxtension'Educator
2 ‘

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5. F.W* Worker (Malo)

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.
,__ _
J, at'the" Rural FW Centres in; W.5
in
Medical Officers.
, 1974)
(vide letter'No.» ,M< 12015/2/74-?B4* dated 13th May
I
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, . c) 'Type-n%.GfenkwV (.50,000, and {ibovs '
1. Medical, Officer
,
-C* :'r. •
■ .pXulat&n? '7 ,!O;:
-'-W < ^..^tension^dneator ?
F. -^'7
5 ,s Lady HoaltH .Visitor 1

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:' : ••’•of Kitonaion ^ducjitors, all the 'posts may be
.. ANMs and'the .g.nmo shQuld ^o filled up duly qualified ANMs, , ,,, ■ ..
. ,
liO’’ '.The 'details oT the staff in position.as on 5O«6-^., rocoi^d.from the^^^
■ - .' .''State .(Jovernmdrjts. along with ■'annual plan proposals^
vnniiv ''
. - that'in some of tbo States, the Auxiliary Nurse, Midwives and F^ily
' ; Welfare ■’Vorkqrs(Male)' taken together wore more than the ^^0 under
agsistance updov
< A' at.'the JJrbajpLevel, ■ 'Ps ,1
•
’ -. A
'.■■ Family. Welfare programme,- is ,admissible-as per pattern ,n V, ~ e Y
•/'■•
<' ’>. ensured- that only tho so posts vfaich are.'admissible as Per P-:
a/rainnt
('< i'/'filled up and excess personnel .available should^.either be adjup
" ■ ■
■ - Atta now .centres'to-'bo opened during' the current ypar pr^tho ^gAii
(■ ■”
on-them'be met by'the State Government from their .own. sQ^°0Alu° of
/<-■ .be'endorsing'to this letter. to State A.G's to ensure in non-blUin., *
’;Wpost. in Gov^rnmont of India/ budget.
a

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, Tbo
.^'relaxation of ban give af Urban Family Alfaro Centres-will 'also b.Hi)'
.'‘.■-'admissible for tta ^ban Centres pun' by_Loc:U ®°dl^QArt-fA A^A.-Anr:
' nisntions ppt. it may be ensured that duly qualified1 nd q .P. ■
are.appointed by them. ' ' .
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. .Ill.'-'List Family Wnlfnr.a Bureau f
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C, ’1 •’Administrative Officer
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. -j- -rM An vaAnrf o-ql
2r Deputy Mias Education -and Information Offxcor(Dist .>xtons
.• ' A:aInvestigators . • 4. FP Field and Evaluation Workers.
- \\ '

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a*.;: 5.Projectionists’

■ ' 6,.Drivers, A

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.' ,' Tta rolaxatidn of/ban given in respect of projectionist an^
OH;'■ ' A- vehicle.
subject to tho condition of .availability of road worthy mobile A .V.Unit ,>*d
In cis^ those.are not available the vacant, posts should not. b. •
.

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. fi lied ti 11, thpse be cope available/..

. :? • '* (

.

' -A ccrtificato/will h«vP-1 o bo given, by the state_Government tpub the
.;'! A>vAnit and vehicle for which ^rivers are being appointed area on the ro
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. In order that'the parsons appointed to thes.o posts possos.s the
’^requisite'qualifi cat ion and ■•exporionce and t ha ro. may . b o avenues for
^.prpmdtion. for\ persons working at, the lower lovols under Family (
j<V7elf are ‘Programme.\ -Qualif ications and Job. funptipns have already ,
/v/’■
"been J.aid down. It is :thorv Coro, requested that the> ppsts may-ho ■
filled-up by duly'qualified and- competent persons,as per rec.ruitmont'
i?ulos already laid down by the State Governments, so that they are
- able to deliver .the goods and push up the programme. The instruc-'
v ' tions in pard 3 & 4 of this Ministry’ s letter No,.M. 1 2012/8/78-'
‘ ’* > •.FtfB dated, 15th May 1979» may also be kept in view viiilo^ filling
UP the posts of Deputy Mass Fdu bat ion and Media ♦Off ice r at the
\ .y District Family v/elfare Bureau and Deputy Director (Mass Education
. ;.ahA InfcrmationJ. at. the State’ Family y/olfare Bureau. \
' •

> j«;.<,/

■'

■

3. 1 In flomo of; the Stated/, th? posts mentioned above have not yet
boon Croat oh in. the ox is
units. As such, sanctioned is also
accpi’ded to. tho State’-Gave raments concerned to create tho posts,
whorever necessaryr, and then fill them up.

•.

\

.

:

5» The expenditure involved^ on-creation of novf posts, where voir
. necessary ..and filling up of vacant posts' may bo met from tho
Jt
■ 7'<•alipcnt.ipn intimated for 1980-81'vide this Ministry’s latter .
• ' j
No.M. 12015/29/80-FW dated 5-9-.1980 and reported to thb Depart-.
.mont through the? quarterly report of expenditure under jlie
appropriate head.
■■
'
•
.

. i

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i

6. As the relaxation now given has boon approved after keeping in
view the urgent requirements of programme andalso keeping in view
the need for economy in expenditure, it is requested that full
utilisation of tho staff- already available and additional to be
■ appointed ns a result, of above relaxation nay bo planned and
’ requested*for further rJ laxat ion,-nay bo avoided.as it may not
t be possible to agree for. any other further relaxation during the
purrent year/
'•••"’
...
7. This isnnet ion issues with the concurrence of Planning Coramission
• vide their 0. M.No.fIhH/5( 1.0)/80-FU dated »19-8-80 and Finance
Division yide their Dy.No.2641-FIN. l/80 dated 30-8-80.
•

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8. It ,may please be ensured 'that the staff, appointed ;oqt of
' Family Welfare Fund is utilised-fpr the implementation of this
■,;*v ' • ".programme only and'not diverted for some otherxprogramme. The
./
V State AccQuniinnt Generals are- being informed so that?' when tho •

■ qmounts are reimbursed this fact is kept in mind
*

■

. >

■

.»

■

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'

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9. The receipt of this letter may please bo acknowledged and
Yarly stops 'may bo takpn to fill up tho vacant posts.
Yours faithfully,

sn/-

.

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Undo

/c,5z'\'•
for Diro.cto!

i'
•5A ,

'CT

0J.§. SANDHU)
‘Uihary t o t ho over nmon t
cm India.

noqlth & F. W. Soryicos.

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3. In eorno
some of; the StateSiYthp
Statesi^.thp posts mentioned above have not yet
/ boon’created in., J'the pxist^g. units
""•^J’ As such, sanctioned is also
' . accorded to.
to: the •.St
-St.ate*'Gayoi&ufents
sate4-Goyo‘Aments concerned to.
to . create the .posts, ,
• \ wherever
fill them up.
.
whorevor necessary,- and then
then'fill
,
.
.

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. In order that', tho persons appointed to thes.e posts possos-.s the
/.Cr equisite qualification and expedience and there, may .bo avenues for
(k,; ''/■■.promotion forepersons working at the lower .levels under Family
We If ar o ‘Pro gramme
.Qualifications and Job. fun pt ions hayo already .
been laid down.
It is therefore, ■ requested that the. posts may.bp
filled'up by duly qualified and competent persons,as per recruitment
rules already laid down by the State Governments,so that they are
able to deliver .the goods and push up the programme. The instruc1 tions in para 3 & 4 of this Ministry's’letter Ho..4.12012/8/78-'
FWB dated 1.5th .May 1979» may also bo kept in view vhilo5filling
.yj up the posts .of, Deputy Mass fid u bat ion and Media ,0f f ice/at the
District Family Welfare Bureau and. Deputy Director (Mass fiducation
.‘and Inf n mat ion). at. the State’Family Welfare Bureau. -

' ;

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■

5.

. ■

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Thb expenditure involved” on creation of now posts,wherever
v .J , W**WA W V

-T

.^4?^ssary. and. filling_ up of vacant _posts'mayw bo met
from thej
....

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vallpcntipn jntiiaated for 1980-81 vide this Ministry* s latter
No.M. 12015/29/80-FW dated 5-9r1980 and reported to thD Depart­
ment
mont through the'
the'quarterly
quarterly report of expenditure under ^Ko
1$
appropriate head.
' '
'
* ■ '
■6. As the relaxation now given has boon approved after keeping in
view the urgent requirements of programme rand also keeping in view
the need for economy in expenditure, it is requested that full
utilisation of. the staff already available and additional to be
appointed; as a result, of above relaxation may bo planned and
requested*’for further relaxation •nay bo avoided.ns it nay not
be., possible to agree for. any other further relaxation during the
’. current year/
• x “ '
■
a.
. ■,
:
■
a ■ ;
.. . '
7.This snnetion issues with the concurrence of Flanning Commission
Vide their 0.M.i'Jo.ilLH/3(l0)/80-Pd dated, 19-8-80 nnd; Finance
Division vide their Dy.No.2641-FIN.l/ao dated 30^8-80.
■ - ’
i
, .
It ■ may please be-ensured 'tha’t rhe staff, appointed ■ oqt of.
. Family Welfare Fund is utilised-fpr the iaplomehtation of this
• programme only and'not diverted for some othervprogramme. z The
Statq Accountant Generals are - being informed so that when the.•J amounts are-reimbursed this fact is kept in mind.

9. The receipt of this letter may please be acknowledged and
• s •• early'steps may be taken to fill‘up the vacant' post s.
' '

i

*

Undor-S^

i'

l-

Yours faithfully,
SD/CJ.g.SATOHU)
sot to the Government
dij India.
' '

. i

for Diro.ctcJ
i.

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Health & F.W.Services.

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■ After the 'above’relaxation^ .the. ban at the DisttFamily Welfare ’
bureaux
exists
in respect,,
of;1, tho
. following categories of
posts:■ O'1'
■. ■
■;
,
■
:
■
.
.

. r.j--U
Clerk,
.■< ■
*\ 2/ Asstt. Accountant. ,
Cashier.
- . v-- 3,■?
4f/U. D,01erks( Store)
>
5,. ‘L.D.Clcr.k-cuniT typist.
•
?St'epo-tyDist. a1. .. t.
1, Auditor. '
■ 3, .Arti^t^oum-photo^rAphar^
z .-'9# Cleaner/peon/Chowpkidar,

Wl.

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No‘vacant post of -the above category be filled. in case it’is1
■k 'lying vaqalnt
vaqa!nt for, more than 12 months as <envisaged in para- 7 of this
1
Ministry’s letter No.M. 120/22/8/78 F’JB dated 15-5-1980. '

'

IV. ■ 8 DITE FM4IL f r|>L'pA.RE BURWiK

, r? Deputy Director (Mass Education and Information Officer)
• 2A‘Administrative .Officer, ■ , .
St,ore Officer,. . •
■
».
• .4, Accounts Officer.,
(
"
5, ' Pemographer. k
.■ ■ < '
J.
• 6/.Inveptigntor (Statistics)
7, /Pditpr/Assistant ,Editor,
8, Statistician.
\
•’'r
9, /Statistical Asstt/Fajnily Welfare Field ipd
>'
' ■
Evaluation Worker. ,
.•
'■■
1.0, Driver,.
/ •

•

»: . ''

*

.,■■■ "The relaxation of bap in respect of Posts mentioned’ against item
i 7 to -IO Vfx, Editor/Assistant, Editor, Statistician, Statistical
Ansistant/Familv’Welfare Field-and Evaluation Worker and Drivers is

’ subject to. the. following.-conditions. \

v

1) Editor/Assistant- Editor. .
•'

;

"

'

■

. According to- ^he pattern, one post of’Editor and ohc post • of a
Assistant Editor has boon, sanctioned for each state Family Welfare
Bureaui -.-In view of need for economy due to'financial constraints
it -has been''decided that'the b\.n may bo relaxed only ?n respect of

, -r those states wheto- both the posts are’ vacant and ^Stata- Govornmont
in^y f'iil ,?d up only one7 of tho-fto posts. On -the basis of inf or mat ion
. received-from the State Governments foi* Annual Plan 1980-81> it is
V-; , seon.'thas both the'posts are lying vacant in Orissa and Uttar Pradesh.
.r;' ‘ A’s such, th<j State Governments of Orissa and Uttar Pradesh only are
. / permitted to ' Fill ^ne of.thusy two posts.
‘

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'i-i)/31atst ic.lan* ‘:-1. : t
' ... / s
■?ho pattern provide f.dr<.'two postg.,pf Statistician at D&£> Coll inthe. Stato Family Vclfarq’ Bureau. th view of financial 'khastraints,,
<.r-\it has.’ been' decided? that the
.may bo relaxed, only.for the so .
.
States/where■ both'.'.tbo post.s. are lying vacant, so that, thpro;
1 ^tlonst' one-’ statistician available at each' D&B, Colle.-. 0^
' '. of ' i4fq»r.nnti.Qn;ivailabl^ •both' tbo. posts are lyin# Vwyt

. ■States ’of'Jammu and Kashm^ox* and Orissa. As such^tho.'State
Governments-of J&K and.Orissa -are allowed to. fill/ond. post'; of•'e
. ^'Statistician* f or ’ the D&E Cell.

it

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'

. Statistical vAssistant/F.P.Field & ^valuation Work^-

•

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f fj a.. ,.

- \ The pattern ‘of 'staffx approved for the B&E Cell Provide‘for one post• • of'Stnfisticnl^s'sistaia^nd postsof Field and’Evaluation .Workers' . ' one . per twadis'1 riots • in the State. Keeping in view- the. need for ocon?my,
it’Was been • decided<that the ban may bo relaxed in • such <a manner that
' / there' should be’ene statistical. Assistant in pa ch D&B Coll ind there
. • ’ should b- Field and Evaluation V/orkor'nt eno for. 3 Districts . instead, x
eno for two districts* On the basis of the,■ detailed information recoi—
‘
v -d>rom thr-States for-'Annual Plan 19CO-31, it -is found that the .
uhdormejntionod additional statistical Isoistant/Fariily-Planning ^ipld*
v" . and Evaluation Workers* are . nujdod to’bo appointed on-the■ basi s .of .
■ • -revised, norm. • ' ’ *”• ■
t.
" * '■ ■i"; • :•••••• ...
/jx*., f.ir■ • ’
'
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No. of Posts to bc filiZ-d..
. . A^sajns

.Haryana;-

1
5 .

> ^••Himachal Pradesh. ...
•'

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Karnataka.
/' ’ ‘
h, Madhya ’Pradesh. *
‘
‘ ^4
. .Haharashtra., ■
'.//:.',' ’ . • •
5
' . Orissa.
■. /.< ■•. /;/' ./•
F
;•
>;Pun‘;jfb',
’3 , '’Rajasthani
•
. 2 '
•/.
Uttar Pradesh.1
'
18 .
.-..f ■
: • v.
;/_ West Pong'll.
..
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The Stir th Government
the ab,'vc’ statj'p may fill up the cabovo. \-mentioned', posts.
. / .. .
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‘i.v,.D-rivcrs.
.
- .
■- .To the’pxtirit nobdod tT. keep th.’ ayailabl.: .r’lod-worthy vuhicles^rjp■■ .vinjy 'A coj.tifici.to'-to this, effect will b j . pivpn while filling up this
' . post th t-■ ?. vohiol .’ is. 'on tKp-roid. •
.
1
,. 2. The relaxation given,'in respect- of District Fanily-Wclfirc Bureau ■
• . •/''.nd Stite Fnroi.ly Velfarp Buroiu nro only in' respect: of those Stites.
-where full flodged.-Burzxus have been &mctionod md will not be npp- -i .. lie ib lo to the. Stitc where sel-ccted stiff for the -State; Pa.mly Wolxiro
Bureau or the Mini District Fnnily. Volf ire Buronux hnvo been smefrionoc..
■ ■
The-Stites .Government s. of those states iro requested' to nxininothoir
•roquiroraents.'.’of.additiJn.nl •posts nuedrl in the light of. iboyo relaxation.
' nnd wend.detailed proposils to this Depirtnont for oxiriination and
.sanction.,
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tW'Vnde rSa ere tary
r‘<SAntembar,-n^?./
Naw 3Delh^-,.
:^
4 S9ptember,- ;^;t-r^
- viA- ■. New
" t - aaaresp
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s'/. ■■-?■-s^'..on
posts impend -n

■.y . ■/• ?..••

relaxation

v <.•••;'" ••> :: : Family Welfare.. Prog
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“y
1 am directed to -foAo
this
’.the
’subjoct • mention^
n 1973 „aB
nf the vacant posts ^^^Jlth Visitors .
;'.. (VoliH)' dated 26th^May, <9^.
°f .Hurse; WWwives and^^
10th May.
that,tho han on
Auxiliary
0Siler aid SVf 4tB Jun® '• . •

? Sir’j <■

5, > ^4*

X’? • -

t / MaS^S0**10* ■

^^(vide'
at*tVlu^l
cer iA JuAc t
\
u’rtn eat or At tnv -

• s

,■; ,, •AUhsUon.of ■■xtsJur

^frYier ess^ntiftl
certain Qther
.
• •' • ’■- .to time tmt XA
( (
... hai no^
it
a ■/,

this .

■ ■ - «ir« ‘Uo"*4
"
'ihln to rulax the. DAA ““J • . Governments «)•
‘ x Mqvq-BO., tho btatv LrOV _ his
. --anaaolY1 ^n,
,
of
’<• •' ' pogsih?,?.
during ^78-79,
■ 1979 «o,^
avoid £,\»a
v~p- “’^^s
...".,7 somX of those posts
on appronck
o£ r
° ot PM M..
' ■
.grater need, for
is, the ^astron ' " a
7
nSlnK
Commission
> .<■ the ■ prograde'.at all 1
pXanning Commissi^

♦

‘

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'Mrther'.^^^Vand With
^vision.
and ■I'inanqu Division,
oategories of pos «
,■ ■
?;
undermen^on , _ ■.’i'l
_
cowUTOR
,' ■ ,.
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tH’
W^MRE ...CWNTI

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S’"112
'- ■
categories

J;-' With the relaxation
■; Y >

X

'4
luv^l now, V.■Welfare .Centres
” ygf.ppstsjT,.
r
- • 'j, Assistant v .
ueUltY|
.cum^Cierk.
<
..■".. ''id)''Stor^-KeeP®1-,
,
■

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b)
.

*
... f. ■
»■

' -- WdLBARK CENTRES-.
URBaN TkMlhV
- , VContre (10,000 to 25,000
,
.a) ryp®
*
..:J ,, ’ <'. popp-iation)
no DU
■-■-■-.'J'/’

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2. Family, Wei far®
"(male)
I

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4

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. ■.

lHV/Extension

1,
2.

Worker

Educator

Worker (Maio)

^opAinixcm*
5Of 000
. ‘ , .’ h.
•i

mice;; at"t;"e Rural ™ centres in. 1975
1974)
of. Medical
uuxx --------------i°anA
in 'reppe ,t'• °iriV1501572/74-PB, date?d ^th May’ . i ■
(_vide iottfr No. M. 12015/^/
•
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(7^f/50,O0Q..
QJ ‘TyPe
Type iitII
-IIfta:Cj9ri|
Cpn^ye:,,
(50,000 and pbove
fibovo ' '.'1 . Medical Officer ' ' ■
popuu.tjo.n5
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"^7 ■ ■i'it.'/.-'lS.f/l/'li

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•■ '■ <-■.";
■..< l.A 3/ Lady
Lady Health-Visitor.
Health .Visitor

7,.i’

’

. ................

-''S/WilyzWolfhTQ .Worker
. •uy ■‘•■Witihjt:hQrhbdvt tslaxa-tion,. tHo- ban’-it' the dri
I ,

•

XHTOV'^m'+4-ioiw«i-wKB

.•••

.

■’

■,'4.. t’.Thn
Wif^re .CentreCTyp^jiiyUsin ■
v" .■'..
: ■:</ •■;! ■ I- ' F6bruh'ry,xV,9
Utter Ne N19Q11/2 7^-Ply, ■dated '
23.2.1976)
h
■''
■
"
■
b
^^..aqcordi-ng
to
revised
pattern,
.tho.post
vo-royiaoa pattern,',..yho
/(post' Qf
of Extension
pxtousion1 EduEdu‘. '■
■ M . • • -v
. catorjvisyoplacM by'ANM.. As.such,
before
filling
"up
the
As-such, before filling up the vUmt
vacant pohts
posts/.'
•o-11i!'dUC&1:Or0’ a11' thc 'p<?sts
converted into tho © of ''
7^ ?*4ry- U failed- up auly. qualified A NMs r ..
■. ■
■
; -A
QTW' staff, in position
positionw
as on 30.6.79.?
30.6.79?roceivec
received from the': ‘
f .•
■4
J' ■
along with.nnnual plan proposals for'1980-81 indiqated
vthat .'i.n-somb .of, tho’! Stat os, mo auxi.
' C p+.'^
Wolfa^Zrr
0^^ QV^^
9’ th° Auxilif?-ry. Nurse; Midvrives and Family'.. ':■ '
’/Q:Lfa
Ju ’7TL^T
ofUrs(.Mnl
)’ taken together
'■. < •“."at :;
■the
Urban
6
tOgr''l:hor Wore' moro' that! the workers admissible
Urbnp. Leyoi
■ ‘ i at,tip
■.W?2
;: ,’ .' •a
: a3 1
assistance under
- •
.(■'. ;n^;yAW!j£ar°. Pr^ammOr .•is admissible
as pOr pattern only, it may bo
’ . " ,'fill
ensured' that only tho©''posts
vhich aro ^ssible ds Per pattern be
' ■'
.••■h'
th°® POst!3 Which
‘..V filled
'
■ -■■'KtL
n.;1"a.ox?c,"s Porspnnol avail-bio stould'oithor be adjusted again..:.' ' ■‘tile i
:*-dbn'£f9ntrr?wi'5 oppnod during the current yPar pr (the: expenditure
be met
b.yvthc Sta
te Government
-t
hon^them.
- hom-bo
ront-by^fai
State
Goyornniont from their .own sources. ' U vd.ll
-Ofi. ntl/A n-rin’i nr.', La X Ll
I I
' t
.
•'.y,( •,be.o
ndorsipg'to this Iletter,
to ‘ State
A-G’s to‘ensure in non-billing of
J?
poysrnment' of
of Indio.'budget.
India/budget ,’
•.
•PP.??*.'
.?^.'
government
■ :
r
.' :
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•<<<•.■■••

■

■

iii)^ i Th) relaxation of ban give'at: Urtan Family Ulfnro Centres, will, 'also be,.
Of-'b''r) Piva'af Urban Family Wol'faro'Centres.'will 'also be..'
V' • ■
ni^sib.}?
for
tip
Upb-an Centres pin
by Local Bodiqs and Voluntary'Or.?'-nSan^-i/x^^ v 1
r' ‘T’ T
^yu-^x wuaxqa uua vqxurnjckry •urg-«, V-r6?gppointod
msations Ipt. iy
it • S
ijxny bo-ensured
‘
- and- •comp9tant .porsonn
O 'OnSUrftd that duly ^^^Ud
./-ure.pppoint'od by. thorn.
,
.
...
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Family w0lfaro Bureau'

*

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1. Administrative Officer . •..•< ■
. ,
.' ..■ '... • \ "
1
•,' '•
2, Deputy Mias' Education .and Information :0ffiCer(Di st'VxUns'i,on
>.. investigators ■ ■ i. «. FP-.Field and Evaluation Workers. "
5.^, Pro^ectiQJtists ,•. I 6. j)ri,vrs.
y','?

J■ ‘

Jnbs T.JX; rc5-J^^on of; han given in respoct'.Of projectionist and Drivers is
.c®»^tion of’availability of road'worthy mobile A.V.Unit Ind
x?aSi^ tfe38.a^ not available the vacant posts should not bo
.
ixxxGci till, thp^e h^ecope available;.
'
.'tif \,"
:..
■'
,'5.'''a- v\k,
'hovp-tp bo .given.by tho State Government that the.
'
■j'nA vehiclo for which drivers afo being uppointpd aroa on tho ro'-d.

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No. M l2012/4/80

TV

'.'I’;’.”." ■'?'?■'i!-'
,yyQatfifls of >st3ffi ^ncl’.'Qth^r expenditure to.be incurred on '
/'/'- >> ■/. 'establishment pf ’ Urb^n...Family Wclfurq ■Q^ntres'during- ■■'
//<i/>l98QT81. on. 1971 Census., population.

<b .y.';.-

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■.j </ yE'-y ■-yyy
■ 25,-coo ■ .<y? ■ y’ yEy?<-::.-JTYPE j If‘(IQ, OOP ±0 •/.>; population) :

■

<. . ’.-Non-recurring
: .
.. .
--------- ...
: J ■ Bgtiipment. -nd f-mi:un , .
<v<<
..
•
.
y ' : Ei'y:'.Recurring:
1
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1 y. e,.. •. Non-recurring ;
z f^b-e. ■: 'yr/f:..Equipment .^hd' furniture'
.
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. Recurring’:. '
1\?L.H.V«
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'

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y’yi.;.y

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As per States scale
of pay'’.an^ allowances ♦ .

TYPE II ^5^000 to 50.^000 population) :

• Rs. 3,000

1

(;'r‘

?

'

•

.. . , Rs.500 wperz annum.

;

/E.y y'yy'i';
I

ay':

Contingencies 1 .

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1
;

•. 1 . . / 1
Family Welfare Worker ..

/

■

. ‘ .

' Rs.2000

..
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■>

/

1

• 2 . A.N.M* . ’

•1

3. Family Welfare
Worker (Male)

1

t

Contingencies :
g..

;

-

’

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I

per Statt-s
scale of pay and
allowances.

■T*,

’

.

Rs.l^QOO per, annum.

.
.

Rs.3000
l^s.3 500

;•

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. TYPE III (50z 00'0 - and above) : ’
— T“ wm—
.

r. W.

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'-.
•:
■
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1Furniture ,and equipment
,2* Surgical equipment.

■ t.

■■

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•

■

■

■

..

■

•

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... ■
z\
' !• Medical Officer (preferablyfemale) ■
1 1 , As* pep States / >.
2.
lady
Health
Visitors
•
*
.1;
■ - ?
scale of pay
■3. Auxiliary ’Nu.r^e Midwives '
2 > , and; allowances.
4 . ’Family. Welf are Worker (Male) 11
‘
St’oro-Tkc'eper-cum-Clerk'
11.
Contingencies; .
j

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'

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1. General contingent expenditure ‘ Rs-lOOO per annum
,2 V Replacement of Surgical
' 4
instalments and- appliances ... Rs. 200 per annum
’ 3, Ren,t for the. building admir ssibie if'the centre is
located, in a rented building
t
(Maximum ceiling) ’
__ ^./i. .T

E-niy

/ copE/
x
• i.

1 for D

I.
I

’ • v (-

Rs.)30O0yper annum

-

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•TV

*

•After .the'/^bove-’relaxation, .the . ban at the Distt. Family Welfare
' bureaux existb'--in respect.,, of the . following catogorios of posts:2Fi A:sstt. Acqountanf, < '

■

V ■ . '■
• il -

'

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•

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A i

i

•

7':-'7A . 7' 7' ’

i

5,^vL.'P;Clcr.h>cumltyplst,
7''x-—_•
■ ■ ■• .'.■•■
"• ^.^Ptepo-typist
. .
...
;/7;
: ^HUAUWJ.-.
Au^i'tbrl .,■' .7

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/
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j7i;?'No-vacant
post of the above
’
.
vacant pest
category bo filled.
‘Y’" lying vacant for, more than 12 •months as. onyi-saged in

■•
'

in
. . case it' is

?. of this . .,

■. ■Ministry1 g letter No;M. 12O/22/8/.78 FWB dated 15-5-1980.
’ > Y777

.7'<

;

• ./•Y...

■.7

(

'

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'

• • IV.-SPATE FAMILY'
/etAre' --------------BWM—
iX
--- :------ -r—r. "
: •

•

,

;7

-,

■ '

• '.

• 1> ;P9PUty Director (Mass Education and Informat ion Officer)

*

■ 4!7\jAdm^4.g'tra‘five • Officer, ■ . .
.
? i
5;St'.a,re Officer., ...
■
/7; .,4; Acqov|nts Officer,
•
,
7/.; 7 " 5, '.■Pcmprjranher. '
'7
' /•■ . ’6/.Investigator (Statistics)
’
■ 7/ Sditpr/Assistant.Editor,
Y/7; •'< 8f Statistician/7 \s :
.
.’'
< 9.;■ Statistidaf Asst.t/Family Welfare Field apd ’
J ■. y' Y''/Evaluation Worker. .
■, * ■ ■
•’ .
. "fy
10. Driver, .
.'

*, 7'..

•

•

■.

.

?

Cleaner/p'eon/Chowpkidar.

•

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-

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■

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., - ■ ^‘Tho relaxation of ban in respect of Posts me nt i one d’ against item
i 7 to -ip' Vfx/ Editor/Ass.ista-nt,-Editor, Statistician, Statistical .
Aasistant/E^mily Welfare Field-'Apd Evaluation Worker and drivers is
•j1.-’ 'subject tp. the. following.’,conditions. y
v
‘
•

/■■''•j.', 7

’•

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i) Editor/A b s i st an t E d it or. .
H

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a :

r-. X

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,

. According to- the pattern, one post of Editor and one post-of Assistant Editor has boon, sanctioned for each state Family Wolf-Are
Bureau, .yin view of need for economy duo to-financial constraints
7 a.
it -has been 'decided that" the b\an. may bo r-laxed only ?n respect'of
, those st.ates whoro‘both t;he pos ts are* vaijant, and Sta.tcv Government.
m^y Pill'd up only one7of tho'wto posts. On-the basis of information
7p ’roocived •from the'State Covorrinpnts f or Annual Plan 1930-81, it is .sogh’that both the'posts are lying vacant in Orissa and Uttar Pradesh. .

* ' As such, the State Governments of Orissa and, Uttar Pradesh only are

.
'

permit|pd to fill >ne of.thos,,- two posts.

•

■

■

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■

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^stician: ■.
.■.•.£he pattern provide f .or, .two po3t$,pf Statistician at D&£ Cull in
..the, Sta,)to Pami).7 t/clfaro'Bureau. •* til view of financial'co'jistraints,
\r^'.
it Bas.’ been, doc id ad; that the -bft,n .may be relaxed, only .for those
I ■ J ■ i'Ast^tps-,
where- bpth;.tho\• po^t.s. are’ lying vacant so thatf thpre. may 'he'* f/
XStlprVst1 ope qtatistician availablb at oacb- B&H ColiZ&ri;
of 'i^^rvn^
tbo'posts are lyingr
■ pf..^amDiu and Kashmir .and Orissa. As ^ucl}j/tbc:;’’Statd.<-A.^‘
. • PeVd^pmont s/ef-J&K. and. Ori'ssa -are ’ all owed to fill'-onb ppst'
' <
j'

\

• ' ^^Statistician, for’ the. D&B Cell.’ \
- '• ■’./<
;V .-V-.- 'Vat
■
\^'5ala?^ant/E<P .l?i^Id '& Evaluation Vorkcr:.'?.^ ,■'•
''; v, \

*

-... ^ The^ pattern, of -.staffs npp;cuyud f or th.) D&E Cell Provide-f or pxip post *1
, ,1V. of \St'ntisticnl..AshistdiIt find posts-of Field nnd”Eynl,ua'tiop .Workers
.
ono’-'per tw-Wlia: ric.ts ’ in the- State. Kooping in\yiow. ■'tho.. rioi^d'^ft^r'1 economy,
it has boon • decided<that tWo bap may' bo - relaxed, in ■ such-.a manner that

■..

■'•thero .should ba’pne statistical. Assistant in -pach D&E Qcll and there‘
should bo field and Evaluation Worker at one for 3 Districts instead x
□nd .fo^r two. districts. On tbo basis of the, detailed-:information reedi'//; v;d -from the'States for'Annual Plan 19-0-31, it is found that the ;
’
undormopt ionod . add it iana.l. statistical Assistant/Fanily1 Planning Field'and Evaluation Workers’ are -nujdod to'bo appointed 'on- the-basis of X'
revised, norm.
•.
,
’
.

■

’>v--.j ■■’• X
,. . .
•i‘ '
x .. Ahsams’•
'
■Haryana;-\ ' •
•z Himachal Pradesh.
- .
• K &
Karnataka . :
■•; Madhya’Pradesh. *
.
Maharashtra. ■Orissa.
,
'■
" / Punjab '
'\
■ 'Rajasthani
, '
/
Uttar Pradesh..
o '-■<
Vest Bengal.
. '

2 .

No. of Posts to bo filled.
6.
' ~7rT
.ii..'’ '•
•V
f-• '
•
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’• .
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5
■
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.
4 '
' "
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6
*14
?
5
\. -..
.
b
•r5\
2 ’
-• •
13
5

.

* . ■' ; The. Stato • Govornme.iytq-; ff tho nbfvo status may fill up the above’
■ ■''•< mpn’tipncd ^posts. ^ ■ /1.

■ '• '.

.•

• • ... •■• h

^i.y,' Drivers.
■' ‘ .■
,
.• “■
z'
.’
•
x
the, extent needed to keep th? available.^add-worthy vehicles no’ , ' ving A cor.tif1 ca.t ci t o this. of feet will b? given while’‘‘f tiling up this
.. post ‘tbah a vchic-1 ? is. * on the- road. .
'

.. ...•2, Tbo relaxation given; in respect of District Family Welfare Bureau
and. State Family Welfare Bureau ar- - only , in r.spect'of th ;sq States
-where full f lodged ;Bur':,aus .hnvli»b ;on sanctioned and will not bo ppp, licnblo to tha Statu whore selected staff for the• State; F.ajaily Welfare
Bureau or tho Mini District Family. Welfare Bureaux have boon sanctioned.
Thd State Governments, of these.states arc requested to examine their •
a •1 requireraentri-’-'-of axiditi on-alposts need-d in the light, of» above relaxation
.
” and ^end detailed prep ps a-is. to this Department for oxnriin.ntion and
I
•' ••S'vaction. n- •
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N
M VZOlZ/l/BO-lW dated15th ;
• No. W *
Ministry of

H..' .

