SITUATION BEFORE THE INITIATIVE BEGAN
People lived in makeshift corrugated iron, plastic sheet or cloth shanty huts. Sanitation and hygiene were very poor. Water was unsafe to drink. Government services were lacking. Infant mortality, birth and maternal mortality rates were among the world’s highest. TB, diarrhea and respiratory diseases ran rampant. Maternal health was poor and most child deaths were from preventable diseases.
ESTABLISHMENT OF PRIORITIES
Asha’s first priority is community empowerment. The community must identify and address its own concerns and priorities for effective and permanent transformation. This primarily involves slum women and requires the establishment of networks and groups focused upon health and environmental improvements. The second priority is partnership development with key stakeholders, particularly with municipal and government departments and ministries. A non-confrontational approach based upon good will is adopted. The third priority is to support community-based structures, through Women’s Associations (Mahila Mandals), lane volunteers, and community based health centers, by providing on-going training. Asha established these priorities over time in consultation with the communities themselves.
FORMULATION OF OBJECTIVES AND STRATEGIES
Asha adopts a holistic approach in identifying and addressing the needs of the slum community in order to take necessary steps together towards slum development and improvement in overall quality of life (i.e., securing land tenure, shelter, health and environmental improvements). Asha’s strategy recognizes that it is the people who are the key to change and by helping a community to develop its human resources, and to choose, plan, organize and create for itself, the community is empowered to access and utilize existing material resources and develop on a long term basis. This need-based stratagem and formation of Asha-community-government partnerships lead to initiation and strengthening of development processes, better community governance and improved community health.
MOBILIZATION OF RESOURCES
Asha has mobilized community members around their shared felt needs, to establish and address their priorities and access government and other resources. Women’s Associations and Community Health Volunteers (CHVs) are established and their capacities built. Each CHV, responsible for about 300 households in her community, is able to provide basic health care and advice to these households, conduct clinics, immunization programmes and other health related activities. Through Mahila Mandals, Asha helps women tackle health and basic sanitation problems, and undertake community development, organization and mobilization.
All health and development activities, plans, improvements and future thrusts have always been in partnership with the stakeholders of the community viz., municipal and government ministries and departments, slumlords, neighbouring colonies and local politicians.
The Mahila Mandals mobilize the substantial resources of the municipal and government entities, who provide technical resources such as architects to draw up plans for slum development and engineers to provide advice on construction and infrastructure improvements. Municipal and government entities also provide substantial infrastructure resources such as new roads, water connections, new pavements, and sanitation and drainage facilities. There is also significant government investment in provision of community centres and health care supplies (certain medicines, vaccines, contraception devices, etc.).
Asha has mobilized financial support for its work through National and International NGO channels like Tearfund-UK, Tearfund New Zealand, Tearfund Netherlands, ICCO Netherlands, British High Commision, New Zealand High Commission, Aus Aid, Kingdom Charitable Trust and Friends of Asha in Great Britain, Ireland and the USA.
Slum transformation involves community participation using healthcare as an entry point. Discussions between Asha, the community and municipal and government bodies result in a process of establishing land tenure through a housing co-operative. Land is allocated to inhabitants following dialogue. Plans are drawn up using technical resources of the municipality. Land lots are drawn. Inhabitants relocate to one part of the slum whilst new shelter is built (partly by inhabitants themselves) using material saved from their existing shelter and materials obtained through loan of construction materials.
New water and sewerage connections, drainage system, street lighting, pavements and community centers are built by the municipality. The housing co-operative set up to facilitate land tenure charges residents a levy to fund ongoing housing estate maintenance. This is the process by which a slum becomes a functioning, self sufficient and permanent housing estate running its own affairs. Asha’s work with the community to improve living standards and health through its community based health programmes and training runs parallel to this focus on securing land tenure.
Asha develops partnerships with slum women by involving them in all stages of the process; planning, implementing and monitoring. Problems are identified and priorities set at the meetings. Asha facilitates their linking with the key stakeholders mentioned in the Summary Section. Asha organizes the women to form Mahila Mandals and also brings their children together to form Bal Mandals. Through these self-help groups Asha works on enhancing their self-esteem and leadership and communication skills. The National Slum Women’s Development Federation (NSWDF) is an umbrella organization representing the 200,000 slum dwellers in Asha areas. It provides coordination of activities, direction, and consolidation of their strength so as to demonstrate an effective voice for the bigger problems concerning the interest of the slum dwellers.
Empowering the women of the community entails formation of groups, capacity building, awareness of rights and responsibilities, finding solutions to problems, interaction with government and fighting for their rights. The aim is to transform disadvantaged, illiterate slum women into literate, confident, earning members of the society who can be a source of strength and guidance to their children and husbands. They are continuously trained in leadership, management, accounting, micro-planning, civic governance, healthcare and legal literacy as part of Mahila Mandals and Registered Societies so that they step out and they step forward and take responsibility.
Children and Youth
Child health is one of the most important indicators of community health. Asha endeavours to give the children the best possible start in life through an integrated programme addressing community based health care (maternal & newborn health, child health and adolescent health & training programmes) and environmental improvement.
Asha gave momentum to the child right’s movement by starting its Child Advocacy Programme through formation of Children’s Associations known as Bal Mandals aged 6-14 years. It aims to increase children’s empowerment to influence their own community environment and service provision. All activities of Bal Mandals are centered around children as advocates involved in raising awareness, receiving training in personality development with leadership and communication skills, and participating in health care and environmental improvements.
