Situational Analysis for Guiding USAID/India and EHP/India Technical Assistance Efforts in Indore, Madhya Pradesh, India
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Activity Report 133 Situational Analysis for Guiding USAID/India and EHP/India Technical Assistance Efforts in Indore, Madhya Pradesh, India Shivani Taneja, Siddharth Agarwal July 2004 Prepared under EHP Project 26568/UH.IN.Y5.KNOWINV Environmental Health Project Contract HRN-I-00-99-00011-00 is sponsored by the Office of Health, Infectious Diseases and Nutrition Bureau for Global Health U.S. Agency for International Development Washington, DC 20523 ii Contents Acknowledgements....................................................................................................... v About the Authors....................................................................................................... vii Acronyms ..................................................................................................................... ix Prologue .....................................................................................................................xiii Summary ..................................................................................................................... xv 1. Introduction & Methodology .................................................................................. 1 2. City profile.............................................................................................................. 3 3. Urbanization and Urban Poverty........................................................................... 11 4. Madhya Pradesh Government’s Policies and Plans for Urban Health.................. 25 5. Child Health Conditions........................................................................................ 39 6. Assessment of Health Services in Indore.............................................................. 75 7. Assessment of CBOs & NGOs in Indore.............................................................. 91 8. Lessons from the Indore Habitat Improvement Project ...................................... 103 9. Recommendations for USAID/EHP India Urban Health Program..................... 109 References................................................................................................................. 111 Annex 1. List of Vulnerable Slums on the Basis of Child Health in Indore............. 117 Annex 2. Map Showing Health Vulnerability of Slums ........................................... 125 Annex 3. India 1992/93 Health, Nutrition, Population and Poverty Total Population ........................................................... 127 Annex 4. FGD Methodology .................................................................................... 131 Annex 5. Socio-demographic Profile of the Slums (Where FGDs Were Conducted)......................................................................... 133 Annex 6. Child Health Indicator Table..................................................................... 135 Annex 7. Role of the Health Department in ICDS.................................................... 139 Annex 8. ICDS Projects in India............................................................................... 141 Annex 9. State Incidence of Poverty......................................................................... 143 Annex 10. Draft National Slum Policy ..................................................................... 145 Annex 11. Child Health Indicators ........................................................................... 175 Annex 12. Format for Information Collection from CBOs and NGOs..................... 179 iii Acknowledgements We gratefully acknowledge the contributions of our partners, for their active help, support and insights without which it would not have been possible to carry out this study. Specifically, we wish to express our gratefulness to Kailesh Vijay Vargiya, Mayor; Nitesh Vyas, Municipal Commissioner; Dr. Mukesh Bhachawat, District Immunization Officer; Dr. Sharad Pandit, Joint Director, Department of Public Health; and Mrs. Manjula Tiwari, Project Director, Integrated Child Development Service (ICDS), for sharing their valuable time with us and providing information on different aspects of the study. We would also like to thank Rajeev George, Prashant Tiwari and Ravi Vijay Vargiya for helping us better understand poverty in Indore. We also appreciate the valuable insights on Indore slums gained from Messrs. Supekar and V.K. Jain. Our sincere gratitude and heartfelt thanks go to the many nongovernmental organizations and community-based organizations in Indore for their active participation during the stakeholders’ consultations. Learnings gained from these meetings helped in building the situational analysis and are reflected in this