/■.Ktpta.wr,- jfeo,■«>. '
'and Union Territories.
;
;
_ ban 6n fill^
-P//""er
fil1*^?.
.X.%6X; -.ASuhf Family Velfare_P_rog™c financial
'
in view of' _?
f: ^Taxation tMVeoi
■ ,,
relaxation t
• •

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, iettjr ».-3^9/72-Pb
• '.T u;' directed to re for' to thisi Ministry
’s
"^loU
.t.v. and U
* r
a the subject -----during
‘
9^
wtxa
tVol/lh Jatedn221lS’up9S’the vacant; posts impose
Visitors
- and lady Health
, ‘ that •'Ifho b^n
on
fining
uy
m-i
“^/or1o“1«mary'»urr
J rerax0 in
i r in rura). -areas
. ' 1974)4and
n.June, 1974 kVXQ
at the .Rural
1MasS Education
. . .. officer in-June
• Blpck Extension ^d,u<?.ato
Media officer
Z' May,
■ J
.■and District ^tension MWelfnre Bureaux) in^ay,

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«»»•“«’O’SZp Assential

■
!.'■

< - if ^ + fl further relaxaxxon xu +

■

^rnm time .to timu but iR' •.
it had not been .

r

“.““o SSL ■
further «WI>
even ttaUKOthough in- “
new

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f.,

i

: durrt? 197M9. W-80'^to avoid »‘“»a^o“^-»=a.a.

. >'• . BomQ of these pos

nurson approach

•

-time- of Plan di _
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[*UiAT' *PHCs:
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bvliarc Vaw>
11)'stord-Koeper-cumnClerk.

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- ’ 2. VaS

; (a)- Type l’Centre (id,060 to 25,000
I

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; ■ v- b) Type;ll Ceptre ( 25.000 to
50,000'iopuWtd.on.
='h : ’ '• U "
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t.LHV/Sxtension'Educator

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-r —Zromcers at the Rural ™ C^reS
9/° *”* in tespect of Medical Off
d nth ,May 1974)
and
' X- (vide
letter-NDc, M.12O15/2/74-PB
M-12015/^/(4 rn,
! •

i
i
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Ap.
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.’■23•2.,1976)- and.-according to revised pattern^ tho ..post* ,Qf Exto-nsion' Edu-r •
w^s^oplaopd by'ANM. As • such, before filling up the vacant posts
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at- .tfoo Urban - Lr-yel, • '.as' 1
assistance, under '
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relaxation’ of ban- give n’t; Urban Family Welfare Centres* will 'also be.
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relaxation of ban given in respect of projectioriist and Drivers is
'•‘i /' subject, to the .condition 'of ‘-nvailability of road worthy mobile A,V.Unit arid
'.'.VQhicld, In ,casa<i‘ these arc not available the vacant posts should not bo
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♦

•

,

SLUM DEMOLITION:IT’S EFFECT ON CHILDREN
CASE STUDY : AMBEDKAR NAGAR, COLABA, MUMBAL

Mani Mistry

Dr. Lalitha D’Souza

Centre for Enquiry into Health and Allied Themes
519, Prabhu Darshan
Swatantra Sainik Nagar

Amboli
Andheri West
Mumbai 400 058

Tel 625 0363 FAX 620 9203 email admin@cehat.ilbom.ernet.in

Acknowledgements

fhe investigation team was invited to conduct an appraisal of the health situation of
the residents of Ambedkar Nagar by Ms.Mahrook Adenwalla, a lawyer and housing
rights activist who has been involved with the legal aspects of demolitions in
Ambedkar Nagar over the past decade.
We would like to express our thanks to the children of Ambedkar Nagar who left their
play willingly to line up for having their weights and heights measured on two
separate occasions. Their enthusiasm and queries about their own future raised several
interesting issues which we hope to deal with in our future research on evictions.

I he women and men of Ambedkar Nagar gave their time to share their experiences
and respond to their queries. They came out and spoke with a great deal of honesty.
We are deeply grateful to them.
We wish to express our thanks and appreciation to Dr.Nick Emmel who has actively
helped in the formulation of the study, data collection, analysis and writing.

1

1.

A HEALTH SURVEY OF EVICTED SLUM-DWELLERS IN AMBEDKAR
NAGAR
Introduction
This chapter reports on a study of the health condition of children in the slum of
Ambedkar Nagar in Colaba, Mumbai. It notes that the health of the children living in this
slum is appalling. Over three quarters are malnourished. Infection in this impoverished
environment is rife. It is reported that this slum has been demolished no less than 45 times
to date. Repeated evictions mean that these slum-dwellers slowly lose their capability to
absorb the impact of further demolitions. The consequences of this are reflected in the
health of the children.

The Context
On the 18th May 1998 approximately 5,000 people living in 1,500 huts were forcefully
evicted from their homes in Ambedkar Nagar slum. This slum was situated in Cuffe
Parade near the Southern tip of Mumbai. Within a few days a slum in which many people
had lived for over ten years had been flattened and and finally cleared with bulldozers and
earth-moving machinery. A ten foot high wall had been built and topped with razor wire
around the 8,000 square metre site. All that remained after the eviction was a single
temple to the Hindu deity, Ganesh.

The successful eviction of the 18th May 1998 was not the first time that an attempt had
been made to evict the residents from Ambedkar Nagar. The residents of the slum have
claimed that there were forty five previous attempts to evict them from their homes; the
Collector of Mumbai, Shri Sanjay Chahande, confirmed these facts. Each time the slum­
dwellers homes were destroyed and they had to rebuild them. An eviction attempt in April
1997 demonstrates how devastating these evictions are. On this occasion the Collector
had issued notices of the eviction in advance1. A list was prepared of 106 families who
would be given alternate pitches in the resettlement area because they could show
acceptable proof of residence prior to 1 January 1995. Among the slum-dwellers there was
considerable confusion as no one was sure of whose names were on the list and whose
names were not on the list. The demolition squad moved in at 11.00 in the morning to
start the eviction, accompanied by armed police. Shortly after the start of the demolition a
fire broke out. The fire brigade arrived one hour later and hosed the area for about ten
minutes before they ran out of water. This fire destroyed 600 hutments and it stopped the
eviction.
For many of the slum-dwellers, their huts had been destroyed either by fire or by
demolition over and over again. In addition, the residents also report that on several other
occasions the demolition squad came to the slum and demolished huts which were
considered to be illegal. These summary demolitions did not constitute full-scale eviction,
nonetheless, they left many families temporarily homeless. The materials from which their

2

homes were built were loaded into trucks and driven away. The residents could pay the
BMC a fine and retrieve the plastic, tin sheeting and bamboo from which their huts were
made, or, as was reported by the residents, they went out and bought new materials to rebuild their homes

The history given by the residents, corroborated on at least two occasions by newspaper
reports, is of regular and systematic eviction attempts by the BMC over about ten years.
On each occasion the slum-dwellers were made homeless they were obliged to spend
approximately Rs. 500, a large amount of money relative to their meagre income, to
rebuild a shelter for themselves and their families.
On the 18* May the eviction was total. The Collector managed to evict and exclude the
slum-dwellers from the site. Their homes, water tanks and shops were all destroyed. In
addition, the bulldozing of the slum-dwellers’ huts was carried out with such haste that no
transit shelter was made for them at all. An imposing ten-foot-high wall topped with razor
wire was hastily erected around the site.
No alternative shelters were provided. The slum-dwellers were forced to live out in the
open in the searing heat of a Mumbai summer. It was not long before the children started
to fall ill. By the evening of the eviction many children were suffering from sunburn and
sunstroke. The Asian Age newspaper reported that by the next day ten children had been
admitted to the nearby Albless and Cama Hospital with acute sunstroke and dehydration11.
The residents in the slum confirmed this report.

By the time this investigation was carried out three months after the eviction the slum­
dwellers had resettled onto a much smaller boggy area to the West of the original site. The
slum-dwellers fear that another demolition is imminent. The Collector has allocated new
plots to those residents of the original slum who could prove according to the ’legal’
requirements that they were residents of Ambedkar Nagar on or before 1st January 1995*“.
However, the majority of the inhabitants of the original slum have been unable to
demonstrate their right of tenure either because they did not hold the appropriate papers,
or, as was evident from our investigation and a survey carried out by Navara Hakk, prior
to the eviction, because many of the households were inadequately surveyed prior to the
eviction. These slum-dwellers have been obliged to make do with whatever space they can
find in the resettlement site.
Many residents showed this team of researchers ration cards dated prior to 1.1.95, asking
why they were not allotted alternative pitches. Community leaders among these group
took on the task of 'allocating* space to households. Thus, in addition to the expenditure
these people have had to make in rebuilding their homes they are also forced to pay bribes
to slum-landlords. Their problem is compounded now as rumours abound in the slum of
another survey of the slum. Associated with this rumour is the widespread belief that a
further eviction will follow. Even the letters issued by the Collector's office to the

3

households with legal proof of residence include a statement to the effect that the
arrangement is a temporary one. The residents of Ambedkar Nagar have lost their homes
many times over the years. They are now unsure as to whether they will have their huts
demolished again. They are reluctant or afraid to invest in adequate shelter for themselves
and their children. In addition they do not have the resources to invest in service
infrastructure like water supply, nor do they have the organisations to demand services
like toilets or paving, guttering and garbage disposal facilities. It is in a context of a slum
population who have had to constantly re-invest in providing themselves with adequate
shelter and services and are now unsure as to their future, th^t this investigation was
conducted.
The health condition of the residents of Ambedkar Nagar
This investigation of the health condition of the residents of Ambedkar Nagar was carried
out over three months between August and November 1998. The investigating team
selected a sample of 100 children aged 0-10 years in order to understand the health
condition of the population. The sample children were selected using a stratified random
sampling technique which relied on a survey of the slum conducted by the research team
along with residents. This survey enumerated the number of children living in each hut.
The sample was stratified into four areas which were mapped by the residents in the slum
in general meetings and reflected their perceived right of tenure. These four areas are
shown in Table 1.1.
Table 1.1: The four areas of the slum defined by the residents of the slum with
,
_________ reference to right of tenure._____________________
Area
No. of Children Resettlement
Perception of tenure
huts
0-10 yrs sites allotted by
I
227
794
Collector
Names on the electoral roll and existing
ration card. _____________________
II
50
147
Local
leaders Households not having names on the
o
and slum lords
electoral rolls, but having other proof of
residence prior to 1.1.95 (example:
ration cards)______________________
III
150
480
Local leaders
No proof of residence prior to 01.01.95
and slum lords
but resident in demolished slum_______
IV
60
216
Self
-UnclearThe sample was selected to reflect the proportion of children in each area. Therefore 48
children were selected from Area I; 10 from Area II; 29 from Area III and 13 from Area
IV

Each child was given a non-invasive clinical examination by an experienced paediatrician,
the intention of which was to identify signs of infection and malnutrition. In addition, the

4

height (or length in children <lyr) and weight of each child was recorded. Accurate birth
dates were only available for 23 of the children so Body Mass Index (BMI) was used to
calculate nutritional status, as this is an agfc-independent index.
A second examination of children was conducted three months after the first. It was hoped
that the same children would again be examined and measured. Unfortunately, only 19 per
cent of the children from the first sample were available in the slum from the first survey.
Most had been returned to their village of origin as there were rumours that another
eviction attempt was likely. One child was reported to have died. The children who were
still in the slum from the first survey were examined and in addition a further 81 were
selected. The same method of selection was used as in the first survey.

In addition to the evaluation of health status amongst the children qualitative research was
conducted in the slum. This approach can be conveniently divided into three stages. The
first was general meetings with residents in the slum in which the researchers sought to
understand the events following the eviction, the settlement patterns and re-building
activities in the aftermath of the eviction. These also allowed the researchers to understand
the employment activities and histories of the slum-dwellers. These general meetings,
which were an open forum, also facilitated the mapping of the slum into the four areas
discussed in Table 1.1. The general meetings were followed by focus group meetings in
each of the four areas involving women from the areas. Each meeting examined the effects
of the eviction, the process of re-building the huts, impediments on building, service
provision and concerns about their health and that of their families. The focus groups were
followed by open ended interviews which allowed for much more detailed case studies to
be developed. Two women were selected from each of the focus group meetings. The
criteria for selection was that they had expressed views and experiences which were
similar to those discussed in less detail in the focus group meetings^.

5

The results from the health survey:
The observations made in clinical examination are detailed in Table 1.2. Figure 1.1 shows
a histogram for the BMI in both August and November.

Symptom

Table 1.2: Proportion of children with symptoms
Grading
Survey One
n=100

Vitamin A deficiency

Mild
Moderate

Vitamin D deficiency
Clinical anaemia________
Clinical
signs
of
Kwashiorkor___________
Clinical signs of Marasmus
Infection________________
Fever
Suspected Malaria ( blood
smear not taken)_________
History from child________
Diarrhoea
History from mother______
Fungal_________________
Skin infection
Scabies_________________
History from mother
Worm Infestation
Lice infestation
New and old
Injuries
Bums
Middle ear infection
Upper Respiratory Tract
Infection

24
8
4
72
3

Survey
Two
n=100
25____
9_____
2_____
87____
2

2

2

7

6
1

17
5
12

9
4
15

6
13

6
19

11
9
1
5
54

16
8
0
8
33

6

Figure 1.1: A histogram for Body Mass Index (BMI) in Ambedkar Nagar for
children aged 0-10 years in August (n=100) and November (n=100)

35 r
30

25
c

i

20

I ------------

=

□ August
i ■ November

CT

'±5

£

I

15
10 -

5
0

r~ta !
0.09

I 1

0.1

I l—

on

0.12

0.13

0.14

0.15

1;

0.16

-----i
0.17

BMI (Class)

Discussion
The children in this slum are suffering. The clinical manifestations of malnutrition and
infection are alarming. The children’s nutritional status is a cause for considerable concern.
An accepted normal range for the BMI is 0.15-0.16v . In August only 28 per cent of the
children had a normal, or slightly higher than normal BMI. In November the number of
children in this range was 16 per cent. The remainder, 72 per cent in August and a
staggering 84 per cent in November, fell below the accepted normal range for BMI. Part
of the difference in the number of children in the normal range or above can be accounted
for by the lack of breast-fed babies in the second survey. In the first survey one child with
a BMI 0.174 and two of the babies with a BMI which fell in the range 0.16-0.17 were
breast fed. At the other end of the scale 8 per cent of the children had a BMI below 0.12
in August. In November, 6 per cent had a BMI of less than 0.12. The only child that the
researchers know had died in the intervening three months had a BMI of 0.092 in August,
he also displayed florid signs of kwashiorkor and xerophthlmia at the time of this survey.
His mother reported that he fell sick one evening with a fever and was taken to a private
practitioner who dispensed a packet of medicines. The next morning the child died. He
was eight years old.
The other signs of malnourishment in this population are disturbing as well. Vitamin A and
D deficiency are both high in this population. It is now widely recognised that children
displaying signs of mild vitamin A deficiency have a greater chance of dying in the next
three months'"; 32 per cent of the children displayed florid signs of vitamin A deficiency in

7

August, 34 per cent in November. Clinical anaemia affected over three quarters of the
children in both cohorts. It is evident that even if the child’s BMI is nearing the normal
range (the modal BMI in August was 0.146; in November 0 139) many of these children
are receiving a diet which does not contain adequate quantities of essential nutrients.

There is only one other survey of nutritional status amongst children in the slums of
Mumbai that the researchers are aware of. This survey, using different indices from those
used in the survey conducted here, reported that approximately half the children in their
survey were moderately to severely malnourishedv". The indications from the surveys
conducted in both August and November in Ambedkar Nagar indicate that the children are
more malnourished in this slum. The qualitative research undertaken as part of this
research provides evidence as to why this may be the case. The survey mentioned above
was conducted by Geetha and Swaminathanv,u in a slum in Dindoshi, a suburb of Mumbai.
It was a resettlement camp provided by the BMC for slum-dwellers who were moved from
a site in Cloaba which was near Ambedkar Nagar, the subject of this study . These slum­
dwellers, although poor, have not faced eviction from the new site in the last ten years.
But, in Ambedkar Nagar the slum population has repeatedly faced eviction. As was
reported above, many of the slum-dwellers had lost their homes as many as forty five
times. Each time they had to rebuild the structures at considerable expense.
The slum-dwellers in the focus groups described a series of ‘coping mechanisms’^ they
have developed, like many poor households in Mumbai, to absorb the impact of disaster.
These include small savings, often held in the community, which they were able to draw
upon to finance the rebuilding of their homes and to maintain their food intake. Once
depleted after multiple eviction attempts, the slum-dwellers are obliged to turn to another
form of household saving, that of household possessions including jewellery and brass
vessels. These too have long been sold to rebuild homes and feed the household. In
subsequent demoltions they have been obliged to take out loans from loan sharks each
time their homes were destroyed. The interest rates on these loans were reported to be
very high, at times in excess of 100 per cent. They do not get a chance to gain economic
stability and food security. On each occasion the household economy has become more
imperilled. 'Less food' one respondent noted, 'is available in our house each time our hut
is destroyed'. This was an experience that was repeated often by respondents in the
research.
Repeated demolitions also mean that people just do not get enough time and opportunity
to establish their homes and environments. They are always having to cope with the filth
and confusion of a new area. Nor do not get an opportunity to establish their proof of
residence for the minimum duration required. And thus they are always a step behind.
With the threat of eviction the slum-dwellers have been forced to flee the city for the
village. It is impossible to comment on the conditions these people face in their home
village, but what is certain is that they have had to telinquish the possibility of their paid

8

employment in Mumbai. Many of the slum-dwellers work as either labourers canwing mud
at construction sues of in cleaning fish at Sasson Docks which is two kilometres from
Ambedkar nagar.

The slum-dwellers who remain in Ambedkar Nagar are unwilling to make large
investments in re-building their homes because of the threat of eviction. Many of the huts
above the high-tide line have mud floors, only a small number have been able to commit
themselves to the expense of concreting them.
fa the areas of the slum where there is a regular inundation of sea-water the condition of
the huts remains appalling. Much of these people’s lives are spent living on flimsy
platforms as the water washes through their homes.

There are no water taps in the slum. During the first round of this .investigation water was
only available from a tanker which parked about 500 meters from the slum entrance or it
b°U8ht f°r RS' 2 for 3 twenty litre handa <water vessel) from ‘he nearby
MHADA transit camp. The malnutrition of the children undoubtedly means that they are
more likely to pick up apy opportunistic infection. The limited quantity of water for
ygiene needs makes the situation much worse. Skin infections are widespread among the
children. The probability of feaco-oral transmission and diarrhoeal disease is noted to be
high due to the lack of water and the poor sanitary conditions. Most of the residents have
no access to a latrine. They use an area adjacent to the new settlement for open
defaecation. When the tide comes in the contaminated water is washed into the huts and
lanes. Children were seen to be playing in deep pools of filthy water in which faecal matter
was seen floating. Inside the huts dampness prevails. The poor environmental conditions
lend themselves to upper respiratory tract infection and possible pneumonia. This is a
population at severe risk of disability arid premature death.
Conclusion
The evicted slum-dwellers of Ambedkar Nagar have faced multiple evictions and summary
demolitions over the last ten years..This has had a profound effect on their ability to
withstand these repeated disasters. The successful demolition of the 18th May left these
slum-dwellers homeless for a considerable period of time before alternative
accommodation was built by them. Even now the threat of further eviction hangs over
their heads. The children’s health is appalling. Over three-quarters of the children are
malnourished . The expenses incurred through repeated eviction means that the
households no longer have the resources to adequately feed their children. Their health
condition is also a reflection of an environment which is not fit for living and in which even
the most basic service provision is unavailable. This site was provided by the BMC and
State Government. It is clear that repeated eviction by the BMC and the action of its .
officials have compounded the health problems of these people.

•

9

2.
AMBEDKAR NAGAR, GOVERNMENT AND OTHER AGENCIES
Introduction

In the last chapter a report of the health of the children in Ambedkar Nagar was reported.
Malnutrition and infection are rife in this very sick population. Poverty and an
impoverished environment, both a result of repeated demolition, were identified as
compounding the health crisis in Ambedkar Nagar. In this chapter the relocation site will
be described in more detail, as will the activities of government and outside agencies in the
eviction and its aftermath. A short discussion also presents the reasons as to why the BMC
and State Government are so intent on the eviction of slum-dwellers from Ambedkar
Nagar.

The site

Ambedkar Nagar is situated on Cuffe Parade, one of the most prestigious addresses in
Mumbai. North of Ambedkar Nagar is the World Trade Centre and beyond this are rows
of apartment blocks for the upper-middle class. There is a five star hotel less than a
kilometre from the slum.

The entrance to the Ambedkar Nagar, is through a narrow lane about one hundred meters
from the Cuffe Parade bus depot. To the right of the lane is a Dhobi Ghat. Lines of
pristine white bed-sheets from some of the most expensive hotels in Mumbai billow in the
wind on washing lines along the side of the path. The residents of Dhobi Ghat have
obtained a stay order from the courts. For the moment their well built huts are safe. To the
left is a ten foot high breeze block wall topped with razor wire. Beyond this wall lies the
well drained site of the old Ambedkar Nagar.
Beyond the Dhobi Ghat the path takes a twist and narrows. It is now far too narrow for an
emergency vehicle such as a fire engine to get into the slum. Where the path narrows
trucks are forced to stop to unload building rubble. Early in the research, in August, this
was a site of intense activity. All day long men, women and little children scraped stone
and mud into containers which had been unloaded from trucks and carried it into the slum.
Even the smallest of children were seen contributing their labour by carrying containers no
bigger than a tiffin box of rubble to reclaim their new homes from the sea.
The path continues along the side of the boundary wall for about fifty yards. To the right
are three straight lanes about five feet wide. Each is about seventy yards long. They stop
abruptly at a stream. The stream is fetid and filled with rubbish and human excrement.
Beyond the stream is the imposing wall of the MHADA (Maharashtra Housing and Area
Development Authority) resettlement camp. The stream is the residents garbage dump.
Paths connect the three lanes at several places. The striking feature of this area. Area I in
Table 1.1, is the regimented surveyed accuracy in which the huts are laid out. Each of the

10

227 plots in this area is ten to twelve feet by ten feet. This is the site for those who have
been officially allocated plots in the new Ambedkar Nagar.

The character of the slum changes dramatically as one reaches the Sai Baba temple which
marks the end of the reallocation plot area. Beyond it the path becomes narrow and
uneven. The huts are noticeably less well built. The area is less well ordered. There are
fifty huts in this area, they are Area II in Table 1.1. Each is about twelve square feet. This
is the site of people who were resident in the old Ambedkar Nagar but who were not
officially allocated plots at the new site. They had evidence of tenure prior to 1 st January
1991 but were not registered in the survey carried out by the Collector’s office. They
community tried to divide the area amongst themselves but the slum-landlords moved in
quickly. One resident, a South Indian, was found dead under mysterious circumstances
one morning shortly after the eviction, his family reported that as a community leader he
organised and resisted the overtures of the slum-landlords.
Surrounding this area is a confusion of lanes, many are no more than two feet wide. The
huts are noticeably smaller. They are also very poorly built. Many have no flooring but
each has a ledge about three feet of the floor which is perhaps eight feet by three. All the
households’ meagre possessions are on the ledge. At high tide the water floods into these
houses. Often, the respondents reported, the water comes up to knee height. Twice a day,
when the tide comes in, these slum-dwellers are forced to sit on the ledge and watch the
sea water, polluted with faeces and garbage, wash into their homes. This is Area III in
Table 1.1.
The area of the slum nearest to the sea is the site of an Ambedkar Mandir and is Area IV
in Table 1.1. Here the design of the huts changes. The huts are on stilts of bamboo. The
sea can flood this area to chest height. This is the most impoverished area of the slum. The
residents who live in this area also stayed here before the eviction. Although their homes
were not part of the site the Maharashtra Industrial Development Corporation wanted for
development their huts were demolished anyway. Now the residents are rebuilding their
huts with sheets of plastic, hessian sack and cardboard. There are twenty four huts here;
impoverished man-made islands in the Arabian Sea.

As was noted in Chapter One, the area is effectively divided into four areas. The residents
define these areas with reference to their perceived security of tenure. This security is
reflected in the sites that households are able to colonise. Those who have been relocated
have the better drained sites and their huts, however crude in their construction, have been
clearly marked out by the Collector’s office. Those who have not been able to prove their
residence prior to the
1st January
1995
have fared far worse.
With increasing lack of security the condition of the people’s huts and the marginal
environment in which they are forced to live becomes ever more inhuman. Their problems
are increased because the failure of any one authority, like the Collector, to organise and

11

control the inevitable development of the area means that slum-landlords are able to move
in and profit from these slum-dwellers’ misery.

The actions of government officials in the eviction of 1998
In April 1995 the Collector of Mumbai attempted to conduct an eviction in Ambedkar
Nagar. In accordance with the procedure which must be followed prior to an eviction (see
next Chapter) a survey was conducted. In this survey 106 residents were registered as
being eligible for alternative sites under the rules laid down by the State Government of
Maharashtra; that is they had evidence of living in Ambedkar Nagar prior to 1st January
1995 such as voters identity cards, photopasses and ration cards or were on the electoral
role.
In the second week of May 1998 moves were afoot to attempt another demolition of the
slum. An NGO, Nivarak Hakk Sangharsh Samiti, has a long association with the slum.
Their activists were convinced that there were considerably more than 106 households
eligible for resettlement in the slum. They visited the Collector and arranged to conduct a
survey of the area. This they did this over a period of three days. They established that
there were in fact 283 households resident in the slum prior to 1st January 1995; nearly
three times the number of people the Collector had counted.

The Collector, Sanjay Chahande, promised to meet with the activists on the following
Tuesday to review the new survey. But on Monday the 18th May the demolition squad
moved into Ambedkar Nagar and demolished the slum. This was a cynical manoeuvre
which meant that lawyers who were preparing a petition for the High Court were unable
to apply for a further stay order on the eviction. A game of cat and mouse in which the
authority of the Courts was once again snubbed by the BMC. The eviction was conducted
before the Collector had acquired the necessary accurate information to ensure that those
who were eligible for resettlement were provided with plots. The slum-dwellers were
denied their fundamental human rights of appeal and re-housing.
What is more, the failure of the Collector to ensure that the necessary legal groundwork
had been undertaken prior to the eviction and his failure to ensure that the reallocation
was planned allowed for slum-landlords to step in and profit from the forced eviction of
the people of Ambedkar Nagar. The Collector amended his list of eligible slum-dwellers. It
still fell short of the survey estimates prepared by the social activist by 56 households. The
Collectors Office started issuing tokens to those who they thought were eligible. They
failed to survey the new site on which the slum-dwellers were to be relocated; a much
smaller boggy area to the right of the original site. No allocation letters were issued. This
confusion allowed for a land-grab to take place and for new authorities to emerge who
acted in their own self interest and not in the interest of the slum-dwellers.

12

The Collector has admitted that the rehabilitation programme has “gone out of control. I
have received several complaints of local politicians and slumlords interfering in the
work of allotment ofplots'*. But the officers from the Collector’s Office still do not seem
to be taking an active role in assigning plots. They have ordered yet another survey of the
slum-dwellers. As has already been noted this has increased the insecurity of the residents
of the slum. The failure of the Collector’s office to conduct accurate surveys and control
the reallocation of slum-dwellers before and after the eviction has increased the suffering
of the slum-dwellers. It has given slum-landlords an opportunity to profit from these
people’s vulnerability.
In Chapter One it was noted that children were admitted to hospital because of sunstroke
following the eviction. The Collector’s office failed to provide adequate protection for the
evictees in the aftermath of the eviction. The Collector has claimed that this was because
the new site could not be allocated until the old site was demolished as it formed part of
the original siteM. But it is also apparent that little has been done to ensure the safety of
these slum-dwellers in the aftermath of the eviction. Water has not been provided at the
site, there is no sanitation, paving and drainage are absent as is any form of garbage
control. As was noted in Chapter One these environmental shortfalls have compounded
the slum-dwellers problems.

The Collector, it must be accepted, has followed the rules laid down for the his actions in
an eviction. His office is under no obligation to provide services to evicted slum-dwellers;
his role is merely to allocate space for the slum-dwellers relocation. But the failure to
ensure that the slum-dwellers are adequately provided for, an issue which will be dealt
with in more detail in the next chapter, means that these slum-dwellers have suffered
intolerably and the eviction has, as was discussed in Chapter One, led to a considerable
burden of disease, disability and death. It must also be noted that the Collector’s survey
was certainly inadequate. This has compounded the health problems of these slum­
dwellers.
Outside agencies and the eviction

It has already been noted that an NGO, Nivarak Hakk Sangharsh Samiti, has had a long
association with the slum-dwellers of Ambedkar Nagar. They have mounted petitions to
the High Court to stay eviction. In April 1996 they were successful. As has already been
noted, in May 1998 their efforts to ensure that a correct ■ survey was undertaken was
accepted by the Collector. But they were out-manoeuvred in their attempts to petition the
High Court for a further stay order to stop eviction. This organisation has also ensured
that the media are aware of the condition of the slum-dwellers and have, through their
work in many slums m Mumbai, raised public awareness of the activities of the BMC in
their eviction activities. They have organised demonstrations and represented many slum­
dwellers who have been treated unfairly in eviction attempts. This has particularly been the

13

case in Sanjay Gandhi National Park where there has been eviction of slum-dwellers over
the last two years.
One of the areas of concern to Nivarak Hakk Sangharsh Samiti has been the activities of
politicians in slums and the undoubted connection between the activities of slum-landlords
and politicians. In Ambedkar Nagar their concern has been the activities of the Youth
Congress Office and, in particular, two politicians who have taken an active interest in
Ambedkar Nagar over a number of years, Ashoka Dhatrak and Dinesh Mishra. The social
activists from Nivarak Hakk are concerned that these politicians are profiting from the
slum-dwellers misery. This may be the case. Certainly there were slum-dwellers in
Ambedkar Nagar who claimed that several of the pitches in Area I of the slum were in
Dhatrak's control. The investigating team was unable to confirm this charge. But, there
were also other stories about who these sites belonged to. Stories such as these which
were told to the researchers by slum-dwellers must always be treated with considerable
caution. There are many political interests at work in a slum and there is little hope of
unravelling the complex political networks which exist, even if research is carried out over
a considerable period of time. Slum-dwellers may represent one interest or another and
will provide researchers with the story that best fits their agenda.
Ashok Dhatrak, a Congress (I) Member of the Legislative Assembly, has maintained a
long standing interest in the welfare of the slum-dwellers. For instance, in 1997 he
expressed concern about the slum-dwellers loss of livelihood in Sasoon Dock if they were
forcefully evicted to the suburbs. In doing so he contradicted the housing minister,
Chandrakant Khaire, who accused him of creating political propaganda^1. In the slum he
and his representatives appear to enjoy popular support from many of the slum-dwellers in
the resettled area of the slum.
He, alongside Mishra, have been active in the slum after the eviction. They recognised the
failure of the Collector to adequately survey the slum after the eviction and set about
conducting their own survey. Ashoka Dhatrak, when interviewed, insisted that the survey
was conducted because they identified a pressing need in the light of the failure of the
Collector to carry out his role correctly. But, many of the slum-dwellers are of the
impression that the slips which were handed out as part of the survey are official
documents and can be used to claim relocation. Many of the households where the
researchers were shown identification papers - ration cards, photopasses and election
cards - also showed us the slips of paper issued by the Congress officials. They are simple
pieces of paper tom from an exercise book which bear the name of the household, a code
number and the stamp of the Youth Congress Office. Several of the slum-dwellers are of
the opinion that Dhatrak and Mishra are in charge of the reallocation. One women who
lives in the slum reported that ^Mishra has given us chits saying that it will get us plotstr.
This slum dweller has proof of residence in the old slum. Mishra claims that the slips were
handed out to help officials identify the legitimate residents. But the message conveyed to

14

the slum-dwellers was quite different. They think they are allotment letters because they
bear the stamp of the Congress Office.

The survey by the Youth Congress was a response to pressing need in the slum It appears
to have sent the wrong signal to slum-dwellers. Ashoka Dhatrak has also been involved in
organising other service provision in the slum which is less controversial. He has
petitioned successfully for the allocation of a site for another NGO, Door Steps Schools,
to run an school in the slum. In addition, just as the survey was coming to an end a water
supply was finally being built in the slum. This is a series of water tanks fed by a pipe
which is supplied by tanker from the main road It is apparent that for the first time in the
new slum water will be available to the slum-dwellers. A committee has been formed, of
which Dhatrak is a member, which intends to petition service providers in the BMC and
bodies of the State Government for other services like toilets and paving. These will
inevitably improve the condition of the slum-dwellers.
Undoubtedly, as an elected politician Dhatrak will hope to make electoral mileage out of
his association with the slum. This relationship between politicians and slum-dwellers is a
long established and accepted way in which development happens in slums"". But, the
researchers can find no evidence that Dhatrak or the Youth Congress Office are profiting
financially from the slum-dwellers. There appears to be considerable verisimilitude in
Dhatrak’s emphatic assertion during an interview that he was not making money from the
slum-dwellers when this accusation was put to him. He was so insistent that he stated that
if the researchers could find evidence against him offinancial gain he would commit
suicide'.

There have been newspaper articles which have presented a thesis that Dhatrak is only
working in the slum for monetary gain™ There is considerable daneer in this approach
There are few dissenting voices in the politics of Mumbai when the issue of eviction of
slum-dwellers is discussed in either the BMC or State Legislature. Accusing one of the
few politicians who does appear to be championing the cause of slum-dwellers in these
forum provides those who do intend to profit from the eviction of slum-dwellers with an
opportunity to discredit politicians who are representing slum-dwellers interests. It is to
the issue of who does profit from the eviction of groups like the 5000 slum-dwellers in
Ambedkar Nagar that this Chapter now turns.
Profiting from eviction
Why was the BMC and State Government of Maharashtra so intent upon evicting 5000
people from Ambedkar Nagar? The simple answer is that the land is worth a fortune. The
first residents of Ambedkar Nagar colonised the site in about 1988. At this time the site
was a mangrove swamp. In this area of Mumbai, where real-estate is amongst the most
expensive in the world, the land was effectively worthless. Over a number of years the
slum-dwellers built up the land. They invested in truck loads of building rubble and

15

reclaimed it from the sea through their own labour. This, of course, was in direct
contravention onhe Coastal Regulation Zone (CRZ) notification of the Environment
(Protection) Act^. The slum-dwellers were breaking the law. But no-one seemed overly
concerned about this. Neither the BMC or the State Government (both of whom do not
seem to be unduly concerned about the CRZ in their developments in Bandra, Versova
and Virar) tried to stop the slum-dwellers. In fact, what the slum-dwellers were doing was
to create a very valuable piece of real-estate and they were giving their labour for free.
The slum-dwellers created an area of well drained land measuring 8000 square meters.
The value of this land is many cores of Rupees. The Maharashtra Industrial Development
Corporation (MIDC) identified this piece of land as an ideal site upon which to build a
helicopter landing pad. They have handed over the site almost free of cost to Akruti
Nirman Private Limited, whose chairman is the industrialist Dhirubhai Ambani™ The one
problem was that the site was home to 5000 people who the State Government labelled as
encroachers. To be sure, the residents of Ambedkar Nagar were encroachers, but it must
be remembered that they encroached on a piece of worthless mangrove swamp out of
necessity because they had no-where to live. In 1997 they were tenants on a piece of land
which was ripe for development, which they had built, and which, if the minor
inconvenience of 1500 homes could be swiftly destroyed, could make a fortune for a
private entrepreneur like Ambani. The deal struck between the state government needs
further investigation. If the government is selling out prime property to big business
houses cannot the same business people be made to contribute to the cost of re-settlement
and take responsibility for the health and safety of the children about whom we express
our concern?

