SNEHA Situational Analysis Report

Society for Nutrition, Education and Health Action
SITUATION ANALYSIS REPORT

On NMaternal and Neonatal Health in 4 Slum Areas of N-Ward, Mumbai
June 15, 2007
SNEHA Sure Start Project Dr. Armida Fernandez, Project Director A-18 Kanara Business Centre, Laxmi Nagar, Behind Everest Garden, Link Road, Ghatkopar (East), Mumbai 400 075 Phone: 2500 7750 / 51
Table of Contents
1) Executive Summary 2) Introduction 3) Background of Situation Analysis 4) Situation Analysis Design 5) N-Ward Profile 6) Vikhroli Parksite Profile 7) Varsha Nagar Profile 8) Kirol Village Profile 9) Kamraj Nagar Profile 10) Summary 11) Suggestions 12) Conclusion 13) Appendix 1: PRA Techniques Used in Situation Analysis Workshop 14) Appendix 2: Vikhroli Parksite Resource Map 15) Appendix 3: Varsha Nagar Resource Map 16) Appendix 4: Kirol Village Resource Map 17) Appendix 5: Kamraj Nagar Resource Map 18) Appendix 6: N-Ward Map
3 5 5 6 8 11 17 22 28 33 34 35 36 39 40 41 42 43
Sure Start Project Situation Analysis Report
Executive Executive Summary

Society for Nutrition, Education & Health Action (SNEHA), an organization working in the field of woman and child health in the slums of Mumbai for the last 8 years, has taken on a new project in February 2007. This Sure Start Project focuses on maternal and newborn health (MNH) in 4 slum communities in the N-Ward of Mumbai. The work will be at 2 levels: 1) at the community level (demand side) with women and youth to ensure individual, household and community action for maternal and neonatal care through action groups and resources centers and 2) at the facility level (supply side) to develop quality standards and an accreditation of maternal and newborn health services with public and private practitioners. The process of conducting the situation analysis (SA) for the Sure Start Project is discussed in this report. The purpose of doing a SA was to understand the local scenario and situations so that effective program interventions and management could be developed and defined. The background work that lead into the formal SA work included a baseline survey in Ghatkopar done in December 2006 and initial networking and rapport building with the Integrated Child Development Scheme (ICDS), health post staff, and municipal health department personnel in March 2007 to gain a better understanding of the area. This process led to the selection of 4 vulnerable Ghatkopar communities, which were already identified by the Municipal Corporation as vulnerable, in which the Sure Start Project will work: Kamraj Nagar (of Ramabai Colony), Varsha Nagar, Vikhroli Parksite, and Kirol Village. These areas slum communities with a total population of 202,870 slum dwellers. A variety of criteria was used to determine the high vulnerability of these communities, including home deliveries, refusal of immunization, late registration of pregnancy, hazardous occupations, limited water access, and poor drainage. The detailed SA exercise used three methods: 1) workshops, 2) transect walks, and 3) informal group discussions. The Sure Start team along with its 20 community organizers (which were selected prior to the workshop) carried out these processes in April 2007 with the aim to gather information on: community profiles, the MNH situations in the communities, and social & resource mapping and to examine the available public & private sector health service providers. Detailed profiles of the N-Ward, Vikhroli Parksite, Varsha Nagar, Kirol Village, and Kamraj Nagar are included. The history, physical geography, population, infrastructure and housing, health facilities, relevant government programs, existing groups, antenatal practices, delivery practices, postnatal practices, other relevant MNH practices, and community suggestions are described in each profile. Many of the issues exist across all the 4 intervention areas and demonstrate that the areas are highly vulnerable. With dense populations, housing construction, water, toilets, drainage and garbage disposal, and road / pathway access are infrastructure issues common in all areas. Some of the areas are located on a hill and for these communities important facilities and resources like schools, clinics, and ration stores are limited and located at a distance. There are also limited qualified health practitioners available and government health facilities are perceived as providing unsatisfactory treatment. Illiteracy, hazardous occupations, low wages, and addictions currently contribute to low economic status and poor health. In the areas, there is scope for increasing community activities through community level groups like mahila mandals and SHGs. The communitys priorities on issues related to MNH are: poor sanitation infrastructure specifically water, drainage, and toilets; limited access to health facilities; poor treatment at government health facilities; and low incomes. These will all be addressed in some form whether through the consortium, workshops, trainings, or income generating activities in the Sure Start Sure Start Project Situation Analysis Report 3
project. Some local private and public doctors have suggested establishing various facility tie-ups, volunteering, and training other medical practitioners and community members. Other topics that the Sure Start team plans to further explore are: utilization of services from private general practitioners, visits by CHVs, habit of saving, and community health insurance. Specifically in regards to MNH, the following were the dominant practices identified Antenatal care. Registration in 7th month, insufficient rest, diet, and routine supplements Delivery. Some home deliveries by untrained women due to costs in an institution (including family planning policy charge for 3rd or more delivery), lack of transportation, lack of access, distance to institution, and to avoid the poor treatment by government facility staff. Postnatal care. Irregular immunization, Insufficient rest & diet for mother, Non-exclusive breastfeeding often because of cultural practices. Other relevant practices. Unplanned families, Unsatisfactory social support & decision making authority, Limited fathers role, Womens health not a priority, Preference of male children, Young marrying age of women. These are all areas that must be addressed and in which behavior change is required in order to improve MNH. And the Sure Start project plans to use expert resource people to develop programs on various MNH issues for all relevant target groups to achieve this change in behavior.
SITUATION ANALYSIS REPORT

NMaternal and Neonatal Health in 4 Slum Areas of N-Ward, Mumbai Introduction
Society for Nutrition, Education & Health Action (SNEHA) is a voluntary, secular, non-profit organization founded in 1999 by a group of neonatologists and social workers from Mumbai. Urban health, vulnerable populations and women are central to SNEHAs mission and it works towards innovative solutions to problems in nutrition, education and health in urban slums. For the Sure Start Project on maternal and neonatal health (MNH), the program location is in the NWard of Mumbai, which covers parts of Ghatkopar, Vidyavihar and Vikhroli (See Appendix 6). The project, which began in February 2007 and ends in September 2010, has the following objectives: Objective 1. To significantly increase individual, household and community action that directly and indirectly improves maternal and neonatal health (MNH). Objective 2. To enhance systems and institutional capabilities for sustained improvement in maternal and neonatal care & health status. SNEHA plans to work with both the community and health service providers to ensure these objectives. Community mobilization and behavior change will be done through community women and by forming MNH community resource centers run by youth groups. Participatory Rapid Appraisal (PRA) techniques and Appreciative Inquiry (AI) will be employed to achieve these activities. At the facility level, action groups will be formed with public and private health providers to develop quality standards and to develop a strategy for accreditation of services at public and private facilities. This dual level approach aims to address both the demand side (community) and supply side (facilities) of health services. SNEHA will also initiate building a consortium for sustainability and getting expertise for the project by involving key stakeholders from the various relevant sectors. The consortium will monitor the initiative and function as an advisory body as well. A situation analysis was done to be able to appropriately plan the project intervention as it provides a thorough understanding of the community history and needs.
Background of Situation Analysis

To determine which areas were the most vulnerable in the Ghatkopar area of the N-Ward, SNEHA conducted a baseline survey in December 2006 to understand the MNH issues from the staff of the 10 health posts as well as to understand the physical geography & infrastructure, the health services profile & utilization, and the socio-economic status of the area. Detailed observations and other available resources and institutions, like community-based organizations (CBOs), were also noted. Following this initial survey, the Sure Start team began to visit the health posts and corresponding areas to gain a deeper, first-hand understanding of the vulnerability of the communities in March 2007. This included observing immunization camps, speaking with health post staff at all levels, speaking to community youth, visiting the Anganwadi workers (AWWs) and their centers of the national Integrated Child Development Scheme (ICDS), visiting vulnerable areas with AWWs and health post Community Health Volunteers (CHVs), discussing with the area ICDS supervisors, discussing with the Municipal Health Department N-Ward Community Development Officer Sure Start Project Situation Analysis Report 5
(CDO), and speaking with the administrator and trustee of a local charitable hospital. Visits were done within Kamraj Nagar, Vikhroli Parksite, and Kirol Village. In addition, other activities and meetings were conducted for the purpose of networking, rapport building, and gaining the cooperation & understanding of important stakeholders working in the area. With the assistance of the Assistant Health Officer, Eastern Bureau (AHO) and using the results of the above observations and interactions, 4 areas were selected as the sites for intervention: Kamraj Nagar, Vikhroli Parksite, Varsha Nagar, and Kirol Village. These areas are slum communities with a total population of 202,870 slum dwellers. The criteria used to determine the high vulnerability of these communities were: Presence of home deliveries Refusal of immunization Late registration of pregnancy, i.e. in 7th month High number of children in families Poor personal hygiene Hazardous occupations, i.e. rag picking Housing structure, i.e. lack of ventilation, temporary construction (kutcha) materials Community classification, i.e. Muslim, Dalit, migrant Poor environmental hygiene, i.e. garbage disposal location Geographical location of slum, i.e. on hill slope, near dumping ground Limited water access Poor drainage Poor sanitation Poor footpath and road access Once the 4 intervention areas were selected, the process of a detailed situation analysis (SA) for each area began. The purpose of a SA is to understand the local scenario and situations so that effective program interventions and management can be developed and defined. It is, therefore, important to complete the SA at the start of the project, as it will serve as the basis for planning the project implementation. It will be the tool used to focus the project work & strategies, to identify partners, and to determine how progress towards the objectives can be achieved (UHRC manual on situation analysis).
Situation Analysis Design