The pioneering effort by Asha in obtaining land tenure through a housing cooperative to residents of Ekta Vihar has paved the way for the Slum Housing Policy and has also influenced India’s National Slum Policy. Former slums have been transformed into lower-middle class colonies with decent houses. There is now good average annual incomes and access to municipal services. Asha’s community health volunteer system, which now provides health care to a population of roughly 200,000, has been replicated throughout Delhi by the World Bank and the Government of Delhi.
The dramatic health impacts seen in Asha slums are due to the holistic approach towards improving quality of life of slum children.
20/1000 live births
50/1000 live births
Infant Mortality Rate
37/1000 live births
67/1000 live births
Under-5 Mortality Rate
47.2/1000 live births
93/1000 live births
Only 1 Maternal Death
408/100,000 live births
90% babies born were of normal weight. 85% children are healthy, 11% mild-moderately malnourished, and 4% severely malnourished (Other Delhi slums- 20% healthy children and 80% malnourished). There are few or no deaths due to lower respiratory tract infections, diarrhoea or measles. There are no clinical cases of the six vaccine preventable diseases as well as vitamin A deficiency. Early breastfeeding, appropriate weaning and nutrition and immunization practices have been established with evident change in health seeking behaviour of the community.
The process of empowerment facilitated by Asha in the women’s groups has raised their self-esteem, allowing a collective ability to make decisions and take effective action as pressure groups leading to increased unity and comradeship and giving them confidence to lobby the concerned authorities. This has resulted in improved access to clean drinking water, decreased open field defecation, cleanliness of toilet areas, reduced amount of stagnant surface water and cleaner lanes and streets. There is better utilisation of civic amenities, fewer community conflicts, and an improvement in the commitment of the community as a whole to keep their surroundings clean is evident. This reflects the sustainability of the project not just in financial terms but in the broader terms of community motivation and ability to continue and maintain activities.
Eventually, on site slum improvements cease to be financially dependant on Asha. The communities with their municipal and government partners jointly provide the financial and other resources required to develop and maintain the colony. The slums in which Asha works, as with other metropolitan suburbs (rich and poor) will always require services from municipal and government entities, the provision of water, sewerage, police etc. They have proved that they are able to sustain the community structures and partnerships, set up with Asha support, to ensure slum dwellers have equal access to these services.
The empowerment of women in the community through the establishment and training of women’s groups has reached a sustainable level in slums where Asha has been working for many years. The women trained by Asha go on to train other women to ensure the survival of their activities. These groups now manage their affairs without Asha’s support. The benefits of developing the women’s self-esteem and confidence have not been lost. The same can be said for changes in the attitude and performance of municipal and government entities, which now maintain their new levels of engagement without Asha involvement. Asha has become redundant in some slum colonies, a true sign of sustainability.
After several years healthy living practices become so well established that Asha no longer needs to be involved in encouraging them. Women and children who have been trained by Asha teach others in the community about sanitation, hygiene, basic health care and family planning and welfare, thus negating the need for training to be conducted by Asha. They also lead by example in their own families and lanes, which results in these healthy practices becoming so ingrained in peoples mind that they see them as normal.
In the same way, respect for each other and social inclusion is now seen as normal. Asha staff have shown these people that they are all equal and that only by putting aside their prejudices about caste, gender and ethnic background and working together, can they achieve real lasting improvements in their lives. This message goes down the generations without Asha’s involvement.
1. Partnerships, and an ability to develop and maintain them, are crucial to sustainable and effective slum transformation, as no one partner can make the changes on their own. Partnerships are not easy to establish and maintain, especially those with institutions or individuals who are disinterested, manipulative or exploitative. The most effective approach to partnership development in Asha’s view is based on non-confrontation, patience and good will. All Asha activities are based on partnership, one of the first things we do in a new project is to get all relevant partners on board.
2. Slum transformation needs an empowered and active community to set priorities, implement solutions and access resources. Without community involvement and ownership, permanent change is not possible. It is therefore vital to develop community-based structures and to build the capacity and self-esteem of community members. This is done through on-going and wide-reaching training of community members.
3. The focus should be on women and children in the community. They bear the brunt of poverty and are the most vulnerable. However, once motivated and empowered they become the members of the community who are most active, influential and committed to positive change.
4. Land tenure and on-site improvement for slum inhabitants are essential. Communities can only invest their time, energy and resources into slum transformation if they are certain that their efforts will be of permanent benefit to themselves and their families. Land tenure is key to giving security and stability.
The Government of Delhi is replicating Asha’s slum transformation initiative throughout Delhi in its slum policy it has adopted Asha’s concept of land tenure through community housing co-operative and its associated relationship-based process. Asha has also influenced India’s National Slum Policy.
Until recently, Asha itself took responsibility for replicating its slum transformation model in new slum colonies, resulting in the introduction of the programme into 32 slums over the period 1988 to 2001. This responsibility has now partly been passed to existing Mahila Mandals through outreach programs, which since 2001 have begun to transfer their experience of establishing a community based health and development programme to neighbouring slum colonies selected on the basis of proximity, size, paucity of maternal and child health services etc.
In October 2001, community saving schemes were started in six slum colonies, a transfer of knowledge facilitated by the Seelampur project Mahila Mandal which had set up its own credit scheme following an exposure visit to another NGO in Mumbai in March 2001. More recently additional focus has been put on ending discrimination against girl children, following an exposure visit to another NGO in Jaipur by various staff and volunteers from the women’s and children’s groups.
Knowledge and expertise is transferred to grassroots slum dwellers through a carefully formulated and well-established training programme. Regular exchange visits between women and children of different slums allow for continuous sharing of experiences.
The National Slum Women’s Development Federation of women’s groups provides a forum to exchange experiences and achievements, discuss problems and identify solutions.