The proposed development of a heliport is not mentioned in the Mumbai Metropolitan
Regional Plan of 1991™*. The planners obviously did not see that a helicopter service
plying between Mumbai Airport and the south of the city carrying WIPs (very very
important persons - politicians and the like), businessmen and foreign tourists for a
reputed Rs. 2500 a ride (much more than a months household earnings for many of the
slum-dwellers), as part of an integrated transport policy plan for the city. Nonetheless the
planned heliport appears to have some powerful advocates in the Maharashtra State
Legislature. The Housing Minister, Chandrakant Khaire, has suggested that ^the heliport
will be a public amenity and will be available to those who do not wish to spend long
hours travelling between the city airport and its commercial hub”™".
The other residents of Cuft'e Parade, the upper middle class, are not too keen on the idea
of having a heliport on their doorstep. They are concerned about the noise and congestion
such a development will cause. But it seems that the building of a heliport might not be the
intention of the MIDC and its private collaborators after all. There is now talk of the
heliport being put on the recently de-commissioned Indian Navy aircraft carrier, INS
Vinaut, and the land, which is now cleared of slum-dwellers, being used for much more
lucrative projects like five star hotels and offices’^. The residents of Cuffe Parade should

16

not worry too much. Their neighbours, the slum-dwellers of Ambedkar Nagar, on the
other hand, have now been evicted. They can peek through the razor wire at the land
which they built from the site that has been provided for them by the State Government
and the BMC. A site which can aptly be named Ambedkar Nagar in-the-sea.

Conclusion
The condition of the relocation site in Ambedkar Nagar is appalling. The slum-dwellers,
unsure about their future are unwilling to invest in building their huts, service provision is
lacking. The Collector has failed to adequately survey these slum-dwellers prior to
eviction and has also failed to provide adequate space for relocation. This has led to slum­
landlords having a free hand in organising housing allocation and profiting from the
eviction. Outside agencies, including politicians are trying to minimise the activities of
slum-landlords through re-surveying the site. But in doing so are sending the wrong
message to the slum-dwellers. They are also involved in trying to develop the site in the
absence of any humanitarian assistance from the government. Meanwhile it is apparent
that the government, and probably individual politicians, alongside already rich
entrepreneurs are benefiting directly from the slum-dwellers free labour in reclaiming the
land upon which Ambedkar Nagar once stood to build their own projects. This is being
done at the expense of considerable human suffering. In the final chapter the report
investigates forced eviction throughout Mumbai in detail.

17

3.
FORCED EVICTION IN MUMBAI

Introduction
Forced eviction is an evocative term. It is also a tautology. For, people do not give up
their homes to the bulldozer willingly. But it is a useful term because it describes the
violence of the act and it provides a starting point in the understanding of pain and human
suffering caused by displacement by force. The eviction in Ambedkar Nagar and the
evictions which will be discussed below cannot be wholly described as illegal evictions - a
term which has been suggested by some observers as a replacement for forced evictions”.
An illegal eviction assumes that there is a framework of enforceable laws which protect
the citizens’ rights to adequate shelter and security of tenure. This is not the case in India
even though its leaders have signed Conventions at the United Nations protecting the right
of its citizens to adequate and secure shelter.
A third term has been used for the removal of people against their will from their homes
and communities. This is unfair eviction. This term does not take into account any legal
framework.

This report has dealt with one unfair eviction in detail, that of Ambedkar Nagar in Cuffe
Parade. Several more examples will support a case that the Brihan Mumbai Municipal
Corporation and the State of Maharashtra are guilty of gross violation of human rights in
their programme of unfair, illegal and forced evictions of the poor in the city of Mumbai.
In Chapter one the disastrous effects of demolition’s on the health of people was amply
demonstrated. Repeated displacement and demolition prevents the normal growth and
development of children who are bom and brought up in these settlements. This report
will deal with two further topics in addition to a general discussion about forced eviction
in the city of Mumbai. It will show how the campaign of eviction of the poor in the city is
not earned out in the interest of development, as is so often claimed. Instead the forced
eviction of people from their homes in this city are carried out, first and foremost, to
enrich politicians, builders and speculators pockets at the expense of so much human
suffering. Already this report has dealt with the issue of human suffering in a very tangible
way in a discussion of the health of children who have been forcefully evicted from their
homes in Ambedkar Nagar to make way for a development project dreamt up by the State
Government of Maharashtra, a heliport.

The politicians, the builders and the speculators
The decision makers in this city, the politicians and their generals at Azad Maidan,
Mantralaya and Kalanagar, have a very limited view of the problems of the city of
Mumbai. Essentially, they claim that Mumbai has three problems. The first is that the

18

population is growing too quickly through migration of immigrants to the city. There is a
belief among them that many of these migrants are illegal’0". Second, it is claimed that
there is not enough land in the city to house all of the twelve million or so people who live
in Mumbai. The third myth is an assumption the poor in the city are a break on its
development. There is another misconception that harassment of the poor by repeated
demolitions will force people back to their native places.

The first untruth can be quickly dispelled. Mumbai is now growing more quickly through
children bom in the city - true Mumbaikers - than through in-migration from rural
Maharashtra and other states. The 1991 Census’04" recorded that in the previous decade
migration accounted for only 16.8 per cent of the growth of Mumbai. The remainder was
through natural growth. New-borns accounted for the addition of 14,00,000 people to the
population between 1981 and 1991.
The second myth is that there is not enough land in the city for everyone to live on. One
need only travel through Mumbai to see that there are large tracts of land which are fenced
off and unused. Again the figures are compelling evidence against the myth. Gonsalves
calculated that there were 8094 hectares of free land in Mumbai in 1982’OU,,. Much of this
land was left in the hand of its original owners if they could demonstrate that they would
use the land for a ‘public purpose’ under the Urban Land Ceiling and Regulation Act
(ULCR). The ambiguity of this term in the act has provided a loophole through which the
development of huge tracts of excess land for public use has been stopped with the
connivance of politicians and bureaucrats™.
The third belief is that the poor do not play an important role in the economy of the city.
Employment rates in the slums of the city are considerably higher than they are in middle
class areas. Madhura Swaminathan has shown this to be the case in two slums’4^. Her
figures compare favourably with the figures published in the Census of India. It is well
recognised that the middle class depend on the over-employed poor in low wage jobs, to
maintain their standard of living. Sweepers, manual workers, tradesmen vendors, auto­
rickshaw and taxi drivers, domestic servants all live in the slums.

In Ambedkar Nagar the women clean prawns and fish at Sassoon Docks, or they work as
domestic servants in upper-middle class households of Cuffe Parade. The men work as
watchmen, or they clean and carry fish at Sassoon Dock for less than Rs. 70/- for a whole
day’s work. Many of the residents of Ambedkar Nagar first came to Mumbai as
construction workers, lured into the city by contractors; cheap labour to build the
ostentatious skyline of the modem city. Once their work was finished they were
abandoned. Now the same builders, in collusion with the politicians of the city, have
forced them out of their homes and grabbed a valuable piece of land for their profit to
build a helipad for the rich.

19

The politicians do appear to offer concessions to those who they order to be evicted. The
State Government has ruled that anyone evicted who can prove their residence prior to the
1 January 1995 in the electoral lists will be resettled. But this generous gesture can be
quickly forgotten or circumvented, as we shall see, when the poor are evicted from their
homes. The reality is that the politicians’ aim is to clear the city of the poor - they have a
vision of a clean Mumbai, a beautiful Mumbai.. The politicians, in league with builders and
speculators, are profiting from human misery.
Forced eviction

It is estimated that over ten million people a year are forcefully displaced to make way for
development projects around the world. The two most common reasons for forced
eviction are the building of dams and the development of urban areas and their
transportation systems**''1. As Sainath recognises**''" forced evictions and displacements for
development projects make more people homeless than armed conflict. The human torrent
of refugee misery streaming across international boarders, the hundreds of thousands who
fled from Rwanda to Zaire for instance, touch us because the media chooses to show us
their suffering on the television and in our newspapers. Rarely, if ever, can we grasp the
enormity of the other refugee problem, the diffuse rivulets of forced eviction - households
and communities who make way for development projects. Around the world the
equivalent of the population of Mumbai are forcefully evicted from their homes every
year. Their plight is unnoticed and the media, invariably, silent.

The Brihanmumbai Municipal Corporation and the State Government of Maharashtra are
actively involved in perpetuating the human suffering caused by demolition orders. In
1985 the Supreme Court**''1" ruled that the BMC and State Government were entitled to
evict pavement and slum dwellers from government owned land and from public roads.
The only concession that the slum dwellers were given in this ruling was that they should
not be evicted during the monsoon. In this judgement the issue as to whether pavement
and slum dwellers should be given notice of eviction, mentioned in Section 314 of the
Municipal Corporation Act, hinged on an interpretation of the phrase “the Commissioner
may, without notice, cause an encroachment to be removed”*"*. The judges decided that
this decision should be left to the discretion of the Commissioner.
The petitioner’s main argument was that forced eviction contravened Article 21 of the
Indian Constitution:
... that no person be deprived of his life except according to the procedure of law.
The learned judges’ approach was to accept the status-quo. They accepted that little could
be done about the massive scale of poverty in India and, having commented on this sad
state of affairs, moved swiftly on to the issues of the notice of eviction and the torts of
trespass. In short, the now infamous Supreme Court Judgement of 1985 provided the
BMC and Maharashtra State Government with the green light to step up forced evictions
of slum dwellers and those living on the pavement. Subsequently, the ruling on ‘notice’

20

has since been changed in favour of the evictees. But, as will be shown below, the notice
given prior to a demolition is often inadequate and does not take into account the working
hours of slum dwellers or the and harsh weather conditions into which those living in
slums are forced to survive without habitation.

The BMC and State of Maharashtra has been only too willing to demolish slums. Slum
and pavement dwellers can, after all, be blamed for every failure of services in the city.
The trains do not run on time because of slum dwellers. The city floods because of slum
dwellers. The bio-diveristy of its coast and national park are being lost ... because of slum
dwellers. Demolition squads are working in the city, razing people’s homes and bringing
upon these people untold misery. The newspapers report only a small part of their
activities. In general the reporting of evictions happens only when a NGO becomes
concerned about the slum dwellers’ plight and brings the forced eviction to the attention
of the local and national press. One of the most significant problems slum dwellers have is
that they are not articulate like the middle class. They rarely have voice. Their plight is
invariably a silent one. Even so, and assuming the reported cases are only the tip of the
iceberg, a review of reported evictions for one year makes exceedingly grim reading.

Table 3f L Reported forced evictions in Brihan Mumbai June 1997 - June 1998m
Date
Site
15 June 1997
Babrekar Nagar and Kharodi Nagar,
Kandivili (E)________________________
3 October 1997
P. D’Mello Road
________________
8 November 1997
Pimpripada_______
?
Ambujwadi, Malad______
Ganesh Nagar, Malad_________________
19 November 1997
Mahakali Nagar, Worli________________
28 November 1997
New Kharodi Nagar, Malad (W)
4-29 December 1997 Gautam Nagar, Kandivili (E)___________
17 December 1997
Deepak wadi Santa Cruz (W)___________
8 January 1998______ Samarthnagar, Chembur_______________
19 March 1998______ Duttapada, Borivali (W)_______________
17 May 1998_______
Ambedkar Nagar, Cuffe Parade_________
25 May 1998_______
Garib Nagar, Bharmapada, Bandra (E)
26 May 1998_______
Rajiv Gandhi Nagar_________________
22 June 1998
Shimpal Cross Road, Borivali (W)
The BMC and the State of Maharashtra are on a demolition drive. In November 1997
Girish Gokhale, Municipal Commissioner in charge of demolition, and his lieutenant, A.N.
Dube, Deputy Municipal Commissioner in charge of demolition, could proudly announce
that they had demolished 11,500 structures. They had made 55,000 people in the city

21

homeless. Their political masters were not content with this achievement. They called on
the demolition squads to raze another 35,000 illegal structures and make another 167,000
people homeless. This orgy of demolition was only slowed down, but did not stop, when
an unexpected General Election was called in early 1998. As soon as the election was over
the drive quickly regained its earlier momentum. The only peace many slum dwellers can
hope for in the city of Mumbai, it would appear, is when the politicians are canvassing for
votes.

Even though the newspapers report only a very small sample of the evictions in the city,
the stories of gross violations of human rights shine through. Two of the reported
evictions were a mistake. The Mayor of Mumbai, R. T. Kadam, ordered the rebuilding of
Shimpal Cross Road settlement because the slum dwellers had already proved their right
to the land in a previous forced eviction a few years earlier. Suresh Jain, the State Housing
Minister, had to admit that the demolition of Duttapada in Borivali was also a mistake.
This must have been of little consolation to the slum dwellers who had lost their homes.

The demolition squads are cavalier in their approach. They care little for the rights of the
slum dwellers whose lives are ripped apart through their activities. In Gautam Nagar, New
Kharodi Nagar and Pirtipripada, even those slum dwellers have been evicted who had
substantial proof of residence prior to 1 January 1995. This is the cut off point for
rehabilitation by the State announced as part of the now defunct Slum Rehabilitation
Scheme. Samarthnagar in Chembur was demolished despite the slum dwellers having
obtained a stay order from the High Court. In Garib Nagar the BMC was ordered to
conduct a detailed survey before they started the eviction. Many of the residents reported
that their huts had not been surveyed and they had not received notice of the eviction.
Indeed, one resident was shocked to return home from work to find that his hut had been
flattened by the bulldozer.

For those who do have proof of residence prior to 1 January 1995 the BMC and State
Government are obliged to provide alternative sites for these people to live. Many of the
65,000 people evicted from Bhabrekar Nagar were shipped to Akashwani area in Malvani
on the outer edge of Mumbai. This site had no service provision. There was no accessible
water supply, no electricity and no sanitation. The nearest bus to the city and to these slum
dwellers’ work places is a half hour walk away. Sections of the site are too slippery and
mucky to walk safely. It is true that R B. Lad, the Deputy Collector, worked hard to issue
reallocation notices to many of the slum dwellers who were evicted from the slums of
Kandivali, Malad and Worli. Serving re-allocation notices is not enough. Where are they
being re-settled? How far is the resettlement site from the demolished site? How far is it
from the place of, work? Is it the site fit for human dwelling? Are basic amenities being
provided in time?
Forced eviction is a violent and disruptive activity. The demolition squad is invariably
accompanied by a phalanx of armed, lathi wielding policemen. In Gautam Nagar forty

22

slum dwellers required hospital treatment during the eviction. Three of the slum dwellers
were so badly injured that they had to be kept in hospital. In Pimpripada the police lathi
charged the slum dwellers. The officials claimed afterwards that there had been stone
throwing but witnesses denied that this was the case. The violence of eviction can often
lead to tragic consequences. On the 26 May the demolition squad moved into Rajiv
Gandhi Nagar. They gave no notice that they were to start an eviction. This blitzkrieg
approach left one eight month old baby dead.

Why then is the BMC and the State Government so hell-bent on destroying so many
peoples lives? We return to the points made in the final section of Chapter Two. The slum
dwellers in Bhabrekar Nagar first colonised the area of their slum over ten years ago. It
was a creek to the Arabian Sea. They have worked hard to make the area liveable. They
have invested large amounts of their labour, time and money reclaiming the land and
draining it. When they moved to the creek the land was worthless, now it is valuable real
estate. These slum dwellers were evicted so that builders can take over the land and make
a fortune erecting sky-scraper flats, offices and shopping centres for the rich.
The second reason is political. Bhabrekar Nagar was razed in a violent maelstrom of
demolition on the 15 June 1997. The monsoon had just started. The claim in the previous
day’s editorial of Saamna that this slum was home to illegal Bangladeshi infiltrators
contributed to the hasty demolition™ The demolition squad’s knee jerk reaction was to
bulldoze the slum. An act of planned ethnic cleansing. The facts were wrongly reported.
Retired judge V R Krishna Iyer™1 established that ninety per cent of the residents of
Babrekar Nagar were from Uttar Pradesh. This, of course, was little consolation to the
homeless families of Babrekar Nagar who were forced to live out in the open during the
monsoon. They were the unfortunate pawns in a game of communal politics. Defiance of
the rulings of the Supreme Court of India, by demanding a forced eviction in the monsoon
can only be done be a powerful few.

Legal or illegal?

At high tide in Ambedkar Nagar, Cuffe parade, water laps around the crudely built mandir
dedicated to Babasaheb Ambedkar. The author of the Indian Constitution looks out from
the faded colours in the picture over the devastation of poverty which is the slum named
after him. Propped up on the rough stone ledge of the mandir above the fetid, tidal waters
one wonders what Ambedkar would think if he could see the progress India has made in
fifty years of Independence. To be sure there is a stark contrast. Reflected in the filthy
waters is the impressive symbol of Mumbai’s present and imagined future, the World
Trade Centre. But the reflection feels like the intrusion of another world. The buzz of
commerce and dealing rooms soaring thirty two stories into the monsoon grey sky of
Mumbai has little relevance to the people of Ambedkar Nagar. They, like the hundreds of
thousands of people evicted from slums and pavements, find little solace in the structures
of modem India; the proud monuments of the commercial capital or in its civil society.

23

Sitting beside the temple. Selvaraj, an old man before his time, expresses the bitterness and
desolation the slum dwellers of Ambedkar Nagar feel:
What does the government give us? - nothing except poverty and grief. They give
us nothing, they just take, take, take. First they took my labour, my youth, now
they take my home. They smash my home and possessions to dust under their
bulldozer. They have forced me to live on a mala (a platform) made of plastic and
bamboo. I step oft' this platform into knee deep water. My government wants to
kill me.
What hope is there for Selvaraj and the other slum dwellers of Ambedkar Nagar? Do they
have recourse to the law? Are there representatives in the civil society of Mumbai who can
provide these people with a secure life for themselves and future generations?

The very sad answer to these questions is that there is very little hope of Selvaraj being
given justice before the law. For him and for future generations of slum dwellers the
present situation looks exceedingly bleak. We have already seen how disinterested the
Supreme Court was in the plight of slum and pavement dwellers in Mumbai. Slum
dwellers are held in very low esteem by the representatives of the rich*™". Here is how the
learned judges of the Supreme Court characterised pavement and slum dwellers in 1985:
Their (pavement dwellers and slum dwellers) homes exist in the midst of filth and
squalor, which has to be seen to be believed. Rabid dogs in search of stinking meat
and cats in search of hungry rats keep them company. They cook and sleep where
they please. Their daughters come of age, bathe under the nosy gaze of passers-by,
unmindful of the feminine sense of bashfulness. The cooking and washing over,
women pick lice from each other’s hair. The boys beg. Menfolk without
occupation snatch chains.. (ad nauseam)xxxlv
As we have also seen, even when the courts pass orders they are wilfully ignored by those
in power in Mumbai. Huts are demolished even though stay orders have been passed by
the High Court of Mumbai. Officials fail to conduct adequate surveys despite an order
from the Supreme Court of India. Slum dwellers continue to be evicted from their homes
in the monsoon. The BMC and the State of Maharashtra are contemptuous of the
authority of the Courts. In Ambedkar Nagar, Cuffe Parade and Malvani they have not
even provided the essentials for life in resettling the slum dwellers.

On two separate occasions the Supreme Court of India has given rulings on basic needs.
In the case of M/s Santistar Builders vs. Narayan Khimalal Totame the judgement ruled
that:
Basic needs of man have traditionally been accepted to be three - food, clothing
and shelter. The right to life is guaranteed in any civilised society. That would take
within its sweep the right to food, the right to clothing, the right to decent
environment and reasonable accommodation to live in. The difference between the
need of an animal and a human being for shelter has to be kept in view. For an

24

animal it is the bare protection of the body; for a human being it has to be a
suitable accommodation which will allow him to grow in every aspect - physical,
mental and intellectual. The constitution aims at ensuring fuller development of
every child. That would be possible only if the child is in a proper home. It is not
necessary that every citizen must be ensured of living in a well-built comfortable
house but a reasonable home.. .xxxv

In 1991 the Supreme Court returned to the issue of interpreting Article 21 of the Indian
Constitution (Francis Coralie vs. Union Territory of Delhi). The learned judges again
considered the issue of the right to life. “We think”, they commented, ‘"that the right to life
includes the right to live with human dignity and all that goes along with it, namely the
bare necessities of life such as adequate nutrition, clothing and shelter over the
head...”^*

The Supreme Court has established that the right to life demands certain basic needs. The
learned judges are not medical doctors or, indeed, educationalists. Their basic needs list is
limited. To their list must be added an adequate and clean supply of water. After all, over
1.5 million children in this country are estimated to die because of diarrhoea every
yearxxxv“; countless more will die prematurely because of repeated and chronic gastro­
enteritis. In the same vein, sanitation must also be considered because adequate provision
of faecal disposal ensures that the lethal chain of faeco-oral transmission is brokenxxxvul. If
children are to develop mentally and intellectually electricity to light their homework is
essential. The State Government of Maharashtra accepts that electrification is a basic
indicator of development.
Indeed the State Government accepts that adequate services are essential for the
development of the slums. In a report they commissioned - A Programme for
Rehabilitation of Hutment Dwellers in Brihanmumbai***1* - the authors suggest that
rehabilitation sites should have adequate water, sanitation and electrification. In
contradiction to their own guidelines and in a contempt of the Supreme Court of India the
BMC and the State Government of Maharashtra continue to evict people from their homes
to flooded, un-serviced resettlement sites which do not have the basic needs required for
the right to life.
What of the larger issue of forced eviction with which this report is also concerned? Indian
law has very little to say about forced eviction. Uprooting people from their homes is, as
Sainath^ has recognised, an integral part of India’s development process. But India is
bound by International Convention. In 1976 India ratified the International Covenant on
Economic, Social and Cultural Rights (1966). Article 11(1) of the Covenant is
unambiguous. It expressly recognises the “right to... housing and continuous
improvement in living conditions”5111 In 1993 it signed an International Resolution on
Forced Eviction^. These UN Resolutions are binding. A recent case in the Mumbai High
Court confirmed that under Article 51(c) of the Constitution of India the State shall

25

endeavour “to foster respect for international law and treaty obligations”. Article 73(1)
extends the executive power of the Union to the “exercising of rights, authority and
jurisdiction as are exercisable by the Government of India by virtue of any treaty or
agreement”xI,,,. The BMC and the State of Maharashtra are bound by the resolutions their
Union Government signed. Under the Covenant the Union Government has the ultimate
legal responsibility for preventing forced evictions.
Conclusion

Resettlement is an inevitable part of the development process. Of course it would be
foolish not to recognise this, at some point, people’s homes will come in the way of
projects to improve the infrastructure of a city like Mumbai. These homes may be in slums
or, much less likely, they may even be in the rich suburbs of Malabar Hill. This report is
not a call for a maintenance of the status-quo in which no resettlement can be considered.
Its concern is that any resettlement should be conducted humanely and should respect the
fundamental human rights of the people who are being resettled. People should have the
right to live in security and dignity in affordable housing which is habitable and provided
with adequate services.
An eviction is fundamentally different from a resettlement. As we have seen evictions are
rarely conducted after adequate and genuine consultation with those who are affected.
Rarely is sufficient notice given to the people who are to be evicted so they can gather
their possessions and make plans for the future. As was seen in the examples cited earlier,
officials of the demolition squad do not provide useful information to the slum dwellers
about when and how the eviction will take place. Resettlement officers of the Collectors
Office do not always provide liveable alternative accommodation for the slum dwellers.
Often, as in Babrekar Nagar, the slum dwellers are simply left to fend for themselves.

Demolition in Mumbai is, more often than not, conducted with excessive force. The police
are employed as boot-boys. We have already noted cases of hospitalisation and one death.
Deaths can be caused directly or indirectly during and after a demolition by injuries,
exposure to the elements, inadequate provision of safe drinking water and proper
sanitation leading to gastro-enteritis and dehydration and inadequate access to medical
care. It is also apparent that when an eviction is to take place the slum dwellers, many of
whom are illiterate, need advice on their legal rights. Neither the BMC or the State
Government of Maharashtra provide these services. In fact, despite publishing guidelines
about how a resettlement should be undertaken,3'1^ the authorities in Mumbai choose to
ignore them. Rather than resettlement the BMC and the State Government of Maharashtra
are actively involved in forced eviction. They are, in the words of the International
Resolution on Forced Eviction, undertaking “a gross and consistent pattern of human
rights violations affecting large numbers of people”3^.

26

On the 15 August, 1947, O P. Ramaswami Reddiar, the Premier of Madras Presidency,
presented a vision of how India would have to grow in its Independence. He stated that.
Unless the common man in this country is well clothed, fed and housed, our
attainment of political freedom will have no meaning. The real freedom can come
only when ignorance and poverty are driven out of our country. The strong should
not oppose the weak but try to elevate them in all walks of life.
Fifty years later, there is ample evidence of neglect and oppression of the weaker sections
of Indian society. Development is seen to cater to the needs of the powerful and the elite
at the expense of the poor. As this report has shown their are many in the city of Mumbai
who have inadequate food, are ill-clothed and are repeatedly evicted from their homes, xx

Conclusion
This paper is the result of the first in a series of investigations that will look into the state
of children living in slum settlements in the city who are evicted from their homes. We
express concern for short and long term ill-effects on the growth and developemnt and
safety of children who are time and again evicted from their homes. Undemutrition,
disease and emotional stress are the end result of both being evicted from their homes and
watching their parents find ways of coping with repeated and violent demotitions.

This study raises a few questions. Can the Municipal Corporation of Greater Mumbai who
are responsible for the health of the city remain oblivious of the devastating effect of the
demolitions carried out by them on the health and safety of children. No attempt is being
made by the state to study the problem. And predictably, there are no preventive measures
instituted to avoid the ill-effects on the health of the children.

Recommendations
Medical facilities are not provided at the site, shelters are not provided to keep children,
women and the old from the exposure to harsh weather conditions.

• Identification of resettlement plots which are fit for human dwelling
• Allottement of pitches by name prior to the demolitions
• Prior provision of basic amenities such as water and sanitation at resettlement site
• After allotment of pitches, a minimum of eight days should be allowed for the change
in residence

• Therefore demolition should be carried out only when homes are vacated
• Shelters to be provided for transit period
• Exposure to harsh weather conditions must be taken into consideration while deciding
the time for demolition
• Medical cover to be provided at site
• Maximum efforts should be made to provide permanent rather than temporary sites

Repeated demolitions should not be seen as a means of persuading people to move back to
the villages. India is a signatory to the UN Convention on Economic and Social Rights and
the Covenant on Rights of the Child. It has also been party to various resolutions passed at
the UN related to evictions. The way demolition's are being carried out today contradicts
any of the commitments made at the UN It is time we strengthen our campaigns to give
teeth to these resolutions.
We call upon health professionals to recognise the effects of the repeated demolitions on
the health, growth and development of the increasing number of children living in slum
settlements . Health care providers should strongly oppose the violence that demolition’s
cause and actively work to help children continue to grow and develop in a safe and
healthy environment.
‘ see Unit—5/Desk 15/Regr No. 393/95 signed by the Additional Collector
" ‘Demolition sends infants to Cama’. The Asian Age. 23 May 1998: l&l 1.
“ Entitlement to reallocation is through proof of residence through Ration Card, Photopass or Election
Card prior to 1st January 1995.
** For discussion of the use of General Meetings, Focus Groups and Open ended interviews see Kruegar.
R.A. (1994) ‘Focus groups, second edition.’ Sage. New Delhi and Patton. M.Q. (1990) Qualitative
evaluation methods. Sage. London.
vGhai. O.P. (1982) Essential paediatrics. Interprint. New Delhi.
* Sommer. A. Tarwotjo. 1. Hussaini. G and Susanto. D. (1983) Increased mortality in children with mild
vitamin A deficiency. The Lancet li:585-8.
Geetha. S. and Swaminathan. M. (1986) Nutritional status of slum children of Mumbai, a socio­
economic survey. Economic and Political Weekly 19(14):896-900.
ibi<L
“ Corbett. J. (1988) Famine and household coping stratergies. World Development 16(9): 1099-1112.
x Desai. D. (1998) ‘Rehabilitation ‘slips’ on politics’ Indian Express, 18 June, 1998.
” Deshmukh. S. (1998) ‘No reprieve for helipad victims’ The Times of India. 29 May 1998
Basu. R. (1997) ‘Slum dwellers, govt, battle over helipoort at Cuffe Parade’ The Times of India. 19 May
I997
de Witt. J. (1996) ‘ Poverty, policy and politics in Madras slum’ Sage. New Delhi. Lynch. O.M. (1974)
‘Political mobilisation and ethnicity amongst Adi-Dravidas in a Bombay slum.’ Economic and Political
Weekly. 9(39): 1657-68.
Desai op. cit.
*v Coastal Regulation Zone (CRZ) and Regulating Activities Notification under Section 3(1) and Section
3(2Xv) of the Environment (Protection) Act, 1986.
** Express News Service (1998) ‘Land allotment for helipad cancelled’ Indian Express. 13 January, 1998.
*** BMRP (1995) ‘Regional Plan for Mumbai Metropolitan Region.’ Government of Maharashtra.
Basu. R. ((1997) ‘Slum dwellers, govt, battle over heliport at Cuffe Parade.’ Times of India 19 May,
1997
”x Express News Service op. cit.
United Nations Committee on Economic, Social and Cultural Rights. E/C. 12/1997/4. General Comment
no. 7 (3). May 1997.
see for instence Hosbet. S. (1998) ‘Forced Evictions’ An Indian People’s Tribunal Enquiry into the
brutal demolitions of pavement and slum dwellers homes.
Census of India (1991) ‘Provisional results for the State of Maharashtra (IX).’ Office of the Registrar
General. Ministry of Home Affairs, Government of India. New Delhi.
Gonsalves. C. (1981) “Bombay, a city under siege’ Institute of Social Research and Education.
Bombay.
Desai

“’Desai
Swaminathan. M. (1995) ‘Aspects of urban poverty in Bombay.’ Environment and
Urbanisation. 7(1):133-143.
Sainath. P. (1996) ‘Everybody loves a good drought.’ Penguin. New Delhi,
'“'ibid.
“'"1 Olga Tellis and Ors. vs. Bombay Municipal Corporation and Ors. Writ Petition Nos.
4610-4612 of 1981.
ibid. p47
m sources :The Times of India, the Economic Times, the Hindu and The Indian Express File 10a CED
XXX‘ As quoted in ‘ inquest of Bhabrekar Nagar’. A Report of the Fact Finding Mission constituted by
Habitat International Coalition. 1997. P.

xxxii Op. Cit.
xxxn* Hospet ibid.
^Tellis ibid. pl.
xxxv Ms Shantistar Builders vs. Narayan Kinmalal Tatame S.C. 633. (1990)
xxxv* Francis Coralie vs. Union Territory of Delhi S.C. 753 (1991)
XXXVH Hardoy. E. Caincross. S. and Satterthwaite. D. (1990) ‘The poor die young’
Earthscan. London.
xxxv,,, Esray. S.A. and Habicht. J.P. (1986) ‘Epidemiological evidence for health benefits
from improved water and sanitation in developing countries.’ Epidemiological Review.
8:117-128
xxx,xTata Institute. (1994) ‘A Programme for Rehabilitation ofHutment Dwellers in
Brihanmumbai.’ Tata Institute. Mumbai.
d Sainath ibid.
d* quoted in Rego. S. (1997) ‘The Urban Shim: exploiting the eyesore.’ Humarscape.
January: 10-13.
d" U.N Commission on Human Rights Resolution on Forced Evictions (1993/77)
d”1 quoted in (1995) The Review 3(1): 11
d,v Tata Institute ibid. p. 1 &
x,v United Nations Committee on Economic, Social and Cultural Rights ibid.

India: World Bank Review Mission
Family Welfare Urban Slums (Population VIII) Project. Or. 2394

IN

September 2000

Aide Me mo ire

__________ Key Project Data
Effectiveness Date
May 1994
Closing Date
June 2001
Project Age
<8 years from
Board approval
% Disbursed
47%

_________ Curren t_I< atings & Fl a gs
Development Objectives
S
Implementation Progress
S
Problem Flags
None

1.
A review of implementation progress of the Family Welfare Urban Slums Project was
undertaken by a team consisting of Mmes./Messers. G. N.V. Ramana {Mission leader), Sadia
Chowdhury, Preeti Kudesia (Sr. Public Health Specialists), Supriya Mukherjee (IEC and Social
Mobilization), Anu Bharadwaj (Training), Subhash Chakravarthy (Civil works). Mam Chand
(Procurement) and Rajat Narnia (Financial Management) during the period September 14 to
October 4, 2000. Mr. Tawhid Nawaz (Team leader) joined the mission between September 28Ocotber 4, 2000. The mission met with Mr. A. R. Nanda, Secretary Family Welfare, Government
of India (GOI), Mr.Gautam Basu, Joint Secretary, Family Welfare, Secretaries of Health and
Family Welfare of the project states, Project Directors and various officials. The mission
undertook field visits to the states of Andhra Pradesh, Karnataka, West Bengal and the national
capital Delhi. The mission would like to thank the officials and project staff for facilitating field
visits and for their hospitality. This Aide-Memoire summarizes cross-cutting issues across all the
project cities and highlights the mission's assessment on the feasibility of completing the program
which was restructured during the Mid Term Review (M FR). T he Aide-Memorie was discussed
with GOI during the wrap-up meeting on October 3, 2000. Separate Aide-Memoires highlighting
specific issues for each project state were discussed and shared with project states during the
visits to the respective states. The mission objectives and list of documents/reports received
during the mission are provided in the annex.