Aims & Objectives. The situation analysis process aims were to gather information on: community profiles, the MNH situations in the communities, and social & resource mapping. The objectives were: To understand poverty and health vulnerability conditions in N-Ward, Ghatkopar To understand the health seeking behaviors & cultural practices affecting MNH of the urban poor To assess the status of available public & private sector health services This was accomplished through three methods: 1) workshops 2) transect walks and 3) informal group discussions in the month of April 2007. The workshops were planned to collect a information directly from various community stakeholders and the transects walks and informal group discussions were to corroborate the information collected from the workshops, to fill any information gaps, and to gain a geographical understanding of the areas. Team. The Sure Start team that conducted the situation analysis included the project coordinator, 2 project officers, and the communications officer. The project coordinator and one of the project Sure Start Project Situation Analysis Report 6
officers were trained by PATH in situation analysis through a 3-day workshop in Nagpur, Maharashtra. The first step was to recruit 20 community organizers (COs). There were more than 60 applicants and the selection of these women was made based on area, personality, social support, education level, and capabilities to do assigned work. These women were envisioned to participate in the activities for the situation analysis. They would help the team gain entry and acceptance into the 4 intervention areas communities. Methods & Processes. The SA workshops were held over the span of 3 days. The overall objective of the workshops was to make a slum assessment through groups that directly know the intervention areas. The specific objectives were 1) To understand the health facilities and providers in the community through visual depiction of the area. 2) To understand specific issues related to maternal and neonatal health at the individual and family level. 3) To understand the livelihood and other social aspects of the community. The workshops were held area-wise and utilized a group work format to gain a better understanding directly from community stakeholders about their communitys profile, geography, resources, and MNH practices. Participants were divided into 6 groups to discuss different topics using PRA techniques (see Appendix 1). Each group gave a presentation followed by a discussion. The 158 participants were the project COs, AWWs, Mahila Mandal / self-help groups (SHGs) members, representatives of non-governmental organizations (NGOs) / CBOs, and health post staff including auxiliary nurse midwives (ANMs), primary healthcare nurses (PHNs), full-time medical officers (FTMOs), multi-purpose workers (MPWs), and CHVs. As a continuation of the situation analysis process, transect walks and informal group discussions were conducted in the 4 communities to address the gaps and unclear information identified during the workshops. This was consciously organized after the workshops as rapport with community members and service providers would be stronger and so acceptance would be greater. Using the maps generated during the workshops, a basic path was charted out and the COs from each intervention area were there to facilitate and guide the process. Over the course of 5 days the Sure Start team visited the 4 intervention areas. Physically visiting the area, meeting the health posts staff, listing private health service providers in each area, interacting with various community members during the walk, noting observations of the community, and holding informal group discussions with community women provided the team with detailed information for the situation analysis. In total, 8 informal group discussions were held across the 4 communities with approximately 80 women participating in all. To gain further insight into the services available, data was collected from the 4 health posts on the services they offer in May 2007. This gathering of information was done after the AHO granted permission and was done over the course of a few days using a tool already developed by SNEHAs City Initiative for Newborn Health project. Problems & Successes. The workshops were unique in that they brought together personnel from various health arenas working in the same communities. And they were organized in a manner in Sure Start Project Situation Analysis Report 7
which the higher-level authorities not only gave permission for their staff to participate, but came to the workshops to show their encouragement and support for the SNEHA Sure Start Project. However, one problem that persisted throughout all the workshops was that groups presented an ideal situation to the topics they were asked to discuss and it was unclear whether these were the actual practices of the community. The groups needed more help to focus on the existing situation. The informal group discussions helped to identify potential key people in the communities as well as validated some of the information collected during the workshops. The transect walks helped the Sure Start team to better understand the physical structure of the community. However, the COs may have provided the team with a limited perspective of the communities during the transect walks as visits were conducted primarily in areas the COs were comfortable in. The information collated from the workshops, transect walks, and informal group discussions may not be completely exhaustive, but is as extensive as the circumstances allowed. Timetable. Below is the timetable of the situation analysis activities Date Activity December 2006 Baseline survey of Ghatkopar, N-Ward March 2007 Detailed vulnerability assessment, selection of 4 intervention areas April 5, 6, 9, 2007 Selection of community organizers April 11, 12, 13, 2007 Situation Analysis workshops April 24, 25, 26, 27, 30, 2007 Transect walks & informal group discussions in intervention areas May 2007 Collection of data from health posts The following profiles are a compilation of all the data and information collected during these SA activities.
N-Ward Profile
Before specific community profiling could begin, SNEHA collected information to paint a broad picture of the N-Ward in which to locate the 4 intervention areas. Population. The N-ward has a population of 700,149 of which 486,187 (or 69.4%) are slum dwellers. The most recent estimate (MCGM, 2005) of the N-Ward showed that the infant mortality rate (IMR) was 33 per thousand live births and the maternal mortality rate (MMR) was 63 per thousand live births. The population is predominantly Maharashtrian, but a proportion of the population has migrated from Uttar Pradesh, Bihar, Gujarat, and Tamil Nadu. Hence the languages spoken are Hindi, Marathi, Gujarati, and Tamil. The religions followed are Hinduism, Islam, and Buddhism. People are daily laborers and fall into the economic levels of lower middle class or below the poverty line. Table 1. N-Ward Population by Health Posts Name of the Health Post No. East Side 1 Ramabai Colony (includes Kamraj Nagar) 2 Rajawadi School 3 Pant Nagar 4 Laxmi Nagar (Ganesh Nagar) Total West Side Sure Start Project Situation Analysis Report 8
Slums 110,000 12,000 34,000 30,000 186,000
Non-Slum
Total 110,000 80,000 82,000 48,000 320,000
68,000 48,000 18,000 134,000
1 2 3 4 5 6
Kirol Village Sarvodaya Nagar Barve Nagar Sainath Nagar Parksite Varsha Nagar Total
51,101 49,100 60,000 40,786 46,700 52,500 300,187
18,870 12,100 5,000 25,042 15,450 3,500 79,962 213,962
69,971 61,200 65,000 65,828 62,150 56,000 380,149 700,149
Grand Total 486,187 Source: Municipal Corporation of Greater Mumbai (MCGM)
Health Facilities. There are a total of 10 health posts in the N-Ward with a staff strength of 170 CHVs, 39 ANMs, 19 MPWs, 10 PHNs, and 9 FTMOs. Health posts are accessed for tetanus (TT) vaccinations and post-natal care (PNC). For antenatal care (ANC), women are referred to maternity homes. Some of the health posts have also been without stock of folic acid and iron tablets for many months. During the situation analysis workshops, the staff at the health posts found out about their transfers. These transfers took place across the N-Ward and affected everyone except the CHVs. The other municipal health facilities in the ward are 6 dispensaries, 1 post partum centre, and 1 maternity home. An additional 5 public hospitals and one charitable hospital (Sarvodaya Hospital) are accessed by people from the area. There are approximately 70 gynecologists and pediatricians practicing in the N-Ward as well as 15 maternity homes. Private Practitioners. Dr. Bakul Parekh, of Dr. Bakul Parekh Childrens Hospital, is a private doctor in the N-Ward and member of the Indian Medical Association (IMA). He is a highly influential practitioner in the area with much clout. He is willing to help mobilize other private practitioners to develop standardized protocols for MNH quality care in the intervention areas and seems interested in pursuing this agenda. Dr. Kini, a well-known private doctor in Vikhroli Parksite, has been very cooperative and willing to help SNEHA with its project in the N-Ward as well. He has agreed to help mobilize other private practitioners (around 80%) for any meetings the Sure Start team plans to hold. The qualifications of private practitioners is one point that will be addressed, as it is not always easy to find properly qualified doctors from whom to access care. SNEHA has been working with the Municipal Corporation of Greater Mumbai (MCGM) and the professional fraternities of doctors for many years, so its reputation and relationship with these bodies will facilitate in mobilizing private doctors from the intervention areas for the purpose of developing quality care standards. Existing Groups. In the N-Ward, there are numerous CBOs including 75 self-help groups (SHGs), 23 mahila mandals, 18 neighborhood committees, and youth groups and nongovernmental organizations (NGOs), such as Indicus, Udaan, Alert India, YUVA, schools, and other trusts. There are also medical associations in the area with many members, like: Indigos Group consisting of 80 practitioners IMA consisting of 700 practitioners Medicos Group consisting of 300 practitioners Other groups, like Asalpha Medicos & Vikhroli Medicos The team plans to collaborate with these organizations and groups to have a greater impact and reach into communities as well as to be representatives on the consortium. Government Relations & Programs. Relationships with various government personnel will be important throughout the duration of the project. The two main bodies the team sees as key Sure Start Project Situation Analysis Report 9
stakeholders for the effectiveness of its work in the N-Ward are the ICDS and the municipal health department. The CDO, Medical Officer of Health (MOH), and AHO of the health department have been very cooperative and supportive of SNEHA as have the 2 supervisors, Community Development Project Officer (CDPO), and deputy commissioner of the ICDS. Another national program for which linkages with the CDO have been developed is the Swarna Jayanti Shahri Rozgar Yojana (SJSRY). Other government programs that are relevant to SNEHAs work in the NWard are the state Slum Rehabilitation Scheme (SRS) and the national Public Distribution Service (PDS or rationing). An understanding of budget allocation and budget utilization of all these programs may prove to be critical at a later stage in the project. Infrastructure & Geography. Major thoroughfares in the area are 7th Road, Andheri-Vikroli Link Road, Golibar Road, M.G. Road, LBS Marg, as well as the Eastern Express Highway. The nearest local railway stations are on the central line at Vidyavihar, Ghatkopar, and Vikroli. Kurla Terminus is also close to some parts of the area. The area is well connected by bus, like the Ghatkopar Depot & Ghatkopar Station, and autorickshaws are readily available in non-hilly areas. The N-Ward has some hilly parts and the communities that have expanded up the hills are highly vulnerable as there are limited resources (transportation, food, water, etc.), hence the vulnerability stands out throughout this report. Electricity is not a problem in the N-Ward as all have access whether through private (Reliance) or public (municipal). Water is a major difficulty for some, however, as it is not available in communities located on the hillsides and so individuals must come to the bottom of the hill to collect water. Other slum communities in the N-Ward also have poor access to water and must bring water for their households from nearby areas. Open gutters are the main drainage structure and there are 2 large, very unhygienic open drains (nallas) in the area. Garbage disposal is in dustbins (if available), into the open gutters, or at a designated spot where the municipal vehicle comes for removal. Although public and private toilets are available, they are insufficient for the population, unclean, and without water. Housing. Non-slum areas are quite well to do and consist of building structures. The slum areas, particularly ones located on the hillside, are semi-pucca (cement, tin, and tarpaulin) and poorly constructed. Otherwise houses are made of cement (pucca structures) with a 2-level structure. Between semi-pucca houses the lane spacing was 1-2 feet, while between pucca houses the spacing between lanes was 3-4 feet. From the baseline survey done in December 2006 it was determined that 75% of homes are owned and 25% rented.
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Vikhroli Parksite Profile
