Rural-urban migration has led to growth in urban
slums that in 1998, India’s urban poor outnumbered the rural [1]. Due to
problems with water, housing, sanitation, and physical space—the
residents of urban slums, especially children, are affected
disproportionately by ill health [2]. A study at Mumbai noted a
significant correlation between morbidity due to common infections and
sanitary conditions in urban areas [3]. Hence, health needs a holistic
approach rather than a disease-based approach. Holistic approach
involves inputs from various domains and hence need an integrated and
model based approach. This is one such attempt to improve the health
status of children in an urban slum by an integrated model based
approach and evaluate the functioning of this model.
Methods
About 40 slums of 3000 population were screened for
government-approved area and Sathya Nagar was selected. Major issues
identified in the community were: (a) lack of potable water
supply; (b) no proper sanitation and garbage disposal, household
toilets as well as public toilets; (c) mosquitoes and rodents
menace; (d) lack of health facilities at the near vicinity; and
(5) lack of financial support for women.
Partner organisations arranged the finances and the
health aspects were taken care by our organisation. In addition, the
trust also gave inputs for the better environment and community
development. There were periodic meetings to review the progress and
discuss the future plans. The area had 10 streets and for each street a
selected female volunteer acted as a link worker for delivering the
services and getting messages/feedback. The following interventions were
done:
Environment: This involved development of
a proper garbage collecting system, sanitary latrines and rainwater
harvesting system. With the help of the government officials and
people’s motivation, every household got potable water supply. Garbage
was segregated at the source according to its degradability and then
removed from the area by vehicles. Drainage system and household toilets
were built with contributions from the people.
Healthcare: Health clinics were conducted
thrice every week initially and subsequently decreased to two per week
and one per week. Every week children with malnutrition were followed
up, treated for infections and mothers were given nutritional counseling.
Adolescent girls were also counseled periodically about growth and
development, menstrual hygiene and mental well-being. Periodic
counseling sessions and health days were celebrated. Apart from this,
Hepatitis B and Rubella immunization camps were conducted.
Financial upliftment of women: The two main
activities were motivating self help groups and prevent debts in the
families. There were more than 10 self-help groups and 20 of them have
learnt tailoring for a year and are doing it as an income generating
activity.
Results
A survey was conducted after a period of 3 years.
Information was collected from 204 families (with 165 under five
children) with a semi-structured questionnaire in September 2006 and key
indicators were generated. 95% of them used a household latrine and 88%
of them used corporation waste disposal methods. Water born morbidity
was 24% (at least one episode of diarrhea in a year) and no vectorborne
diseases. The mean duration of exclusive breastfeeding was 7 months and
the complementary food was started in 8 months. The children were
breastfed on an average for 15 months. 71% of the couples were protected
from unwanted pregnancies by a method of contraception. There were no
maternal and under-five deaths in this slum in the implementation
period.
Discussion
The Millennium Development Goal of reducing two
thirds of child mortality is possible only if we apply a holistic
approach rather than a disease-focused approach. This approach
integrated three components namely environment, microeconomics and
health. 62% of deaths and 74% of DALY’s in children are attributed to
poor sanitation and water supply [4]. Hence provision of safe water and
sanitation universally has been one of the goals in millennium
development. This model provided these components to this urban slum.
Need based approach, partnership building, and
participation of community are important in bringing up children of
slums [5]. The community participation was active in this slum and was
the key factor for the success of the model. Involving all classes of
people (equitable distribution), using micro-credit system for financial
upliftment (appropriate technology) and co-ordination of several
departments (intersectoral collaboration) were the other favorable
factors for the functioning of this model. It is lucid that the
principles of primary health care can be easily adopted for improvement
of health. The improvement of environment is evident by household
toilets and proper disposal of wastes. This has been facilitated by
periodic community meetings and participation.
The presence of female volunteers in every street in
the community enhanced the process of health care improvement. The link
workers role in improving health care of communities has been
established worldwide [6]. The outputs of exclusive breast-feeding for a
mean duration of 7 months and total breast-feeding for mean duration of
15 months are reassuring. The working of this model is also evidenced by
the decrease in prevalence of waterborne diseases and absence of vector
borne diseases.
Sustainability of the model has been ensured by
community participation and ownership. Since people from the community
played a vital role in their empowerment, they can sustain this model.
Moreover financial sustainability has been ensured using micro credit
systems for women. It is possible to replicate this model in other
settings provided the community participates and takes ownership, and
the model is need based and based on principles of primary health care.
Integrated model based approach works better in slums
provided it takes in account the needs of the community and the
principles of primary health care.
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