Background:
2.
The project provides credit to support (iOl’s National Family Welfare Program by
assisting four municipalities (Bangalore. Calcutta, Delhi and I lyderabad) to reduce fertility and
improve maternal and child health in slum populations. The MTR of the project undertaken
(jluring May/June 1998 estimated savings of about USS 38 million mainly due to depreciation of
Indian Rupee against the SDR and implementation of IDA assisted nationwide Reproductive
and Child Health Project that overtook the need to utilize about US $ 10 million for preparation
of state-specific projects in additional states. The MTR mission appraised GOI’s proposal to re­
structure the Project to:
•
expand successful activities in current four metropolitan areas so as to increase coverage
by additional 1.5 million beneficiaries
• expand the geographic scope of the Project to 94 additional smaller municipalities and
cities in the current Project States of Andhra Pradesh. Karnataka, and West Bengal
covering an additional population of about 4 million; and
• strengthen the logistics system to improve the quality of urban family welfare services in
the additional States of Uttar Pradesh and Tamil Nadu.

3,
The Country Portfolio Performance Review of June 1998 reviewed this proposal and
concurred with the restructuring. However, several factors, including two national elections,
resulted in significant delays in obtaining GO! clearance for the revised scope of the project.
Cabinet clearance was finally obtained only in January 2000. 1 he Board cleared tlie expanded
scope of the project subsequently and the legal amendments were signed on August 21, 2000.
Due to delays in obtaining GO1 clearance, the May 2000 review highlighted concerns regarding
the feasibility of completing the agreed additional activities before project completion. It was
agreed that GOI would undertake a detailed assessment and discuss the feasibility of completing
these activities during the September 2000 mission. The Aide-Memoire summarizes the main

findings and recommendations.
Development Objectives:

/

The development objectives of the project are being met in four project cities, a) Reduce
4.
fertility among slum populations in four municipalities: More than half of the eligible couples in
project cities use one or other modern family planning methods compared to a third at baseline.
There has been a steady increase in use of spacing methods and 47% of the low parity couples
(less than 2 children) in Calcutta and about 17% in Delhi have adopted Family Planning, b)
Improve maternal and child heath: Fhe output indicators from the MIS suggest that more 80/o of
women delivered during past 6 months in all the four project cities had three antenatal check-ups
during pregnancy. Except for Delhi, where less than a fifth of the beneficiaries had institutional
delivery, other project cities had close to 90% safe deliveries. Nearly two-thirds of eligible
children in all the project cities received measles immunization. These findings are corroborated
by MTR studies and RCH rapid household surveys.
Completing the Remaining Project Activities:

5.
The feasibility of completing the remaining project activities was discussed in detail with
each state and GOT The mission notes that the work program including civil works and service
delivery for:

(i)

(ii)
(iii)

the program for the project cities can be completed in the remaining lime, provided the
state governments ensure the funds for this fiscal year are released in time and monitor
implementation closelv. I he civil works in Hyderabad and Delhi need considerable
acceleration but are doable;
the program for the additional cities in all the three states can also be completed by June
2001 provided that all works are grounded by November 30, 2000: and
the Ipgistjc support component can also be complclcd by June 2000, piovidcd that all
works are grounded by October 31.2000.

Although this program can be accomplished within
6.
witnin this
mis time
ume frame,
iramu. nit will
win require
icqiniu
considerable acceleration. This is an optimal scenario and some delays may result which are yet
unforeseen at this time. All state governments and GOI have affirmed their fullest support and
committed to monitoring the program during the next nine months. I he Bank team will also be
continuously monitoring progress against very firm benchmarks and deadlines. Should any
slippage occur, it will advice the government to cancel those parts of the program that are not
meeting these deadlines. The following is the status of activities in these components.
...

2

• -i

-------------------- 1

Activity Status:
Project cities Component:

7.
Overall implementation progress of the project continues to be satisfactory in Calcutta,
Bangalore and Hyderabad. GOI has expeditiously addressed the funds flow problems m Delhi
and Hyderabad highlighted in the May, 2000 review. Consequently, implementation progress in
Delhi has improved during the past 6 months and the mission rates it as marginally satisfactory'.
In the case of Hyderabad, the State needs to provide Rs. 12 Crores without which the agreed

commitments cannot be met.
8.
More than three-fourths of the planned community based workers are in position and are
acting as social mobilizers to inform and motivate the slum residents to access I P and MCI I
services offered in the project. Outreach and clinical services are being provided to slum residents
as planned and service records indicate increased utilization of facilities. Calcutta continues to
demonstrate good public-private partnerships. Staffing of maternity homes, especially staff nurses
and specialists, need urgent attention in the remaining project cities. Most training programs
planned in the project have been completed (see state specific Aide-Memoires). I raining of
trainers provided in the project cities improved the effectiveness of the medical officers as
trainers of community based volunteers. All cities are implementing decentralized hands on
training for the community volunteers and outreach workers. Agreements were readied with
project cities regarding special training inputs required in clinical and inter-personal sk. Is during
the reminder of the project and integration of project training activities with that of RC k A
project cities continue to implement IEC activities based on agreements reached m the July 1999
workshop giving attention to improve behaviors relevant to project development objectives. Delhi
continues to lead in IEC efforts with strong focus on monitoring outcomes after IEC inputs.
9
Management Information Systems (MIS) established under the project continue to
function well in Delhi and Calcutta. Bangalore and I lyderabad, which lagged behind, have also
started generating disaggregated data on the status of project beneficiaries. However, this data
needs to be regularly validated. With 9 months remaining m the project, steps now are needed to
integrate the project activities with that of the primary health care program and referral hospitals
in the project cities. Specific agreements were reached with the project authorities towards this

end.
'10.
In both Hyderabad and Delhi nearly 50% of the major works are in different stages of
completion which need to be closely monitored. Both Calcutta and Bangalore have made goo
progress in completing most of the originally approved works. The major pending works include
maternity homes approved diirinp the M l K. I lelln has completed only 10 out of the . I health
centers and 2 out of 6 maternity homes. I lydeiabad has completed hall of the 6. urban family
welfare centers and 3 of the 5 maternity homes. Site visits were undertaken to review progress
and agreements were reached to complete all the facilities by April 2001 ( I ables 1-4 Annex V).
The mission is satisfied with the progress of procurement actions which are in accordance with
the approved procurement plans for FY 2000-01. To fully utilize IDA funds the project cit.es
need to spend about Rs. 90 Crores during the next 9 months. Both GOI and the states need to
ensure adequate availability of funds and closely monitor the implementation and the agreed

benchmarks.
Addi lion al Cities Component:
As per the agreed benchmark. GOI has assessed the feasibility of completing activities
approved during the MTR. All three states have made good1 start on both the service delivery' and
.
.
•
>4
nAAA A 2000.Drnrlncn
n
Anihra_Prade_sh_has
entered in to innovative turn-key
civil works components since May
r

contracts with NGOs to provide service delivery and social mobilization. ROH services are being
provided in M.S locations operating, from rented prcmis.es and civil works progress is good. 1 he
project management needs to be .slicng.llivnrd al the slate and irgional level-. Io cll( < lively
monitor a program which is spread over 73 smaller towns. So tar. 18/ sites were handed over to
the construction agency, six works have been completed and work is in progress in 107 facilities.
It has been agreed to cancel the works for which sites will not have been identified by October
31, 2000 or for which work orders have not been issued by November 7, 2000. In West Bengal,
community based volunteers have started outreach activities in 1,075 out of the 1,090 blocks and
plans have been prepared to start services in 35 health posts by November 30, 2000 and 11
specialty OPDs by February 2001. Contracts for all 36 works approved under the project (25
urban health posts and 10 OP1) cum maternity homes) have been awarded and specific
benchmarks for operationalization of these facilities have been agreed. Karnataka has obtained
state cabinet clearance for the project including the new posts. As per the agreed benchmark,
consultancy services have been procured to implement the civil works program and contracts for
all the 53 works (45 health centers and 8 maternity homes) will have been awarded by October
1 5, 2000. Recruitment of staff is in currently in progress and service delivery is expected to be
started by December 31,2000. The mission strongly recommends the project authorities focus on
mapping project beneficiaries and monitor utilization of services. Another important area that
needs to be addressed is the establishment of referral linkages with hospitals in respective towns.
Taking in to consideration the average time required for completion of each work, specific
deadlines have been reached to cancel the works will not have been awarded by the dates noted
above. Procurement plans have been cleared for AP and WB, while Karnataka is finalizing its
plan

Logistic Support Component:
Both Uttar Pradesh (UP) and Tamil Nadu (TN) have made good progress with start-up of
12.
implementation. UP has constituted a sub-committee under the state RCII society to manage the
program while the existing medical supplies corporation will be responsible for management in
TN. UP has entered in to consultancy arrangements with 3 corporations to help in design and
supervision of 13 warehouses. In 174, the corporation is directly implementing the construction
of 5 warehouses. Both states will be awarding the contracts for civil works by September 30,
(2000. Procurement plan for TN was cleared by the Bank and UP has submitted revised plan
based on discussion with the Bank recently. Following up the agreements reached at the MTR.
MOHFW had organized a meeting with USAID. Bank and UP State officials in August, 2000
where it was agreed that USAID would provide technical support for training and software
development for the logistic management information system.
Disbursements and Savings:

13.
There are three main reasons for the low level of disbursement to date. Fiist is the
13.
delayed effectiveness of the project. Second is the slow start-up of civil works, especially in Delhi
and Hyderabad, due to difficulties in acquiring urban metropolitan sites which were not foreseen
at the time of project preparation. As a result, the procurement of goods and furniture, which
needs to be synchronized with the works, was also delayed. \\ bile these two factors led to the low
level of disbursement in the early phase of the project, the exchange rate decline as well as non­
utilization of large amount of funds which had been earmarked for future project preparation
resulted in substantial savings b\' the mid term. However, a decision taken early on to focus on
social mobilization and service delivery from rented premises provided good outcomes and
substantial justification of project objectives as noted in the M I R.

4

Out of the total credit available of US$ 77 million, the project has disbursed USS 36.3
______ ____
million by September
2000. Project cit ,es so far spent about Rs. 182 Crores out of an original
outlay ofRs. 223 Crores. With the restructuring, the outlay for the project cities have increased
to Rs. 272 Crores (Table 1 Annex I). Based on GOI review, the revised outlay for the additional

14.

cities and logistic support components will be about Rs 107 Crores and Rs. 25 Crores
during the next 9 months the project has to spend
respectively (Tables 2 and 3 Annex I’
). Thus,
I
of
around
Rs.
27
Crores per month. SOEs of about USS 3.3
Rs. 240 Crores -- an average cf-------- T-.
-ry
month
(Annex II) during the remaining project period.
million need to be submitted to IDA eve _

This is a tall order and the mission requested GOI to closely monitor whether this pattern of
expenditure and disbursements are taking place in the coming months.

Key Benchmarks:

It was agreed that the following benchmarks are critical for completion of the
restructured program.
15.

G01 should ensure release of funds to Hyderabad and provide bi-monthly feedback on
•

availability7 of funds to project implementing agency
GOI and the states should monitor the agreed civil works benchmarks (Annex IV),
especially in Hyderabad and Delhi and cancel major works not awarded by October 31,

•

2000 and minor works by December 31.2000
GOI and the states should expeditiously follow-up the implementation progress,
1 \ reviews and site visits
including SOE reimbursement by undertaking monthly
an
additional
disbursement
of I IS $ 1 5 million takes place
GOI should ensure that at least

•

by March 31,2001.
GOI and states should ensure that all critical positions of specialists and staff nurses are

•

filled by October 31.2000

' , to reviewed with the Bank by March 31,2001, should
Progress in achieving these benchmarks,
determine the amount of cancellations of funds that may be required. The Bank team will also be
A^ntlni.AHclw mnn'flni ino ntf »<» f (‘
3111 St thcSC I )CUC 1111131 l< S 311(1 (IC3(HilieS.
continuously
monitoring progress Jll'
against
these benchinaiI.

Implementation Completion Report (ICR):
A

(

discussed the JC 7 process with GO1 and stales. It was agreed that by
16.
The mission
‘ ‘ assign
’ ] 3 senior officer familiar with operations as formal contact
December 31,2000 GOI would
Bank for\be ICR process and award contracts for the studies/reviews being planned.

with the 1

5

Annex I

Table 1 Project Cities : Revised Estimates and Expenditures (Rs. Lakh) - September 2000
" ’
‘ ’
Total
bad
________ Category________ Bangalore _ Calcutta~~[ Delhi ~ I Hydera
J746.67f
1538.91 ' 10068.47
3290.7
'
2492719
Civil Works_____________
Revised
1293.51 ~ 6221.35
1149.12]
2558.45
1220.27
Procurement_____________
Estimate
3050.07
1106.44
389.88
1025.27
528.48
Consultant Training_______
7843.48
1237.02
2440.27
2750.59
1415.6
Incremental Operating Costs
27183.37
~
5175.88
‘
6725.94
9625.01
5656.54
Total __ _______ ___ _
6822.48
' 961.77
1217.69
’ 2038.1*8
2604.84
Civil Works '____________
Expenditure
"617.35
601.1 " 3732.77
1737.72
~~ 776.6
Procurement_____________
2198.2
822.34
__ 259.39
753.29
363.18
Consultant Training_______
5436.07
___
968.5
1924
.05
876.85
Incremental Operating Costs
_1^L67
18189.52
3353.71
3761.1
" 4054.81
Total____________ ______
L22L9'2
3245.99
577.14
15
28.98
___
685.86
454.01
Balance to be Civil Works_____________
2488.58
692.41
820.73'
531.77
443.67
Procurement_____________
spent before
~2847T
■
851.87
130.49
271
.98
__1653
Project Closure Consultant Training_________
2407.41
268.52
773.6
~ 826.54
538.75
Incremental Operating Costs _
8993.85
1822.17
2964.84
2605.11
1601.73
Total
____

Table 2 . Additional Cities in Slates of Andhra Pradesh, Kar nataka and West Bengal
Revised Estimates (Rs. Lakh)
I otal
WB
Kai nataka
AP
5757
1457
1400
2900
Civil Works
2488.96
I
137.82
Z99.39
551.75
Procurement____ ____
”966.49
235.09
105.4
626
Consultant Training________
“
787.55
1533.12
270.57
475
Incremental Operating Costs
10745.57
3617.46
2575.36
Total

Table 3. Logistic Support Projects in Uttar Pradesh and Tamil Nadu Revised Estimates

-—————— up

(Rs. Lakh)
Total

TN

’914]

Civil Works_________ ___ __ _
Procurement
Consultant Trainjiig
incremental Operating Costs

560
95

18(2

1749i ’

Total

6

425
82.5
26.7
234.12
768.32

1339
642.5
“121.7

414.12
2517.32

Annex 11

Table 2.1 Family Welfare Urban Slums Project - Disbursement Status
September 2000 (US S)

Undisbursed

Disbursed

Disbursement Category

12948269.69
7615245.07
3978962.92
7781364.90

Civil Works
Procurement_____________
Consultants & Training
Incremental Operating Costs
Special Account________
Unallocated

3972304^65
0.00
36296147.23'

241 1844.04
22313037.40
~ 6582032.34
7024505.20
_-357Zl^-83_
5725500.00
40479362.15

Table 2.2. Family Welfare Urbdn Slums Project: Financial Summary - September, 2000

Balance

Civil Winks
Procurement
Consultapts and training
incremental Operating
Costs_______________
Special Account ____
Unallocated

Expenditure Project Cities

Pipeline
Expcndit irePi oject cities

Projected
Expenditure Addl. Cities

Rs. Million

Rs. Million

Rs. Million

324.60

248.86
85J9
240.74

899.39

76.89
0.00
57.2j
40.25

174.35

575.70
248.90
96.65
153.31

1074,56

Projected
Expenditure 1 ogistic
support
Projects
Rs. Million

133.9
64.25
12.17
4 1.412

251.73

Total
Estimated
Expenditure

Rs. Million

Illi 09
562.00
251.2[
475.72

2400.03

IDA funds
available
as of May
2000

IDA share

Rs. Million

999.98
449.60

USD
Million

2010.02

6.72

43.70

-3.58
5.73
40.48

Annex III

KEY BENCHMARKS FOR MOHFW - OCOTBER 2000 to MARCH 2001
___________________________ Benchm ark__________________________ Target date______
October 31,2000
GO1 should ensure release of funds to Hyderabad and provide bi­
December 3 1,2000
monthly feedback on availability of funds to project implementing
February 28, 2001
agency_______________________________________
GO! and the states should monitor the agreed civil works benchmarks
(Annex IV). especially in Hyderabad, and Delhi and cancel
a) October 31,2000
a) major works not awarded by and
December 31.2000
b) minor works by
____________________
Till the end of the
GOI and the states should expeditiously follow-up the implementation
project
progress, including SOE reimbursement by undertaking monthly
reviews and site visits______________________
__________________
March 31. 2001
GOI should ensure that at least an additional disbursement of USS 15
million takes place by_____________________________ _
GOI and states should ensure that all critical positions of specialists and October 3 1.2000
staff nurses are filled by
December 3 1.2000
GOI to assign a senior officer for ICR process and award contracts for
ICR studies/review
___

7

Million

2.41
22.31
6.58
7.02

21.74
9.77

25j.2f
309.22

DSD

Annex IV

Status of Selected Output Indicators
Bangalore - July- Sept 2000
Achievement till Sept. 00
Estimated
Indicator
Number
% of estimated
(Annual)
No.
number______
54.45%
4,16,362
226,779
Contraceptive prevalence among
eligible couples__________________
99.7 %
95,279
95,558
Pregnant women having 3 Antenatal

visits____________________________
Measles Immunization

88,101

93.6%

82,487

Calcutta July- Sept 2000
Achievement till Sept. 00
Estimated
Indicator
Number
% of estimated
(Ann ual)
No.
number______
46.8
84,159
1,79,828
Contraceptive prevalence among
couples having less than 2 children
91.0
23,309
25,615
Pregnant women having 3 Antenatal

visits_____________________ _
Institutional deliveries____________
Measles Immunization

Indicator

23,288
22,576

Delhi July-Sept 2000
Estimated
Number

Achievement

26,278

4370

% of estimated
number______
16.6

8,153

7,890

88.3

8,153
8,153

1313
6.767

16.1
83.0

No.
Contraceptive prevalence among
couples having less than 2 children
Pregnant women having 3 Antenatal
visits _______________________
Institutional Deliveries____________
Measles Immunization

Hyderabad April 2000
Planned

Contraceptive - Permanent
Contraceptive use - IUD____
Pregnant women having 3 AN
visits________________
Institutional deliveries______
Measles Immunization______
* Higher % due to Campaign

92.0
79.0

22,425
17,835

Achievement

4797
1917
9344

No.
3472
990
5904

%
72.4
51.6
63.2

7330
8383

4217
4827

57.5
57.6

8

Annex V
Page 1 of 4
Summary Status of Civil Works

Bangalore_____
Work
Work in
Completed
Progress
5
4

Project
Target
2

Sites
Identified
3

1. Construction of
Health Center

55

55

6

54

2. Renovation of
Maternity Home

27*

25

4

24

3. Renovation of
JFWC

26

23

3

20

4. Construction of
Staff Quarters

7

7

1

6

5

5

5

6. Construction of
Staff Quarters
attached to new
Maternity Homes

5

5

5

7. Construction of
Training Center

1

1

1

8.. Renovation of
Stores

1

1

Project Activities
________ 1

_______ I
5. Construction of
new Maternity
Homes

si.
No.
1.
11.
III.
IV.

V.
VI.
VII.
VIII

Project Activity

Health Administrative Unit
(HAU) Exclusive__________
ESOPD- HAUs
ESOPD cum Maternity Home
HAU. ESOPD and Maternity
Home ______ __________
Maternity Home with Clinic
Central Medical Store
Sub Centers (New)
Sub Centers (Repair and
renovation)________

Benchmark
Already
Operationalized
___________ 7___________
6
54~
To cancel the remaining
work is there is no
decision is received by
October 31,2000
1 works to be completed
21
by October 31,2000 and
remaining 3 works to be
completed by December
31,2000______________
Balance 3 to be
20
completed by December
31,2000_______________
To complete the
6
electrical and water
connections and hand
over remaining 2
quarters by October 31,
2000 ________
Three centers to be
completed by December
31,2000 and remaining
2 centers by March 31,
2001 ____________ ______
Quarters in 3 centers to
be completed by
December 31,2000 and
remaining 2 centers by
March 31,2001 _____
Finishing and furnishing
to be completed by
October 31,2000

1

Revised
Target
97

_____ Calcutta
Work
Work in
Qompletcd
Progress
91
6'

Remarks

6 Nos. io be completed by December 2000

7
17
1

0_
0_
0

7
17
1

All Completed

5

5

(i

1
114
159

_0
_5
0

1
109
159

I o Submit bid evaluation report to Bank by
October 15. 2000_________
Completed________ ___ ______________ _
5 Nos, to be completed by June 2000
All works completed

9

All Completed
Completed

Annex V
Page 2 of 4
Delhi
Project
Target
2
21

Sites
Identified
3
21

Work in
Progress
4
9

2. Construction of
UHC cum Maternity
Home

6

6

4

3. Construction of
Health Post

105

105

18

Project Activities
________ 1

1. Construction of
Health Centers

i!

10

Agreed Actions
Remarks,
Work
Completed ________ If any_______
__________ 7_________
5
Completed- 10
io
Work under progress - 9 To complete:
Three facilities by
October 15, 2000
One by December
31,2000
One by January 31,
2001 and
Four by March 31,
2001____________
To issue work
To be grounded - 2
orders by
November 30,
2000 and complete
by April 30,2001
Completed - 2________
2
Work under progress - 4 To complete and
operationalize by
November 30,
2000___________
Last date for issue
Completed
67
67
of work orders
December 15,
2000

Annex V
Page 3 of 4

Hyderabad
PROJECT ACTIVITIES

_________ __

1

SITES
REVISED
TARGET IDENTIF1E
D
3
2

I) I Construction of new
Urban Family Welfare
Centers

c

II) Renovation ofUFWCs
into *D’ type Health
Posts.

REMARKS, IF ANY
ALREADY
WORK
COMPLETE OPERATTONALISED
D
7
6
5
19
Completed
(9
11
T"
Basement

WORK IN
PROGRESS
4

26

26

4~

Finishing

T

To complete and operationalize 5
facilities by 31 October,2000 and
one by November 2000
To agree on follow-up action for the
site with legal problems by October
31,2000
18
Completed

16

18

18

36

36

Brick work

Excavation
Basement
Roof Level

IV) Construction of quarters
for staff nurses of
Maternity Centers.
V) Augmentation of Office
accommodation for
City Family Welfare
___ Bureau.___________
VI) Construction of 9 new
Type D Health Posts
(UHPs: 6, UFW:2,
Health Centre:!)

T“

3 (in two
phases)

3

2
(Phase-U)

2 (Phase-1)
1 (Phase 1 &
ID

3

T3
Finishing
To complete and operationalize 8
facilities by October 31,2000, 4
facilities by November 30, 2000 and
2 by March 2001.
To agree on follow-up action for the
3 sites with problems by October 31,
2000._______________ __
Finishing states of Phase II 2

2 (in one
phase)

2

2

()

0

Brick work

1

Finishing stage

T

4

4

1

1

9

9

L

Ill) Upgradation/
Construction of
Maternity Centers (with
30 beds) and Neo-natal
care room.

2“

1

3

3

Roof level

1

1

1

Completed

1

Sites not yet handed over 5 9
facilities. Tendering
completed and work orders
to be issued.__________ __
To Cancel the works for which sites
[arc not identified

V

11

Annex V
Page 4 of 4
AP Additional Works - September 2000
ACTIVITY

REVISED
TARGET

1

2

b

187

192

Construction
of Urban
Health
Centers

REMARKS, IF ANY

ALREADY
WORK
WORK IN
SITES
IDENTIFIED PROGRESS COMPLETED OPERATIONALISED
6
5
4
3
1

6

113

8

7

Completed: 6 Immediately
operationalize
Basement .40 Operationalize
by 31 ? Dec, 2000
Operationalize
Lintel:
9
by Nov. 30,
2000__________
Operationalize
Roof: 26
by Novermber
30, 2000
Finishing: 32 Operationalize
by October 31,
2000

■
ACTIVITY

1
S.No.
Construction of New
1

REVISED
TARGET

SITES
IDENTIFIED

2

3

REMARKS, IF ANY

ALREADY
WORK
WORK IN
PROGRESS ( OMPLE I ED OPERATIONALISEI?
6
5
4

8

7

45

45

0

0

0

Cancel works for which October 15,
2000
contracts arc not
awarded by__________
May 2001
Operaionalize

8

0

0

0

Cancel works for which October 15,
2000
contracts are not
awarded by__________
May 2001
Operaionalize

Urban Health Centers

11

Construction of New
Maternity Homes

8

Ill

Repair of Health Centers
Repair of Maternity
Homes

21

Complete by

March 2001

14

Complete by

March 2001

IV

WB Additional Works - September 2000
already
WORK
WORK IN
PROGRESS COMPLETED OPERATIONALISED
5
6
4

ACTIVITY

REVISED
TARGET

SITES
IDENTIFIED

1

2

3

1

Construction of Urban
Health Posts with
Medical Stores

10

10

10

0

0

II

Construction of Urban
Health Posts

25

25

25

0

0

Hl

OPD cum Maternity
Home

11

11

11

0

0

S.No

12

REMARKS, IF ANY

8
Operationalize
Roof level for
First Floor: 8 by 31, March,
2001_________
Foundation: 2 Operationalize
by 31, May,
2001_________
Operationalize
Roof for 1st
by 31. March,
Floor: 24
2001________
Foundation: 1 Operationalize
by 31. May.
2001
Ground Floor Operationalize
by 31, March,
Roof: 9
2001________
Operationalize
Foundation
by 31, May,
level: 2
2001
7

Annex VI

Mission Objectives

The objectives of the mission are to:
a) review implementation progress in project cities and additional activities which became
effective on August 21, 2000 by undertaking site visits to Delhi, Andhra Pradesh, Karnataka
and West Bengal states and review meetings at MOHFW
b) to review detailed assessment undertaken by MOHFW on feasibility of implementing the
approved activities and reach agreement on cancellation of project savings that may not be
spent before project closure and
c) to discuss the ICR process and reach agreement on preparatory' activities including the end
line surveys.
(

Documents/Reports received during the mission

The following documents/reports received during the mission are available at NDO.
Andhra Pradesh : a) Project Status Report - April 2000- 31 August 2000 - Municipal
Corporation of Hyderabad(MCH); b)) Report on Performance Indicators June 2000 - Hyderabad
c) Status Report - Urban Slum Health Care Project Sept. 2000 - Commissioner FW, GOAP,
Hyderabad d) Reference Manual - Andhra Pradesh Urban Slum Health Care Project - Sept. 2000
— Commissioner FW, GOAP, Hyderabad;
Delhi: a) Progress Review - August 31, 2000 - Municipal Corporation of Delhi (MCD); b)
of critical
Report on MIS activities - August 31,2000 - MCD c) Report on Rapid
F . ' ’ Assessment
'
inputs in JEC strategy of IPP-VIIl Project- Disha, New Delhi;

Karnataka ; a) Project Review Status April 2000 to August 2000 - Bangalore Mahanagar Palike
(BMP) b) Status Report on Additional City Project - Sept. 2000 - Government of Karnataka;

West Bengal: a) Project Review Status August 2000 - Calcutta Metropolitan Development
Authority (CMDA) b) Status report on 1PP VIII extension to 10 Additional Cities - State Urban
Development Agency, West Bengal c) Baseline Survey in 10 additional cities — Draft — Institute
of Local Government and Urban Studies, GoWB d) Guidelines for implementation of
’ Reproductive Health Education Program - IPP VIII Calcutta

13

r

WORLD HEALTH

i World health

The World Bank and global cooperation in health: the case of
Bangladesh

Kent Base, Catherine Gwin

The final quarter of the 20th century saw a profound change in international health cooperation. The World Bank
emerged and consolidated Its position as the leading external financier of health-sector activities in countries of low
and middle income. As a result of its resources, philosophy, and legitimacy, the World Bank leveraged fundamental
reform of the health-sector agenda as well as Institutional relations at global and national levels. The scope of the
Bank’s involvement, and the nature of its policy thrusts and investment strategy In the sector, are outlined in this
paper and Illustrated with specific reference to Bangladesh. This backdrop serves to raise four issues and enables us
to explore their relevance to global health cooperation In the first quarter of the 21st century.

From a modest start 25 years ago, the World Bank has
become the largest external financier of health activities in
countries of low and middle income, a major voice in ,
national and international health-policy debates, and a
significant contributor to health-policy research.1 In the
process, it has altered significantly the institutional
landscape of international health cooperation. Many
health professionals and policy makers have welcomed
the Bank’s presence, since it has raised the profile of
health on domestic policy agendas, injected needed
financial resources into the sector, and drawn attention to
critical policy issues previously largely ignored by national
policy makers and international organisations. One clear
message that emerged from a World Bank health-sector
strategy’, issued in August, 1997,’ was that the health­
sector activities of the Bank will continue to grow.
The Bank’s expansion in health has also raised several
questions—in particular, what has been, and what will be,
the impact of Bank leadership and its new strategy on
international health cooperation at country level? And
what should the Bank’s position mean for the role of
other international health institutions, particularly WHO,
and the interactions among them? This paper first
examines the Bank’s growing role in health, the type of
health-sector development it has pursued, and its new
strategy. The case of the Bank’s involvement in health in
Bangladesh illustrates the agency’s growing influence at
country level. We conclude by highlighting several
challenges that must be faced by the Bank and the
international community as the world’s “pre-eminent
development institution” takes a leading role in global
health cooperation.
The Bank’s health role and agenda

The World Bank is a lending institution (panel 1).
Whereas other bilateral and UN organisations in the
health sector provide grants, the Bank gives out loans,
primarily to governments, which the governments

guarantee to repay. For all borrower countries except the
poorest, Bank loans are made on non-concessional
terms—ie, they are long-term but at rates of interest near
market rates; whereas for the world’s poorest countries,
the Bank provides long-term “credits” that carry’ only a
minimal service fee. Health is part of a health, nutrition,
and population (HNP) sector. Financial suppon in this
sector began with lending for population or family­
planning programmes in 1970, and was followed by
financing for nutrition projects and health components of
loans made in other sectors. Direct lending to free­
standing health projects was introduced in 1980.'
.After 1980, the Bank’s involvement in health grew
quickly—as pan of a general increase in investments in
human capital. By the end of 1996, the cumulative HNP
portfolio had reached USS 13-5 billion (in 1996 dollars),
encompassing. 155 active projects in 82 countries and an
additional 70 completed -projects. In 1980, annual
lending in HNP was S500 million and accounted for 1%
of the Bank’s total lending; in 1996, lending reached a
record high of S2-4 billion—11% of the Bank’s annual
commitments. By comparison, total official development­
assistance to HNP for the period 1985-93 amounted to
only S2 billion annually in 1996 prices, excluding Bank
loans/ whereas WHO’s regular budget was frozen during
this period at roughly S400 million per year (1996
prices), with another S400 million provided for in
extrabudgetary resources.4
The Bank magnifies the impact of its financial
investments by ensuring that most of its project activities
Panel 1: Structure—World Bank group
International Bank for Reconstruction and Development (IBRD)
Lends on commercial terms for governments
Money raised on global markets

International Development Association
Makes low-cost finance available to poorest countries
Contributions from member countries and from IBRD

s

International Anance Corporation
Supports private enterprise

Lancet 1998: 351: 665-69

Health Policy Unit, London School of Hygiene and Tropical
Medicine, London WC1E 7HT, UK (K Buse msc); and Overseas
Development Council, Washington DC, USA (C Gwin pmo)
Correspondence to: K Buse
(e-mail k.buse@lshtm.ac.uk)

Multilateral Investment Guarantee Agency
Promotes foreign investment through guarantee

International Centre for Settlement of Investment Disputes
Arbitration for disputes

665

THE LANCET • Vol 351 • February 29. 1908

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I

WORLD HEALTH

ii

particular, as weak and over-bureaucratic—though it
retained unique technical expenise in specific health
2-5
areas? As a result, overall funding for WHO stagnated,
-O— World Bank loans for health
20 —WHO total budget
and donors have increasingly moved away from suppon
§
= 1-5 of WHO’s core budget to targeted financing of special
10programmes, some of which were operated outside
WHO. Consequently, some analysts see the publication
0-5 O O
o o
by the World Bank of its 1993 World Development
0 ->________________________________________________
i
i
iiii
i 1
i
i
i
i
i
i
Report, Investing in Health, as the watershed when
1984 1985 1986 1987 1988 1989 1990 19911992 1993 1994 1995 199<
leadership in international health passed from WHO to
Year
the World Bank.7
Growing role of World Bank in health
The second trend, which has accompanied the increase
in Bank lending for health, has involved a shift in
emphasis within ±e Bank’s sector activities. Early Bank
receive matching funds from client governments as well
support in HNP focused mainly on the financing of the
as cofinancing from other donors. The Bank can thus
development of physical and human infrastructure, and
triple or quadruple the funds going to efforts it supports.
provision of supplies to enable governments to deliver
In addition to project lending, the Bank provides an
basic health and family-planning services. Although ±ese
expanding volume of non-lending services (ie, research,
efforts achieved modest success, both Bank and external
policy dialogue, and donor coordination). Increasingly,
assessments revealed that the approach overlooked the
owing to the quantity and perceived quality of these
systemic conditions necessary’ for sustainment of broader
senices, the Bank provides intellectual leadership to the
sector.
,
health improvements over time. This observation led the
Two other significant and inter-related trends have
Bank to place three substantive issues on the health policy
accompanied Bank expansion in the health sector: the
agenda.
relative decline of other international agencies, and a shift
Systemic reform was the first, and included a re­
in priorities within the sector. The Bank’s growth in HNP
examination of the appropriate role of the State in health­
correlates with stagnation in the level of resources
care financing and delivery." The Bank advocated greater
available from other international institutions active in
reliance on cost-recovery’ and on private-sector provision,
health, notably WHO (figure).5 This trend can be
together with a refocusing and' reduction of public
explained, on the one hand, by the skills and resources
involvement in service delivery in the context of
the Bank has been able to marshal in response to new
organisational and managerial reforms. The second
challenges, and, on the other, by developments within
substantive issue to which the Bank drew attention was
WHO itself; although WHO’s largely biomedical
the targeting of public-sector investments. In its 1993
expertise gave it an advantage over the Bank in relation to
World Development Report, the Bank provided a rationale
specific health threats—in spearheading the successful
and methodology for estimation of each country’s burden
campaign to eradicate small pox, for example—it was less
of disease, based on estimates of “disability-adjusted life
well positioned to take the lead on complex sector-reform
years” lost to various illnesses. This data, when coupled
initiatives. At their core, most reforms centred around the
with
information
on
the cost-effectiveness
of
role of the State in mixed capitalist economies, and
interventions, provided a powerful, albeit imperfect/ tool
secondarily on prioritisation of resource allocation and
for resource allocation within the sector. Consequently,
organisational change. Leadership demanded know-how
Bank support is now directed mainly towards ensuring
in the fields of economics and of policy and institutional
that the public sector provides a subsidised “package of
analyses. In addition, and crucially, leadership required
essential services” with far greater involvement in the
access to senior decision makers in Ministries of Planning
delivery of those services by the private sector.
and Finance in recipient administrations with the political
A third dimension is currently being added to this
clout to champion the agenda, and access to large-scale
agenda which, among other things, is intended to
resources to finance—and, when necessary, leverage—
encourage all donors and governments to operate within
reform (panel 2). By contrast, WHO’s influence as a
*die framew’ork of reform outlined above. The mechanism
specialised health agency was largely confined to
entails a gradual shift from the provision of project­
Ministries of Health. By the beginning of the 1990s,
specific investment to a sector-wide approach. Al±ough
moreover, WHO was seen by many member
variously
defined, within a sector approach both
governments, observers, and donor governments in
government and donors agree to: sector-wide policies and
strategies; a prioritised public-expenditure programme
Panel 2: Governance—World Bank (IBRD)
incorporating domestic and foreign resources; and a
common management framework for implementation of
Board of Governors
Meets annually
the strategy over a time-bound period. Through this
Composed of representatives of 180 member governments
sector approach, the Bank hopes to make donor
assistance
conditional
upon
the
government’s
Board of Executive Directors (in Washington DC, USA)
Meets twice weekly
demonstrated commitment to the agreed reforms—and
Oversight of policy and lending
thereby to ensure that all public expenditure in the health
Individual seats held by: China, France, Germany, Japan, Russian
sector is targeted to high-priority services (eg, primary
Federation, Saudi Arabia, UK, and USA
and reproductive health care); that organisational and
Listed countries together have 46% of World Bank voting power
financial reforms are enacted; and that the recipient
Other member countries combine into 16 groups, each with a
government (and donors) do not support initiatives
representative Executive Director
outside the agreed reform agenda.
'666

7

THE LANCET • Vol 351 • February 28, 1998

WORLD HEALTH
The new health-sector strategy
Underlying the Bank’s new corporate strategy are the
. views that the main threats to good health are well
known; that affordable solutions are frequently available;
but that market imperfections, inappropriate public
policies, and weak governmental capacity all impede
effective and equitable delivery of health-care services.
Reforms are therefore required to redefine the roles of the
State and of non-State actors so that they will produce
more effective public-health activities and improve
regulation of an expanded private sector in health.
To respond to these challenges, the Bank strategy*
identifies three main objectives: improvement of the
health, nutrition, and reproductive outcomes of the
world’s poor, and protection of other segments of the
population from the impoverishing effects of illness,
malnutrition, and high fertility; improvement in the
performance of health-care systems; and the securing of
sustainable health-care financing.
According to the Bank, its “sharpened strategic
direction” means that although it will continue to attend
to what the poor need most in terms of basic health
services, it will concentrate more than ever on sector-wide
'eform efforts. The bank will stop financing “old-style,
2hristmas-tree projects”, which provide a “shopping list”
of physical inputs, and become much more focused and
selective in targeting resources towards technical and
other assistance to facilitate reform activities. The Bank
will also supply direct budget suppon to Ministries of
Health that agree to a sector-expenditure programme in
line with the Bank’s reform agenda (notwithstanding its
concentration on sector-wide approaches and reform,
funds will also remain available for vertical projects
targeted at priority' diseases, such as AIDS and malaria).
Moreover, as it has explicitly stated, the Bank will do less
in countries that do not meet a basic threshold of
commitment to the sector.
Two changes in Bank-wide business practices have
been introduced, which should facilitate implementation
of the new health strategy. First, the Bank will introduce
two lending instruments: mini-loans that can be rapidly
allocated on approval by a regional vice-president and
used for the pilot testing of activities before being
expanded to major national reform efforts; and
?anel 3: Rough annual dlsbursement/commitment by major
donors to Ministry of Health, Bangladesh, through consortium
and outside consortium (USS millions)
Donor consortium
(disbursed)
World Bank
German GTZ and KfW
European Commission
Canadian CIDA
Norwegian NORAD

UK DflD
Dutch DGIS
Swedish Sida
Australian AusAid
Total

27-1
13-0
7-6
5-5
4-2
3-9
3’7
1-6
0-8
67-4

Non-consortium donors
(committed)
American USAID
30-0
UNICEF
14-0
Asian Development Bank 10-0
6-0
UNFPA
5-0
WHO

Total

65-0

GTZ: German Agency for Technical Assistance. KfW: Kredit Anstalt fur
Wiedsraufbau. CIDA: Canadian International Development Agency. NORAD:
Norwegian Agency for International Development. DflD: Department for International
Develooment. DGIS: Directorate General for International Cooperation. Sida:
Swedisn International Development Cooperation Agency. USAID: United States
Agency for International Development. UNICEF: United Nations Children s Fund.
UNFPA: United Nations Population Fund. Although UNICEF, UNFPA, and WHO are
"associate members" of consortium, they do not channel their regular budget funds
through consortium arrangement.