COMMUNITY PROFILE History. Initially, the area was known as red signal (lal batti), as it had a light on the hilltop that guided airplanes. The place was covered with lush greenery and few houses, hence it came to be called parksite. The various nagars or clusters in the community have their own minor histories as well. The community is able to come together during times of crisis as demonstrated during the July 26, 2005 floods. Debris (stones, mud, etc.) and houses had slid down the hill causing much property damage and many deaths. The open gutters claimed lives of some children. Youth and community members cooperated and supported each other by assisting people to access government funds. Physical Geography. The community is located on a hill slope. The areas near the bottom of the hill are: Municipal Colony, Shimla Nagar, Anand Gad, Lower & Upper Depot Pada, Ambika Nagar (Chinappa Chawl), Sagar Park, Municipal Building, Khin House, Yeshwant Nagar, Amrut Nagar, Fire Brigade area (or Bumpkhana), and Noor Mahmood Compound. Those on the hillside or with poor access to health facilities are: Khandoba Tekhdi, Siddeshwar Nagar, Sanjay Gandhi Nagar, Tekhdi area, Ram Nagar A, Ram Nagar B Dag Line, Rahul Nagar, and Hanuman Nagar A & B. Population. The slum population of Vikhroli Parksite is 56,000 and the total population is 64,960. On the topside of the hill many blue and saffron flags symbolize the Buddhist & Hindu communities respectively. In Rahul Nagar, at the extreme top of the hill, the settled community is Maharashtrian Buddhists and Uttar Pradeshi (UP) /Bihari migrants. At the bottom of the hill, in Lower & Upper Depot Pada, Muslims comprise more of the population. People come together to celebrate festivals, like Ambedkar Jayanti. The languages spoken in the area are Marathi & Hindi. Families are nuclear and joint in strucuture. Alcoholism is a problem in this community. The families residing at the bottom of the hill are economically better off families and the area is well-developed. All children go to school. Both men and women work in Vikhroli Parksite. Men mainly work in the private sector, like small-scale industries, companies, and factories. Near the Lower Depot area men work in garages and many men are also rickshaw drivers. Women are required to do all housework as well as often work outside due to their economic situation. They are involved in domestic work, small-scale industries (like the garment industry), rag picking (dry garbage scrap collection), and home-based income generating activities like year round rakhi-making, papad / picklemaking, and chair-making (Rs. 9/chair). Home-based work is also a result of a cultural practice of Bihari and Uttar Pradeshi men not allowing their female relatives to work outside the house. The Hiranandani Complex employs many people from the community as Sure Start Project Situation Analysis Report 11
domestic workers. Children also work in hotels, tea stalls, garment factories, and engaged in rag picking. The approximate income is Rs. 50 per day and Rs. 1,500 per month. The distribution of income sources by occupation is given in Chart 1.
Chart 1
Small Scale Industry, Factories, Companies 40% Ragpickers 10%
Daily wage laborers 20% Domestic workers 30%
Infrastructure & Housing. The classification of land ownership in Vikhroli Parksite is: collectors land, Maharashtra Housing Development Authority (MHDA), Municipal Corporation of Greater Mumbai (MCGM), and private. The community is 30-35 years old and has seen many changes over the years. Houses are now permanent structures and water taps & government toilets have been installed. These changes have impacted the hygiene, economic, and social conditions in the area. Houses have been built on the hillside by cutting into the hill. Any available space was occupied and homes built according to the economic capacity of the family. The area is densely populated and homes have minimal ventilation. The chawl structure is dominant. Most homes are pucca (permanent material) or semi-pucca in construction, but some weak, kutcha (temporary material) houses are visible in highly vulnerable areas, namely on the hilltop and the margins of the area. Homes from the hillside have tin / metal roofs and uneven or no proper floors. On the lower side of the hill, homes have mud roofs and level, tiled floors. Anand Gad and Upper Depot homes are larger than those found on the hillside. All homes had low walls. The houses are built so compactly that some have been constructed directly over gutters. Almost all the areas are unauthorized, only some are authorized like the slums at the bottom of the hill. The Upper Depot Pada consists of 4 transit camps. Earlier, water used to be available at night. This negatively impacted the community as boys would tease & abuse girls who went to collect water and robbery / theft cases increased. The water supply timings are still variable and at the hilltop water is scarce, coming for only 10-15 minutes in 15 days. This forces community women to carry water on a daily basis from the bottom of the hill to their homes on the hillside. This task creates both mental and physical strain on them. Some households on the hilltop have private water taps, but that connection only provides water once a week. Water taps (often in row) are the main type of connection. Though many connections have been fitted, only one water tap in working condition for 10 households is available. The lower parts of the hill have water access for 4-5 hours every day through their own private water taps. The
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water is supplied by the municipality and is used for all purposes, namely drinking, cooking, cleaning, etc. The drainage system is open gutters (drains). These are highly unhygienic with pigs roaming around in them and garbage clogging them. The lack of water also prevents gutters from getting cleared and the area from staying clean, particularly on the upper side of the hill. The municipality contracts workers to clean gutters, but they are not given any protective wear (gloves, shoes, etc.) and the removed garbage is piled on the footpaths near the houses. There is also no proper road access to homes on the hillside. There used to be a very small kutcha road for people to go uphill, but now there are staircases. However, the staircases are poorly made and paths / small alleys over open gutters and through pools of water are common. During the monsoon season, these access routes become even more dangerous and hazardous. Community members living at the top of hill are able to climb down to the bottom in about 15 minutes without any proper stairs or railings typically 4 times a day for water, food, and to go to their childrens schools. At the lower side of the hill, pucca roads and paths have been built, however, open gutters are still present. Owing to the forested area, people were at a high risk of being attacked by wild animals, especially as there was no access to toilets. The risk of this happening now has been reduced with the availability of toilets. On the hillside, one toilet is available for 1 to 3 societies. Though toilets are available, they are unclean, often without water, and insufficient for the population. Some people contribute Rs. 10 to have a cleaner for their toilets. Children defecate outdoors. Electricity is available to everyone from Reliance. Families living in the lower parts of the hills have individual electricity connections. There are 10 private and 4 municipal schools in the area along with 18 Anganwadi centers. Children living on the hillside walk 15-20 minutes to their schools at the bottom of the hill. The Indira Gandhi College of Arts & Commerce / Sandesh Vidyalaya and Junior College of Arts & Commerce and various other resources such as tuitions/special classes, stores selling all types of goods, private clinics, and Anganwadis are all located at the bottom of the hill. On the hill slope, the only available resources are small petty stores and public phones (See Appendix 2). Relevant Government Programs. The health post and ICDS Anganwadi workers have helped to generate awareness in the community on health care and nutritious food. The AWWs have also worked on developmental issues of adolescent girls in the area. Community members do use the ration store (PDS) to buy their provisions. The Slum Rehabilitation Scheme (SRS) exists in Vikhroli Parksite and some slums have been reconstructed through it. Existing Groups. Many housing societies exist in the area and are typically a group of 20-25 households that have registered as a society in order to protect their interests should the need arise. CBOs include 5 women & youth groups (mandals) and 1 credit society. There is also an SHG for CHVs of the area. However, typically, there are not many SHG or saving groups for women and Sure Start Project Situation Analysis Report 13
none present on the upper side of the hill. The NGOs working in the community are: Gurukul School (Dr. Kinis child-friendly play school), Quran Trust, Kishor Shati Yojana, and Vidyadeep Education Sanstha. The 16 religious institutions are: 10 Hindu temples (mandir), 4 mosques (masjid), 1 church, and 1 Jain temple. Health Facilities. The health post is located at the bottom of the hill and has the following staff strength: 1 PHN, 2 MPWs, 20 CHVs, 4 ANMS, and 1 attendant. The FTMO post is currently vacant. The health post has no stock of iron / folic acid tablets & condoms and community members do not regularly take advantage of the facility. Regular immunization camps are conducted, such as the pulse polio campaigns. Visits by CHVs, ANM, and AWWs were found to be irregular in the area. Relationships between CHVs and AWWs are tense as CHVs have a much lower salary and do not receive government benefits. Apart from the health post, community members also utilize 2 municipal hospitals (Rajawadi & Muktabai). People living on the upper parts of the hill access more of the public facilities and immunization camps. The other health facilities in Vikhroli Parksite are private clinics and maternity homes. One of the preferred maternity homes is Pushpak Nursing Home, but there are 4 others that the community also utilizes. There are approximately 42 private clinics in the area that have doctors of varying qualifications, which are all located at the bottom of the hill. As a result, those living close by have access to health facilities. Women and children prefer private practitioners when they are ill. Unfortunately, women do not give priority to their health and so only seek medical help when serious complications arise. This preference for private facilities is mainly due to the negative attitude of staff at government facilities. However, women cannot afford the expenses for treatment at private facilities.
MATERNAL & NEONATAL HEALTH SITUATION Antenatal Practices. Women realize they are pregnant when they miss a menstrual cycle, feel nauseous, and are not hungry. Women often wait for another month to be certain. The first person they tell is their mother-in-law (or another elderly female relative) or husband. Sometimes a neighbor is told. Women typically do not rest during their pregnancies, as their families are dependent upon them to look after the household and any young children. They often work through to their 9th month of pregnancy. The diet of a pregnant woman consists of whatever is available in the house. Economics plays a part in preventing proper nutrition. Pregnant women are not pampered or cared for differently during their pregnancies by anyone, including their mother-in-law or husband. Most women register with the hospital during their 7th month of pregnancy (or if there are complications) due to the distance and, therefore, do not have routine check-ups or follow any treatments as they feel nothing will go wrong. CHVs and AWWs advise pregnant women as well as provide iron and folic acid supplement tablets to them, but women are unaware of its importance. For the past 1-2 years there has been no available stock of the supplement tablets and TT injections. Delivery Practices. The majority of deliveries are institutional, particularly those from the bottom of the hill. Home deliveries occur in emergency circumstances on the hillside due to lack of access to the hospital especially at night, lack of transportation, or the cost of delivery in an institution. It is not clear whether traditional birth attendants (dais) are trained or not for conducting home deliveries or how many are available in the community. Though cleanliness is of paramount importance during a home delivery, environmental hygiene and personal hygiene are poor, Sure Start Project Situation Analysis Report 14
particularly on the hillside. The lack of water on the hillside may also contribute to this. In case of complications during a home delivery, the mother and baby are taken as soon as possible to a hospital or maternity home. Otherwise, they are brought the next day. Postnatal Practices. In institutional deliveries, doctors and nurses advise to breastfeed the baby, including the colostrums. Breastfeeding of the newborn is done within one hour of delivery and in the case of caesarian sections immediately after the mother becomes conscious. For a normal delivery, the mother and child are kept for 3 days whereas in other situations the length of stay is 5 days. Institutional deliveries are a positive change that has taken place in the community. After delivery, the woman is expected to work shortly after coming home and has no special diet; in fact she is regularly beaten if her husband is an alcoholic. The BCG immunization is given immediately to babies born in institutions, but sometimes after a month to a baby from a home delivery situation. Those living at the lower parts of the hill have fully immunized children. Case of Shantibai Shantibais house on the hilltop was small, dark, and dirty and her 3 unclean children were sitting inside eating. Her husband is a daily wage earner. They live & adjust based on their economic situation, which sometimes means sleeping on an empty stomach. She gave birth to all her children in her village. As she lives in a nuclear family structure, she had no one to talk to and no one to guide her or explain things to her. And Shantibai is not part of any community group. She knows all her children have been immunized, but she did not know for which ones, except polio. Other Relevant Practices. The role of the father is non-existent during the pregnancy, delivery, and newborn caretaking stages. The decision makers are generally the elderly members in families and womens health is often less of a priority. But some mothers, especially from the bottom of the hill, do make decisions regarding health care. Elderly women and neighbors give social support to the mother; the CHVs play no significant role. On an average, women are married at the age of 18 or even less. Some very young women have 3-4 closely spaced children. Preference is given to male children. This is primarily a result of the cultural norm that a male child will be the one to look after the parents and will perform the final rites for the parents. Suggestions. The community has given the following suggestions for the improvement of their areas: Water should come regularly at designated times A big wall should be built for security around the area Each society should have a separate toilet facility Cleaning of toilet facilities should be maintained Open gutters should be closed Dustbins should be made available in each area Rag should be collected and cleaned everyday Street lights should be everywhere Education should be made free to children from poor families A proper road should be constructed so that the hilltop can be accessible to emergency vehicles, i.e. fire brigade, ambulance, etc.
15
Any form of assistance (including monetary) to help ill people come down the hills as the areas are inaccessible by taxis or autorickshaws The dispensary should be restarted & the dispensary services should be improved in the area Quality childcare / daycare / babysitting should be available for working parents Household businesses should increase One hospital & maternity home are required in the area
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Varsha Nagar Profile
