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Building Public Sector - NGO Partnerships for Urban RCH

This symposium explores the challenges and opportunities of building partnerships between the public sector and NGOs for urban reproductive and child health programs. The presentation covers topics such as urban growth and poverty, existing infrastructure and programs, issues with present RCH services for urban slums, experiences and lessons in government-NGO partnerships, and the value that NGOs can contribute to urban RCH programs.

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Building Public Sector - NGO Partnerships for Urban RCH

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  1. Building Public Sector - NGO Partnerships for UrbanRCH Symposium on Urban RCH 31st Annual National Conference of Indian Association of Preventive & Social Medicine February 29, 2004 Dr Siddharth Country Representative, USAID-EHP Urban Health Program

  2. Presentation Outline • Urban Growth and Urban Poverty • Reproductive Child Health Scenario among the Urban Poor • Public Sector Services for the Urban Poor • Existing Infrastructure and programs: UFWCs, Health Posts, IPP VIII etc • Issues around present RCH services for urban slums • Experiences/ Lessons in Government-NGO Partnerships in IPP VIII and Other Programs • What Value can NGOs Contribute to Urban RCH Programs? • Suggestions and Recommendations

  3. Urban Population Growth

  4. Especially in Their Smaller Cities

  5. Urban Growth in India

  6. Where Should efforts focus?

  7. Take Home Messages • Virtually all growth will be urban in the future • Growth is fastest in concentrations of urban poor – e.g. slums • (2-3-4-5 syndrome) • Most growth and population will be in small and medium size cities • Mega-cities will continue to grow – and have importance beyond their proportion of the urban population • Urban growth in India has been exponential over the last few decades • In India, 43% of urban poor reside in the 8 EAG States

  8. Reproductive and Child Health Conditions among the Urban Poor

  9. Coverage of Child Health Services in Urban Slums of 6 Municipal Corporations and Rural Areas of Gujarat Coverage State-wide Multi-Indicator Cluster Surveys (MICSs), 1996

  10. Child, Infant and Neonatal Mortality in M.P.

  11. Childhood Under-nutrition in Urban M.P. NFHS 2 Re-analysis, EHP 2003

  12. Immunization Coverage by Age 1 among Children 12-23 monthsMadhya Pradesh – NFHS 2 Re-analysis, EHP 2003

  13. Contraceptive Prevalence in Urban M.P. NFHS 2 Re-analysis, EHP 2003

  14. Delivery Related Services in Urban M.P. NFHS 2 Re-analysis, EHP 2003

  15. Take Home Messages • Urban averages mask sharp disparities between the rich and poor in urban settings • By many health indicators, urban poor populations are comparable to nearby rural populations – or worse in many cases

  16. Issues with Public Sector Urban Health Services

  17. Urban Health Infrastructure in the Public Sector • UFWCs (1950), Health Posts (under Urban Revamping Sceme1983) : • 1083 UFWCs & 871 Health Posts, many run from hospitals, not proximal to slums • With the total urban population of 290 million, (with 1954 UFWCs & HPs), this works out to one UFWC/HP per 148,413 Urban population • PP Centres(1966): 1562 (many closed owing to discontinuation of Central funding) • IPP VIII (1993 to 2003) covered 7 million slum population in 4 mega cities and 94 smaller towns in 4 states

  18. Scenario 1: Areas Where Some Public Sector Primary RCH Services Exist • Inadequate physical and social access • Low demand for services among slum dwellers and weak community linkages • Poor quality (timing, attitude, atmosphere) of services • Insufficient reach to the under-served slums • Weak monitoring and tracking of coverage • Low focus on behavior change • Little emphasis focus on sustainability • NGOs active in several areas.

  19. Scenario 2: Areas where Public Sector RCH services are Not Existing • 2nd tier hospitals are burdened with primary care • Large pockets of urban poor left out • Private informal providers are the major resource • NGOs active in small areas

  20. Low Utilization of and Access to Public Sector Services Urban Slums Rural Areas Gujrat State-wide Multi-Indicator Cluster Surveys (MICSs), 1996

  21. Cross-cutting Issues • Weak inter-sectoral linkages with non-health sectors e.g. Dept. of Urban Development • Insufficient focus on hygiene & sanitation improvement and on other basic services • Limited experience with and capacity for effective partnerships in diverse settings • Every city/town is different, hence context appropriate strategies remain vital

  22. Experiences in Govt. –NGO Partnerships for Urban RCH

  23. Some Examples of Government- NGO partnership for Urban Health • IPP VIII - A.P./Bangalore: • Link Volunteers & Women's Health Groups promoted through NGO • Financial incentives to WHGs through revolving funds. • Emphasis on empowering women (NGO supported) • Behaviour counseling (child health, nutrition and hygiene) • First tier facilities operated by NGOs • IPP VIII - Delhi • First tier facility and maternity services operated by NGOs • EC Supported UH Program in Guwahati • First and 2nd tier facilities operated by Charitable Hospital

