Multi-stakeholder Urban Health Program in Indore (11789 read) In partnership with Department of Public Health, the Municipal Corporation

of Indore, the District Administration, NGO partners and the local communities, the Indore Urban Health City demonstration Program was initiated in March 2003. The program operates with the objective of improving maternal and child health and nutrition among the slum dwellers in Indore. It focuses specifically on:

Increasing coverage of health services and adoption of healthy behaviors to improve diarrhea control and other child health issues for ensure better child survival rates. Improving capacities of Community Based Organisations (CBOs), NGOs, private and public sector health providers for health improvements. Empowering the community and develop leadership to facilitate collective action for taking charge of their communitys health

With the help of the elected representatives of Indore Municipal Corporation including the Mayor, officials of Department of Health and Indore Municipal Corporation (IMC), UHRC undertook the listing, geographical mapping and vulnerability assessment of all listed as well as unlisted slums. Apart from the 225 listed slums in 2002 an additional 314 slums in Indore were identified. Based on criteria such as housing conditions, sanitation facilities, employment status, availability and access to public health services, gender equity, a vulnerability assessment of all 539 slums was undertaken. This exercise helped in identifying and targeting the most vulnerable slums Program Approaches Two program strategies were developed to improve health of vulnerable slum communities in Indore in consultation with different stakeholders. These included the 1. Demand-Supply and Linkage Approach 2. Multi-stakeholder Ward Coordination Approach It emerged that the city had a rich tradition of community level processes. Several city slums had community organizations formed as a result of earlier governmental and nongovernmental initiatives. These organizations were interested in health improvement in vulnerable slums. The urban health planning process concluded that utilizing the existing CBOs and building on their capacity could be a viable strategy to sustain health improvements in slums of Indore. CBOs had the potential to spread health awareness, increase demand for health services and provide logistical support and mobilize the community during health events such as immunization camps. They also had the capacity to effectively engage with the health providers in the public and private sector to improve health conditions in their slums. This led to the evolution of the Demand, Supply and Linkage approach. This approach which began implementation in March 2003 now covers 150,000 population spread across 75 slums in Indore which previously had little or no access to health services.

Demand-Supply and linkage approach The program focuses on training slum based health volunteers in improving health awareness and promoting desirable behaviorsin their slums. Different methods such as individual and group counseling, street plays, puppet shows, video shows, healthy baby contests and healthy expectant mothers competition, interactive health quiz are conducted at slum level. These activities seek to motivate slum dwellers to adopt appropriate heath behaviors. Apart from this, slum groups also forge linkages with public and private sector health providers to provide regular health services in their slums. By facilitating the logistics of organizing monthly health camps, the CBOs have been successful in increasing the supply of health services to their slums. Even though there are a number of health providers both in the public and private sector, they were not accessed by slum communities due to lack of confidence or simply because they have been turned away from health facilities. Helping communities organize themselves helps them negotiate for better and more regular services and helps them demand and utilize services when needed. Collectivized slum communities have also been able to effectively influence the Municipal Corporation to improve other services such as water, sanitation and drainage in slums which have beneficial impact on health in slums. Strengthened the community-provider linkage has been an important outcome of this process of empowering the community to demand and utilize health care. Program Outcomes after 3 years As a result of the urban health program, a cadre of capable slum based organizations with an army of health volunteers has emerged with a mission to improve health conditions in their slums. There are 90 Basti (slum level) CBOs, 9 Lead CBOs (which are more experienced CBOs which support and monitor the slum level CBOs) and 5 NGOs who have been actively pursuing the mission of better health in underserved slums of Indore. The NGOs-Lead CBOs coordinate directly with the Health Department and Private/Charitable institutions to organize

over 50 Maternal and Child Health outreach camps each month. The program has developed linkages with the private service providers. Approximately 10 ANC camps are organized each month to cover 25 slums where qualified private doctors provide antenatal checkup and advise to pregnant women at a nominal contribution.

A midline survey conducted in March 2006 evaluated the Indore City Demonstration Program. It revealed substantial improvements in key MCH indicators where the demand supply linkage model was implemented. Public/ Private Partnership Approach Recognizing the capacities and skills of slum based organizations and NGOs developed by the UHRCs program in Indore, the Department of Health and Family Welfare, Indore is partnering with UHRC to facilitate monthly MCH clinics on the first Sunday of every month at 5 locations to expand services to underserved slums of Indore. This arrangement which has been operational since September 2006 has been organizing 5 outreach camps every month.

The Ward Coordination Approach The health of slum communities is influenced by work of several governmental and nongovernmental agencies. The key stakeholders include the health department, ICDS, urban development department, municipal bodies and non-governmental organizations. It is observed that these agencies work independently with little or no coordination with other stakeholders and that there was considerable scope for developing synergy in several activities. The "Multi stakeholder Ward Coordination approach" facilitated efficient convergence of resources of different stakeholders such as the government, non government agencies, private organizations, community groups and charitable institutions at the ward level which is the

smallest adminstrative unit in the city. This is a public sector driven approach, focusing at service improvement, specifically targeted at immunization outreach in Ward 5 of Indore. Ward 5 is the largest of the 69 wards in Indore. It has a slum population of over 50,000. The approach was subsequently replicated in Ward 7 where it covers another 35,000 population in 28 vulnerable slums. The ward coordination committee is facilitated to meet on a monthly basis and review progress and strategize utilization of local resources in a complementary manner. Through coordinated action, immunization camps (7 camps covering 28 underserved slums in Ward 5 and 6 camps covering 24 slums in Ward 7) are held each month. The Ward Committee has been collaborating with technical experts from Indian Academy of Pediatrics and National Neonatology Forum for enhanced quality of services and community counseling

. The Ward Coordination Approach

Partners in Indore Demonstration Program Program Partners include 1. The Department of Public Health and Family Welfare, Indore and District Health Society, Indore 2. District Administration and Municipal Corporation of Indore 3. NGOs o Centre for Community Economics and Development Consultant Society o Bhartiya Grameen Mahila Sangh o Indore Diocese Social Service Society o Pushpkunj Family Helper Project Trust o Bal Niketan Sangh 4. One Federation of slum womens groups Sampoorn Mahila Samiti 5. 8 Cluster Coordination Teams 6. 90 Basti-level CBOs (women's groups) and 8 children's groups 7. Slum Communities 8. Charitable organizations, public and private doctors Related links for downloads

Jan 28, 2011 Indore Conclave of women's and Children's groups - Jan 28, 2011 Report Maternal and Newborn Care Practices Among the Urban Poor in Indore, India Hygiene Behavior among Urban Poor in Indore:Reasons for Current Practices and Program Options Improving Age Appropriate Immunization Among Urban Poor Infants:Possible Options and Approaches Partnerships for Improving Health in Vulnerable Slums of Indore Situational Analysis for Guiding USAID/India and EHP/India-Technical Assistance

Efforts in Indore

Slum Women take part in health meet, Indore, Hindustan Times 58 , ,

City Health Programme Lauded, Hindustan Times 24 October, 2008 [Printer friendly page]