COMMUNITY PROFILE History. Varsha Nagar being adjacent to Vikhroli Parksite, it was also called red signal (lal batti), as there was a red light on the hilltop that guided airplanes. Between 1980-90, the area was forest land which made it easy for criminals to hide. As a result, the community had a high crime rate. Gangs and exiled criminals (tadipars) living in Varsha Nagar caused further insecurity in the area. In 1992-93, conditions started changing. The area was registered with the municipality, municipal corporators were democratically elected to fulfill the basic needs of the people, and the forest was cut down for residential purposes which in turn decreased the criminal population in the area. This changed peoples attitudes. One incident that left a significant mark on the community was the rape of a young girl which resulted in awareness among womens groups (mahila mandals). This incident has shown that the community will come together and file complaints should it happen again. Physical Geography. The community is located on a hill slope and it adjacent to the Vikhroli Parksite area. One part of the area is a cremation ground, from Ambedkar Society to Varsha Nagar. The clusters in Varsha Nagar include: Swami Narayan Nagar, Siddharth Nagar, Sanjay Gandhi Nagar, Ambedkar Nagar, Nagababa Nagar as well as others. Varsha Nagar & Vikhroli Parksite, by nature of proximity, are similar in characteristics and problems. Population. The approximate population is 50,000 slum dwellers. In Ambedkar Nagar and Siddharth Nagar, the majority of the population are Maharashtrian Buddhists and UP / Bihari migrants. These pockets of people have settled together at the hilltop. Communities come together to celebrate festivals, like Dr. Babasaheb Ambedkar Jayanti, Ganesh Jayanti, and others. The languages spoken in the area include Marathi & Hindi. Families consist of both nuclear and joint structure. Most children go to school, but adults are semiliterate. Alcoholism among men has resulted in worsening families tendency not to save. Both men and women work in Varsha Nagar. Men typically drive rickshaws, are daily workers, and are privately employed. Women are required to do all housework as well as work outside due to their economic situations. They are involved in domestic work (like at Hiranandani Complex), sewing clothes, small-scale industry / factory / company, and home-based income generating activities like rahki-making, and hairpin making. Children also work because of the low income of families. They work in collecting and selling rag, distributing / selling newspapers, small shops (like tea, pani puri, vada pav) and small-scale factories. They also look after their younger siblings at both parents often work. The approximate income is Rs. 60 per day for women and Rs. 100 per Sure Start Project Situation Analysis Report 17
day for men. The monthly income is between Rs. 2,000 Rs. 2,500. The distribution of income sources by occupation is given in Chart 2.
Chart 2
30 25 20 15 10 5 0
Smallscale
Percent
Permanent
Domestic
Ragpicking
Factories
workers
Garment
Vendors
industry
Infrastructure & Housing. The community is 30-35 years old and has seen changes over the years. Previously, there was a lack of water, transportation, toilets, nearby schools, and electricity. However, now public & private schools, Anganwadi centers, and a health post have opened. These changes have impacted the economic and social conditions in the area and have resulted in some rising out of the below poverty line (BPL) category. Swami Narayan Nagar, a newly developed area, still lacks basic facilities like water and toilets, due to which women and children have health problems like skin diseases, diarrhea, dehydration, and fevers. Since the beginning, water has been a problem. A water tank built at the Ambedkar School in Ambedkar Nagar and significantly improved the water problem, but its supply was limited and not sufficient for the area. On the hillside there is one tap for 10 families and the water supply timings are variable and very irregular. The little time water comes, about 10-15 minutes in a week, requires that women carry water from the bottom of the hill up to their homes everyday. The lower parts of the hill have water access for 4-5 hours through their own private taps. The water is supplied by the municipality and is used for all purposes, namely drinking, cooking, cleaning, etc. Any available space was occupied and settled, including the hillside. The area is densely populated and homes have minimal ventilation. Homes were not built with the assistance of any government or external source. There are both unauthorized & authorized slums and houses are of kutcha, semi-pucca, and pucca construction. The kutcha houses are structurally weak. House have low walls made of mud and brick and roofs made with mud and metal / tin. Tin roofs make homes very hot during the summers. Homes from the hillside have uneven floors, while on the lower side of the hill homes are made with level, tiled floors. The land in Varsha Nagar is municipal land. An open drainage system is exists throughout Varsha Nagar. The gutters are kutcha in construction, mostly broken, and often times clogged; hence, they are highly unhygienic. On the hillside, there are no drains or very small, clogged drains present. At the bottom of the hill, municipally contracted workers (daily wage laborers) clean gutters and the removed garbage is piled on the footpaths near the houses.
jobs
work
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Kutcha roads are dominant in the area, though at the lower side of the hill, pucca roads and paths have been built. Community members living at the top of hill are able to get down with ease several times a day without any proper stairs or railings. Poorly made paths / small alleys over open gutters is common. During the monsoon season, these routes become even more dangerous and hazardous, making access to any facilities difficult. The monsoon season also causes communication connection cuts. Approximately one toilet facility is available for 200 families. They are unclean and often without water. One pay and use facility (2-level building) is available at a cost of Rs. 2. Children as well as adults who cannot afford to avail the facility or do not have access to any facilities defecate outdoors. Electricity is available all over Varsha Nagar from Reliance through individual electricity connections. There are 6 public and private schools in the area along with 5 childcare centers (balwadis). The majority of children attend government schools. Children living on the hillside walk 15-20 minutes to their schools. Other resources found in the area are tuitions / special classes, stores selling all types of goods, small cooperative societies, and private dispensaries. However, all of these resources, including Anganwadi centers, are located at the bottom of the hill. On the hill slope, the only available resources are small petty stores that stock candy, cold drinks, and other snack foods and public phones (See Appendix 3). Relevant Government Programs. The Slum Rehabilitation Scheme (SRS) exists in Varsha Nagar and some slums, like Siddharth Nagar, have been reconstructed through it. The use of the ration store by the community is still to be determined. Existing Groups. The CBOs in Varsha Nagar include: many registered housing societies, mahila mandals, youth group, 3 SHGs, savings groups, and 1 neighborhood committee (of 250 members). Mahila mandals deal and work for womens rights to ensure security for women. However, there are no groups present on the upper side of the hill. The 8 religious institutions are 5 Hindu temples (mandir) and 3 Buddhist temples (vihar). Health Facilities. The health post is located at the bottom of the hill and has among the staff 1 ANM, 1 MPWs, 15 CHVs, 1 clerk, and 1 attendant. The PHN and FTMO positions are currently vacant. It is about 10-15 minutes from the community and transportation is a problem for the community. Those residing on the lower side of the hill have access to the health post, but for people living on the hillside, they primarily access the health post during immunization camps (like pulse polio campaigns) or when their children fall ill. Visits by CHVs are irregular. Apart from the health post, community members also access Rajawadi and Muktabai municipal hospitals. The other health facilities are private clinics and maternity homes, which are all located at the bottom of the hill. Many of the service providers overlap with the Vikhroli Parksite health facilities. There are approximately 16 private clinics in Varsha Nagar that have doctors of varying qualifications. Some women who can afford the costs prefer Pushpak private nursing home. When women and children are ill, treatment is sought at private practitioners who are located at the bottom of the hill. This preference for private facilities is due mainly to the negative attitude of staff at government facilities. However, since the cost of treatment with private practitioners or charitable hospital Sarvodaya is only affordable to some, women must seek treatment at Sure Start Project Situation Analysis Report 19
government hospitals, maternity homes, or the health post. Services are availed of at the health post for minor illnesses, but it is often out of stock. Women do not give a priority to their health and so only seek medical help when serious complications arise.
MATERNAL & NEONATAL HEALTH SITUATION Antenatal Practices. Women realize they are pregnant when they miss a menstrual cycle and have morning sickness (feel nauseous, vomiting). The first people they tell are their husbands or another close relative. Women typically do not rest during their pregnancies, as their families are dependent upon them to look after the household and any young children. They often work to their 9th month of pregnancy. The diet of a pregnant woman consists of whatever her husband brings home or whatever is in the house. Economics plays a part in preventing proper nutrition. Pregnant women are not pampered or cared for differently during their pregnancies by anyone, including their mother-in-laws or husbands. Women register with the hospital during their 7th month of pregnancy and, therefore, do not have routine check-ups or follow any treatments. They only visit a doctor if there are complications. When CHVs visit the community, they give advice to pregnant women but the health post does not have the stock to provide iron and folic acid tablets to them. Delivery Practices. The majority of deliveries happen in institutions (Rajawadi or Muktabai), but home deliveries do happen at the top of hill due to poor economics, lack of transportation down the hill, or distance to hospital. In the case of a home delivery, a dai or experienced neighbor is called to conduct the delivery. It is not clear whether the dais are trained or not for conducting home deliveries or how many are available in the community. Though cleanliness is of paramount importance during a home delivery, good environmental and personal hygiene are lacking. In case of complications during a home delivery, the hospital is informed immediately and the woman is referred to a hospital. Postnatal Practices. At institutions, breastfeeding of the newborn is done within an hour of delivery or immediately after the mother becomes conscious in case of a cesarean section. Doctors and nurses advise to feed the baby, including the colostrums, and the majority of the community now follows the directions prescribed by doctors showing a change in practices. Some follow the practice of giving the baby water and honey for the first 3 days. After 6 months, babies are given food other than breast milk. For a normal delivery, the mother and child are kept for 3 days whereas for cesarean sections the length of stay is 7 days. The BCG immunization is given within 3 days to babies born in institutions. After delivery, the woman is expected to work shortly after coming home and she has no special diet she may not even have 2 meals a day. Other Relevant Practices. The role of the father is non-existent during the pregnancy, delivery, and newborn caretaking stages. Men do not even know how many months pregnant their wives are. Social support is poor in Varsha Nagar; their husbands and family members sometimes beat up women. Elderly women and neighbors give some social support to the mother. The decision makers related to care issues are generally the elderly members in families and mothers health is often less of a priority. But some mothers, especially from the bottom of the hill, do make decisions regarding health care.
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It is observed that women are married before the age of 18. Families often consist of more than 3-4 closely spaced children. Preference is given to male children. Suggestions. The community has given the following suggestions for the improvement of their areas: Water facilities should be made available to the public Number of toilets should increase Open gutters should be closed The location of a dustbin in front of the Ambedkar School should be changed to another place A maternity home should be available nearby Vehicle and money is needed by some families to reach the hospital Improvement of access from the hills to help ill people go down easily, as autorickshaws and taxis cannot go to the hillside
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Kirol Village Profile
COMMUNITY PROFILE History. In 1996, during the monsoon season, there was a landslide in Ekta Nagar (picture above) one cluster of Kirol Village. Residents did not heed the municipality warning of a landslide and one evening stones fell killing 70 families. After this incident, the community came together to help those in need. The municipal health department, fire brigade, police department, local politicians, and national politicians like Sonia Gandhi, Sushil Kumar Shinde, and Prakash Mehta all provided assistance. Sonia Gandhi also helped reconstruct houses in the area and now the new settlement has been named in her honor. This event has left a major imprint on the people of Kirol Village. The other clusters (nagars) in the community have their own minor individual histories as well. Physical Geography. One part of the community is located on the Asalpha hill, specifically Kaju Tekhdi and Hanuman Tekhdi, while the rest is on level ground. The other clusters in the area include: Ekta Nagar, Parsi Wadi, Azad Nagar, Akbar Lala Compound, Ambedkar Nagar, Soniya Gandhi Nagar, Achanak Nagar, and Chirag Nagar. A large open drain (nalla) runs though Kirol Village. Kondaji Baba Dhere Marg is a road dividing the community. Population. With a total population of 73,596 (58,096 slum), Kirol is predominantly Maharashtrian Buddhists, with significant migrant communities from UP, Bihar, and Gujarat. Hinduism is prevalent, but in Azad Nagar, Akbar Lala Compound, and Sonia Gandhi Nagar, Muslims comprise most of the population. Many areas are mixed settlements, though Muslim clusters are separate. The languages spoken in the area are Marathi, Hindi, and Gujarati. 80-90% of people are alcoholics, which has caused the destruction of many lives and families. Addiction & crime among adolescent youth is a problem as well. Communication between parents and children has decreased / become limited and relations with neighbors have also decreased. Both nuclear and joint families are present in Kirol Village. All children do not go to school, often as a result of poverty and parental illiteracy. Some adults have been educated up to 3rd or 4th Standard (maximum), but most are illiterate. Mostly men work in Kirol Village in smallscale industries, like broom-making, carpentry, garment-making, and garage work. Some have permanent jobs. Some are involved in hazardous work like rag picking and daily wage laboring. Only in some circumstances like single mothers or poverty do women work, as otherwise they Sure Start Project Situation Analysis Report 22