‘•adjustable” lines of credit for up to 10 years in support
of an agreed sector-wide reform programme, which
would allow for course corrections without the need for
new loan negotiations every few years. A second set of
changes will “empower” staff through modifications in
personnel practices and improved training, the moving of
more staff to the field, and decentralised decision making.
The way the Bank’s presence and evolving agenda
influence health-sector development is illustrated well by
the case of Bangladesh.

The World Bank in Bangladesh
Bangladesh is among the poorest of the least-developed
countries, and has thus been a leading contender for
official development assistance and health-sector
assistance. To a large extent, donors have underwritten
the Government’s programme for population and health
over more than two decades. At present, at least 31
bilateral and multilateral organisations suppon Ministry
of Health activities, and account for roughly 35% of the
ministry’s budgeted expenditure.10 Early suppon was
directed mainly towards fertility’ reduction through a
massive family-planning programme, to which elements
of maternal and child health were added. Improvements
to the infrastructure—which includes buildings, supplies,
and equipment, together with staff salaries—took up the
lion’s share of external assistance. External suppon
contributed to several achievements, notably’ sustained
fertility reduction in an unfavourable socioeconomic
environment,
dramatic
increases
in
Expanded
Programme of Immunisation (EPI) coverage, and
substantial reductions over the previous 5 years in
mortality among children. However, since the early
1090s, donors, led by the Bank, have increasingly focused
on systemic reforms in response to their perceptions of
wide-spread inefficiency in the health sector.
One of the striking features of the health sector in
Bangladesh is the nature of the Bank s involvement as
leader of a consortium of donors overseeing a large
cofinanced project.11 The history’ of the Bank s work in
the sector can be traced to an appraisal in 1973 for its
first population project, 2 years after the country s violent
war of independence. The Bank attracted cofinancing
from six bilatateral donors to this project. Each successive
project has engaged additional donors and has more than
doubled in value. The current Fourth Population and
Health Project, supported by nine bilateral agencies, will
have disbursed roughly USS780 million over its /-year
lifespan. Bank lending supplied SI90 million, the other
donors gave S282 million, and the Government provided
S310 million. Through the consortium, external agencies
disburse roughly S67 million per year. By comparison,
another five major donors, which are not members of the
consortium, collectively commit an annual sum almost
equal to that from the Ministry of Health (panel 3;
consortium figures are projected disbursements by each
agency divided by length of project. Other figures are
commitments made by agencies for various programme
periods: expenditure may be much lower).
Although the consortium arrangement has evolved over
time, and currently fulfils functions relating to donor
coordination and oversight of the cosponsored project, it
has also become one of the most influential agents in the
sector with regard to other donors and the Government
itself. A project-support unit, based at the Bank but

667

the L.VNCET • Vol 351 • February’ 28, 19Q8

13S

1

WORLD HEALTH

financed jointly with the cofinanciers, has been
strengthened over the years in line with the increasing size
and complexity of the successive projects. The unit
currently comprises three professional staff based in
Washington DC, USA, and five in Dhaka, Bangladesh.
Responsibilities entrusted to the Bank include the leading
of regular meetings and missions of consortium members,
and representation of the agreed views of the consonium
to non-member donors and to the Government on issues
in the sector. The consortium arrangement improves
coordination among participating agencies by providing a
venue for consultation, consensus building, optimisation
of the comparative advantage of each contributor, and
streamlining of interactions between donors and
Government. Owing to the number of its members and
the volume of its resources, the consortium also
dominates the country’s health-policy agenda.
Although the Bank and the United States Agency for
International Development (USAID) are the sector’s
largest donors, the Bank’s leadership is bolstered by its
central position within the consortium, which is
exemplified by recent events. Concerned about lack of
progress in addressing the sectoral inefficiencies, the
Bank, in 1996, in consultation with other consortium
members, indicated it would not proceed with processing
a further credit for health and population activities in
Bangladesh until the government produced a strategy that
set our an agenda for substantive reforms. With guidance
from the Bank and other donors, the Ministry* of Health
, prepared the requisite strategy document. *- This strategy
commits the government, among other things, to a
sector-wide approach—a powerful mechanism that
increases the probability of government compliance with
an “agreed agenda’’. In the case of Bangladesh, this
agenda is heavily influenced by Bank thinking, the
objectives of which include the promotion of primary
care, cost-effective delivery pattern, and alteration of the
public-private combination in health-care delivery.
The purpose of this selective and generalised review of
Bank activities in Bangladesh has been to highlight the
Bank’s current position at the fulcrum of sector
developments. The Bank has also mobilised far greater
resources for the sector than would otherwise have been
obtained, and through its project-support unit enabled
the government to manage a far larger health and
population programme. The Bank can be credited in
addition with placing legitimate and timely issues on the
health-policy* agenda, and with bringing greater
coordination to the large number of donors active in the
sector.1’
The Bank and future global cooperation for
health-sector development
The Bangladesh case illustrates the Bank’s much
expanded role in the healtlf sector. The Bank’s
contribution to improved public health, though
indeterminate, is likely to be substantial. Owing to its
scale, business practices, and agenda, the Bank has
altered sector priorities and donor-recipient relations at
the global and national levels. These dramatic changes
raise several compelling issues that must be debated, both
inside and outside the Bank, since they will have
profound implications for health-sector development in
low-income countries over future decades.
First, how can the Bank reduce the conflict between

advancing a central “corporate” strategy in health while
also pursuing country-specific approaches to sector
reform which are overwhelmingly conditioned by local
issues, agents, and processes? Although these two thrusts
may not be inherently incompatible, past tendencies
within the Bank have favoured global prescriptions over
local diagnoses and solutions—an example being the
rapid, wide-spread introduction of user-fees in Bank
projects in several countries after the Bank’s publication
of “An Agenda for Reform”.14 In countries where suitable
institutional safeguards were not in place (most),
unintended and deleterious consequences resulted until
the fee policies were adapted to local conditions or
dropped altogether. The Bank seems to have learned
from such experience.
The current approach to the corporate-local conflict is
one of selectivity, focusing Bank resources on those
countries deemed able to make the greatest use of them.
Bangladesh is an illustrative case. According to Bank
sources, Government of Bangladesh commitment to a
specific and substantive reform agenda was a
precondition for further funding to ±e sector from the
Bank and other consortium members. Consequently,
preappraisal of a credit was linked to the formal adoption
of a Health and Population Sector Strategy and action
plan, which was prepared through a collaborative process
involving the Government, Bank staff, and other
consortium members.14 Through this process, the Bank
ascertained that there was high-level Government
commitment to a set ot agreed principles without which
the Bank would not do business. Joint-Government­
consortium preparation of the strategy also ensured
sufficient local ownership among key Ministry of Health
staif to vest in it a reasonable chance of success. Having
secured Government commitment to a set of agreed
principles, the Bank will now attempt to provide the
Government with flexibility to implement the reforms at
its own pace and with technical assistance suited to the
circumstances. The Bank’s trend towards greater country*
selectivity will probably address the tension partially, but
the Bank will continue to need to ground global
conceptual thinking within local contexts. The proposal
for greater field presence and decentralised authority may
help, but only* in so far as Bank staff are encouraged and
willing, when warranted, to deviate from global dictates.
Second, the Bank strategy places increased emphasis
on showing actual results on the ground—an objective
which may prove double-edged. On the one hand, this
strategy should lead to greater Bank and client attention
to effective implementation of programmes and projects;
on the other, such results may be difficult to achieve
because objectives aim at long-term rather than short­
term outcomes; the desired outcomes entail institutional
changes that are difficult to produce, and in areas in
which the Bank has not shown an advantage (of some 63
health projects assessed by the Operations Evaluation
Department of the Bank, only 17% achieved
institutional-development
results
that
were
substantial ’);” the strategy proposes tackling problems
of poverty which have not only proved insurmountable
but may not be the priority of borrowing governments;
and the sector-wide approach requires that all major
donors and government agencies cooperate to a degree
often lacking in the past. Moreover, the Bank has been
self-critical of its prevailing management culture, staff
policies, and incentives, which placed too much emphasis

668
I Hl-. I.Wl.EI • Vol 351 • Febman1 28, pJOH

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WORl-D HEALTH

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1

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i

on loan disbursement and quick, process-oriented
results.1'* In practice, when local-capacity to design and
implement projects is weak, Bank staff have a strong
incentive to take up responsibility to get things done, and
thereby thwart the long-term development process of the
country’s own capacity'. Bangladesh provides a case in
point on both potential difficulties. The systemic-reform
type subcomponents of the consortium project, such as
the management-development unit, reorganisation of the
Ministry’, and development of a human-resources master
plan, ran into the greatest difficulty (and failure) in
implementation. There is also concern that the
increasingly large project-support unit, which has evolved
to
facilitate
loan
disbursement
and
project
implementation,
may
undermine
Bangladesh’s
ownership, capacity-building, and the sustainability of
donor investments.
Tension seems to exist, moreover, between the trend to
hold down Bank research and staff costs, and what may
be required for the new health strategy to succeed. The
corporate-strategy paper makes several points: over the
past decade, HNP staff have increased by 86% whereas
lending has grown by 272%; past and future cuts in HNP •
budget and staff-time for analytical work are cause for
concern, given that scant attention has so far been paid to
the important issue of the political economy of reform,
and its economic, regulatory’, and institutional
underpinnings; and the budget for supervision of projects
has been almost halved, even as the number of projects
undertaken is increasing. In Bangladesh, this tension has
been partially alleviated by getting other donors to meet
the costs of Bank staff. Nevertheless, the staff have
concentrated on project implementation rather than the
conceptual and operational issues associated with reform
programmes. Analysts are particularly concerned that
there is insufficient evidence to identify which reforms
work, which reforms do not. and what the unintended
consequences might be; they therefore argue that greater
emphasis must be placed on the monitoring and analysis
of reform programmes.*'
Such concerns lead to one final and over-riding issue
regarding the future of international cooperation for
health development. Clearly, the Bank has stepped in to
fill a leadership gap in health-sector reform and financing.
But the Bank does not have (and is in no position to
develop) technical expertise across a whole range of
health matters—which, over past years, has been the
mandate of WHO. But there is reason for concern that,
with the ascendancy of the Bank and the define of
WHO, technical know-how is being unoerused,
particularly at the country level, and a constructive
pluralism of views on global health is being lost. As the
forces of globalisation and development alter the health

THE LANCET • Vol 351 • February 28, 1998

^2 •-..

status and health risks of people worldwide, more effort is
needed to preserve and better employ essential technical
expertise; to improve the' operations and complementary
interactions of the various international-health agents;
and to protect the multiplicity of opinions that have a
legitimate claim to health-policy development.1’ A sharper
and improved sector strategy on die pan of the World
Bank is one •but not the only—constructive element in
this process.
\\"e thank Brad Michaels (Overseas Development Council, Washington
DC, USA) and Patrick Vaughan (ICDDR. B, Dhaka, Bangladesh) for
their help in the preparation of this article.

References

De Beyer JA, Preker AS, Feachem RGA. The role of the World Bank
in international health. Soc Sci Med 1998: in press.
2 World Bank. Health, nutrition and population sector strategy paper.
Human development network: Washington DC: World Bank,
1997.
3 World Bank. Health sector policy paper. Washington DC: World
Bank, 1980.
4 WHO. Work of the World Health Organization, 1997.
5 Vaughan JP, Mogedal S, Kruse SE. Lee K, Walt G, de Wilde K.
Financing the World Health Organization: global imponancc of
extrabudgetary funds. Health Policy 1996; 35: 229—45.
6 Godlee F. WHO in crisis (senes of eight articles). BMJ 1994-95; 309:
1424-28, 1491-95, I5OO-70, 1636-39; 310: 110-12, 178-82,
389-93, 583-86.
7 Brown P. The WHO stnkcs mid-life cnsis. .Vett* Saentut 1997; 153:
12; Australian Agency for International Development, Royal Ministry
of Foreign Affairs, Norway and Overseas Development
Administration, UK. Cooperation for health development:
extrabudgetary funds in WHO, 1997.
8 World Bank. Financing health services in developing countncs: an
agenda lor reform. World Bank policy studv. Washington DC. World
Bank. 1987.
9 Anand S, Hanson K. Disabilits-adjusted lile years: a cnticai review.
7 Health Ucon 1907; 16: 085 702.
10 Government of Bangladesh. Based on analysis of annual and 5-year
development plans. 1075-97. Dhaka: Ministry of Planning.
11 World Bank: operation' evaluation department. Population and the
World Bank: implications from eight case studies. Washington DC:
World Bank. 1902.
12 Government of Bangladesh. Health and population sector strategy.
Dhaka: Ministry of Health and Family Welfare, 1997.
13 Busc K. Aid coordination in the health and population sector m
Bangladesh: a case study and lessons learned. Prepared tor the UN
inter-agency task force on basic social services for all. Dhaka. 1997.
14 Gilson L, Russel S. Buse K. The political economy of user fees with
targeting: developing equitable health financing policy. J Internal
Develop 1995; 7: 369-401.
15 Stout S, Evans A, Nassim J. Raney L. Evaluating health projects:
lessons from the literature. Discussion paper. Washington DC: World
Bank, 1997.
16 Wapenhans A. Effective implementation: key to development impact.
Task force report. Washington DC: World Bank. 1992.
17 Zwi A, Mills A. Health policy in less developed countries: past trends
and future directions. J Internal Develop 1995; 7: 299-328.
18 Buse K, Walt G. Role conflict: the World Bank and the world’s health.
Sac Sci Med 1998: in press.
1

669

DRAFT NATIONAL HEALTH POLICY 2001
Points That Need A Critique
Positive Features

•

Direct, indirect acknowledgement of

-High levels of morbidity and mortality;
-Poor functioning of Public Health Sendees

-Gross under-funding of the Health Seivices.

*

impact of globalization has not been glorified; somewhat critical view ol the role of TRIPS

*

fakes note of higher public health expenditure in other countries; and its impact in health-status.

*

P.ecommcndation for doubling of central govt, health ex|)cnditurc by 2010.

c

*

Increased proportion of expenditure on primary health care. (55:35:10 fonnula)
■4/ 4
Lnvisaucs i emulation of private sector.
f S

*

Envisages improvements in medical education.

*

Concern about ethics, mental health, family medicine

c.

G

Negative Features
(h neral

•

No mention of Alma Ata Declaration and Primaiy Health Care Approach.

•

No intersectoral linkages seen in determination of health-status and provision of health care services.

Primary role of water, food, sanitation, environment etc. lias been mentioned in the passing, at the
end.
•

Linkage between distorted development and morbidity pattern not recognized.
double burden of old and new diseases; epidemiological polarization.

No mention of

Hence no policy to affect

determinants of health through an intersectoral approach.

*

No mention of special vulnerability of women due to the triple burden (pregnancy, child care, labour

in unorganized sector) and the role of patriarchy.

Specific Points

•

in Box 1, die achievements have not been compared with the gear, for th. year 2000. as envisaged in

the 1983 policy.
*

No indicator of malnourishment has been even mcnivij'J

prevalence of undernouialiment in children, anaemia in w-nncn

rncriik’n of continued high

In section 1.5, there is no mention of road-accident deaths(more than 50,000 deaths per year); a
product of wrong policies about transportation system in India.
No critical analysis of overwhelming domination of F.P. programme.
No mention of medico-social issues in drug policy. This is despite the fact that in the proposed

pharmaceutical policy 2001', there is not even mention of any of the medico social aspect of drus-

policy.
No mention of the Community Health Worker for First Contact Care. No departure from doctorcentered model of medical care.
No critique of pi ivatization of medical colleges.

Nothing on restricting ‘cross-practice’.
No cognizance of opposition by women’s and health-groups to injectable contraceptives, No change
in the cunent unethical policy on this issue.
Nothing on gender sensitization of health-care personnel and on health impact of domestic violence.

Goals bet in Box EV look arbitrary. They are unrealistic in the context of the experience so far.
«***«►*>!«>!<
1

>

20 o n S^Td'cO

/

National Health Policy-2001
A comparison with the People’s Health Charter
Sr.
1.

People’s Health Charter
;NHP-2001
The concept of comprehensive primary health :
Alma Ata Declaration not mentioned
care, as envisioned in the Alma Ata ■
Declaration should form die fundamental basis i 4.3 DELIVERY OF NATIONAL PUBLIC HEALTH
tor formulation of all policies related to health : PROGRAMMES
care. The trend towards fragmentation of:
health delivery' programmes through conduct : j j NHP-2001, envisages a key role for the Central
of a number of vertical programmes should be :
designing national programmes with
reversed. National health programmes be •
.
• • integrated within the Primary Health Care i
active participation of the State Governments,
system with decentralized phnningv decision- ■ Also, the Policy ensures the provisioning of financial
making and implementation with the active : resources, in addition to technical support, monitoring
participation of the conununity. Focus be : and evaluation, at the national level by the Centre,
slutted from bio-medical and individual based However, to optimize the utilization of the pubEc
measures to social, ecological and community
infrastructure at the primaty level. NHP-2001
based measures.
.
.
.
, .
x* 11 t. m
envisages the gradual convergence 01 all health
programmes under a single field administration.
Vertical programmes for control of major diseases like
TB, Malaria and HIV; AIDS would need to be
continued till moderate levels of prevalence are
reached. The integration of the programmes will bring
about a desirable optimisation of outcomes through a
convergence of all pubbe health inputs. The pobey
also envisages that programme implementation be
• effected through autonomous bodies at State and
j district levels. State Health Departments’
interventions may be Emited to tlie overall monitoring
of the achievement of programme targets and other
technical aspects. The relative distancing of tlie
programme implementation from the State Health
: Departments will give the project team greater
operational flexibiEty. Also, the presence of State
Government officials, social activists, private health
j professionals and MLAs/MPs on the management
• boards of tlie autonomous bodies will faeflitate well; informed decision-making.

2.

: The primary health care institutions including 4.6 RQLE_ OF^OCAL^SELF^OVERNNIENT
trained village health workers, sub-centers, and ■ INSTTfUTIONS
: the PHCs staffed by doctors and the entire •
■ range of communiw health functionaries : 4 6 j Nnp^oOi lays great emphasis upon the
including tlie ICDS workers, be placed under
,
. ..
r 1 r 1 ui
*1
u
: u
\ . - .
.
j r1
1 • implementation or pubhc health programmes tlirough
: tne direct administrative and financial control . ,
1 . . . 1 JT
of tlw relevant level Panchayati Raj local self Government institutions. The structure of
institutions. The overall infrastructure of the ; 1116 national disease control programmes will have
■ primaiy’ health care institutions be under the : specific components for implementation through such
control of Panchayats and Gram Sabhas and : entities. The Policy urges all State Governments to
provision of free and accessible secondary and consider decentralizing implementation of the
teniaiy level care be under the control of Zilla ■ programmes t0 such Institutions bv 2005. In order to
I anshads. to be accessed primarily through:
♦u;.. «
:
.1..

referrals from PHCs.

3.

The essential components of primary care
should be:
■ Village level health care based on Village
Health Workers selected by the
community’ and supported by the Gram
Sabha ! Panchayat and the Government
health services wliich are given regulatory
powers and adequate resource support

achieve this, financial incentives, over and above the
resources allocated for disease control programmes,
will be provided by the Central Government
* Primary health care approach not mentioned at all

Primary’ Health Centers and sub-centers 4.4 THE STATE OF PUBLIC HEALTH
with adequate staff and supplies -which : IP*
INFRASTR UCTlfRE
provides quality curative sendees at the
primaiy health center level itself with ; 4.4.1 NHP-2001 envisages the kick-starting of the revival
good support from referral linkages
; of the Primary Health System by providing some essential
; drugs under Central Government funding through the
; decentralized health system. It is expected that the
; provisioning of essential drugs at the public health sendee
■ centres will create a demand for other professional sendees
; from the local population, which, in turn, will boost the
: general revival of activities in these service centres. In
J sum, this initiative under NHP-2001 is launched in the
: belief that the creation of a beneficiary' interest in the
■ public health system, will ensure a more effective
■ supervision of the public health personnel, through
: community monitoring, than has been achieved through the
: regular administrative line of control.

■

A comprehensive structure for Primary' j 4.9 URBAN HEALTJi
Health Care in urban areas based on urban j
PHCs. health posts and Communtty Health : 4.9.1 NHP-2001, envisages the settingup of an organised
Workers under the control of local self urban primary health care structure. Since the physical
government such as ward coininittees and features cf an urban setting are different from those in the
municipalities.
rural areas, the policy envisages the adoption of
appropriate population norms for the urban public health
infrastructure. The structure conceived under NHP-2001 is
a two-tiered one: the primary centre is seen as the first-tier,
covering a population of one lakh, with a dispensary'
providing OPD facility and essential drugs to enable access to all the national health programmes; and a second-tier of
the urban health organisation at the level of the
Government general Hospital, where reference is made
from the primary centre, fhe Policy envisages that the
funding for the urban primary health system will be jointly
borne by the local self-Government institutions and State
and Central Governments.

4 9.2 Hk- X’ational Health Policy also envisages the
establishment of fully-equipped ‘hub-spoke' trauma
varc networks in large urban agglomerations to reduce
a^idcnr mmlalitx.

■

4.

Enhanced content of Primary Health Care
to include all measures wliicli can be
provided at the PHC level even for less
common or non-coupnunicable diseases
’(e.g. epilepsy, hy^eitension. arthritis, pre­
eclampsia, skin diseases) and integrated
relevant epidemiological and preventive
measures

4.15 xXATIONAL DISEASE SURVEILLANCE
Surveillance centers at block level to NETWORK
monitor the local epidemiological situation
and tertiary care with all speciality : 4 js .] NHP-2001 envisages the full operationalization of
services, available in everxr district.
integrated disease control network from the lowest rung
; of public health administration to the Central Government,
j b\’ 2005. The programme for setting up this network will
include components relating to installation of data-base
; handling hardware;.IT inter-connectivity' between different
tiers of the network; and. in-house training for data
collection and interpretation for undertaking timely and
effective response.
A comprehensive medical caie programme 4.1 FINANCIAL RESOURCES
financed by the government to the extent of at
least 5% of our GNP, of which at least half be The paucity of public health investment is a stark reality.
disbursed to panchayati raj institiiuons to Given the extremely difficult fiscal position of the State
finance primary level care. This be Governments, the Central Government will have to play a
. accompaiued by transfer of responsibilities to key role in augmenting public health investments. Taking
• PRIs to run major parts of such a programme,
into account the gap in health care facilities under NHP'■ along wnth measures to enhance capacities of
2001 it is planned to increase health sector expenditure to 6
PRIs to undertake the tasks involved.
percent of GDP, with 2 percent of GDP being contributed
as public health investment, by the year 2010. The State
Governments would also need to increase the commitment
to the health sector. In the first phase, by 2005, they would
be expected to increase the commitment of their resources
to 7 percent of the-Budget; and, in the second phase, by :
2010, to increase it to 8 percent of the Budget With the
stepping up of the public health investment, the Central
Government's contribution would rise to 25 percent from
the existing 15 percent by 2010. The provisioning of
higher public health investments will also be contingent
upon the increase in absorptive capacity of the public
health administration so as to gainfully utilize the funds.

42 E9.LWL
4.2.1 To meet the objective of reducing various types of
inequities and imbalances - inter-regional; across the rural
- urban divide; and between economic classes - the most
cost effective method would be to increase the sectoral
outlay in the primary' health sector. Such outlets give
access to a vast number of individuals, and also facilitate
preventive and early stage curative initiative, which are
cost effective. In recognition of this public health principle,
NHP-2001 envisages an increased allocation of 55 percent
of the total public health investment for the primary health
sector; the secondary and tertiary' health sectors being

: targcttcd for 35 percent and 10 percent respectively. NHP: 2001 projects that the increased aggregate outlays for the
: primaiy health sector will be utilized for strengthening
■ existing facilities and opening additional public health
: service outlets, consistent with the norms for such
: facilities.
' -

5.

: The policy of gradual privatisation of:
; government medical institutions, tlirou^li j
• mechanisms such as introduction of user fees '■
; ejven for the poor, allowing private practice by :
. Government Doctors, giving out PHCs on ■
■ contract, etc. be abandoned forthwith. Failure •
: to provide appropnate medical care to a citizen =
: by public health care institutions be made :
• punishable by law.

6.

i J-SSSi1
i s JT20?

.
m ,he “n,M °f,,“

and basic doctors, m place of die present trend ; avai
sPread of allopathic graduates in their
ross cUds over-production of personnel trained ' |QrisQlcllcn' State Governments would consider the need
m super-specialities. Major portions of
the P<>ol of medical practitioners to include a
undergraduate medical education, nursing as ■ cadreot Ilcentiates of medical practice, as also
well as other paramedical training be imparted : Prac^^°ners of Indian Systems ol .Medicine and
. in district level medical care institutions, as a ; ^onioeoPathy. Simple services/procedures can be provided
: necessaiy-’ complement to training provided in •
suc^ pra^hioners even outside their disciplines, as part
• medical/nursing colleges and other training i of
pnnian-’ health services in under-served areas.
institutions. No more new medical colleges to ; Aiso- ^^-2001 envisages that the scope of use of
be opened in the private sector? No • paramedical manpower of allopathic disciplines, in a
commodification of medical education. Steps • prescribed functional area adjunct to their cun ent
to eammate illegal private tuition by teachers functions, would also be examined for meeting simple
comnnl
At
P,,bllc :^lth recl™entS. These extended areas of
(niedkal Lr^..u”derSradua,e : ^Lordng of different categories of medical manpower
be made m^r
J™edlcaI) education : can be permitted, after adequate trainine and subject to the
in*, not b. taSi '"Xy“ I5:
°f Il,"r perf“m’“™
ptrfesbional

rural posting after post graduation be made :
compulsorv.
j 4.5.2 NHP-2001 also recognizes the need for States to
: simplify the recruitment procedures and rules for contract
; emploraent in order to provide trained medical manpower
; in under-served areas

rhe unbridled and unchecked grauih of die 4.1J ROLE OF THE PRIVATE SECTOR
commercial private sector be brought to a halt.
'
----------- ----------: Strict obsen'ance of standard guidelines for ; 4 i; i x-jp
.
.■ medical and surgical intervention and use of - 4
■ dP’-( 1 ^visages the enactment of suitable
diagnostics, standard fee structure, and legislaiicns for regulating minimum infrastructure and
: periodic prescription audit to be made . quality standards by 2003. in clinical
obligatory’. Legal and social mechanisms be set eslab•asr.-ments medical institutions, also, statutory
up to ensure obsen'ance of minimum standards guidelines for tb.c ccnuuct of clinical practice and delivery
by all private hospitals, nursinginatenuty ot meoicai services are to be developed over the same
homes and medical laboratories Prevalent pctuxj he p- »1!CV aisc. encourages the setting up of private
practice of offering commissions f?i referral io i.nswr^.-.. m-.-.rumcr.t. :or increasing the scope of the
be made punishable by law !-or ’fj.. purpose a. vc\r-1_; . . me >vc. nuary and tertiary' sector under private

j

: body with statutory powers be constituted, ; health insurance packages.
wltich has due representation from peoples :
_
: organisations and professional organisations.
: 4.13.2 To capitalize on the comparative cost advantage
• enjoyed by domestic health facilities in the secondary and
: tertiary sector, the policy will encourage the supply of
; services to patients of foreign origin on payment. The
: rendering of such services on payment in foreign exchange
• nail be treated as 'deemed exports' and will be made
• eligible for all fiscal incentives extended to export
• earnings.
4.13.3 NHP-2001 envisages the co-option of the non­
governmental practitioners in the national disease control
programmes so as to ensure that standard treatment
protocols are followed in their day-to-day practice.

8.

4.13.4 NHP-2001 recognizes the immense potential of use
of information technology applications in the area of tele­
medicine in the tertiary’ health care sector. The use of this
technical aid will greatly' enhance the capacity for the
professionals to pool their clinical experience.
A rational drug policy be formulated that ■ No mention of rationality of drugs here or in the
ensures development and growth of a selfdrug policy
reliant industry for production of all essential
dings at affordable prices and of proper
4.23 IMPACT OF GLOBALISATION ON THE
quality. The policy should, on a priority basis:
HEALTH SECTOR
■ Ban all irrational and hazardous drugs. Set j
up etfeciive mechanisms to control the i " 4.23.1 NHP-2001 takes into account the serious
apprehension expressed by several health experts, of
introduction
of new
drugs and :
formulations as well as periodic review of •
the possible threat to the health security, in the post
currently approved drugs.
TRIPS era. as a result of a sharp increase in the prices
• Introduce production quotas <fc pnce
of drugs and vaccines. To protect the citizens of the
ceiling for essential drugs
country' from such a threat, NHP-2001 envisages a
■ Promote compulsory' use of generic names
national patent regime for the future which, while
■ Regulate advertisements, promotion and
being consistent with TRIPS, avails of all opportunities
marketing of all medications based on
to secure for the country, under its patent laws,
etlucal criteria
affordable access to the latest medical and other
’ ■ Formulate guidelines for use of old and
therapeutic discoveries. The Policy also sets out that
new vaccines
the Government will bring to bear its full influence in
■ Control the activities of the multinational
all international fora - UN, WHO, WTO, etc. - to
sector and restrict their presence only to
secure
commitments on the part of the Nations of the
areas where they’ are willing to bring in
Globe, to lighten the restrictive features of TRIPS in its.
new teclinology’
application to the health
■ Recommend repeal of the new patent act

■

9.

and bring back mechanisms that prevent
creation of monopolies and promote
introduction of new drugs at affordable
prices
Promotion of the public sector in :
production of drugs and medical supplies, :
moving towards complete self-reliance in :
these areas.
:

Medical Research priorities be based on ; 4.12 MEDICAL RESEARCH
morbidity and mortality profile of the country', :
and details regarding the direction, intent and ; 4 12.1 NHP-2001 envisages the increase in Govemment...cns of all researcn programmes be made i fimded medir.nl research to a level of 1 nercent of ioial

: entirely transparent. Adequate government ; funded medical research to a level of 1 percent of total
: fimding be provided for such programmes. : health spending by 2005; and thereafter, up to 2 percent by
: Etliical guidelines for research involving : 2010. Domestic medical research would be focused on new
human subjects be drawn up and implemented : therapeutic drugs and vaccines for tropical diseases, such
. after an open public debate. No further ias
• as jb
TB and Malaria, as also the Sub-types of HIV/AIDS
experimentatioil involving hunum subjects, Jje : prevalent in the country'. Research programmes taken up by
allowed without a proper and legally tenable the Government in these priority areas would be conducted
informed consent and appropriate legal in a mission mode. Emphasis would also be paid to time­
. protection. Failure to do so to be punishable
bound applied research for developing operational
; by law. All unetliical research, especially' in the
applications. This would ensure cost effective
• area of contraceptive researclL be stopped
. forthwith. Women (and men) who, without dissemination of existing / future therapeutic
; tlieii- consent and knowledge, have been drugs/vaccines in the general population. Private
: subjected to experimentation, especially until entrepreneurship will be encouraged in the field of medical
: hazardous contraceptive technologies to be research for new molecules / vaccines.
: traced
forthwith
and
appropriately
; compensated.
Exemplary’ damages to be
awarded against the institutions (public and
private sector) involved in such anti-people,
unethical and illegal practices in the past.