document. Our special thanks to Dr. Massee Bateman (USAID) for his active interest and constant guidance during the entire course of the study and Sarah Fry (EHP) for her constructive suggestions and comments on the draft report. We value the untiring copy editing efforts of EHP colleagues including Breeda Hickey, Arti Majumdar and Mani Gupta. The efforts of Ms. Shweta, Anju Dadhwal, S.K. Kukreja, Priti Kumar and information support from Pravin K. Jha and Dr. Damodar Sahu also went a long way in helping us successful prepare this document. We hope that this report will be able to extend its reach as it is used by various stakeholders and program implementers. It can also serve as a model for carrying out other quantitative and qualitative studies. We look forward to comments and suggestions from its readers. v About the Authors Siddharth Agarwal has more than 18 years experience in medicine, project management, and technical assistance in community health. He works with the USAID-EHP, Urban Health Program, as the India Country Representative. He supports the Government of India’s Reproductive and Child Health (RCH) Program and provides technical and programmatic oversight to city-based urban health models. He has worked with CARE India, providing technical and programmatic support to projects for community-based child and newborn care and managed CARE’s Maternal and Infant Survival Project in the state of Madhya Pradesh. Dr. Agarwal has experience working with the Government of Uttar Pradesh’s Department of Health and Welfare as well as with the LLRM Medical College, Meerut. He holds a degree in medicine from the LLRM Medical College in Meerut. Shivani Taneja has over six years experience working in urban slums of Madhya Pradesh. She works on child education, women’s empowerment and maternal and child health issues in slums of Madhya Pradesh through Muskaan, a Bhopal-based nongovernment organization. In addition, she supports USAID-EHP’s Urban Health Program in India, as a consultant. She holds a master’s degree in social work from the College of Social Work at Nirmala Niketan in Mumbai. vii Acronyms ADB Asian Development Bank ANC antenatal care ANM auxiliary nurse midwife ARI acute respiratory infection ASO Assistant Statistical Officer AWC Anganwadi Center AWW Anganwadi worker BGMS Bharatiya Grameen Mahila Sangh - CBO BPL below poverty line CBO community-based organization CD civil dispensary CDPO Child Development Project Officer CECOEDECON Centre for Community Economics and Development Consultants Society CSS centrally sponsored schemes DFID British Government’s Department for International Development DHFW Department of Health and Family Welfare DMEISM Department of Medical Education and Indian Systems of Medicine DPT diptheria pertusis tetanus DWCDO District Women and Child Development Officer EHP Environmental Health Project EPI Expanded Program for Immunization FGD focus group discussion FWWB Friends of Women World Banking HDI Human Development Index HNP health, nutrition and population ICDS Integrated Child Development Service IDA Indore Development Authority IHIP Indore Habitat Improvement Project IFA iron and folic acid ix IMC Indore Municipal Corporation IMR infant mortality rate JRY Jawahar Rojgar Yojana, a government employment program for rural unemployed and underemployed. LBW low birth weight MC Municipal Corporation MGD millions of gallons per day MICS Multi Indicator Cluster Survey MMDA Madras Metropolitan Development Authority MP Madhya Pradesh MPHDR Madhya Pradesh Human Development Report MTP medical termination of pregnancy NFHS National Family Health Survey NGO nongovernmental organization NIUA National Institute of Urban Affairs NMR neonatal mortal rate NRY Nehru Rojgar Yojana, a government employment program for urban unemployed and underemployed ODA Overseas Development Authority OECF Overseas Economic Cooperation Fund (Japan) OPD outpatient department ORS oral rehydration salts ORT oral rehydration therapy PHC primary health center QMP qualified medical practitioner RMP registered medical practitioner (i.e. unqualified) SC sub center SLI Standard of Living Index SHG self-help groups SJSRY Swaran Jayanti Shahri Rozgar Yojna SRS sample registration survey TCS Tata Consultancy Services TT tetanus toxoid UFWC Urban Family Welfare Center UIP Universal Immunization Program x USAID United States Agency for International Development UN United Nations UNICEF United Nations Children’s Fund VAD Vitamin A deficiency WHO World Health Organization WVI World Vision of India xi Prologue Responding to the growing need to address child health issues in urban poor settlements, the USAID/India-funded Urban Slum Child Health and Nutrition Program selected Indore in the state of Madhya Pradesh (MP) as one of the first cities for program interventions. The process of determining the “what” and