are needed to care for the high number of children. Women are involved in home-based activities, such as sewing, rakhi-making, embroidery, papad / pickle-making, domestic work, carpet cleaning, toy making, tiffins, mats (chattis), after delivery work like massaging newborns and mothers, and so on. Women also help their husbands with work. Children work in carpentry, garages, small hotels, tea stalls, loaders (hamali), domestic work (girls), and in rag picking. The maximum daily income earned is Rs. 200 and the maximum monthly Rs. 3,500. The distribution of income sources by occupation is given in Chart 3.
Chart 3
Permanent Job After Deliv ery Work Other Home-based w ork (papad / pickle-making) Sew ing Clothes, Embroidery , Bindi-making Tea Stall, Vada Pav , Small Hotels Vendors, Street Stalls Broom-making, Carpentry Rag Picking, Garages, Banana Godow ns
10
15 20 Percent
25
30
35
Infrastructure & Housing. The community is around 40 years old and has witnessed some important changes through the years. Earlier from open drains, lack of water, lack of transportation, and lack of health facilities to presently more closed drains, common toilets, increased water supply & transportation, availability of the health post and an emphasis on education, these changes have impacted the health, hygiene, economic, and social conditions in the area. The area is densely populated and the homes small. Houses are both pucca (permanent materials) and semi-pucca in construction. The homes in Azad Nagar, Akbar Lala Compound, and Sonia Gandhi Nagar are semi-pucca with no ventilation. The slums near the Asalpha hill Akbar Lala Compound are in a poor condition: homes are kutcha (temporary materials) in construction and the dirt & garbage from the hilltop drops straight down into their community. Kutcha homes have tin / metal roofs and uneven / no proper floors. Pucca / semi-pucca homes are made with mud roofs and level, tiled floors. All homes had low walls and are built compactly. There are both authorized and unauthorized slums in the area. The classification of land ownership in Kirol Village is collector, municipal, and private. Achanak Nagar and Soniya Nagar are new settlements, while Chirag Nagar, Azad Nagar, Ambedkar Nagar, and Ekta Nagar are old communities. Water is supplied by the municipality and is used for all purposes, namely drinking, cooking, cleaning, etc. It is available twice a day for 4-5 hours total, but in Akbar Lala Compound and Sonia Gandhi Nagar, the water supply is irregular or not available. The main connections are through public taps and hang pumps, however, only one working water tap is available for 20-25 households and it is polluted. In some areas, water pipes and gutter pipes are linked and leaking.
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The drainage system is open gutters (drains). They are kutcha in construction and sanitation pipes are connected to the gutters. These are unhygienic and garbage clogs them. As there is no proper garbage disposal, residents throw their garbage behind their houses or down the Asalpha hill slope and there is no system in place to clean these areas. There are also no proper roads; they too are kutcha in construction making access to various facilities difficult during the rainy season. Access to homes is through small gullies, often crossing the open gutters. Toilet facilities are public and only one toilet is available for a population of 500-600. The facilities are unclean and often without water. Some of the public toilets have now been taken over by NGO Sulabh Sauchalaya. Toilet facilities in some areas are pay and use. In areas where toilets are not available, such as the predominantly Muslim areas, people use open spaces for defecation. All children defecate outdoors. Electricity is available to everyone from Reliance through individual connections. There are 5 private and 2 municipal schools in the area along with 12 Anganwadi centers, however, these are not sufficient for the area. Government schools in Kirol Village educate up to the 7th Standard, thereafter, children must attend schools far from the area. Small general stores that stock candy, cold drinks, and other snack foods and have public phones are readily available. The Netaji Subhash Chandra Bose Library & private dispensaries are also present (See Appendix 4). Relevant Government Programs. Community members use of the ration store (PDS) and the presence of the Slum Rehabilitation Scheme (SRS) in Kirol Village are still to be determined. Existing Groups. The CBOs working in the community include: 3 groups (mandals), 1 credit society, and 1 resident committee. The 8 NGOs present are: Palavi Stree Shakti Savardhan Kendre, Jeevan Jyoti, Indicus Public Trust, Sulabh Sauchalaya, Anjuman Sharda-E-Mustafa Public Trust, Darbar-Ul-Naqshbandiya Foundation, Stree Shakti Mahila Association Utpan Sahakari Sanstha that implements Dattak Vasti Yojana, and Ghatkopar Educational Welfare Society. 4 SHGs / mahila mandals are also present in Chirag Nagar, which has monthly meetings and festival celebrations. The 10 religious institutions are: 6 Hindu temples (mandir), 2 mosques (masjid), and 2 Buddhist temples (vihar). Health Facilities. There are private, government, and charitable health facilities available in the area. Generally, health facilities are difficult for the community to access. The health post is located at about 1 km away from Kirol Village and has a staff strength of: 1 PHN, 2 MPWs, 16 CHVs, and 1 attendant. Regular immunization camps are conducted area-wise, such as the pulse polio, TT, and BCG campaigns. Awareness has increased in the community because of the health post workers and as a result maternal and newborn deaths have decreased to some extent and miscarriages, low birth weight, and child disabilities have tried to be controlled. The health post is often out of stock i.e. iron and folic acid tablets and visits by CHVs, ANM, and AWWs are irregular. Apart from the health post, community members also utilize 2 municipal hospitals (Rajawadi & Muktabai) and 1 government dispensary. People access these public facilities when children fall ill, during immunization camps, and for antenatal & postnatal care.
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The other health facilities in Kirol Village are private clinics, maternity homes, and hospitals. There are 11 maternity homes and hospitals that the community also access along with approximately 36 private clinics that have doctors of varying qualifications [Bachelor of Medicine / Bachelor of Surgery (MBBS), Unani, Ayurvedic, and others]. When women and children are ill, they prefer private practitioners. This preference is due to the negative attitude of staff at government facilities. They are physically & verbally abusive causing frustration in the patient. However, women cannot afford the expenses for treatment at private facilities on a regular basis.
MATERNAL & NEONATAL HEALTH SITUATION Antenatal Practices. Women realize they are pregnant when they miss a menstrual cycle, feel nauseous, and are not hungry. The first people they tell are an elderly female relative, husband, or close neighbor. She takes advice from those that she trusts, who tell her to visit the doctor to confirm her pregnancy, which she does. Women typically do not rest during their pregnancies, as their families are dependent upon them to look after the household and any young children. They often work to their 9th month of pregnancy. The diet of a pregnant woman consists of whatever is available in the house. Economics play a part in preventing proper nutrition. Pregnant women are not pampered or cared for differently during their pregnancies by anyone, including their mother-in-laws or husband. Most women register with the hospital during their 7th month of pregnancy (or if there are complications) and hence do not have routine health check-ups or follow any treatments, i.e. tetanus injections are not taken. CHVs / AWWs do not regularly come into the communities and CHVs do not provide iron and folic acid supplement tablets to pregnant women in Kirol Village. Delivery Practices. The majority of deliveries are institutional mainly Rajawadi Hospital and is the preferred method, but home deliveries do happen, particularly in Azad Nagar and the hill area. This happens as a result of: illiteracy, superstitions, fear of hospitals, fear of medical equipment and supplies (i.e. needles), poverty, fear of fine for having more than 2 children, distance to and lack of transportation (especially at night) to hospital, fear of hospital staff, religious misunderstandings, and not wanting to miss daily wages. If the woman has already delivered 2 children, an additional Rs. 500 is charged per delivery as part of the family planning policy. Often times, patients are made to run from hospital to hospital because care / space not available. Traditional birth attendants (dais) conduct home deliveries, though their training qualifications & hygiene practices are unclear. Despite cleanliness being of paramount importance during a home delivery, environmental and personal hygiene continue to be poor. In case of complications during a home delivery, the mother and baby are referred to the nearest hospital or maternity home. Postnatal Practices. At institutions, breastfeeding of the newborn is done within hour to one hour of delivery or immediately after the mother becomes conscious in case of a cesarean section. Doctors and nurses do advise to feed the baby immediately and the majority of the community follows directions prescribed by doctors showing a change in practices. For a normal delivery, the mother and child are kept for 3 days in a public facility and in a private facility the length of stay is 5 days.
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The BCG immunization is given immediately to babies born in institutions, but not in the case of a home delivery. The population and migration, both of which cause a strain on the current infrastructure, are related factors to individual behavior changes. Some people are ready to change, as in the case of polio vaccinations and regular immunizations taking place in the community. Some of the cultural feeding practices include giving honey to a newborn. After the 6th month, other complementary foods to breast milk are introduced to the baby. Women breastfeed until the child is 1 or even 2 years old. Massages for the newborns are unaffordable for families in Kirol Village, so mothers learn on their own how to do them for their babies. Women are unaware that there are massages conducted for mothers as well, probably since women do not give any priority to their own health and are not pampered by their families. After delivery, the woman is expected to work shortly after coming home and has no special diet, just what is provided or at home. As giving birth is considered to be a normal event, the mother receives no special attention (social support).
Case of Khadija Khadija,19 years old, was sitting on her doorstep with an older female relative nursing her 1-month old baby. Her home was in a very unhygienic & cramped area: a clogged, open gutter ran right in front of her doorstep with a maze of stone slabs placed over it allowing people to walk in the narrow alley. The houses were packed tightly side-by-side with no ventilation. During her pregnancy, Khadija never visited a doctor. She said that she registered at Muktabai Hospital for her delivery, but she was transferred from there to Rajawadi Hospital and then to Sion Hospital for the delivery. She only had high blood pressure she said. Thus far, her baby had not received any immunizations. She seemed indifferent about caring for her child in a healthy way as well as seemed resistance to further inquiries about her childcare practices. Other Relevant Practices. The role of the father is non-existent during the pregnancy, delivery, and newborn caretaking stages. The decision makers are generally the elderly members in families and mothers health is often less of a priority. As women do not give priority to their health, they only seek medical help when serious complications arise. Abortion costs are higher than delivery costs. Women are married between the ages of 16-18. Some very young women have 2-3 children in the community. Spacing between children is approximately to one year and families often consist of more than 8-10 children; they have so many kids they do not remember all their names. Women do not have tubectomies (the operation). Preference is given to male children and as a result women give birth to many children. This preference is primarily a result of the cultural norm that a male child will be the one to look after the parents in old age. Changes are visible across generations in terms of health behaviors such as rest for pregnant women, husbands involvement, and marrying age showing that small steps have been taken towards healthier behaviors. Suggestions. The community has given the following suggestions for the improvement of their areas: The trend of positive changes should be seen completely in the community, benefiting the entire community and not just some as it is now Sure Start Project Situation Analysis Report 26
Home deliveries should be decreased Immunization programs should cover every needy child Family planning awareness should be encouraged Addiction among youth should be decreased Education in school on addictions should be given Social organizations support Trained dais In the ward transportation facility Nearby maternity home Health education through social organizations working on health issues Free and balanced diet for pregnant women Keep environment clean Income generation activities for women Men need motivation for family planning Mobile toilets Yoga Recreation center
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Kamraj Nagar Profile