  24. Learnings • Govt.-NGO partnership helped in institutional capacity building of NGOs and community groups and improving health coverage among slums. • Financial contribution from community members helped improve sanitation, wells • Reach to marginalized groups improved through a) WHGs and b) Link Volunteers. • Flexible contract (developed through participatory planning workshops) and regular meetings helped in solving problems ensuring better management. • Complementary and clearly defined roles of partners prevent sense of competition. • Effective program strategies were replicated

  25. What Value Can NGOs Add to Urban RCH Programming?

  26. Contribution # 1Identifying, Mapping Underserved Urban Populations • Locating and mapping all slums and vulnerable pockets including unlisted slums, hidden and marginalized pockets. • Providing services/linkage to seasonal urban migrants • E.g. NGOs helped identify hidden urban clusters during Pulse Polio Campaigns, CINI ASHA & MUSKAAN mapped slums in Uttaranchal and West Bengal

  27. Marginalized Social Groups Constitute A Large Proportion Of Urban PoorBackground Characteristics of Urban Uttar Pradesh - NFHS II

  28. Marginalized Social Groups Constitute A Large Proportion Of Urban PoorBackground Characteristics of Urban Delhi – NFHS II

  29. Contribution # 2Improve Access to Sanitation and Other Basic Services • NGOs can facilitate sustainable community managed sanitation programs utilizing resources from National schemes such as Nirmal Bharat Abhiyan • Forge linkages with NSDP, SJSRY, DWCUA and other Ministry of Urban Development programs • Can lend an advocacy voice to the basic needs of the underserved slums at the city level • E.g. SPARC, Apnalaya & other NGOs have facilitated sanitation programs in Mumbai, Pune

  30. Contribution # 3 Enhance Demand & Utilization of Services, Build Community Capacity • Context appropriate communication activities • Capacity building of community link volunteers for counseling, linkage to health services • Mobilise slum communities for effective outreach activities • Promote community institutions e.g. NHG, SHG • Quality Assurance of existing primary care services and of less qualified providers • E.g. In IPP VIII in A.P. and Bangalore, NGOs helped improve demand for services, SAATH and SEWA in Ahmedabad.

  31. Contribution # 4Wholly Manage Primary Level RCH Facilities • Where capacity is available and public sector is absent, NGOs/Charitable hospitals can manage First tier facilities • E.g. Govt. of Uttaranchal has proposed this model in Haridwar, FPAI manages one UHC in Bhopal, Marwari Charitable Hospital in Guwahati

  32. Contribution # 5 Effective Partnerships and Convergence • Partnership building and maintenance. Facilitate coordination of meetings, help record minutes • Community-Provider (ANM) linkage, support and encourage ANMs • Linkage with other Departments, ULB, Schools, Traders Associations, Lions etc. • E.g. Counterpart International-AMC partnership, EHP Indore Ward Coordination Model, Janagraha - Bangalore

  33. Contribution #6 Innovate & Develop Models for Replication & Scale-up • Still a lot to learn about Urban Health Programming: NGOs can serve as learning centres • They can conduct operations research to provide evidence for larger buy-in • Study tours, learning lessons, building a critical mass of essential skills needed to create a snowball effect • E.g.: Apnalaya in Mumbai: Arogya Sevikas

  34. Contribution # 7 Capacity Building, Institutional Strengthening and Sustainability • Serve as trainers on a variety of topics e.g. urban vulnerability, behaviour change communication and counseling • Strengthen community-based organizations and link volunteers • Train Private informal providers • Foster Sustainable Programming • Promoting ownership among partners of program objective and processes • Facilitate Health Funds at various through available sources including community contribution • Encourage the humanistic paradigm in programming and minimize exclusion and inequity • E.g. VHAI and FPAI have served as trainers in many states; Slum Networking Project in Ahmedabad through SEWA and SAATH focus on institutional capacity at slum level

  35. Contribution # 8 Strengthening/Developing Urban HMIS • Focus on an appropriate unit for monitoring • Promote denominator based monitoring • Innovations such as “Family Chit” prior to outreach camp • Murphy’s Law: “One single accurate measurement is infinitely superior to 1000 intelligent opinions”.

  36. Contribution # 9 Develop the Field of Urban Health as a Professional Field • Emerge as UH Programming and Resource Centres on a Regional basis • Support State Govts in Planning and Monitoring Urban RCH programs • Document Urban Health Program experiences and promote cross-learning • Compile and Disseminate Urban Health Literature including data • E.g. All India Institute of Local Self Governance for Urban Development issues, SPARC for Urban Sanitation issues

  37. Looking Forward To Urban Health Program/Policy • Long Lever of : • Commitment • Knowledge • Experience • Motivation • Proximity to problems NGOs

  38. Suggestions and Recommendations

  39. Capacity Building at State and City Level Required • Capacity to select and identify the right partners: apply appropriate selection criteria • Capacity to execute and monitor partnerships/agreements • Capacity to foster and maintain external networks • Enhance orientation to focusing on the underprivileged

  40. Summary and Key Messages Innovation & Development of Models EAG States - a priority Govt. NGO Multi-Stakeholder Coordination Quality & Demand Capacity for Planning, Management & Monitoring Reach the Un-reached Sustainability: Institutional, Programmatic, Financial

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