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Community Governance (CG) – Includes development of basic systems for local management
and maintenance of existing facilities, community accountability of local principal agents; and
effective community-government relations and utilization of SCM data for evaluation,
enforcement, and identification of future needs.
Social Capacity Mapping (SCM) – Geographic Information System (GIS) databases will link
data on community needs and capabilities and programs to facilitate better targeting of new
interventions to existing needs; promoting referrals and partnerships, encouraging individual
utilization of needed health services, and facilitating advanced health systems offerings such as
micro health insurance.
Impact on Existing Services Impact on
New
Utilization Impact Sustainability
Services
Behavior Change +++ + + +
Communications
Community Governance ++ +++ ++
Information technologies + + + +++
Combined intervention + + ++ ++
The proposed three-year project will focus on the development and optimization of each of
these approaches in each context, with evaluation of impacts concentrated in the final year of
the project and in follow-up studies.
Background for Delhi Project
With 17% of the world’s population and 20% of births, India’s success in averting infant and
maternal mortality will also determine the world’s success (US Census Bureau 2008). In 2006,
India’s Infant Mortality Rate (IMR) was 37.1 per 1,000 infant (31.5 for boys, 42.1 for girls).
Although this is below the global average, India nonetheless accounts for more infant deaths
than any other country. With a Maternal Mortality Ratio (MMR) of 540 per 100,000 births, India
accounts for 26% of the world’s maternal deaths, more than three times the next biggest
contributor.
Progress in these areas has posed continued challenges. Even as the Government of India rolls
out a nationwide catastrophic health insurance plan, only 51% of newborns receive a full battery
of childhood immunizations, compared to 86% of infants in its poorer neighbor Bangladesh.
While states in South India such as Kerala are pointed to as exemplars of low-cost delivery of
health services, states in the rural areas of the northern plains and Himalayan foothills as well
as urban slums face continued difficulties in meeting targets for infant, child, and maternal
health. The advanced technical capacity and innovation of India’s health system have led many
to conclude that there is a problem of demand, yet the evidence suggests problems of supply as
well as demand. Key supply side challenges include high rates of worker absenteeism, low
levels of worker productivity, and services inappropriate to population needs. While studies
suggests that overall health utilization is high among most population segments, poorer and
more isolated communities are often less likely to trap into modern medical practices and
preventative health services. A new national health insurance scheme focusing on catastrophic
care offers the promise of improving access, yet success and cost control will require efforts at
improved health education and prevention.
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Delhi Project Work in Progress
Jaishankar Memorial Centre (JMC) is a non-profit society set up in 1990 with the objective of
working with disadvantaged urban communities in the areas of health, education, environment
and livelihood with focus on children, women and youth. Towards this end, the Society has
undertaken several programs, including research and evaluation studies, community
interventions, and the running of the Gender Resource Centre (GRC). In 2008 JMC was
requested to shift the location of the GRC to the informal settlements and peri-urban villages of
Jasola village, Sheenbagh, Madanpur village, and Abu Fazal on the southeastern outskirts of
Delhi. The majority of the population are vulnerable families living in cramped housing colonies.
Their livelihood is not secure, and the nature of work they do ranges from casual workers as
rickshaw pullers, construction labour, etc. Their problems are compounded by poor hygienic
surroundings, unsafe water, poor sanitation and poor nutrition intake. Quality of education is
poor and their children have no proper environment for play or leisure. Most girls marry young
and bear 4-6 children before they are 30 years. A sizeable number are migrants in search of
livelihood and “better opportunities” in the capital city.
In 2009, the Delhi NCR government began to implement the Samajik Suvidha Sangam
(convergence of services for vulnerable population) program, offering GRCs as a single window
outlet for improved utilization of services and schemes. The SSS-GRC provides health services
through camps and mobile clinics. However, a lasting solution will have to be found to equip
them to understand their health situation, to demand new services, and to mobilize the
economic and political resources to gain access to those services.
To this end JMC and the Josef Korbel School of International Studies at the University of
Denver (DU) jointly initiated the Delhi Capacity Mapping and Health Education Project. The
long-term goals of this program are three-fold
1) Develop a map and database of existing health, social service, and gender sector
resources to assess quality, to identify gaps in service or physical access, and raise
awareness of untapped resources
2) Provide general health education and map-based referrals to community members
through a cadre of trained community health assistants drawn from the community
3) Work with health assistants and community leaders to raise broader community
engagement with existing health services and to stimulate the action and resource
procurement necessary to fill resource gaps.
The project also seeks to evaluate the GRC’s capacity and services in line with the Delhi
Government’s Mission Convergence Initiative (SSS), which aims to better coordinate social
service delivery for the poor.
In Summer 2009 three interns from DU conducted an initial assessment and mapping in Jasola
and Abu Fazal of health services and facilities available in these two areas, to assess general
health facility utilization (particularly in regard to Maternal and Child Health services), to
determine the barriers to accessing and receiving care, and to assess the overall health needs
of this population. The data collected are currently undergoing statistical analysis, in addition to
spatial analysis, to support recommendations and proposals for improving health services and
utilization. These data are also being used to demonstrate the need for capacity building and
increased government support to GRC, which is still unknown and barely accessible to many
residents of the community. An example of the mapping is shown on the next page, where the
residences of surveyed populations are mapped against plausible service areas of existing
facilities including GRC. We note the proximity to the Apollo Indraprastha Hospital, which did not
participate in the initial assessment and was not listed by any of the surveyed respondents.
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Next Steps
In the coming year New Concept, JMC, and DU will work together to formalize internal mapping
capacity at JMC and New Concept, to carry out further data collection/analysis, to lay the
groundwork for health assistant training programs in Summer 2010, to develop proposals for
conducting further work support of SSS, and contribute to joint DU-New Concept-JMC funding
proposals. Further, we plan to apply the lessons learned from this and other health education
projects in India to a training partnership with DU’s Masters of Development Practice (MDP)
program and universities in Delhi NCR.