COMMUNITY PROFILE History. During the monsoon seasons in Sion Koliwada area, peoples huts with all their belongings would get washed away. They decided to migrate and settle in Ghatkopar where municipal construction was underway. The majority of these people were of the Dalit community, as so the area was named Ramabai Colony after Dr. Babasaheb Ambedkars wife. On July 11, 1997 a statue of Dr. Ambedkar was vandalized, sullying the reputation and statute of Dr. Ambedkar. This triggered a series of events burning of buses, shops, and other property. In order to bring a stop to the destruction, the police were given orders to shoot during these events. The motivation for this order was believed to be political against the Dalit community. In this firing, 11 people died. A riot followed. To demonstrate their anger, community members threw stones at the police station. The court suspended some police officers as a result. The incident is still remembered as a nightmare and has caused tremendous fear in the community. In the future, police should be seen as security. The community is able to support each other during times of crisis as demonstrated during the July 26, 2005 floods. Because of the heavy rainfall, people lost their huts with all their possessions. The community came together to overcome this crisis in a matter of just a few days. Physical Geography. Kamraj Nagar is a part of the larger Ramabai Colony area and is on level ground. It is located off the Eastern Express Highway. Kamraj Nagar Road divides the area into two parts: old and new. A garbage dumping ground borders new Kamraj Nagar. Jalprabhat Nagar and Nalanda are two other clusters in the community. A creek (nalla) runs along Jalprabhat Nagar. Homes have been constructed along side the nalla which get affected by the water during the monsoons. Population. With a population of 107,000, Kamraj Nagar comprises of Maharashtrian Buddhists and migrants from UP, Bihar, and Gujarat. The community comes together for celebrations, like Ambedkar Jayanti. Hinduism is prevalent, but there are Muslim pockets as well. Many areas are settlements of mixed groups. The languages spoken in the area are Marathi, Hindi, and Gujarati. Though there are many nuclear families in Kamraj Nagar, there are joint families too. Alcoholism is a problem in this community and has even caused some deaths. There is no place to purchase alcohol in the area, so people go outside to drink.
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All children go to school. The literacy rate in the community is approximately 60% male and 40% female. The Anganwadi centers, Balwadis, and non-formal educational centers have developed an interest in education among children. Both men and women work in Kamraj Nagar, as they live independently and so are responsible for the running of their households. Men work in carpentry, daily wage earners, companies, factories, and as vegetable vendors. Along the highway there are many small-scale industries (like Ashwini Welding Works). Many men are also autorickshaw drivers and some have permanent jobs. Women are involved in rag picking (dry garbage scrap collection), domestic work, garment making, and home-based income generating activities like papad / pickle-making, embroidery, embossing, and bindi-making. Children also work in hotels, distributing newspapers, washing vehicles, tea stalls, and in rag picking. The approximate income is Rs. 100 per day and Rs. 3,000 per month. Most jobs are temporary (not permanent) and many people are unemployed. The distribution of income sources by occupation is given in Chart 4.
Chart 4
Permanent Job 10% Small-scale Industry, Autorickshaw Driver 20% Rag Picking 40% Domestic Worker, Homebased Work, Garmentmaking 30%
Infrastructure & Housing. The community is approximately 40 years old and has seen changes over the years. Some roads have been constructed, educational centers have opened, and health facilities have increased. These changes have impacted the hygiene, health, economic, and social conditions in the area. However, the infrastructure facilities are not sufficient for the population of the area and though changes have taken place, there are still many changes required. The improper sanitation and lack of water remain major problems in the area. The area is densely populated and the homes are small, compactly built, and have little or no ventilation. Houses are both pucca (permanent materials) and kutcha (temporary materials) in construction. Kutcha homes with their weak structures have tin / metal roofs and uneven / no proper floors and are the predominant structures in Jalprabhat Nagar. The tin roofs make homes very hot during the summers. Pucca / semi-pucca homes have level, tiled floors, unlike in kutcha houses. All homes had low walls. The slums are both registered and unregistered and the land in Kamraj Nagar is owned by the central government. The drainage system is open gutters (drains) of kutcha and pucca construction. These are very unhygienic and are often clogged with garbage. There is no proper garbage disposal in the area. Garbage is dumped near residents homes (front & backsides) and though complaints have been made to have the municipality to clean the area, there has been no response. Since the interior slums of Kamraj Sure Start Project Situation Analysis Report 29
Nagar are illegal, the municipality will not come for garbage collection in those areas. So, everyone contributes Rs. 10 to have someone clean the place. Access to many homes is through small gullies, often crossing open gutters. There are no proper roads either. As they are kutcha in construction access to various health facilities is difficult, especially during the rainy season. The dumping ground also serves as an access route from new Kamraj Nagar to Jalprabhat Nagar; a well-trodden path goes through the ground. Food vendors block the road near the market in the evening causing traffic problems. The water is supplied by the municipality and is used for all purposes, such as drinking, cooking, cleaning, etc. The old part of Kamraj Nagar has proper water access for 4-5 hours every day. One water tap in working condition is available for 15-20 households. The main connections in the old part are public taps and hand pumps. However, in the new part, water supply is irregular or not available, so residents living there carry water on a daily basis from the old area to their homes. Residents from the old part that have private taps sell water containers to those in need at Rs. 40 per container. Toilets are free, private facilities, but insufficient in number for the population. Currently, there is only 1 toilet for about 1020 households. The available toilets are unclean and with irregular water supply, they are in such a poor condition that even animals are found inside. In areas where toilets are not available, like Jalprabhat Nagar, people use open spaces to defecate. All children defecate outdoors. Electricity is available to everyone from Reliance through individual connections. There is 1 private and 1 municipal school in the area along with 4 Anganwadi centers. Schools are in Hindi, Marathi, and English medium. Primary education (up to 7th Standard) is available in Kamraj Nagar; however, opportunities for secondary education are not. Students must go out of Kamraj Nagar to continue studying; girls are sent to continue their education also, but many students quit studying after the 7th Standard. Small petty stores that stock candy, cold drinks, and other snack foods and public phones are available in the community. Other resources include some general provisions. The market is about a 15-20 minute walk from Kamraj Nagar and private health clinics are scattered all over Ramabai Colony (See Appendix 5). Relevant Government Programs. The Anganwadi midday meal scheme is running properly. The schools distribute free books and notebooks to need children. Community members use of the ration store (PDS) and the presence of the Slum Rehabilitation Scheme (SRS) in Kamraj Nagar are still to be determined. Existing Groups. Kamraj Nagar has few community groups. The presence of SHGs, registered housing committees, neighborhood committees (shejar samiti), and mahila mandals were discussed, but no specific ones were identified and no NGOs were identified as working in Kamraj Nagar. Two youth mandals, namely Trun Mitra Mandal and Citia Mitra Mandal, were found. The 2 religious institutions identified are 1 Buddhist temple (vihar) and 1 church.
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Health Facilities. Kamraj Nagar does not have its own health post and so must access the nearest one at Ramabai Colony. The Ramabai Colony health post is located about 15 minutes away and has an open, clogged gutter running in front of its facility. Its staff strength is: 1 Assistant Medical Officer (previously known as FTMO), 1 PHN, 22 CHVs (11 for Kamraj Nagar), 4 ANMS, 3 MPWs, and 1 attendant. The health post is out of medicines most of the time, but conducts polio immunization camps. The community relies mostly on government health services. Apart from the health post, community members also utilize 3 dispensaries and municipal hospitals (Rajawadi, Ramabai, Sion, Gokul Park). Previously, there was no government hospital accessible, but there is still no maternity home nearby. The other health facilities in Kamraj Nagar are private practitioners and hospitals. Private practitioners are often used due to proximity and because municipal facilities also have charges. There are approximately 17 private & charitable clinics in the area that have doctors of varying qualifications, mostly homeopaths and Ayurvedic streams of medicine. One traditional birth attendant (dai) from UP is known in the community. When women and children are ill, they prefer private practitioners. This preference is due to the negative staff attitude at government facilities; they can be physically & verbally abusive. There are also too many patients per doctor and not all the equipment at Rajawadi Hospital is functional i.e. x-ray, sonography, etc. Some feel as though Rajawadi Hospital refers all its patients to private doctors and that the health services provided there are poor. However, women cannot afford the expenses for treatment at private facilities on a regular basis.
MATERNAL & NEONATAL HEALTH SITUATION Antenatal Practices. Women realize they are pregnant when they miss a menstrual cycle, feel nauseous, and are not hungry. The first people they tell are their husbands, mother-in-laws, or a friend. She confirms her pregnancy through self-conducted urine tests. Private hospitals charge to confirm pregnancy, but Rajawadi Hospital does not. Sonography charges at Rajawadi Hospital are Rs. 30 whereas in private facilities it is Rs. 100. Women typically do not rest during their pregnancies, as their families are dependent upon them to look after the household and any young children. Pregnant women are not pampered or cared for differently during their pregnancies. Most women register at Rajawadi Hospital during their 7th month of pregnancy (or if there are complications) and, therefore, do not have routine health checkups or follow any treatments. They feel that everything will be fine so no extra precautions are necessary. The diet of a pregnant woman consists of whatever is available in the house. Economics play an important part in preventing proper nutrition. CHVs / AWWs do not regularly come into the communities and CHVs do not provide iron and folic acid supplement tablets to pregnant women in Kamraj Nagar. Women go on their own to take the tetanus injections. Delivery Practices. The majority of deliveries is done in institutions mainly Rajawadi Hospital and is the preferred method, but home deliveries do happen. This happens as a result of poverty, fear of fine for having more than 2 children, distance to and lack of transportation to hospital, and reluctance to interact with hospital staff. In a public institution, though there are no fees per se, but the costs for syringes, needles, gloves, and cotton are borne by the patient. And, if the woman has already delivered 2 children, an additional Rs. 500 is charged per delivery as part of the family planning policy. Sure Start Project Situation Analysis Report 31
Traditional birth attendants (dais) conduct home deliveries, though their hygiene practices are unclear. Despite cleanliness being of paramount importance during a home delivery, environmental and personal hygiene continue to be poor. Postnatal Practices. At institutions, breastfeeding of the newborn is done within one hour of delivery or immediately after the mother becomes conscious in case of a cesarean section. Doctors and nurses do advise to feed the baby immediately and the majority of the community follows directions prescribed by doctors showing a change in practices. However, in some cases, mothers are not allowed to see the baby for a month preventing immediate breastfeeding and in other circumstances breastfeeding is started only after 3 days. For a normal delivery, the mother and child are kept for 3 days in a public facility. The BCG immunization is given immediately to babies born in institutions, but not in the case of a delivery in a private institution. Some of the cultural feeding practices include giving honey & apple oil to a newborn and after the 6th month, other complementary foods to breast milk are introduced to the baby. Women breastfeed until the child is 1 or even 2 years old. Massages for the newborns are unaffordable for families in Kamraj Nagar, so mothers learn on their own how to do them for their babies. Women are unaware that there are massages conducted for mothers as well, as women do not give any priority to their own health and are not pampered by their families. After delivery, the woman is expected to work shortly after coming home and is required to look after herself and her family. She has no special nutritious diet, just what is provided or at home. Other Relevant Practices. The role of the father is non-existent during the pregnancy, delivery, and newborn caretaking stages. The decision makers are generally the mother-in-law and the mother, but womens health is often less of a priority. As women do not give priority to their health, they only seek medical help when serious complications arise. Women are married between the ages of 15-17. Spacing between children varies from 5 children in 5 years to 2-5 years in between children. Families often consist of 3-4 children. Women look after each others children when possible. Preference is given to male children and as a result women give birth to many children. This preference is primarily a result of the cultural norm that a male child will be the one to look after the parents in old age. Suggestions. The community has given the following suggestions for the improvement of their areas: As taxis / autorickshaws are not available at night and in the area, a day and night ambulance service is necessary for sick and pregnant women. Government maternity hospital should be nearby Increased toilet facilities Cleaning of gutters Clean and safe drinking should be made available Proper roads should be constructed Health post should be in Ramabai and Subhash Nagar Collaborate with Nair Hospital to improve MNH services in Kamraj Nagar
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Summary
Many of the issues exist across all the 4 intervention areas and demonstrate that the areas are highly vulnerable. The table below summarizes these main issues. Table 2. Summary of Main Issues Across 4 Intervention Areas Specifics Status 1. Infrastructure Water Many areas with no access or highly irregular availability, Must bring water from other areas Toilets Not sufficient for population, Unclean, Without water, Children defecate outdoors Drainage Open, clogged gutters Garbage disposal In gutters or open space Land status Unauthorized / unregistered slums, Government ownership Limited resources Some areas with limited schools, Resources of any kind far away Roads / Pathways Many kutcha roads, No road access in some areas, Poor access pathways 2. Population Education Adult illiteracy, Not all children attend school Hazardous occupations Rag picking, daily wage laborers, Child labor Economic regularity Rs. 50-150 per day, Men and women work, Low economic status contributes to poor nutrition & home deliveries Addictions Alcoholism, No habit of saving 3. Housing Construction Minimal ventilation, Presence of kutcha / weak houses Density High 4. Maternal and Newborn Health Practices Antenatal care Registration in 7th month so no care or treatment taken, No rest or proper diet for mother, Mother does not take vitamin supplements Delivery Sometimes home deliveries with untrained dais in unclean setting Postnatal care Irregular immunization, No rest or proper diet for mother, Nonexclusive breastfeeding Other relevant practices No family planning, Weak social support, Lack of decision making authority in mothers, Limited fathers role, Womens health not a priority, Male preference, Young marrying age 5. Health Facilities Access / Transportation Road access or availability of transportation is poor in many areas which is necessary to reach facilities, esp. during deliveries Distance Many areas have to go quite a distance to access facilities Limited facilities Some areas without any health service providers Limited qualified practitioners Many without proper qualifications Poor treatment at government Physical and verbal abuse, Out of stock of medicines, Equipment facilities not always working, Irregular visits by staff 6. Existing Groups Community activity Many areas without community level groups like SHGs / Mahila Mandals / youth groups 7. Geography Physical structure Location of communities on the hillside affects all aspects of life i.e. access to facilities and resources, sanitation infrastructure Sure Start Project Situation Analysis Report 33
Suggestions
Recommendations were collected from the community level, the facility level, and from the teams own inputs. For the community the issues of priority and recommendations are below. Once these basic needs are addressed, the community feels that MNH behaviors can improve. Poor sanitation infrastructure specifically water, drainage, and toilets. The community wants regularly accessible to water, for open gutters to be cleaned and closed, and for toilets to increase for the population. As this is not directly within the scope of the project, it will be addressed through the projects consortium. Limited access to health facilities. Proper road access and availability of transportation at night and in remote areas is critical, especially in the time of deliveries and illness. Increased health facilities maternity homes, hospitals, dispensaries, and health posts are also requested to be nearby. This access issue will be partially addressed through the youthrun resource centers that will collect information about transportation services to health facilities. Poor treatment at government health facilities. Better treatment by staff and improved services would encourage increased use of government facilities. Workshops with health service providers on communication using Appreciative Inquiry techniques will be conducted to address this issue. Low income. To address the lack of income, women suggested income generating activities for themselves. This will hopefully be achieved through capacity building of the community organizers mahila mandal groups in MNH related activities like massages, selling of diapers, etc. Livelihood skills and vocational training for youth will also be done to address this issue. From pediatricians and obstetricians / gynecologists the suggestions put forth were as follows There should be a link of the community with public hospital, private hospital, and charitable hospital. A tie-up with private nursing homes that will cater to poorer patients at a fixed price can be established. However, the nursing homes should have acceptable standards of care. The specialists can volunteer to help out at health post level to see patients. The 2 levels in a 5-storey maternity home at Sainath Nagar can be revived with the help of these private practitioners. Training of general practitioners to identify high-risk patients and to prevent malpractice. Educating adolescent and students. The Sure Start team would like to further explore the following with the intervention communities: Utilization of services provided by private general practitioners Taking of vitamin supplements during pregnancy Immunization of children Exclusive breastfeeding Registration during pregnancy Availability of trained dais Visits by CHVs Habit of saving Health insurance All of these areas will be addressed through various project interventions like group discussions in the community, health messages distributed through the community organizers, and meetings on Sure Start Project Situation Analysis Report 34
various related issues (like nutrition) with relevant community members using expert resource people and audio-visuals. Behavior change in these areas is required in order to improve MNH practices. At a later stage in the project, planned parenthood, physical exercise, and quality childcare for working parents may be addressed. Detailed planning and strategizing will be developed based on this report and will be synthesized during the logical framework analysis (LFA) exercise. All information gathered from the community, on MNH, and from other relevant resources as well as the teams ideas for activities will be focused and shaped through LFA.
Conclusion
This report identifies much scope for work in partnership and the team envisions collaboration with various stakeholders to take ahead the Sure Start project on the issues identified in this report. To ensure sustainability in all aspects of the project, a consortium will be formed from the stakeholders list below. Division amongst partners will be based on strengths and work of each consortium member. Municipal Health Department strengthening the relationship and communication with communities by improving services. Its responsibility for the health of the city and its vast health infrastructure makes it a vital partner & member of the consortium. Integrated Child Development Scheme (ICDS) conducting joint programs with the Anganwadi workers as their target groups are similar, namely newborns, pregnant women. Private service providers providing standardized, quality care to improve MNH in the community among both general practitioners and specialists from all medical streams. Corporate sector involving corporates based on their strengths and services, such as Kotak Education Foundation & Godrej. Academic bodies achieving accreditation of health facilities, such as IMA, FOGSI, MOGSI, Indigos, IAP, NNF as they are active in every ward. NGOs / CBOs developing community ownership and responsibility with the input of various constituents, like mahila mandals, youth groups, YUVA, Udaan, Stree Mukti Sanghtana, Dattak Vasti Yojana, Palavi Stree Shakti Savardhan Kendra. Suarna Jayanti Shahri Rojgar Yojana (SJSRY) developing income-generating programs for youth and women.
The consortium will also serve as a platform for collaborations to develop integrated methods of work on similar issues, for example an alliance between ICDS Anganwadi workers, the Health Department Community Health Volunteers, and the Sure Start projects community organizers.
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Appendix 1: PRA Techniques Used in Situation Analysis Workshops

