Urban Healthcare Improvement: Dharavi , Mumbai

1. Urban Healthcare Improvement:Dharavi, Mumbai Team 2: Marisa Reddy UsnishMajumdar Christopher Cai Benjamin Harris John Hack Sreemoyee Som

2. Initial Reaction Mental Illness Infant Mortality Overpopulation Lack of Transportation High Birth Rate Land Mafia Social Stigma of Diagnosis No Higher Education Shame Culture Sexually Transmitted Infections Drug Resistance Corruption Non-Chronic Diseases Poor Medicine Distribution Caste Segregation Marginalization Potential Gentrification Illegal Immigration Gender Inequality Poor Education Little Government Involvement Malnutrition Intimate Partner Violence Suicide Unclean Water Uncollected Waste Potential Gentrification

3. Urban Health Improvement Necessities Diagnostics Medicine distribution Data Education and prevention Infrastructure The underlying societal structures that organize this effort

4. Traditional, Concrete Organization Product of Developed world Hospitals, Clinics, Labs Expensive Equipment Ability to Incur High Transaction Costs Trained Doctors to Serve Entire Community

5. What structures Dharavi? How does it naturally organize itself?

6. Identifying the Organic Structure

7. Existing Attributes of Dharavi Give Rise to Implementable Goals

8. Community Health Care Organization Empowering lay-people to redefine doctoring • Healthcare Distributers • Early Detection Overall Health is Improved • Patient Monitoring • Healthcare Educators • Health Information Collectors • Health Education

9. The Community-Hub Model • Nagar x • Nagar y • Nagar z Hub -field work training -data integration -medication storage

10. Creative Financing LokmanyaTilak Nagar The ‘Hub’ S.M. Chawl P.K. Kunte Nagar

11. Social Entrepreneurship Empowering Community-Oriented Infrastructure Improvements Pay Per Use Toilets Improved Sanitation Ceramic Water Filters Potable Water Healthcare Masks Disease Prevention

12. Retrofitted Auto Rickshaws (RARs) • Mobile Clinical and Research Units • Drug Cooler • Diagnostics Equipment • Truenat MTB • Sputum Sampling Kits • WHO Pneumonia, Diarrhea Kits • Water Sampling Kit • Decentralize Clinical Interaction

13. Retrofitted Auto Rickshaws (RARs) • Employs existing Auto Rickshaw drivers and older women in each Nagar • Little to no training needed. • Driver nagivatesDharavi • Female delivers drugs and enforces DOTS • Economic incentives: • Driver income higher than previous wages • Female receives income and work experience

14. Retrofitted Auto Rickshaws (RARs) • Employee Uniform • Female – checklist and tuburculosis mask • Male – hat and shirt • Benefits: • Professionalism • Community identification • Increase in sense of authority, purpose, and ownership • Especially for women

15. Women’s Empowerment • Control over fertility • Drop in domestic violence • Fastest growing Indian states = highest % of women in labor force Source: Rae Blumberg

16. Healthcare Educators • Individuals who travel around their sector of Dharavi • Targeting particular areas and problems to talk about each day • Offering advice on: • Cleanliness • Home care • Family Planning Methods • Distribute care items: • Masks • Contraception Unger A, Riley LW (2007) Slum Health: From Understanding to Action. PLoS Med 4(10): e295. doi:10.1371/journal.pmed.0040295

17. Healthcare Educators • Trained by government workers in the Hub • Grandmothers and Mother-in-Law • Women with greater social mobility • Elder respect will ensure greater compliance with their advice Unger A, Riley LW (2007) Slum Health: From Understanding to Action. PLoS Med 4(10): e295. doi:10.1371/journal.pmed.0040295

18. Data Collection • Creation of registrars that track demographic and disease incidence data: • Used to monitor and evaluate our own progress • Mainly used to direct NGO funding and coordination • Point-of-Care Diagnosis when Feasible • Employing Young Unmarried Women who have greater exposure to technology • Using existing cell phones and GPS technology to track incidence of various diseases • Provide them with an income and work Experience “The Importance of Epidemiology” http://www.cdc.gov/24-7/local/documents/226601_C_247_Epidemiology_FS.pdf

19. Upcoming Diagnostic Technologies Hub Turnaround: 12 Hours

20. Benefits • Diagnostics save money • Cheaper than hospitalization • Cheaper than current resistant testing • Reduces turnaround time • Saves manpower • Transition to Point of Care Source: MIT Technology Review http://www.technologyreview.com/featuredstory/508576/the-machine-that-will-help-end-tb/

21. Goals for Development Infinity and Beyond • -Sustainable NGO Partners • -Independent Social Enterprise Year 3 Year 2 • -Increased NGO Partnership • -Social Enterprise Funding -NGO Partnership -Targeted resource allocation -Social Enterprise Funding Year 1 -RAR -Hub -Field work Timeline

22. Budget

23. Women • Change the way Dharavi works without changing the way Dharavi is • Ensure long term sustainability • Promote equality and ensure invesment in Dharavi’s future The Human Infrastructure Community Involvement Flexibility

24. Fluid Infrastructure