10.

.All coercive measures including incentives and
disincentives for limiting family size be
abolished. The right of families and women
within families in determining the number of
cliildren they want should be recognized.
Concurrently, access to safe and affordable
contraceptive measures be ensured which
provides people, especially women, the ability,
to make an informed choice. All long-term,
invasive, systemic hazardous contraceptive
technologies such as the injectables (NET-EN,
Depo-Provera, etc.), sub-dermal implants
(Norplant) and anti fertility vaccines should be
banned from both the public and private sector.
Urgent measure be initiated to shift to onus of
contraception away from women and ensure at
least equal emphasis on men's responsibility
for contraception. Facilities for safe abortions
be provided right from the primary health
center level.

11.

: Support be provided to traditional heaiiiig • 2.26 z^TE^ATIVE S YSTENIS OF MEDICINE
; systems, including local and home-based
: healing traditions, for systematic research and 2.26.1 Alternative Systems of Medicine - Ayurveda,
: community based evaluation with a view to Unani, Sidha and Homoeopathy - provide a significant
: developing the knowledge base and use of supplemental contribution to the health care services in the
: these systems along with modern medicine as country, particularly in the underserved, remote and tribal
; part of a holistic healing perspective.
arecas. The main components of NHP-2001 apply equally
to the alternative systems of medicine However, the policy
features specific to the alternative systems of medicine will
be presented as a separate document.

12.

: Promotion
of
transparency
and
• decentralization in the decision making
: process, related to health care, at all levels as
: well as adherence to the principle of right to

■

Refer to National Population Policy-2000.

: information. Changes in health policies to be ■
• made only after mandatory wider scientific ;
• public debate.

13.

Introduction of ecological and social measles ;
: to check resurgence of communicable diseases. ■
Such measures should include:
Integration of health impact assessment :
into all development projects
Decentralized and effective surveillance ;•
and compulsory notification of prevalent :
diseases like malaria, TB by all health care :
providers, including private practitioners
Reorientation of measures to check •_
STDs/AIDS
through
universal
sex j
education, promoting responsible safe sex :
practices, questioning forced disruption :
and displacement and the culture of
commodification of sex. generating public
awareness to remove stigma and universal availability of preventive and curative .
services.
and special
attention to
empowering women and availability ot •
gender sensitive senices in this regard.

]4.

Facilities for early detection and treatment of
non-communicable diseases like diabetes.
: cancers, heart diseases, etc. to be available to
all at appropriate levels of medical care.

15.

■
■

•

•

■

Women-centered health initiatives that ■ 4.17 XVOMEN*S HEALTH
include:
Awareness generation for social change on : 4.17.1 NHP-2001 envisages the identification of specific
issues of gender and health, triple work programmes targeted at women s health. The policy notes
burden,
gender
discrimination
in : thafwomen, along with other under privileged groups are
upbringing and life conditions writliin and ! slonif1Cantly handicapped due to a disproportionately low
outside the family; preventive and curative ac^ess t0 health care. The vanous Policy recommendations
measures to deal with health consequences ; of NJHP-2001, in regard to the expansion of primary' health
of women's work and violence against :
will facilitate the increased access of
women
women to basic health care. NHP-2001 commits the
Complete matenub' benefits and child care :
Qf
Central Govemment to
funding
facilities to be providedI in aU occupations :
O£ffamnles relatlng to woman’s health,
emplovmg women, be they tn the :
y
need t0 review
staffing,
organized or unorganized sector
;
>
u
health administration to more Special support structures that focus on :
f
aFwnm^n
single, desened. widowed women and comprehensively meet the specific requirements of women,
minority' women witich wall include
religious, ethnic and women with a
different
sexual
orientation
and
commercial sex workers; gender sensitive
sendees to deal with all the health ;
problems
of women
including
reproductive health, maternal health, :
abortion, and infertility
Vigorous public campaign accompanied :
by legal and administrative action against
sex selective abortions including female
feticide, infanticide and sex pre-selection.

i

»

16.

: Child centered health initiatives that include:
: ■

: •

. ■

; ■

17.

18.

19.

20

A comprehensive cliild rights code.
adequate
budgetary
allocation
for
universalisation of child care sendees
An expanded & revitalized ICDS
programme. Ensuring adequate support to
working women to facilitate child care,
especially-’ breast feeding
Comprehensive measures to prevent cliild
abuse, sexual abuse', prostitution
Educational, economic and legal measures
to eradicate child labour, accompanied by
measures to ensure free and compulsoiy
quality elementary education for all
cliildren.

I.- Special measures relating to occupational 4.21 OCCUPATIONAL HEALTH
and emironmental health which focus on:
■ Baiuiing of hazardous tecluiologies in : 4.21.1 NHP-2001 envisages the periodic screening of the
industry and agriculture
health conditions of the workers, particularly for high risk
■ Worker centered monitoring of working health disorders associated with their occupation.
conditions with the onus of ensuring a safe
and secure workplace on the management
• Reorienting medical services for early
detection of occupational disease
■ Measures to reduce the likelihood of
accidents and injuries in difierent settings,
such as traffic and. industrial accidents,
agricultural injuries, etc.
The approach to mental health problems
should take into account the social structure in
India which makes certain sections like women
more vulnerable to mental health problems.
Mental Hetilth Measures that promote a shift
away from a bio-medical model towaids a
holistic model of mental health. Community
: support
community based management of
mental health problems be promoted. Services
for early detection & integrated management
: of mental health problems be integrated with
• Primary Health Care and the rights of the
’ mentally ill and the mentally challenged
peisons to be safe guarded.

Measures to promote the health of the elderly
by ensuring economic security, opportunities
for appropnate employment, sensitive health
. care kicilites and, when necessaiy’, shelter fui
the elderly. Sendees that cater to the special
needs of people in transit, the homeless,
nugratory workers and temporary settlement
dweileis
Measures
promote the health of physically
’.nd mentaUv disadvantaged bv focussing on

4.10 MENTAL HEALTH

4.10.1 NHP - 2001 envisages a network of decentralised
mental health services for ameliorating the more common
categories of disorders. The programme outline for such a
disease would envisage diagnosis of common disorders by
general duty medical staff and prescription of common
therapeutic drugs.

4.10.2 In regard to mental health institutions for in-door
treatment of patients, the policy envisages the upgrading of
the physical infrastructure of such institutions at Central
Govenment expense so as to secure the human rights of
this vulnerable segment of society.

.. '

the abilities rather than deficiencies. Promotion
of measures to integrate them in the
community with special support rather than
segregating
them;
ensuring
equitable
opportunities for education, employment and
special health care including rehabilitative
measures.

21.

Effective restriction on industries that promote
addictions and an unhealthy lifestyle, like
tobacco, alcohol pan masala etc., starting with
an immediate ban on advertising, sponsorship
and sale of their products to the young, and
provision of services for de-addiction.

:

/

POVERTY ALLEVIATION, EMPLOYFfFNT
SiBjjgRATION AND RURAL DEVELOPMENT
LOrgan^tsed by Akhil Bharat Sarvodaya, Maha Sangh )
A DRAFT NATIONAL PLAN OF ACTION

PREAMBLE
f
R
thC inalienable right of the Indian people, as of any other people to have
freedom and to enjoy the fruits of their toil 4nd have necessities of life L that thev

J' ™»

““ <•->

lepenaence Pledge that was being taken on 26“> January evei-y year nrinr tn
Swararo/cornnkt
,years after the 1931 Lahore Congress Resolution on Puma
of
? u IndePendcnce- Now, as things stand, these hopes and aspirations
even JtX^s
^^staS!LucTbS

below ie pot^X? independence since over one-third of our population now live

regions as also between urban and rural areas^

soda!curse of umouchVabiliXaiwhichrOthPS
old

’

“

,mbalances between

,"e “th‘r
w,,nessin8
th' is the age°f
fm
ections
e w
ofst of which

and national integration. SometSh^ W bl'd^ ?'
unity
begin somewhere and let that be i^ the foL of
!•
11113 tide’ We have to
poverty dovetailed with social transfnrmaH
of a nation-wide drive for eradicating
development in the shape of a Samodaya movemm?01^ refieneration arl ! al’round

government and^by thtTp^op^ What0^131^118
that haS been donc 80 far by the
of intentions, the me^s that’ have b'enTdoX^"
^th/b^
with the result that our real achievement^
P ?
the cost involved and the nation
vf' HUt °f
pSuperisan, forcing

Pr°Ved largely self-defecting
ProPortion to the
the enormity
enormity of
of
at
of ecTnomfc

treaties and investments on their term<j v/ °reign countries for loans and grants
that, by doing Si
are^o,™'
“ hare te»‘ »” PercepU“ to
and self-reliance. The t^haTc^
honour, suspect
honour, and rebuild the foundation and edifice• of^ur
r SltUabonour national
e recourse to the Gandhian path of Swaraj, Swadeshi aid S^^^ " tO

Employment^n^on15^^^ Develip^enTw J°rkshop on Poverty Alleviation,
Saiwodaya Maha Sangh on behalf of th7 i

f

organised by the Akhil Bharat

Committee to prepare an action plan and take follow-up action in furtherance of the
task of the Workshop, The Standing Committee has accordingly formulated a plan of
action for poverty alleviation, employment generation and rural development as
follows:L POVERTY ALLEVIATION
1)

AQRI CULTURE

rennrtr.dintCe 1116
of Poverty is the utmost in the agricultural sector which is
task^hluM ahCCOUnt f°r.ovcr 70 Per cent of to® Poor in India, our poverty aUeviation
return.!
Cgl>
secto^• 1716 obJect is to eradicate poverty by ensuring higher
returns per capita and per unit of land and also to help agriculture absorb more
techiioues6
111113 delude (a) intensive farming, (b) improved tools and
facies m wastTT? ‘T31113’ (d) rati°nal and remunerate prices, (e) maXtog
facilities (f) waste land development, (g) soil conservation and (h) water management
(a) Intensive Farming

In adopting intensive farming, we could benefit by experiments made bv
Achsuya Vinobaji
vmobaji and
Prof. S.A.
S.A. Dabholkar of Kolhapur^ MahXstoa The
Acharya
and by
by Prof.
latter has demonstrated that one-quarter of an acres is suffiSent to%up~rt M

intensive farming in
Sh°uld be asked t0
planned, monitored and the rennltn
farmin8 should be meticulously
suitably trainX7rso“ ov« * nerirS rrCCOrdCd &t eVCIy 8ta«e
^P^
or
y
neo persons over a period of one year to study how it works.

progreXly""m ^sTeond h11"
farinin8 should bc enlarged
first year, so7that withix!cour- nfT^l
.°n *C success in the
in U,: vui^e oomeT^SX
'h'
“1’d"

holdings of spedficP«te^l«U^^idOfblhr.d??>e!i1I^Cn^ ^5 cclhngs on land
land so obtained should brSstriSd^lc8islation
surplus
and
tenants-at-will.
This’e task could hr
t
agricultural labourers
impartial
and reepee^
oXS
transparency and justice to the concerned people
(b)

m °rdCr tO enSUre

Improred tools and technique

experiments Sd
by V“°b'* «"« « ™ Dabhoikar s
this action plan, steps stouXe tX toX"* ”
tools and to manufacture them in easily XSXnS ""‘““■'J' »' <hese
(O)

SoU Testing and Crop-planning

Soil testing laboratories-cum-reach taluk or block head quarters to test die soifand
centres should be set up in
I determine what types of
2

crops are most suitable for every farm or cluster of farms and also help farmers
by advising then with crop planning patterns to suit their soil and availability of
water.
Every block or taluk should provide for efficient, well-informed and
helpful consultancy services to enlighten and guide farmers in matters
concerning the soil, suitable crop planning, improved methods of cultivation,
availability and use of useful inputs, improved tools and such other things
calculated to bring about continuing improvements in agriculture and allied
occupations.
(d)

Improved inputs

The necessary inputs are (i) improved seeds and (ii) enriched manure
(i)

Improved seeds should naturally be high-yielding indig* nou*. varieties
with enhanced nutritional value and their production should be
decentralised and should adopt natural and biological processes.
Imported or hi-tech processed seeds should not be entertained.

(ii)

Use of enriched manure is a must for increasing agricultural production.
But this should be done without affecting the fertility of the soil. It is an
admitted fact that continuous use of chemical fertilisers impoverishes
the soil. Hence it is in the interest of agriculture that the use of chemical
fertilisers is gradually given up yielding place to enriched organic
manure. This should be done in a planned and systematic manner by
(a) composting of all available organic material like cattle dung, garbage
and other organic waste, (b) by instaffation of biogas plants extensively
so that every family having sufficient number of cattle has a biogas plant
within a period of 2 to 3 years and every village has a community biogas
plant connected to community latrines and household latrines and also
using village garbage and (c) by extensive adoption of wormiculture in a
scientific manner by having wormiculture laboratories or units in all
villages for increasing agricultural production and improving fertility of

(?J

Rational, remunerative and non-fluctuating prices

’

Under Market Economy it is the needs of the market that determine the
prices and this is always detrimental to the interest of the farmers and it
is one of the major factors that renders agriculture uneconomical, brings
rum to farmers, particularly small and marginal farmers and is largely
responsible for the prevalent poverty in the farm' sector. It is hence
necessary that, in the interest of agriculture, this sequence is reversed so
that prices of agricultural products cover the entire cost of production
re^nable
to help the farmers enjoy a decent, standard of
living. The market should accept the prices so evolved. Any consequent
disadvantage to the consumers has only to be offset by helping km
earn more purchasing power rather than clamour for reduction in the
paces of farm products.

The support
support prices
prices offered
offered by
by government for food grains and other
commonly consumed products should
-- ----- J hence be weighted in favour of farmers
and not consumers. Such a ] ”
° .enSUring
prices to farmers
would also offset to a certain extent the
excessiver«Hunerative
burden
--------- 1 on the nation by the
3

exhorbitant salaries and perks paid to government employees as a result of
acceptance of the recommendations of the 5'" Pay Commission, so that part of
”eo„omyS”S b“k ,0 the
thereby bener.bng nationa!

ID

Crop Insuranoe

Crop insurance is a must in a (country like India where the vagaries of
the monsoons and the resultant drought
conditions play havoc with the lives of
farmers particularly small and
marginal farmers, tenants-at-will and
agricultural labourers. The State
must provide suitable facibties for crop
insurance on convenient terms to help farmers in such eventualities?
(£)

Marketing fadUties

natnraf4^11”8 contributes largely to the success of agriculture The most
which
? convenient market for agricultural produce is the local m^keJ
overhe^° t"
“p'n8e’ tor at°ra8'. tranapori, mideUemanry id
another id is eoS^Toh.^ Sr
■’r?du“" “d consumers k„X one
themselves and tn that
1Pbart?r or exchange °f goods between producers

done
■ triaaX, |eX"7eM "aX
wholesale
These
the
“hd°—
prevent
of authority directly

»

Marketing particularly to distant places involves scientific and cheep
strange facilities to facilitate long-term storage and
prevention of decay or
destruction from rats and pests,
’ S1iita.ble storage bins could
poor farmers and common jstorage
'
fadlitie, eouid alsi
“
be provided in their
villages or at common centres at reasonable changes.
(h)

Nearly 50
P,er ^nt °f available land in India
barren or sahne Und
It would be a boon
” ------1 *S rePorted to be waste or
to our
”
n
hllf
tO
°
Ur C°Untry ln 8eneral
agriculture in particular ev
even
if half
could
u
_______ _ned
forl^ture
o Vri
be convert<=d into
thanks to experiments in MaharasS aild HarJSja
Y
1S
°Ur reach’
In Satara in Maharastra, in an c
experiment in iintensive farming on dry
, barren soil
icruie soil. Even the colour of the ; ” *
— is
-j converted into
soil
becoming
black
in
a
f
treating it with certain
few months period by
organic and other inputs. It is well wnrth h • ‘ j
J
on an extensive scale m
i a systematic manner for recll^aU
^h
8 & °Pted
cultivation.
on ol barren land for

4

can help in reclamation of saline lands for cultivatiop.

Government can promote this waste land reclamation project cn an'extensive
scale by distnbutmg such land free of cost among landless agriculture, labourers and
nants-at-will and finance the operation by means such as 50 per cer < erant and 50

iiiiHiSSS

be a great leap “
^tXtion
a’S^60 n‘““°.n
»'“» would
devised to undertake this bie
k’,
SU15able O1ganisational set-up could be
attempted at ?
8
tlon'buildlng task. Is it not
hot worth being seriously
(i)

Soil Conservation

. -

r

- ------------------ --j

rain,

It is precisely this top soil that is crucial for

„X°n "ddman
Xr°™:
““ byenthis
tSrL
“and
“<lth°““n^ to conserve
soil

»' —

U is a dcbt we
from
becoming
a
desert.
Systematic
erosion by programme's sSX-bc "nd^nto Precious land
f2"t1°"_bUndmg’
Panting, and growing green
----- 1 be encouraged to take up
or
groups to help them become
prospective farmers on such lands.

InfCen^S ~”ld^^e^n7?^Xn^sCOUld

U)

Water Management

c^vafioXTeTenXe LT TOs^Xfo^f " “

Pr°moting

institutions or non-governmental organisation^ToTb
e?trusted to Panchayatraj
the uSe of water for irrigation by pXXfl e
8
C&re of Ec°nomising
techniques like drip irrigation a^sprinSirriradon 6 Wa‘er11°gging and by adopting
ground water to prevent its depletion and^^ure it^
regulatin8 the use
waxauuru possible number of
bnaure its '‘•-^availability to the

to the aeople of iSSa'^j'S^ote^
7“'“' “S “ naUonal “set belonging
source should
must be' treated

particular state or revion
d nOt be treated as* the
Hence an H
aonronX^^^V
1116 presetve 3
formulated withstandSg all region^orPoon "T
Water poli<* haa to be
water poh»?y has
npa^n or pr.aeHptive
in^le”
"o'
Viewed in this contevt

‘

even at the r
i or superfast
project in the higher
3 interest of the nation
“uie. it would also create

5

unmense employment opportunities during the period of construction of the project,
and, to a certain extent, for its maintenance after its completion.
(1 OTHER CATEGORIES OF RURAL OCCUPATIONS

Since agriculture is the principal area for poverty alleviation and since
agricultural operations, particularly
i
- on dry
- lands arc seasonal, the primary task for
other < ‘
categories of rural occupations is to provide employment to needy or
underemployed peasants some dependable avenues of income during the period they
are idle as an adjunct to agriculture.

Khadi ideally suits this purpose.

rmZamme t0

Gandhiji devised

1S gap in the Peasant's life-

the

hand-spinnimz

Hand-spinning has undergonf

immense improvements since his days. It needs very little training the investment is
very small and the return is immediate. It produces an article Jhich is in common
Craaf V1”? forms part of one of thc basic necessities of life. The present-dav new
^fiteh^^ 4111(1 ltS lmproved versions with 8 to 10 spindles can produce fine yam

easXZ mn t
The entire family can be engaged in it. It is hence one of the
d most convenient means of alleviating poverty among Indian peasantry.
and ViUge^InXSes
indU^eS COmin8 under the purview of the Khadi
industries8 are tiuT capable oi? pmvid^ off8 agr°-baSed and simple food-processing

rural oSpaXllSX SK’’'’',''“"S “<i

“““I- ba**

° provldln8 Part-time or whole-time

employment to peasants and others in

are
prosperity.
They are all ideally sufted tn f
eco?orny 4111(1 ensuring rural
Swadeshi, Grain Swaraj and Production by th^aX Bu?^ concepts of
success, in the midst of competitive marult
sscs- But thelr usefulness and
globalisation and the organised mechanisTd^ndu^000^’ ueCOnOmic Hberalisation,
all remunerative rural industries caiU f
ustries which are trying to take over
T
------ -from Saeernme”,’?,PPOn’
““
protection
the
--------... i:iraportance
of rhe..
in „adicaUng
country.

th’t
Outy or the state to help rural industries
according to Article 43 of the Constituti
ion of India which reads as follows "

■
““ W°rk'rs
a living wage
<tn individual or co-Z^’tive'bX^^^0^ tO Prom°tc cottage indues™
Cottage industries here < '
obviously mean rural industries,
assistance and protection which
The support,
-i the government is bound to
programmes is as follows:give for these

()

(a)
(b)

(c)
(d)

(e)

(0

Providing adequate financial assistance on convenient terms through budgetary
provision or through banks ;
Development of appropriate technology to iimprove productivity
2
’ '
and quality,
ensuring suitable training, supply of improved tools and
suita^e
------ ----------- ; agencies for
the programme ;
Marketing assistance and avoidance of middlemaiiy •
Above all, reseiwation of these industries and their products exclusively for the
rural sector to stabilise this important poverty aUeviation programme •
97 M1S1
thC- Memorandum Presented to the Prime Minister on
2/ -1 1 -1 J98 by a delegation representing the khadi and village industries sector
assumes importance and we fully support all the issues raised and demands
made in the said Memorandum which is yet to be considered by government
tn after 1 A year and urge upon the government to accept and act upon them
. ince, according to the 23^ Amendment to the Constitution of India, khadi and

s

u^'brXrim

activiti6s of Panchayatraj institutions, steps

should be taken immediately to work out modalities for entrusting these
p™T™m'S 1<> lhe“ 1OCaI
bo,lie.
are „o« suiMfor "e

Since poverty alleviation i:
is an integral part of rural development, matters
pertaining to planning, monitoring, co-ordination and those concerning the
appropriate agency for the programme are
all dealt with under Rural Development.
3)

SMALL SCALE AND TINY INDUSTRIES,

other vocations

Though 01686 industries and vocations do i
not have much bearing on
potential forlaUO1] n™0"8 agriculturist8 and rural artisans,
> they do have plentiful
potential for employment generation ; *
semi
po
^
erty
eradication
among the educated,
technically qualified, skilled,
semi-skilled and enterprising persons and those who
follow hereditary callings.

compared to village indultriel ri^ce thev^hav8
h°Wever hetter-placed when
banks and other financial institutions and^also c easler a6cesslbihty to finance from
of marketing while, small scale indust^
advailtages in respect
base and supporr Xever ae “
" P
haVe ‘ SUonS »8an.satio„al
undeniable.
however their impact on poverty eradication in positive and
II.

EMPLOYMENT GENERATION

Employment generation iin India in realistic terms p.;
employment opportunities by the state <
means the creation of
or other agencies to help the r—p
employed to earn enough purchasing power
or’ herself
wt^th^
ir to
to provide
provide himself
himself or
herself with
th< 8 S°
necessary wherewithal t„
to meet optimum basic necessities of life and enjoy a decenl
standard of living in terms of food
domestic and community life social relatin’ h0USlng’ health, education, culture,
doubtless gets directly related
should hence be taken up in a
( p^ned
ble bod.ed persons get employment

This is indeedupon^U^task^f
Vari°US reasons.
come to be looked
Employment has
employer and has the public exchequer unrf°Ve?ment beCaUSe 0 *8
J the biggest
government employment are quite a^tracdv^^^H^^L
its control,
—‘ terms of
and have the
advantage of
7

security, adequacy, pensionability and bargainability, there is an obvious scramble for
it. But there is also an obvious limitation of availability of this kind of employment.
Besides, the government has also a further responsibility cast upon it for ensuring
emp oyment to the great majority of the people at large who far outnumber those who
Hence the role of the
wise,

La

r,n“ciaUy

mass employment
industry and trade the banks the entire
well Bernal!
ac^ "'d
well
i
assisted, play
consensus.

u ln w^lch
government, private
rUral todUstri's
"

HL RURAJL DEVELOPMENT
nearlv

D°“iXn.

aft-repeated axiom. This
' is verily so because
jes and agriculture
tn India in wholly village - centered,
pri»^
during
tk. “
~r
ProsPerity of our villages was
during the freedom struggle.
His celebrated
~
,.
rural development programme. ’ Rural
-1 other development projects of the
1 to remain incomplete,
1S accompanied by effective
_. j and • all-round rural

" is

tZX Sri’LXTZ.”" • wholeri? b°u"d t-

development.

poverty ^S^empl^en^gen^ra^ to helo V"1633

iS dove^led with

the under-employed in all sectors ^>f life to nrnd P 016 P°Or’ 016 unemPloyed and
purchasing power to get over their novZrL
Pr°duce enough wealth and enough
enjoy a decent standard of living. A?decSt s^dm'
cco'lomic conditions aS

there ls improvement in all areas of tortSi ’^ding of living is not possible unless
should therefore not be eonlSSX^ SJ
Run11 ^riopme"
mclude eocol. educational, cuhural Jid
* h°“S,ic aPPf“eh

and shPouldnLi°b^ohSebde w
thus be a co-ordinated endeavour.

P

1 f ** natlon as a whole and should

as the name itself
unemployed and uinder-employed people in villages and t u
areas of rural g_.
drawbacks found i
improvement over them,
employment in rural areas.

8

development of the

But the one glaring drawback that may well defeat the very purpose of the
scheme is the omission to specify the principal categories of productive operations that
should constitute the ' key activities ’ envisaged in it. The crux of the matter is that,
unless the key activities are productive and are linked to the basic necessities of life,
namely food, clothing and shelter, as envisaged by Mahatma Gandhi in his concept of
Production by the Masses, the products of these key activities will not have an assured
and ready market, local or outside, and the programme cannot sustain itself, thereby
defeating the very purpose of the scheme, specially in the background of the
government's policy of throwing open agro-based and food-processing 'ndustries and
production of the bulk of the cloth required by villagers to the organised sector and to
multinational corporations .
The government should therefore spell out its stand in the matter, provide
unreserved policy support and create favourable conditions for the scheme to succeed,
preferably by reserving the bulk of agro-based and food-processing industries as well
as the production of coarse yam and cloth and also house-building materials needed
by villagers to the rural development sector which alone can ensure success to this
self-employment scheme.
Rural development, in its real sense, envisages a co-ordinated scheme for
all-round, integrated and total development of rural people and proper utilisation of
natural resources to help rural development without disturbing the econological
balance. It involves the maximum and balanced development of rural India. It is a
process of bringing about the economic, social, educational and cultural progress and
well being of all persons, families, groups and other sections. This pre-supposes the
creation of an atmosphere of peace, amity and mutual helpfulness among people
without which no progress is possible.
K P P

” !hU’f“

effecive meju™

hdn’thJ TOmm “ “'“7 nOt “S'

"><l unemplo^u^but Ssow

eradicat'

“brine

—

It is thus clear that the :scope of the
J. programme should be much wider
and its iimpact much deeper than what
"obtains
today. It is equally clear that our
entire rural .population
; J who
~
. ------- 1 and
not imerely those
ye
below the poverty line, stands in
need oj integrated and aU-round development and cultivate
the values of democratic
and harmonious social life. It is therefore not fair c
----------or proper for the state to deny the

th'".ob"X
a““d'XT07o^of concept hofr
10°dU
be«noted
in Masses
his ideology of Siv“ ayTor L
'.Pr
i°" by the “
“Seo and
Production
Ziid

beyond U,e demand, of So^Ll Jus&Taid^.;^
v'" vefy nature, include “
d 80
- /.
and
legitimate
interests
of
minorities
and
other weaker sections of society The time has
egmmate
ttTe'Xe"™^
arisen .0
to widen the scope m.d
and impact of the programm
population and work it out as a
Programm
°U‘ “ ’ ““P-hcnsive and co-ordinated developmental
experience gained and the lessons

9

A.

Objective*

■<H

f> ■ J

The following are among the principal objectives of rural development,
• «

1)
2)

3)

4)
5)

6)
7)
8)
9)
10)
11)
12)
13)

14)
15)

iil

Removal of poverty and unemployment and bringing down economic
disparities through production by the masses;
<
The maximum utilisation of all available resources and productive
capacities aimed at optimum, all-round, balanced and enui table
economic growth;
. u
Development of agriculture based on intensive cultivation as the core of
rural economy with a view to getting the highest possible yield per acre
and per unit of investment ;
Development of other rural occupations and subsidiary vocations to
further improve production, employment opportunities and standards of
living ;
Providing assured marketing facilities and ensuring remunerative prices
to farmers and other producers for their products ;
Development of the necessary infrastructure for the contemplated growth
of agriculture and other economic activities;
All-round and purposeful education to ensure maximum human
resource development among all people, young and old ;
Rural housing, and, wherever necessary, rebuilding of villages •
Comprehensive health and family planning services;
Utilising all available alternative sources of energy;
Environmental monitoring and maintenance of ecological balance •
nsunng people's participation in developmental programmes ; ' ’
Co-ordmated development of all regions and the country as a whole
alongside all-round and total development of blocks so as to remove all
regional imbalances ;
icmove an
Eradication of corruption at all levels and regeneration of moral valuesProniouon of economic and social equality, economic and social justice
”'aker “ction’

16)
B.

ORGANISATION

without an effective
process.
This for achieving
combination ^f "sp^

h

wiU.rcmain a distant dream
& P1**1111118’ assisting and monitoring the
bC a ^rkable

participation and efficient and transparent admffiist^ation

P’

enthUSlashc

P°Pular

years Las S^S^emd? ^bi:0111^ dfCVel°Pment ProJ«t of yestercomprehensive block development admini«fmHdlUm
dcYeloPment with its
elected bodies with it. Unfortunately the
On
assoc*adon °f popularly
trial. The primacy of the weU-coneeiv/d^
?Ot glVen a fair ^d sustained
re-established with suitable improvements “ n^.develoPment block setup has to be
round and integrated rural dSo
t
m°ddicaUons as the instrument for all-

consisting of (1) The ^ck Adm^lualon^^ElJct d °'°rdinated rural development

Block or Taluk Panchayats, (4) The District Panch6
age Panchayats> (3) Elected
governmental organisations.
4 Panchayats or Panshats and ( 5) Non-

10

1.

The Block Administration

Thm would, as at present, be headed by the Block Development Officer with the
difference that he should have the status of an Assistant Director or Assistant
Commissioner m keeping with the importance of the tasks entrusted to him and the
level of official and public contracts he has to maintain. He should preferably be
ffidusntr£sm deVelop™ent departments like those of agriculture, animal husband^,
industries co-operation, education, etc. If suitable and willing persons with the

supervising and co-ordinating the rural development programmes

^ecuting,

The Block Development Officer

dealing with the
1)

3)
4)
5)
6)
7)
8)
9)
10)
U)

Agriculture and Horticulture
Animal Husbandy
Rural Industries and other rural occupations
Minor Irrigation, and water management’
Co-operation and Marketing,
Roads, Bridges and Public Buildings
Housing and Village re-building,
Health and family Planning
Adult Education,
Welfare of Women, Children and other Weaker Sections
Affiorestation aAd Environmental

12)

Other subjects.

The Block Development Officer
and Assistant or Junior Development
Officers should all receive the nt
necessary
orientation training prior to their
appointment,
Appropriate refresher
-•
courses
should also be
periodically.
-J arranged for them
complement of miSsteria^arTd1^?^?^k td,yinistration will have the
__________ t“d
aMouM,'^
There should also be a bui
as well as vigilance against corruption and m^p'ra"’^' SUpemsion ' a“dit and review

-ord^ato'SXi^Tfte™^ oTtSS? W0“W.’~ advantageous to
have a Coof the Block
... or Taiuk Panohayat, the Block Development OiTweT^T^sSX”
representatives of develooment d
taluk
officials as may be decided by government

Om the

1!

citable non

2)

Elected village Pa nch ayata

whesrA ^ople's participation in rural development should begin at the village level
h I tJie people
cach other and are personally aware of the problems and
for6 develoDm^t001^’ 5helr.J®™1110® an4
village community as a whole. Planning

SJX3
Potion or plans for ths Xe and the
noted Xt
°f U1C programmc
their areas. It would however be
noted that harmony and amity in village life are essential for fruitful people's
c^1mPatliOn and effective Panchayat administration. These would suffer a setback if
are
gr°UP
Or Terences, which invariably accompany party politk/

3)

Elected Taluk or Block Panchayat*

Taluk otXk ;°™ hayL^^ XT’"0" ’in rural development is the elected
were in existence in many states in the past
and are now being revived under different
these DUem°CratlC hX
pla^ngS^mplementeJlSo^Z
bod?s should be fully involved in

^XiniTtr^on^
P5o,gr^lmc•“ 1116 block. The executive c o____°:f
indicated
These
by way of dde^^n^fX^bt^eT^^881asaUthorit
y byearlier.
legislation
dected’bod "

■

■

also in respect of these taluk or block-leve^efooXd^^s^'
panChayatsf’ 30
1preventing participation by political r—
bodies,» the advisability of
..
parties
trade unions
in the elections thereto
should be seriously considered in the
largeror interest
of 1
these bodies which „e
local self'goveming
harmonious functioning of
3)

Elected Diatrict-lcvel ZU1. Partahat. or Panchayat.

coordination of the vSagedevel anTtalu^or^l^k^l
.OVera11 monitoring and
work at the district level is the Zilla Parishm
ock-level planning and development
the all-round and co-ordtaaud
WhiCh Sh°Ukl 1“'» *”
a convenient conduit for the flow of
distnct as a whole. It could also be
district.
fund8 for vanou® project® and programmes in the
4)

Non governmental Organiaationa

person^ ^X^edT^Su^^

becomes more direct,

of rural development and spreading out Uie^e^fitXh8 lnfCar^ln8 °ut different items
purpose co-operative institutions at the village block^X’ S1?8le-PurPOse or multiup one or more items of the programme
k • lnterme<haiy levels for taking
marketing, village industries iSrTT housin “ agnCulture- agricultural supplies

consulted registered societies, trusts’^ o^vo^ta^boX0*1^"

Pr°Perly

or experts could be
Programme through
12

advisory or consultative committees in respect of particular activities or the overall
implementation of the programme. Persons other than these who belong to certain
speciiic sections or classes of people like women, youths and students, professional
men or working classes could also involve themselves in the progrcimme in their
individual capacities or in groups or through their respective organisations. It is thus
possible to get the bulk of rural population to take active interest in the programme in
some form or other and make it a people's programme.
Yet another means of enlisting organised non-official effort in rural development
which may not necessarily be from within the block, is by persuading well-known
institutions to adopt particular villages or groups of villages to give fillip to the
intensive implementation of specific items of the programme or the programme as a
whole in the area of adoption. Institutions like the Ramakrishna Mission, Rotary or
ions Clubs, youth leagues, women's organisations, professional bodies or social
C^s could bUOnS- SOlne
Whl?h
already engaged in such activities in scattered
areas could be encouraged to take up the area adoption scheme in a systematic and
co ordinated manner in selected blocks in every state.