Group A Timeline. The purpose is to get a historical review of the community and to find out if any major events have impacted the community. The group will be asked to give their basti name and write a historical review of how the slum came into existence, including any major events that took place in the basti. The output is that the information collected will help us understand the community, their background, and the circumstances that have affected them. It also helps to find out what changes and adaptations they made when influenced by adverse circumstances. Questions Asked 1. Name of the community 2. History of the community clusters 3. Have any circumstances impacted/affected the community? 4. How did the community react and face the incidence(s)?
Group B Trends Analysis. The trends of change in the community help us to understand how things have been changing in various fields over an approximate given time. The group will be asked to identify major changes that have taken place in their community over a period of time. Older people will be asked how things were when they were children and what changes they notice now i.e. what are the changes in healthcare, education, livelihood, eating patterns, clothing, etc. This change of trend if recallable in a lifetime shows the response of people is changing circumstances by way of modification of their attitudes & actions. The trend shows in which direction they are moving and what new changes are likely to be acceptable to them. Questions Asked 1. What changes have happened in your community in the last 5 years? 2. When you were child how was your community and now how is it changed? 3. What are the changes in healthcare, education, livelihood, eating patterns, clothing, etc? 4. How do you see these things changing trends? 5. What other changes are you looking forward to in your future?
Group C Pie Diagram. Pie diagrams can be prepared for livelihood analysis. Preparation of a pie diagram will show the livelihood sources of the community. The group will be led to imagine that all the income from the various sources throughout the year are converted to money and placed in one place. This should be imagined to be 100 Rupees. From the pie diagram will emerge how many different sources of income exist. The output will help identify the major sources of livelihood. Questions Asked 1. In your community do both men and women work? 2. Men are mostly involved into what type of work? 3. Women are mostly involved into which type of work? 4. If you take 100 Rupees of your community income how many different sources of income exist? 5. What are the daily wages of the different income sources? 6. Do children also work in your community? If yes, what type of work are they involved in?
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Group D Participatory Resource Mapping. This is to give an overview of the resources available within the community in the form of social, economic, and geographical details. The community members will be asked to draw/make the map of the roads (kutcha/pucca), houses (kutcha/pucca), shops, health posts, Anganwadi centers, toilets/latrines, drains, water taps, maternity homes, school building, etc. The resource map output will serve as the base for discussion for others in the community & for outsiders to understand the location of various facilities.
Group E Discussion on Social Factors in Community. This is to understand the social factors of the community. The group will be given the following topics to discuss: Questions Asked Access to Healthcare Distance from health services comment on the outreach to the health service Poor access to MCH schemes Proportion of house deliveries & why Mobility Available facilities for MNH care private, public, charitable Type of Settlement Land tenancy Authorized/unauthorized House characteristics katcha, overcrowded New vs. old slums recently relocated Sanitation, Drainage, Water Supply Absence or poor sanitation Point of water supply, number of taps Type of drainage Toilets are they sufficient Social Variables Do children attend school Literacy among adults How are women treated in the community Religion/caste differences Alcoholism Age of marriage Poverty Irregular wages, type of employment Access to government programs Whether people save money Others Political support Are there SHGs, CBOs, MMs list if possible Are there any occupational hazards Any particular language spoken
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Group F Situation of MNH in Community. The group will be asked to discuss issues in their community on MNH. The purpose is to get information on the current MNH practices, specifically
Questions Asked During Pregnancy When first identified that they have missed period whom do they talk to, whom do they approach What do they do What is the care taken by health providers Care: which month registration done, TT injections, Iron, Folic Acid Are services available Are services satisfactory What are the traditional practices in health & nutrition Nutrition during pregnancy During Delivery Preparation for delivery home or institutional Why is home delivery done Whom do they call traditional birth attendant, etc. Practice during delivery cleanliness What is done if case gets complicated Postnatal Practices Practice for the new born child when breastfed, etc. How long is she admitted in hospital, public / private BCG vaccine given or not Nutrition of mother after delivery Role of father and other family members Social Support at the Basti Level Moral support Dialogue with health system Who take initiative What support does the basti need at this level
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Appendix 2: Vikhroli Parksite Resource Map
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Appendix 3: Varsha Nagar Resource Map
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Appendix 4: Kirol Village Resource Map
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Appendix 5: Kamraj Nagar Resource Map
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NAppendix 6: N-Ward Map
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Society for Nutrition, Education and Health Action

SITUATION ANALYSIS REPORT

June 15, 2007

Sure Start Project Situation Analysis Report

Executive Executive Summary

Sure Start Project Situation Analysis Report

SITUATION ANALYSIS REPORT

Background of Situation Analysis

Situation Analysis Design

Slums 110,000 12,000 34,000 30,000 186,000

Total 110,000 80,000 82,000 48,000 320,000

68,000 48,000 18,000 134,000

51,101 49,100 60,000 40,786 46,700 52,500 300,187

18,870 12,100 5,000 25,042 15,450 3,500 79,962 213,962

69,971 61,200 65,000 65,828 62,150 56,000 380,149 700,149

Grand Total 486,187 Source: Municipal Corporation of Greater Mumbai (MCGM)

Sure Start Project Situation Analysis Report

Vikhroli Parksite Profile

Daily wage laborers 20% Domestic workers 30%

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Varsha Nagar Profile

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Kirol Village Profile

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Kamraj Nagar Profile

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Appendix 1: PRA Techniques Used in Situation Analysis Workshops

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Sure Start Project Situation Analysis Report

Appendix 2: Vikhroli Parksite Resource Map

Sure Start Project Situation Analysis Report

Appendix 3: Varsha Nagar Resource Map

Sure Start Project Situation Analysis Report

Appendix 4: Kirol Village Resource Map

Sure Start Project Situation Analysis Report

Appendix 5: Kamraj Nagar Resource Map

Sure Start Project Situation Analysis Report

NAppendix 6: N-Ward Map

Sure Start Project Situation Analysis Report

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