A more effective method of bringing about such involvement in a big way would
be to induce big industrial or business houses or groups like the Tatas BhlasyBaiais
Modis, Mafatlals, Kirloskars or such other groups as also public sector or’ private
ZnJtXST nnits like the Hindustan Aeronautics Limited, Hindustan
Machine Iools Limited, Bharat Heavy Electrical Limited, Escorts etc all of whom
comniand plentiful e^ertise, spare personnel and surplus funds t bi employ^

SESSS——
dislrict'.'

Pb°:T “ “Vrer "Tof rural 'ndto. ”»“>>

d™™id

Of about S50
-~”e’sr:

in national building endeavour.
A PLAN OF ACTION

The general features and objectives
of all-round and integrated rural
development as identified
earlier lead
lead us to
identified earlier
the
next
logical step of determining a plan
of action for achieving the objectives in
a
manner
consistent
with the vision of all­
round develooment
nf rural India.
development of
1.

Economii Survey

The programme has to begin with economic —
- planning.
is a
universally accepted pre-requisite for sv<jtpmat• a suivey
' and ----------•««Planning
“****
in respect of systematic rural development Th °Pment
ft is particularly
PartiouJari, so
comprehensive survey covering all the
t *S naturally preceded by
whole on the basis of suitably foSnuttet
Unships and the block J a
: as a
__ ___ ' QJ-

n? COuld be utilised fo/the
.urve, wouMbeU,; basis

13

2.

Preparation of Plan

The Process of planning should begin at the village level,
The Block
it Officer and his staff, assisted by an i
include non-official experts, would first examine iappropriate committee which should
in detail the results of the survey in
respect of every village in the block and prepare an
“
outline of plan for the village. This
is placed before the village panchayat
]
for detailed consideration in terms of the
objectives of the programme, the problems and i
------- requirements of the village and the
priorities to be fofiowed in
m providing
providing employment
employ™,.,,. to
unemployed and
fan.Uie, below Ibe po,,^ as well as
the entire village population in relation to the
needs of individuals, families and the viUage'^ommu^
thus prepared for the------------------------------------------------------- as a whole. A draft plan is
assembly of all people having voting rights i^th Ci?rC 1116 ^rama Sabha> which is the
?? ba
votingofri^
55 in the village t0
modifications, if any
in ??
the8
8 light
JhSr
their V*eWS 311(1 effect
basis of consensus
”2’.’ in
' ‘^xe
h? light of tabha"^
their suggestions. The.
* flnalised On the
consensus
in
the
Gram
Sabha
and
is
then
taken
Administrations and the Taluk or
d„
111611 ta^<en u
UP ’by the Block
taluk or block.
‘ °r B1°Ck Panchayat for preparing a pfanToruTe “ntfre
Taluk oJ B^oP^^Pan^clmya^widlOactive^assistana^e<^f^,^

Administraban and the

chairpersons of village panchayats reores^tnti °f
rconsultation with the
institutions, representatives of relevant d
°
l5an^s
d other financing
Government, National levd or sLt
°f
State Or
other development activities In £e SuL
C°1]’Oratlons * charge of one or
the Members of Parliament and State
adopUn8 organisations, if any,
may be decided by the State GoverXnt®
C U1
°r bl°Ck 311(1 oth"s as

development, will also be within the framework adfhering
016 objectives of rural
pnorities and guidelines laid down JyX^enfra^and^t
ideol°gies. the
course, the availability of finance from differed d S
governments and, of
from
different
mobilised from within the block.
sources including finance to be
3-

Poverty Alleviation

major progrLame. aCtl°n f°r Poverty alleviation has already been explained earlier as a
Infrastructural Fadlitiea

eontemplatedPeconomic IISivTtiesTZi e^Ien^11"^ tO facilitate and sustain the
transport, easy a1

«nd lh(. „quired inpuis for agrjcuitu% »p

devdopment.

ystematic

14

manner

to

facilitate

rural

economic

Education

5.

Comprehensive educational programme which is a vital segment of rural
development should provide for and include the following:
(1) General education aimed at an Integrated physical, mental and moral growth of children and youths

Compulsory pre-primary and primary education, preferably correlated to rural
occupations should be organised in open schools and improvised buildings where
there are no regular buildings, with working hours and holidays so scheduled to suit
village occupations so that children who help their parents in their family callings are
enabled to do so and also attend classes. The system should be a harmonious
combination of formal and non-formal education. There should ' be a national
movement to bring every child of school-going age under compulsory ppe-primary and
primary education within period of ten years. The services of volunteer teachers could
be enlisted for fixed periods to supplement the existing teaching force to take up this
task. The scheme should include the establishment of at least one fully equipped and
staffed pre-primary and primary school for every 1,000 of rural population. Formal
higher education above the primary state, for obvious reasons, need not come within
the purview of rural development.
(U)

Vocational Education

Regular vocational education pertaining to the vocation a pupil proposes to
pursue in his or her life after completion of compulsory primary education could be
arranged in residential schools or convenient day-schools in every block to enable the
pupds to acquire the necessaiy technical knowledge, skill and training to help become
efficient, self-reliant, self-confident and not become misfits in their occupations.
(Ui)

Community Education

lhere should be provision for built-in community education in schools in Ihc
lorm of community work, common prayers, group songs, cultural activities, group
exercises, yoga practices, practical lessons in good neighborliness, community service
in villages, etc., which help youngsters to become patriotic, democratic and
progressive-minded citizens, and cultivate a sense of concern for others, social sense
discipline, tolerance, helpfulness and the art of living in society.
Adult Education

Adult education seeks to help adults who have not had the opportunities for
literary education to become literate and self-reliant for purposes of S and
acquismon of knowledge. It also seeks to help adults, whether literate or not to

“d <uiturai

“d

Adult education, to achieve its aims, should consist of a five-fold programme

15

(b) General and functional education programme for adults to stabilise their

social service organisations, women's organisations, youth leagues, etc.,

(C) /unetl ai?S PrOgram“e should be undertaken to supplement general or
functional education for adults by means of mobile units equipped with
hatLT’ mOdC S °f lmpr°Ved tO°1S and techniques, audio-records, etc.,
having their own commentators and demonstrators.

(d) Revival of folk arts should be further encouraged, enlarged and brought
under systematic monitoring and able leadership at various levels.
(e) Every block should have a folk school or Janata Vidyalaya. These schools
major ^r^
general education
advanced practical training in
major rural occupations to rural youths who, by reason of their low formal

-SSS' They also provide
'““‘-in
training in

ciUzenship, enlightened leadership and in
in the
the management of village
hke panchayats- co-operative societies
that take up programmes like village industries or voluntary associations
social services, cultural
activities, etc., for enrichment of village life.

and efTicien^^U^rc^de^hL66!!^11118 kt°UndR

progressive- minded

with their own farms and workships where tii^Duoil^86^ Self-supportin8work. They could be run on tkf ?P
r u
P P
en8a«e m Productive
Peethas of the Adult EdueaHn
°f
Danish Folk Schools or Vidya
improvements and modifications ^he0^110^
Karnataka witb suitable
one
ewove^depen^Xen’-thX’u'SeXm”" Pr'’V,d'd “““*
Housing Programme

to providing
development, if it is confined only
improvements in living conditions in villages The nr^11 0 k*
1.tSClf bnng about
villages
from
out
of
their
soualor
,
u
•
•
C
process
should
aim
at rebuilding
of
consist of (i) building low 5s
C°nvditions'
-heme
wou^hus

houses of their own or have houses bX the
US h°U8CS f°r
pe°Ple wh° have no
Phased manner by using locafiv ava^hl
minimum standards of habitability, in a
labo^r as also labour of ^e'h^eficj^^.^a^ Dart°of^h
materials ^’loc^
people may have their own 'houX1:? Te^bv0'^1'S? *at a11
(u) providing clean, tidy and healthy conditions of
I
10^ Plan Period;
water, family latrines supplemented by well mni
•VUL8’ Wth provision for drinking
women with arrangement^ for heading
PUbliC latrineS for mcn

an, e^e or commu4;
7.

w

(

Health and rainily Planning

Health and f_.v j
facilities for in-patient and out-

' ,SpenS‘mes

■ - 7P

Period,cal camps for tre„Hng speciJ.--

vXtl'S

- or widespread ailments, regular
16

X

health surveys and health check-up of individuals and families, preventive health
services, maternity and child welfare services, assured supply of protected and
otherwise safe drinking water, village sanitation, clean environment and a concerted
drive to popularise family planning.
8.

Alternative Sources of Energy

Utilisation of alternative, non-conventional or renewable sources of energy such
as biogas, solar energy and wind power has become a national necessity. It helps save
conventional or exhaustible sources of energy like firewood ( the use of which eats into

entrepreneurs,°f emPloy™nt to
9.

Ecological Balance

possible, the growth of valuable flora and fJ’ Pr° e^Uon’ Preservation and, .wherever
perennially educating children and vouth^113
’ eqU£tlly or even more important,
public through persuation lectu™ dem™, t
COllegeS
about the vital importance of die subi^t fo^Th °nS’ adv<;rtlfscm-ts and propaganda
other organic life on earth and indimini tu f .
survival of the human race and of
the matter and willingly accept ai!d acfun^T th
aCtive.and continuous interest in
in this behalf.
P
Ct Up to the resPonsibility that is cast upon them

IV

promotional agencies

A national r.
r-----O8^.m' f" pwcny
’“'"'V aueviatic
alleviation, employment genetation and rural
pmen nee s suitable promotional agencies
J or media for motivating, monitoring,
c°Jordinating and periodical
effective and coi
-uing
government, by
sh°““* »'
£3
lr_even “WSW “PPreciable s^cces?^^^0/bringing

devein

the Central or State govenSslXrhave Ae

XCentral °r S,at'

norh“.ve"he

C°"StitUtC the

in

and
experience
for the Xsmt
task. SXoffieSTo7o
uUrCa,
w
ell as
implementation
f°" h^T
d'Pe"d f"
X
'or the ™^e“-e.ntaV.°n consists of officers
_-ie understanding of the problems and
b ack].1116 concern f°r the poor
experience. And many of the experts who are contffi^ refhtle,S or
necessary
programmes are
requirements.

™>Uy ^ided hy westen, id«T^rXS'dVh„“eXWX0oUu:

m»UvaM,peSLXgbXX"v'esto“,ed'

17

experienced and highly

f

governmental and non-governmental talent and effort,
suggested to serve the purpose.
ii

National Commission
Development

f<>r

Poverty

Alleviation,

The following pattern is

Employment

Generation

and

Rural

A Commission such as the above is needed to take up the task of oromoting the

are suitable for^e
considerations
It shouki h

d

C°nSiSt °f & Chairman ^d other members who
appointments are not governed by political

and should be free from
other ministry or governmental body
eoneemins ufe
could bTl'
T
deull^
errectiveneso.
t-°mm'si,,on could b' “orked out. keeping in view its objectives and
2x

State* level Poverty Alleviation,
Employment Generation and Rural Development Commission*
Boards
or

matters Pining to the

concerned'^states m Thdrmem^

bf similar to the membership of the

Notional Commissiom These"bodie^sh
under the Chief Ministers of the concerned States
i

* aUtOn°mous> working directly

r-LMtrict-level Commlttwai
for Poverty Alleviation,
Employment Generation *nd Rural
Development

by

appoint SX’r""

” “""'I- Details of their constitution
V.

GENERAL OBSERVATIONS

^0nst^tu°eVecert^necriidc0aj’oermcru0^Seareasnofrnationajild

deVel°pment- sin« ^ey

also to conform to national goals
a ?
development and progress, have
favourable atmosphere and helpful conditions' S &nd
C&11 for creation of
•

Social Justice

ever po^sS^' The^JaSb^of0^

n°

dcveloPment of the people is

programmes for removal of poverty Xi brta^^
indeed inherent in the
education to youngsters and Xults heakh 8 h^- eCOnomic disparities, aU-round
engender self-confidence self reliX ’ heaIth’ ht,usxng and other schemes w’nX
enlightenment and culture Xong^peSXstand^s

weaker and economically vulnerable P F m 8eneraI and, in particular
among the
determined and sustained endeavours directed to™8/8 t0
fUrther
reinforced
by
urs directed towards eradication of
untouchability
18

in all forms, removal of communal segregation, lessening the rigidity of caste and
communal barriers, elimination of all forms of domination over or discrimination
against women, children and the socially and economically backward classes and
promotion of social justice generally. Besides, the values and practices of social
equality and social justice should be assiduously inculcated among youngsters and
adults alike in all areas of education and in all community or cultural activities and in
social and family life generally. It may however be noted that the demands of social
justice are included in the idealogy of Sarvodaya and hence a full-fledged
implementation of sarvodaya programme would naturally marginalise the demands of
social justice.

However, the predominantly weaker sections of our population suffering from
extreme socio-economic backwardness, namely large numbers among Scheduled
Castes, Scheduled Tribes and other backward classes need special attention and
hence suitable package programmes should be devised for them to bring about
speedier socio-economic development.

2.

Development of Urban Areas

Mere all-round rural development does not bring about a comprehensive and
integrated national development if urban areas namely towns and cities, which are the
nerve centres of national life, are left out.
Villages and urban areas are
interdependent for various purposes, economic or otherwise, so that progress or a
setback in one is bound to have repercussions on the other. Urban India, with its
built-m exploitation of one class by another, its problem of unemployment ainong the
educated and the uneducated, its pronounced social and economic tensions ^nd strife
somee?hfnar .industrallsatlon
over-urbanisation, its slums which have become
L*" m?fPerab!e necessity for the industrial and commercial life of cities
with their own problems of poverty, insanitation, disease , crime and overpopulation
ini>
n° HSS
°f all’round development than rural India. Just Ts both are
ordinated^leldkT t mUtUa?,ly ^Pl^ntary, their development should also be coentire counit /hiJ“ aU"rou.nd- balanced and harmonious development of the
d?e State XJ
/
SP
responsibility of the Government of India and all
imnlpm
h emments. Appropriate plans and programme have to be drawn up and
implemented for the integrated development of urban areas in co-ordination ^id? Sta
ultimate38
aU’rOUnd
total development of India as a whole which is^he
3.

Eradication of Corruption

f°r -impeded

rural d^^HS Z^On^snh

inevitably leads to delav misma^
616
.sta?e
development
misappropriation of funds unfair distortion’ o/CeneSs CenShmOnTPf
groups in certain positions of auth tv
d
d
CIlcllts> enrichment of persons or
onty and tends to defeat the very purpose of the

S^tOns

Wider

deeper reaches

immediate purpose of this note, a few steps (oOldTe
"eCeSSai^ for
overcome it in the administration of rural development
SUggested to c-trol and
(h)

One of the effective
ways of controlling administrative corruption is to hold
heads of offices and heads of departments rresponsible for corruption in their
responsffii/ty’ffitormlti^rd013
haVC 3 m°ral and constructive
full control of, and also
.. Corruption in the
19

dieCkB^o<^IlanPaniShatadininiStrati0n COuld similarly be contained by holding

m'b'f^\™^rBhXC&eXd5
(ii)

?o'upor“ X'TS coS. *p,p°to‘^‘“'e »®eers for cvety block or
Ld eiected omce-beXs taXTa
'he r“"«.onlng of all oIBcW.
various levels and also anboint v.e.'if11"11312'^0? °f llJraJ development at
conduct sunrise checks. PP
' SqUadS “ »' »» “>« move and

watchdog groups for the numT«.
themselves in block develot^ie t

U,™ .o get
(iii)

prone,to be i‘bovc
to
up vigilance work by forming
fr"31 teams of volunteers could station

q

work donc

^:c

•?

“-p-

from
the evil. Steps such as the above tend L wmain
?
he‘P COntain
of corruption if pursued with seriousness and a
TtVen eradicate the evil
a lasting solution to the problem is
p
devotlon by all concerned. But
values among all aeotioLrf
epi‘fo
tb' .***»
i»«™l
fomdybreand soeia! and economic actMties and'fo^™8 Uk'
4.

The Drink Evil

lull beLr"» or mXeve’op^" luX^l'X" “ “1' Way °'

the

econoooc development, which would otheewT"3*11118 faSt' R eats int° the l™its of
addtcto, and dentes it3 benefits °°XwS” T?
itS henefielaries who ie driti

as private, its obvious. It is hence of utmn i ' tS lmPact on morality, public as well
if U is not found practicablTto S0** 11118
^ould at least
announced by the late Prim*» x#*
eradicate it. The Twelve
rx.

5.

The Do^

Woman who
real upbringers and
case, the

population but also are the
•he 30

20

*

increasing atrocities on women including those that are linked with the dowry evil call
lor special attention of the entire nation as well as the government. This necessitates
suitable amendments to the concerned laws to help speedy trial, identification of the
accused and deterrent punishment and also constant vigil by law-enforcing agencies
and social workers to prevent the evil. Nongovernmental voluntary organisations have
a special role to play in creating the necessary awareness and provide counseling
service among the people in general and the concerned families in particular when the
matter pertains to dowry claims and harassments.

Steps should also be taken to provide homes in all districts for destitute,
dispossessed and discarded women to bring hope, succour, self-respect and an
opportunity to live a life of honour to them. This is also a poverty alleviation
programme.
6.

Child Labour

The need for abobshing child labour is increasingly getting acceptance. But one
should note that there is the other side of the picture. Children in a poor country like
India are also a source of economic help to their parents. In many cases, children
work outside and add to the family's meagre income. There are also instances where
it is the children who work and maintain their sick, aged or disabled parents and
sho^iki h 1S OfKCOUlSei tiUe.11131 Child laboUr is Kcnerally exploited by employers and
shouM hence be abolished. But what is to be done in cases where their support is
needed by their poor famines ? Are we to force more poverty on such families in the
name of abolishing child labour ? The solution lies in eradicating poverty everywhere.

A constructive way of approaching the problem would be to provide more
gainful employment to the parents and other able-bodied members of thePfamilies and

necessaniy mean schooling and schooling of the present-day t^e

7.

ThTway out couM

Economic Extremist Movements

extrem?."

£ So™ o'?

drOU8ht prOV'

h“ >'■* •»

areas concerned and not purely a lawthe local people rive suonort^nd
T
Because of- unrelieved
—— ***wvvd poverty,
poverty.
themSelves
mosdy uneP^ployed
N&XalitCS
protection intO
tof Naxalites.
/ •
„
in these disappointment, frustration
and desperation, take to extremism with a —
r------revenge
on the established order. It is
hence necessary that the powers-that-be and i
d
political
leadership wake up and hold
with Naxalite leaders
u"
underl
yin8 economic problems
-—‘ matter to h

xrssrs' iead'rs “d h'ip

21

4

8.

Burden of bureaucracy on the nation

The 1bureaucracy has along been a heavy
heavy burden
on the
the nation.
nation. This was
burden on
so
even before independence
.-.J as is pointedly brought out in the Independence Pledge.
bureaucracy i, ex^.y’Jiap

SC“^iSSi°"’S r“‘>■”»-<>■«■»» has cast
"“n b“ tJ'*,'"’" ““

concerning such an extravaoonf
-—gitca^^S

9-

?>peni on it.

.

Conatltutlonal and tepd p^on. to enable for Poverty

The entire issue
-ans of

and related

Pledge
" aS *S S.et forth in
Independence
includes their right ” to enjoy the fruits of
enforced bV law. This
economic freedom and economic eaualiH,
u0 *
which is the foundation of
gandhi, the placing of all means of nr^d^fio^0111lnY.olves- according to Mahatma
hands of the actual producers.
P
Uon* lncluding agricultural land, in the

Government of India*1 f^ 'wiewbig^^^oridn^^f "th C°mmittee aPP°inted by the

welcome decision by identifying constitution*!

Constituti°n has, taken a

8

h™*"8

» nec.^ry con.tltudo^ „d lceal provSX'hHp

10.

Need for a Forum or Lobby in Parliament
Meed

,’r

U>« cause of

and help it which will certainly guy a ffljp to U^f^.POn
11.

j*

<o take up

“°V'’ shou“ »"“■»«

The need for PoHUcal Will and National Con^mau.

unemployment and bih^g abou^a!^^011^
f°r eradicating poverty and
clear-cut national goals caiLt concXX"^eT'T*11
develoPment with

r—'
12.

National Integration

National Integration i ‘ *
which is a process of finding unity in f
diversity and the
- some form or 0^ run's
i^"
of nation^
employment jgeneration
---and rural development cuttin/^c°i( ?°Verty ^^ation,
caste, community or social distinctions
J
1. TheV proXX8 h •
°f
belonging to various strata and
segments of society. They encouraXutuX- Pe°Ple

22

operation and common endeavour which tend to work as a commenting force that
binds the people emotionally and otherwise. Further, removal of poverty, bringing
down economic disparities and achieving social and economic justice are calculated to
work towards economic and social equality and create a favourable climate for unity
and harmony among people. The total implementation of the programmes, by its very
sweep and momentum, is bound to set into motion the forces of national integration
among people by fostering in them an urge to live, let live and grow together.

8.V. Maojuaath
Secretary, Standing Committee
and President, Akhil Bharat
Sarvodaya Maha Sangh

23

J.

I

i-

I

^H=7—

'-

THE SEVENTY-FOURTH CONSTITUTIONAL
AMENDMENT AND THE EMPOWERMENT
OF MUNICIPAL GOVERNMENT
— A CRITIQUE
Gangadhar Jha*
The Seventy-Fourth Amendment to rhe Constitution of India is sa.d to be the harbmger
X new em of empowemd and vigorous system of urban local
™

municipal amhorities will henceforth derive then voy extstence fr»m tl“
itself The expectations are high that it will refurbish the whole system of urban- loca
self-goveman^by implanting a new structure of municipal authorities with ^ditiona^
devolution of functions, planning responsibilities, new system of fiscal transfers and
™erment of the women and weaker sections of the society. The Amendment s
™ed to provide the much needed institutional capabilities to the otherwise fragde
syst^i of urban government in dealing with the impulses of urbanisation and urban gro .
Is it really so?
With a view to comprehend the various dimensions of this Amendment as also to properly
Zp^iamL XPmd epithels. it wouid be desimbie to look a. the euvuo— m whtch

it has been enacted and the specific features of prov.sions incorporated in it.

The Context of Amendment
Though Lord Ripon, the founding father of the municipal authorities in British India^
“ sysXaiktrostain .he munidpal rancdona) domain, inadequa.e resource base, a weak
|

executive system and pervasive state control.
The undefined role of municipal authorities has resulted in considerable erosion in the
is manifested in state encroachments mto«
functions and formation of para-statal and specific purpose organisations in'
*he
of water supply sewerage and drainage, slum improvement, urban planning and

“.oeXxe^
has SvcSrly consuained the provision of services and their operaoonal upkeep. A large

MM fcM -m- ««»."
55

M«‘ “yp-. n=« m.i

*

1g

number of municipal authorities are not in a position to pay even the salary to their staff
for months together. About 42 to 97% of the municipal authorities are incurring per capita
expenditure on various municipal services which is much below the suggested norm of
the Zakaria Committee. The executive system, especially in the municipal corporations
which are the largest and the most autonomous form of municipal authorities, is highly
fragmented as it is based on separation of executive powers and functions. Whereas the
executive powers are vested in the Council and its executive committees, the executive
functions are performed by the appointed Commissioner. Substantive executive powers
enjoyed by an appointed executive rather than by the elected representative has led to
bureaucratic control and hence erosion in local democracy and self rule. This is in
contradiction to the institution of self- government.

An elaborate state control on the day-to-day functioning of municipal authorities is
crippling them. These powers are frequently exercised through inspection, calling of
records and giving directions for performing civic functions. Besides these, the state
governments also possess overwhelming powers of control and supervision in matters of
appointment, approval of contracts and estimates above a pre-determined amount,
sanctioning of new posts and framing of bye-laws and rules. In the fiscal matters, the
control relates to rates and expenditure incurred. Despite being the units of selfgovernment, it is incredible that the municipal authorities do not have powers to approve
their own budgets and decide the tax rates. Even the Municipal Corporations are required
to obtain state approval of expenditures beyond certain limits. This in Kerala is Rs. one
lakh, in Andhra Pradesh, Rs. 50,000 and in Himachal Pradesh, Rs. 20,000. In
municipalities, the limit is still less. In Tamil Nadu, for example, it is Rs.8000 only.
Obviously, with these controls, the municipal authorities could hardly be treated as
embodiments of self-government.

The most drastic mechanism of control is applied by the act of supercession without
reconstituting the Council through a fresh election for years together. Due to this, a large
number of municipal councils are under prolonged suspension. Even the Madras Municipal
Corporation which has the first municipal body to be constituted in this country, happens
to be the first municipal authority with the longest spell of supersession, i.e., since 1974.
As of 1989, as many as 39 out of 71 Municipal Corporations were superseded in different
states. Such elaborate and comprehensive control system smacks of the French system of
administrative tutelage which the French have themselves abandoned with the new wave
of decentralisation under President Mitterand’s regime.
These have gone a long way in weakening the institutional capability of municipal
authorities. The decline in the institutions of self-government is so pervasive that it has
acquired a connotation which is identified with everything that is second grade and inferior.
The debate to empower them has ensued ever since Independence. The Seventy-Fourth
Constitution Amendment is the culmination of this prolonged debate and has been pushed
through for strengthening of municipal authorities so that they acquire the institutional
capability to deal with the problems created by urbanisation and urban growth. Is this
Amendment really going to enhance the institutional capability of the municipal bodies?
With a view to comprehend the efficacy of this Amendment in taking care of the ills
presently afflicting them, let us first have a look at the important provisions of the
Constitution Amendment in terms of (i) structure, (ii) composition, (iii) powers and
functions, (iv) finances and (v) planning.

56

\>
\

The Constitution Amendment
Structure
.
A
thp rnnctitution of India now provides for constituting of three
Through the amendment, the
nrnpn. These are (a) Nagar Panchayats which
types of institutions of urban sei
transition frOm rural to urban. This has been
are to be constituted in areas w i
impUises in such settlements as also to bring
conceived to properly channelise g
conditions’ (b) Municipal Councils in
some sort of order in their grow arse
ion; in ]arger urban
Which
smaller urban settlements, and (c) MunKip
urban
has
)eft to
areas are to be called transitionalprovidef for decentralisation of municipal
the disecretion of the
Committees in territorial areas of such municipalities .
administration by constituting Ward Co^te“ has
ided t0 maintain a close
which have more than three lakh popu
$
seif.govemment so that the citizens
^-6ov«. in die wake of de.og.apb.c

and physical growth of cities.

t Am a iTal area having more than three lakh population. As a consequence of
Notified Area Committees and the Town Area Committees which are n^mated
^f S bodies have to go. But what is curious is the complete silence in the CA

1 m

!

xix. or

authorities performing
constitutional provision f
X—li! is one

Zs ■£

municipal authorities mean the demise of even
ype
injurious to the civic administration of
areas of ie Amendment and indicates that the

*

Amendment was not premeditated.
State Governments in deciding the
.v^., , “smaller areas” l
smaller” area could continue to be a

as it had specified that a Nagar Panchayat was to
20 000 Municipal Councils in the town with a population of
a population of 10,000 to 20,000, Municipal• jn the cities of more than 3 lakh population,
20,000 to 3 lakhs and Municipal
CorP°of
rata’°"^"
"
f.govemment in
consritution
three “
tier
local sel
self-government
in cities
cities with
with
1V1 U 111 VI MCA!

—---------- » -

ivemment institutions could be brought to the “door-steps
Commitlees so tat ta local 8° e
scheme o( jeeentralisaiion do no. compare
r u
the structure as also the scheme of decentralisation do not compare
of the c'tizens. T gin^BiU
,,
_Fifth Amendment
on taTubjec.. The Sixtv
Six^-Fifd.
Amendmem was not
no. approved
bXpX°XbVny
o„ two
,wo grounds.
ground,. First,
Firs., the
rhe provisions were said to be a blow’
8 ■ ’ " . on
----r thA Sitate Governments as it tried to thrust the provisions on them,
autonomy of the State OovemmeRi11 were said t0 conceived
of.be proposed Amend™. Bil.
^d degenerated a great deal of political heat, the
in a great deal of hurry. As the
74th Amendment perhaps became too conscious of the respect for state
of »d
the diiu^^provisions
74th Amendment pc snbsun.iali,
P ~
aulonomy"
by giving a great dea] of discretion to

I

i

several critical provisions of the Constitution

57

]

tried to be taken care
and even before.

of by the 65th Amendment have been debated since Independence

vI

■ 1

Composition

right to vote in the meetings of the Council.
Empo»e^„.

Pf°^ch seats is to be reserved for the women belonging to these castes. Besides such

for the backward castes.

X^alC^u^

of the elected

are to be filled. Hence the type of persons who are to be on

as the Secretary to the Mayor-in-Council.
Another ve^ important provision of the CA pertains >0 the monieip^
to exist. It gives a term of five year!beeanse

X™S
58

’nTn1 !l

henceforth prevent the prolonged supersession for years together. By restoring the

Powers and Functions
The Amendment envisages to devolve to the municipal authoritie5 functions relating to
preparation of plans for economic development and social justice as .well as f
implementation of various development schemes. It has aPP60
a
to the Constitution of India which lists out functions to be performed by them Jt lists out,
in all 18 functions, many of which have traditionally been local functions although some
of them are unconventional and even ambitious in nature, for the mumcipal author! ic^
Urban planning, regulation of land use, construction of buildings roads and bridges, wate .
Zly and slum improvement form part of the Twelfth Schedule and hence it suggest

that the era of constituting specific purpose authorities by
the municipal arena will come to an end with the enactment of the 74th Con
Amendment. It also gives an impression that henceforth the gradud state cnc«»c^
on municipal functional domain will stop altogether as these have been specified in the
new Schedule of functions.
However, a closer look at the enabling provisions does not make it so^This is pnmanly
because of the discretion which the CA has again given to the State Governments. Left
tn the State Governments, the devolution of functions may not be as complete as is
supposed to be in the Twelfth Schedule. Drawing from the experience of indifferent attitude
of tS State Governments in the past, the CA should not have left the acturd devolving
of functions on the will of the State Governments who are required to push through new
enactments providing for local functions, according to the new schedule. It is only a pious
hope that they will actually do so. A couple of developments in this regard lead one to
believe all the more that the functions listed in the Twelfth Schedule are going to be
confined to the Twelfth Schedule itself; they are not going to be actually devoJved^ .
municipal bodies. Amendments recently introduced in the Bombay Provincial Mumcipal
Corporation Act in Gujarat under the garb of “new enactment”, for incorporating the spirits
of th^ new Constitution Amendment, is almost a patch work rather than altogether a new
enactment. This being a patch work, the functional domain continues to bei what it ha^
been in the past. Parastatal organisations and specific purpose auto ont es like the Slum
Clearance a^d Improvement Board, Water Authorities, and Urban Development Author
ties and the like still thrive in the state and the traditional municipal funcUons are as
fragmented as before. Second, the Indian Parliament, besides enacting the 74th
Constitution Amendment, also enacted a new law for the National Capital Territory o
Delhi taking away water from the Municipal Corporation of Delhi (MCD).
that slum improvement is also to be taken away from the functions devolved to the MC
It is worth recapitulating that all such functions are listed in the Twelf* Schedule and
to be devolved to the municipal authorities. What was therefore required was to provide
for a local list of functions in the Constitution of India in unambiguous terms, the Twelfth
Schedule aught to have been made mandatory, not discretionary.

!
I

i

Another area of doubt relating to toe devolution of functions pertains to the nature of some
of the functions which seem to be quite ambitious and even redundant and irrelevant for
the municipal authorities. Planning for economic and social development, protection of
the environment and promotion of ecological aspects and urban poverty alleviation are
functions which belong to this category. It is not that these are not important funct.ons.

i

59

PerTormance o( such fimctions tequims a much
resources which the municipal bodies are lacking miserably.

r^utino

and effectively therefore seems to be a tall order indeed.

^th^ndTeXZ—^
to be performed by it.

Municipal Finance
Devolving of functions without devolution of sources of revenue does not carry any
capability of municipal
meaning. As discussed earlier, the decline in institutional
i—
,
authorities is largely due to weak fiscal capabilities. However, the CA has iy
conveniently ignored this critical area of municipal governance. The taxes, du «»’
and fees to be^evied by them and assigned to them as also the grants-m-aid to be gi e
to them have been left to the discretion of the State Governments. We have seen in e
‘

s.°" cTvemment. Left to the disotetton of State Go—I>. th

F

sp^Jor

ConstSon of India irf so that
there could be constitutional protection and guarantee about it.

!

I

Constitution Amendment.
The mechanism of the FC seems to be the only hope for rejorbishing of ^^on “ Tte
rec»ndXTto°te g^n\y\he FC will fill this void as it also has the mandate to
60

1

functions urban, ,n
organisations, may have to be transierr

municipal authorities. But this again seems
r&r There is nothing

Sons are no. devoid on. of die Tweifdi Sehedufe die ™sfer
.hn. fc will be shortsighted limited and meaningless. Moreover, as it is to be a composi
Finance Commission for Ihi Pach.yaii Raj insti.mions as well asta mmie.pa!
one has lo wail and watch if it gets dominated by the rural local bodies interests.

assassa

supplemenl^Ute resources ofofX m^l^

mcommenda tons mak^ the FC Thus
n^
■fXe ™^ie\“XXm the Eieventb Finance Commission onwards. This is an

amendment of far-reaching importance.

Urban Planning
_
to consolidate the plans
The CA provides
for
sening
up
of
Mu^dpaUtleslnd the Panchayats within the district and to prepare a draft
SvPeTpXpi» f“—
IT.niunieipehUes
k
The municipalities are
are fohe
to be represenred
represented on
on
common
it The draft development plan has to be prepared with respect to the matters of commo
interest between thf Panchayats and municipalities including spatial piannmg,■ sh^
“X Ind other physical and natural resources, integrated development ofinfrastructure
of infrastructure
and environment conservation. Plans so prepared are tc’
Metropolitan fanning
Planning
of the Planning Committee to the State-Government. Similarly, Metropohtan
CoXinS ^io f^. »P in
mehopobtun areas on which
mun.c.pai authorities
auihonhes
‘
‘ ; municipal
similar planning exercise for the
are to be represented. The Committee will be doing a i
metropolitan area as is to be done by the District Planning Committee in
i a district.

urban seulements and ihe consolidaiion of lhe plans so prepared <0 forir..Dasing

by the PRIs are to be consolidated.to form the draft Distnc
61

■

.-'•V

*

for in the Seventy-Third Amendment, where from the PRIs derive the powers to formulate
the plan? And if the Plans are not prepared by the PRIs, how are they to be consolidated
along with the municipal plans to form a District Plan?
The setting up of Metropolitan Planning Committees (MPC) is going to create further
confusion about the role and relationship of the myriad Urban Development Authorities
(UDAs) vis-a-vis the proposed Metropolitan Planning Committees. Does it mean e
demise of the UDAs? Or are the UDAs to be merged with the municipal authorities as
their planning and development agencies? These questions are not settled in the
Amendment Act. If, however, the MPCs and the UDAs are to exist s.de by side, it will
make the planning function fragmented and chaotic, adding further to the already

compounded problems of co-ordination.
In sum, though the Seventy-Fourth Amendment has several infirmities, it is historic in
many ways. First, it gives the right to the municipal government to exist as it provides
for fresh elections within six months of dissolution of the Council. Second, it empowers
the weaker sections and the women by providing for the reservation of seats. Third, it
provides for creation of Ward Committees which will reduce the distance between the
citizenry and the local government and will hopefully make it much more responsive to
the needs of the local community and will ensure accountability. Fourth, the provision for
constitution of a Finance Commission and the amendment in the terms of reference of e
Central Finance Commission is expected to contribute to strengthening of fiscal
capabilities of the municipal authorities.
Alongwith these brighter aspects of the Amendment, there are, however, the greyer areas
as well. It has missed a valuable opportunity to specify the functions and also the sources
of local revenues. This would have prevented state encroachment into these sp eres. y
giving a lot of discretion to the State Governments in these and other areas, the Amendment
has left the problems unsettled. The experiences in the past indicate that the State
Governments have not cared to make them vibrant units of local self-government at the
grassroot level. But as the municipal authorities are the creatures of State Governments,
the latter will “hopefully” fend for the former in the new reactivated environment of the
Seventy-Fourth Constitution Amendment. “Hopefully”, because m the past the State
Governments have been found visibly cool in taking initiatives to strengthen the units of
urban local self- government, one has to wait and watch if the required mitatives come
in ample measure from the State Governments in this regard. A couple of initiatives already
taken in this regard (in Gujarat and Delhi), however, do not augur well for the incorporation
of the basic spirit of the Seventy-Fourth Constitutional Amendment Act.
I

62

1

THE

CONSTITUTION

(SEVENTY-FOURTH
ACT. 1992

AMENDMENT)

AN ACT

further to amend the Constitution of India
Be it enacted by Parliament in the Forty-third Year of the
Republic of India as follows:—

1. (T) This Act may be called the Constitution (Seventy:
fourth Amendment) Act. 1992.

Short tills snd
commence­
ment.

(2) It shall come into force on such date as the Central
Government may. by notification in the Official Gazette, appoint.
2. After Part IX of the Constitution, the following Part shall
be inserted, namely:—

Insertion of
new Pert IXA.

•PART IXA
THE MUNICIPALITIES

243P. In this Part, unless the context otherwise requires —

Definitions.

(a) -Committee" means a Committee constituted
under article 243S;

(b) "district" means a district in a State;
(c) “Metropolitan area" means an area having a
population of ten lakhs or more comprised in one or more
districts and consisting of two or more Municipalities or
Panchayats or other contiguous areas, specified by the
Governor by public notification to be a Metropolitan area
for the purposes of this Part;
(d) “Municipal area" means the territorial area of a
Municipality as is notified by the Governor;
(e) “Municipality" means an institution of self-govern­
ment constituted under article 243Q;

(0 “Panchayat"
under article 243B;

means

a

Panchayat

constituted
t

(g) -population" means the population as ascertained
at the last preceding census of which the relevant figures
have been published.

243Q. (1) There shall be constituted in every State —

1

Constitution of
Municipalities.

(a) a Nagar Panchayat (by whatever name called) for
a transitional area, that is to say, an area in transition from
a rural area to an urban area;
(b) a Municipal Council for a smaller urban area; and
(c) a Municipal Corporation for a larger urban area,
in accordance with the provisions of this Part;
Provided that a Municipality under this clause may not be
constituted in such urban area or part thereof as the Governor
may. having regard to the size of the area and the municipal
services being provided or proposed to be provided by an
industrial established in that area and such other factors as he
may deem fit. by public notification, specify to be an industrial
township.
(2) In this article, "a transitional area" "a smaller urban
area" or "a larger urban area" means such area as the
Governor may. having regard to the population of the area, the
density of the population therein, the revenue generated for
local administration, the percentage of employment in nonagricultural activities, the economic importance or such other
factors as he may deem fit, specify by public notification for the
purposes of this Part.
Composition of
Municipalities.

243R. (1) Save as provided in clause (2). all the seats in a
Municipality shall be filled by persons chosen by direct election
from the territorial constituencies in the Municipal area and for
this purpose each Municipal area shall be divided into territorial
constituencies to be known as wards.
(2) The Legislature of a State may, by law. provide —
(a) for the representation in a Municipality of—
(/) persons having special knowledge or experi­
ence in Municipal administration;
(//) the members of the House of the People and
the'members of the Legislative Assembly of the
State representing constituencies which comprise
wholly or partly the Municipal area;
(Hi) the members of the Council of States and
the members of the Legislative Council of the State
registered as electors within the Municipal area;
(/v) the Chairpersons of the Committees consti­
tuted under clause (5) of article 243S:
Provided that the persons referred to in paragraph (/)
shall not have the right to vote in the meetings of the
Municipality;
(b) the manner of election of the Chairperson of a
Municipality.

2

i

1

<

j

1

243S. (1) There shall be constituted Wards Committees,
consisting of one or more wards, within the territorial area of a
Municipality having a population of three lakhs or more.

Const ft uti on
and composi­
tion of Wards
CommHIaes,
•fc.

(2) The Legislature of a State may. by law, make provision
with respect to—
(a) the composition and the territorial area of a Wards
Committee;

(b) the manner in which the seats in a Wards
Committee shall be filled.
(3) A member of a Municipality representing a ward within
the territorial area of the Wards Committee shall be a member
of that Committee.
(4) Where a Wards Committee consists of—

I

(a) one ward, the member representing that ward in
the Municipality; or

(b) two or more wards, one of the members repre­
senting such wards in the Municipality elected by the
Members of the Wards Committee,
shall be the Chairperson of that Committee.

(5) Nothing in this article shall be deemed to prevent the
Legislature of a State from making any provision for the
constitution of Committees in addition to the Wards Commit­
tees.

243T. (7) Seats shall be reserved for the Scheduled Castes
and the Scheduled Tribes in every Municipality and the number
of seats so reserved shall bear, as nearly as may be. the same
proportion to the total number of seats to be filled by direct
election in that Municipality as the population of the Scheduled
Castes in the Municipal area or of the Scheduled Tribes in the
Municipal area bears to the total population of that area and
such seats may be allotted by rotation to different constituen­
cies in a Municipality.
(2) Not less than one-third of the total number of seats
reserved under clause (1) shall be reserved for women belong­
ing to the Scheduled Castes or, as the case may be, the
Scheduled Tribes.

(3) Not less than one-third (including the number of seats
reserved for women belonging to the Scheduled Castes and the
Scheduled Tribes) of the total number of seats to be filled by
direct election in every Municipality shall be reserved for women
and such seats may be allotted by rotation to different con­
stituencies in a Municipality.

3

RM«rvation Ol
Mil.

(4) The office of Chairpersons in the Municipalities shall be
reserved for the Scheduled Castes, the Scheduled Tribes and
women in such manner as the Legislature of a State may. by
law. provide
(5) The reservation of seats under clauses (1) and (2) and
the reservation of office of Chairpersons (other than the
reservation for women) under clause (4) shall cease to have
effect on the expiration of the period specified in article 334.

(6) Nothing in this Part shall prevent the Legislature of a
State from making any provision for reservation of seats in any
Municipality or office of Chairpersons in the Municipanties in
favour of backward class of citizens.
Duration of
Municipal ilia a,
ate.

243U. (1) Every Municipality, unless sooner dissolved
under any law for the time being in force, shall continue for five
years from the date appointed for its first meeting and no
longer:
Provided that a Municipality shall be given a reasonable
opportunity of being heard before its dissolution.
(2) No amendment of any law for the time being in force
shall have the effect of causing dissolution of a Municipality at
any level, which is functioning immediately before such amend­
ment. till the expiration of its duration specified in clause (1).
(3) An election to constitute a Municipality shall be com­
pleted.—
(a) before the expiry of its duration specified in
clause (1);
(b) before the expiration of a period of six months for
the date of its dissolution:
Provided that where the remainder of the period for
which the dissolved Municipality would have continued is
less than six months, it shall not be necessary to hold any
election under this clause for constituting the Municipality
for such period.
(4) A Municipality constituted upon the dissolution of
Municipality before the expiration of its duration shall continue
only for the remainder of the period for which the dissolved
Municipality would have continued under clause (1) had it not
been so dissolved.
'

Disqualification
for membar­
ship.

243V. (7) A person shall be disqualified for being chosen
as. and for being, a member of a Municipality
(a) if he is so disqualified by or under any law for the
time being in force for the purposes of elections to the
Legislature of the State concerned;

4

i

Provided that no person shall be disqualified on the
ground that he is less than twenty-five years of age. if he
has attained the age of twenty-one years;
(b) if he is so disqualified by or under any law made
by the Legislature of the State.
(2) If any question arises as to whether a member of a
Municipality has become subject to any of the disqualifications
mentioned in clause (1). the question shall be referred for the
decision of such authority and in such manner as the Legisla­
ture of a State may. by law. provide.

243W. Subject to the provisions of this Constitution, the
Legislature of State may. by law. endow—
i

i

rI

Power* autbo*
rity and re­
sponsibilities
of
Municipalities,
etc.

(a) The Municipalities with such powers and authority
as may be necessary to enable them to function as
institutions of self-government and such law may contain
provision for the devolution of powers and responsibilities
upon Municipalities, subject to such conditions as may be
specified therein, with respect to—
(/) the preparation of plans for economic
development and social justice;
(/7) the performance of functions and the
implementation of schemes as may be entrusted to
them including those in relation to the matter listed in
the Twelfth Schedule;
(b) the Committees with such powers and authority as
may be necessary to enable them to carry out the
responsibilities conferred upon them including those in
relation to the matters listed in the Twelfth Schedule.

243X. The Legislature of a State may, by law—
i

(a) authorise a Municipality to levy, collect and
appropriate such taxes, duties tolls and fees in accord­
ance with such procedure and subject to such limits,
(b) assign to a Municipality such taxes, duties, tolls
and fees levied and collected by the State Government for
such purposes and subject to such conditions and limits;
(c) provide for making such grants-in-aid to the
Municipalities from the Consolidated Fund of the State;
and

5

Power to
impose taxes
by, and Funds
of. the
Municipalities.

(cQ provide for constitution of such Funds for crediting
all moneys received, respectively, by or on behalf of the
Municipalities and also for the withdrawal of such moneys
therefrom.
as may be specified in the law.
Finance
Commission.

243Y. (7) The Finance Commission constituted under
article 243-1 shall also review the financial position of the
Municipalities and make recommendations to the Governor as
(a) the principles which should govern—
(7) the distribution between the State and the
Municipalities of the net proceeds of the taxes,
duties, tolls and fees leviable by the State, which
may be divided between them under this Part and
the allocation between the Municipalities at all levels
of their respective shares of such proceeds;
(/7) the determination of the taxes, duties, tolls
and fees which may be assigned to, or appropriated
by, the Municipalities;
(Hi) the grants-in-aid to the Municipalities from
the Consolidated Fund of the State;

(b) the measures needed to improve the financial
position of the Municipalities;
(c) any other matter referred to the Finance Commis­
sion by the Governor in the interests of sound finance of
the Municipalities.
(2) The Governor shall cause every recommendation
made by the Commission under this article together with
an explanatory memorandum as to the action taken
thereon to be laid before the Legislature of the State.
Audit of
accounts of
Municipalities.

243Z. The Legislature of a State may, by law, make
provisions with respect to the maintenance of accounts by the
Municipalities and the audit of such accounts.

Elections
lo the
Municipalities.

243ZA. (7) The superintendence, direction and control of
the preparation of electoral rolls for, and the conduct of, all
elections to the Municipalities shall, be vested in the State
Election Commission referred to in article 243K.
(2) Subject to the provisions of this Constitution, the
Legislature of a State may. by law. make provision with respect
to all matters relating to or in connection with, elections to the
Municipalities.

Applicaiion
to Union
Territories.

243ZB. The provisions of this Part shall apply to the Union
territories and shall, in their application to a Union territory,
have effect as if the references to the Governor of a State were

6

references to the Administrator of the Union territory appointed
under article 239 and references to the Legislature or the
Legislative Assembly of a State were references in relation to a
Union territory having a Legislative Assembly, to that Legislative
Assembly.*
Provided that the President may. by public notification,
direct that the provisions of this Part shall apply to any Union
territory or part thereof subject to such exceptions and modifica­
tions as.he may specify in the notification.

243ZC. (1) Nothing in this Part shall apply to the
Scheduled Areas referred to in clause (1). and the tribal areas
referred to in clause (2), of article 244.
(2) Nothing in this Part shall be construed to affect the
functions and powers of the Darjeeling Gorkha Hill Council
constituted under any law for the time being in force for the hill
areas of the district of Darjeeling in the State of West Bengal.

Part not to ap­
ply to cartain
araaa.

(3) Notwithstanding anything in this Constitution. Parliament
may. by law. extend the provisions of this Part to the Scheduled
Areas and the tribal areas referred to in clause (1) subject to
such exceptions and modifications as may be specified in such
law. and no such law shall be deemed to be an amendment of
this Constitution for the purposes of article 368.

243ZD. (1) There shall be constituted in every State at the
district level a District Planning Committee to consolidate the
plans prepared by the Panchayats and the Municipalities in the
district and to prepare a draft development plan for the district
as a whole.
(2) The Legislature of a State may. by law. make provision
with respect to—
(a) the composition of the District Planning Commit­
tees;
(b) the manner in which the seats in such Committees
shall be filled:
Provided that not less than four-fifths of the total
number of members of such Committee shall be elected
by. and from amongst, the elected members of the
Panchayat at the district level and of the Municipalities in
the district in proportion to the ratio between the pojxjlation of the rural areas and of the urban areas in the
district;
(c) the functions relating to district planning which
may be assigned to such Committees;

CommlttaM tor
district
plan­
ning.

(d) the manner in which the Chairpersons of such
Committees shall be chosen.

7

1

(3) Every District Planning Committee shall, in preparing
the draft development plan,—

(a) have regard to—
(/) matters of common interest between the
Panchayats and the Municipalities including spatial
planning, sharing of water and other physical and
natural resources, the integrated development of
infrastructure and environmental conservation;

(/7) the extent and type of available resources
whether financial or otherwise;
(b) consult such institutions and organisations as the
Governor may. by order, specify.

(4) The Chairperson of every District Planning Committee
shall forward the development plan, as recommended by such
Committee, to the Government of the State.
Committee lor
MetropoUten
planning.

243ZE. (1) There shall be constituted in every Metropolitan
area a Metropolitan Planning Committee to prepare a draft
development plan for the Metropolitan area as a whole.

(2) The Legislature of a State may. by law. make provision
with respect to—
(a) the composition of the Metropolitan Planning
Committees;
(b) the manner in which the seats in such Committees
shall be filled:
Provided that not less than two-thirds of the members of
such Committee shall be elected by. and from amongst,
the elected members of the Municipalities and Chairper­
sons of the Panchayats in the Metropolitan area in
proportion to the ratio between the population of the
Municipalities and of the Panchayats in that area;

(c) the representation in such Committees of the
Government of India and the Government of the Sate and
of such organisations and institutions as may be deemed
necessary for carrying out of functions assigned to such
Committees;
(d) the functions relating to fanning and coordination
for the-Metropolitan area which may be assigned to such
Committees;
(e) the manner in which the Chairpersons of such
Committees shall be chosen.
(3) Every Metropolitan Planning Committee shall, in prepar­
ing the draft development plan —

8

(a) have regard to—
(0 the plans prepared by the Municipalities and
the Panchayats in the Metropolitan area;
(//) matters of common interest between the
Municipalities and the Panchayats, including co­
ordinated spatial planning of the area, shanng of
water and other physical and natural resources, the
integrated development of infrastructure and environ­
mental conservation;
(m7) the overall objectives and priorities set by the
Government of India and the Government of the
State;.
(rv) the extent and nature of investments likely to
be made in Metropolitan area by agencies of the
Government of India and of the Government of the
State and other available resources whether financial
or otherwise;
(b) consult such institutions and organisations as the
Governor may, by order, specify.
(4) The Chairperson of every Metropolitan Planning Com­
mittee shall forward the development plan, as recommended by
such Committee, to the Government of the State.

243ZF. Notwithstanding anything in this Part, any provision
of any law relating to Municipalities in force in a State
immediately before the commencement of the Constitution
(Seventy-fourth Amendment) Act, 1992. which is mconsisten
with the provisions of this Part, shall continue to be in force un i
amended <x repealed by a competent Legislature or other
competent authority or until the expiration of one year from
such commencement, whichever is earlier:
Provided that all the Municipalities existing immediately
such commencement shall continue till the expiration of duration. unless sooner dissolved by a resolution passed to that
effect by the Legislative Assembly of that Slate or. in the case
of a State having a Legislative Council, by each House of the

Continuance Of
existing
laws
and Munieipamiea.

Legislature of that State.
243ZG. Notwithstanding anything in this Constitution.
fa) the validity of any law relating to the delimitation of
constituencies or the allotment of seats to such constituencies, made or purporting to be made under article 243ZA
shall not be called in question in any court;
(b) no election to any Municipality shall be called in
question except by an election petition presented to such
authority and in such manner as is provided for by or
under any law made by the Legis'ature of a State;

9

Bar to Interfw•nca by courts
In etociofai
matiers.

1

Amend rr^ '? of
article 280

3. In clause (3) of arKcle 280 of the Constitution, subclause (c) shall be lettered as sub-clause (d) and before subclause (d) as so relettered, the following sub-clause shall be
inserted, namely:—
(c) the measures needed to augment the Consoli­
dated Fund of a State to supplement the resources of the
Municipalities in the
?e on the.basis of the recommen­
dations made by the Finance. Commission of the State;".

Addition of
Twelfth
Schedule.

4. After the Eleventh Schedule to the Constitution, the
following Schedule shall be added, namely:—

"TWELFTH

3HEDULE

(Article 243W)

1. Urban planning including town planning.
2. Regulation of land-use and construction of build­
ings.
3. Planning for economic and social development.
4. Roads and bridges.

5. Water supply tor domestic, industrial and commercial purposes.
6. Public health, sanitation conservancy and solid
waste management.
7. Fire services.

8. Urban forestry, protection of the environment and
promotion of ecological aspects.

9. Safeguarding the interests of weaker sections of
society, including the handicapped and mentally retarded.
10. Slum improvement and upgradation.

11. Urban poverty alleviation.
12. Provision of urban amenities and facilities such as
parks, gardens, playgrounds.
13. Promotion of cultural, educational and aesthetic
aspects.

14. Burials and burial grounds; cremations, cremation
grounds and electric crematoriums.
15. Cattle pounds; prevention of cruelty to animals.
16. Vital statistics including registration of births and
deaths.

17. Public amenities including street lighting, park­
ing lots, bus stops and public conveniences.

18. Regulation of slaughter houses and tanneries."

10

u

i

FXTRACI OF ARTICLE 243 I & 243 K FROM CLAUSE 2 OF
SI CONSTITUTION (73RD AMENDMENT) ACT. 1992

wH%“*Re Sferbeo to !«

the constitution

(74TH AMENDMENT) ACT, 1992
of
243-1 (1) The Governor of a State shall, as soon as may Constitution
Flnanco Com­
be within one year from the commencementI of the Constitution mission to ro(Seventy-third Amendment) Act. 1992, and thereafter at the view financial
position.
expiration of every fifth year, constitute a Finance
to review the financial position of the Panchayats and to make
recommendations to the Governor as to(a) the principles which should govern—
(i) the distribution between the State and the
Panchayats of the net proceeds of the taxes, duties,
tolls and fees leviable by the State, which may be
divided between them under this Part and the alloca­
tion between the Panchayats at all levels of their
respective shares of such proceeds.
(ii) the determination of the taxes, duties, tolls
and fees which may be assigned to. or appropriated
by. the Panchayats;
(Hi) the grants-in-aid to the Panchayats from the
Consolidated Fund of the State;
(b) the measures needed to improve the financial

position of the Panchayats,
(c) any other matter referred to the Finance Commis­
sion by the Governor in the interests of sound finance o
the Panchayats.
may, by law.
(2) The Legislature of a State may.
law, provide
the
.. .for ...J
composition of the Commission, the qualifications which sha I
be requisite for appointment as members thereof and the
manner in which they shall be selected.
(3) The Commission shall determine their procedure and
shall have such powers in the performance of their ’unctions as
the Legislature of the State may, by law. confer on them.

(4) The Governor shall cause every recommendation made
by the Commission under this article together wrth an expUnatory memorandum as to the action taken thereon to be laid
before the Legislature of the State.

243K (1) The Superintendence, direction and control of the
preparation of electoral rolls for, and the conduct of. all
elections to the Panchayats shall be vested in a State Elechon
Commission consisting of a State Election Comrmssioner to be
appointed by the Governor.

11

Elections to
tho P«nchayats.

J
a/

(2) Subject to the provisions of any law made by the
Legislature of a State, the conditions of service and tenure of
office of the State Election Commissioner shall be such as the
Governor may by rule determine:

Provided that the State Election Commissioner shall not be
removed from his office except in like manner and on the like .
grounds as Judge of a High Court and the conditions of service
of the State Election Commissioner shall not be varied to his
disadvantage after his appointment.
(3) The Governor of a State shall, when so requested by
the State Election Commission, make available to the State
Election Commission such staff as may be necessary for the
discharge of the functions conferred on the State Election
Commission by Clause (1).
(4) Subject to the provisions of this Constitution, the
Legislature of a State may. by law, make provision with respect
to all matters relating to. or in connection with elections to the
Panchayats.

12

Plan for Delivery of Family Welfare
Services in Slums (Bangalore City) Based on The Need Assessment of Slum
Dwellers (IPP-VIII)
A S Mohammad
Dept, of Community Health
St. John's Medical College, Bangalore 560 034
Bangalore is the fastest growing city of India with a total population of 41,08.013
(1991 census). This unprecedented, unplanned growth has resulted in the growth of
many slums and lack of basic civic amenities. Bangalore has organised urban health
services provided by the net work of hospitals, health centres, maternity homes and
dispensaries but these facilities are not available to lower section of the urban
community for various reasons. Out-reach services of these institutions do not exist
or are inadequate to meet the Primary Health Care needs of the slum dweller.
In the present proposal efforts are made to identify problems and to strengthen the
delivery of family welfare/primary health care services to the urban poor. This is
consistent with the objective of the national health policy which aims at taking the
services nearer to the door steps of the people and ensuring full participation of the
community in health development process. It is proposed to reorganise and strengthen
the existing facilities as per the requirement. Strengthening of out reach services and
involvement of community in taking care of its health needs are the main points of the
present proposal.

Various strategies for improving the delivery of family welfare/primary health care
services to urban poor could include the following

a) Development of effective out-reach services
b) Strengthening of infrastructural facilities
c) Involvement of Private Medical Practititioners and NGOs and
d) Intensive IEC (Information, Education & Communication) compaign.
A health centre will serve a population of 50,000. Family welfare and Primary health
’ care services will be provided through link workers, domiciliary visits of ANM/LHV. To

26

1

Diagram -1
AGRICULTURAL
DEVELOPMENT

DEVELOP­
MENT
PROJECTS

ANIMAL
HUSBANDRY

KFD

DENGUE

?

JE

ARBO
VIRUSES
LABOUR
MIGRATION

ALPHA
VIRUSES

FORESTRY

CHANDIPURA
CHIKUN
GUNYA

URBANIZATION
(Including larger
villages)

WILD LIFE
SPORTS
(Hunting,
Hiking)

WEST NILE

INTERNATIONAL
TRAVEL/ ECO
TOURISM

I

■ SPSS'S'
»« be seteM The services MuXde

te

“meol ,hee<,sit’"0

»-»■>
homes

1. Cere o, piephae,«, inc,utfM „ea|mM o|
I

2. Sale deliveries
3 Mn^-tna,a! Care irlclLJdin9 care of new born.
4 Nutritional care upto the age of five
5.

6y
prachces. mmuh°snafonCm”"iouS'dmlho p™” h™8',eM'"9 and "ean'n0
9

KnowSaeOof?nOr a"™015 °f W°men and c^dren

laC,a"°n' e'C

X*

■0. Oeleclion

SETTING UP OP NEW HEALTH CENTRES ANO UP GRADED HEALTH CENTRES
lhat 97aheShcentresX^YupgradldEh0'^ POpu'aliorl i e- 48-78 'akh by 1995

2^alth centres and upgraded health cenbesirA1^^!'.^reqU,red' The break-up

Status

Health Centre

Required
Existing
Addl. requirement

Upgraded Health Centre

97
37 *
60

24
30 Maternity Homes

24 **

. Strengthening in terms of stall,

equipment, drugs and contingencies '
Strengthening in terms ol stall,
for 6 centresjand con^ingencier0'903601’ arnbu,ance> drijgs, stall quarters (only

; phaSSSXSS'? ce"'r8S md se"^ *»' new centre will be taken in
Year
New centres (60)
Strengthening ol37HCs
Strengthening ol 24UHCs ‘

j

I
20
5

6

Strengthening ol exisiting HCs

II
15
5
5

III
10
10
5

S UPHCs
27

IV
8

12
5

V
7
5
3

Total
60

37
24

-

centres will be

Diagram -1
ANIMAL
HUSBANDRY

AGRICULTURAL
DEVELOPMENT

DEVELOP­
MENT
PROJECTS

KFD

DENGUE

FORESTRY

?
JE

ARBO
VIRUSES
LABOUR
MIGRATION

ALPHA
VIRUSES

CHANDIPURA
CHIKUN
GUNYA

URBANIZATION
(Including larger
villages)

WILD LIFE
SPORTS
(Hunting,
Hiking)

WEST NILE

INTERNATIONAL
TRAVEL/ ECO
TOURISM

I

ORGANIZATION CHART
COMMISSIONER/ADMINISTRATOR

I

HEALTH OFFICER

I
Additional Health Officer
(FW&MCH)

Private Medical Practitioners
Training Unit
- Apex training team

Administration and Monitoring Unit
- Deputy Health Officer (FW & MCH)
-Statistician
-UDC
I

Upgraded Health Centre
l
Sr. Medical Oflicer
1
. 1
Gynecologist cum Resd. IMO
1
Paediatrician
1
Anaesthetist (Part time)
4
Staff Nurse
Clerk
2
TASKS
3
Pharmacist cum store keeper
1
Lab. Technician
O.T. attendant
1
1
Statistical assistant
1
Peon
3
Sweeperess
1
Chowkidar
1
Driver

I

I

T
HC

HC

_____

Lady .Medical Officer
1
2
LHV/PHN
ANM/Heafth worker (Female) 7
Health worker (Male)
1
. 1
Computer cum clerk
1
Peon
Sweeper cum cfjowkidar
1
10
Dias (link worker)

I

TASKS

I E C Unit
- Extn. Education Officer
- Extn. Educator
- Driver cum projectionist

Out patient services
Specialised MCH Care
Conduction of Normal and high risk
deliveries
MT P
Sterilization
Inpatient care of Gynae/Obs cases
Laboratory services
Referrals
Supervision of Health centres

Treatment of common ailments of mother and children
including diarrhoos (mild dehydration)
Ante Natal, Natal and Post Natal care
Immunization
. Vit. A for prevention of blindness
ORS for diarrhoea
Supplementary Nutrition
Family Planning
■ IUD insertion, Condom and Oral pill distribution
Urine (Albumin & sugar) and Blood Esamination
Referral for Sterilization, High risk & completed cases to
upgraded Health centre and other Hospitals
Surveillance of vaccine preventable diseases & Diarrhoea.

It is suggested to introduce varipus records and reports at various levels, right from
the field staff, HC, and UPHC, to monitoring unit. So the information can flow both ways
i.e. from field staff to the decision maker and vice versa,
■28

I

!

Non-Government Organisations

•

. Health Centre (HC) HC

-

I.

training plant
Catergories

1. Apex training
loam

Venue of
Training

Trainers

National
Institute of
Health and
Family
Welfare
Services,
NEW DELHI.

Faculty
from
NIHAFWS

3 working
days

a) Emerging Urban Health
needs and problems
of slums.
b) Project Strategy for
delivery of Family
Welfare Services.
c) Communication
Technology
d) Planning and organisation
of training programmes and
management techniques.

Faculty
from
H.F.W.I.C.

2 working
days

a) Motivational technology with Locturer/discussions
special reference to Family Demonstration and
Welfare.
field training
b) Inter personal
communications.

Faculty
from
H.F.W.I.C,,

4 days

a) Planning, organisation and Lecture/discussions
evaluation of training
group discussions
communication techniques and field (raining.
In health and family we’ktre.
production and testing of
training & communication
materials.
b) Extension techniques,
plannlng.organisatlo'n and
testing of training/
communication centres

Faculty/
H.Officers
SMOs.
Extension
education
officer

5 Days

a) Problems of Urban Primary
Health Care, new
b) Use of communication
strategy In training
c) Awareness creation,
motivational technology.
d) Management techniques
e) Clinical update
I) Monitoring and Supervision

SMO/MO
Extension
Educator

5 Days

2. Sr. Medical
H.F.W.I.C.
Officers,
specialists.
Gynaecologist

Duration

Paediatrician
3. Extepsion
Educator

H.F.W.I.C.

I
4 LMOs, PHNs. H.F W.I.C
I HVs

5. Health worker Health centre

Training

Training
Methodology

Needs

I a) Update in prevention and
promotive health care
b) Amenatal checkups.
■ deliveries Postnatal
check-ups.
c) Identification of high risk

29

Loctures/discussions
and.group
discussions

Lecture/workshop,
group oiscussions
ano held experience

Lecture/workshop
field experience and
practical training/
demonstration

Catorgorios

Vonuo of
Training

Trainors

Duration

Training
Needs

Iraining
Mothoujiogy

mothers.
d) Care of new born & infants
e) Motivational techniques
person to person
communication
f) Maintenance of various
records and reports.
6. Link workers
(Dai)

Health
Centre

PHN/l HV.
ANM
Extension
Educators

30 Days

a) Contacting community for
awareness creating.
b) Motivating women
particularly pregnant
women.
c) Update on delivery method,
aseptic delivery, care of
pregnant women, postnatal
care, care of infants and
care of minor ailments in
the community.

Lectures/group
discussion
Demonstration.
Holeplay
Fie'd ooservation ano
real situation.

7 Private
practitioners,
NGOs anc
Karnataka
Slum
Clearance
Board(KSCB)
workers.

Health
Office

Health
Officer
consisted
by extension
educators

1 Day
orientation
/seminar.

a) Orientation to innovation
approach/extension
approach.

Lecture, individual
presentations and
discussions

8 Angawadi
worker

Health
centre

LHV/PHN
Extensiorf
Educator

1 Day
orientation

a) Contacting community for
awareness creating.
b) Motivating women
particularly pregnant
women for ANC and T.T.
Immunization.

Lecture. Hole play

3
I:

A survey conducted in slums of Bangalore revealed that 85% of population is
availing the services of Private Medical Practitioners (PMPs). It is because of fact
that they are in large number and have high level of local acceptance and respect
particularly in slum areas. So, the success of implementation of the programme of
strengthening of family welfare services in urban areas will also depend largely on the
involvement of PMPs and NGOs providing these services.

During the interviews with PMPs, all PMPs expressed their willingness to
participate in the Government Health programme. So, it is proposed in the plan to
identify the PMPs and NGOs and involve them in the following activities -

30

I

PI AN FOR INVOLVEMFNT
Arua

5

Institution

Task

Supplies
(free)

Records

To

nmumzation
i free)

Nursing Homes
Polyclinics
clinics'
dispensaries

Immunization
of eligible
children
attending
institution

Vaccines
Cold chain
equipment

List of
Immunised
children
doese wise
Mothers TT

UFWC/ .
area
ANM

Family
Planning

Nursing homes
Poly clinic
cl'hic-’
Dispensaries

F P services
including
MTP(only)
Nursing
homos)

lUCDs
Oral Pills
Condoms

Appro­
priate
register
of services
done

Area
UFWC/
ANM

MCH ANC
Natal
PNC

Nursing homos
Poly Clinic
ClimeDispensaries

Motivation
for regis­
tration &
referral to
appropriate
institution

Iron and
Folic acid
and TT

Appropriate
registi/r
of fwork
done

Area
UFWC
ANM

ORT

Nursing homes
Poly clinics
clinics'
dispensaries

Assessment
of degree
of dehydra
tion and
treatment

ORS Pkts

Appropriate
register ol
work done

Area
UFWC/
ANM

do

Motivation ,
& advice
on Preven­

Leaflets
Posters
etc
tive Measures

Health
Education

communicabon (orattitu^khTnges dtooq
ac"vl,ies and mler-personnel
w'l|beresponsibleforplanningandoroan^sai^on^m
url't ™sunil
with ANM/LHV and "a.e worker in .nl coXZZXS

31

Position: 72 (20 views)