Asha is a health and community development programme in New Delhi, India, that believes it is not enough simply to provide medical care in the slum communities. It believes the only way to bring about real and lasting improvements to these communities is through a holistic approach to community health.
Asha (the name means ‘hope’ in Hindi) works in the slums of Delhi, where conditions are very difficult:
- Over 3 million people live in 1,500 slum colonies.
- The average house measures just 2 by 3 metres but is home to six to eight people.
- One water pump serves, on average, 1,000 people.
- Many slums have no sanitation facilities.
- 40% of children are severely malnourished.
- 75% of men and 90% of women are illiterate.
By definition, slums are informal settlements built on any unused public land that migrant people can find. They are often built near railway tracks, drainage canals or low-lying areas likely to flood. Slum dwellers typically live in small huts constructed from whatever materials can be found. The huts, which are crowded together along narrow mud lanes, lack proper ventilation and offer little protection from the extreme heat of summer, the rains of the monsoon and the chill of winter. Disease and fire are ongoing problems. Slums suffer from serious environmental disadvantages and lack basic facilities. Residents have to cope with clogged drains, stagnant ponds, poor water supply and inadequate waste disposal and sanitation. These problems become worse in hot weather and the monsoon rainy season.
People’s environment, particularly their access to sanitation and safe drinking water, has a major impact on their health. As well as providing healthcare, Asha sees improving facilities and the local environment as key to its work. It develops and supports empowerment and self-help schemes for slum dwellers, particularly women and children. Through the mobilisation of the slum communities, people find motivation to improve their environment.
Asha’s community health volunteers work with many community groups to bring about change. These groups include mahila mandals (women’s associations), mal mandals (children’s associations), and also groups of youths and men. Asha provides training to encourage members and give them confidence to lobby local politicians to provide assistance and services.
Changes across society
After identifying problem areas, local ‘agents of change’ work on three levels – individual, household, and community.
Targeting individuals They work to educate and motivate family members, friends, and the general slum popu lation. They encourage people to practise good household and personal hygiene, to use latrines rather than defecating in drains or on the streets, to use safe water supplies and to clean up and dispose of waste safely. Their efforts make a real difference. However, only so much can be achieved by individual behaviour change.
Targeting groups Asha provides training and support to encourage groups to work with local government and public health officials Their support is key to making improve ments to facilities and conditions in the slums. Slum residents are taught about their rights and the responsi bilities of local government to provide improvements. People are also given skills training in making presentations, negotiating, advocacy, and lobbying.
The women’s groups (mahila mandals) often prove to be highly effective pressure groups in lobbying local authorities to improve public facilities. This has resulted in improved access to safe drinking water through providing taps, handpumps, tube wells, tanks and tankers. The building of community toilets has reduced defecation in the open. Lanes are now paved with bricks or concrete and have a proper drainage system. Improved and unblocked drains have reduced the amount of stagnant surface water. Due to community education, there is better use of latrines, fewer community conflicts, and commitment by the community to keep their surroundings clean.
Asha emphasises the importance of commitment and perseverance in achieving results. Staff will provide support when needed, including accompanying community members when they visit the relevant authorities. Many local politicians have come to respect, trust, and even rely on advice, from organised community groups for ways to improve the living conditions in slums. Community empowerment has greatly increased the accountability of local government and politicians. They now see it as essential when slum improvement programmes are carried out.
Targeting community action Dr Kiran Martin, the founder and director of Asha, has also established innovative slum housing projects in cooperation with the city’s government. These efforts have led to the granting of land rights through a housing cooperative. Land is allocated, with housing plans prepared by local government staff. Lots are drawn for the land and people move out to another part of the slum while they build themselves new homes. They re-use building materials from their existing homes and buy new materials by obtaining loans. New water and sewage connections, drainage systems, street lighting, pavements and community centres are built.
The housing co-operative charges residents a regular small fee to cover the costs of maintaining the area. This enables the slum to become a self-sufficient housing estate running its own affairs. These projects have completely transformed swampy, dirty, overcrowded slums. One unique and innovative feature is that land ownership is given to women living in the slums. This model has now become the basis of Delhi’s slum policy. The city’s government has replicated this model in many slums.
Improving the slum environment, combined with land tenure, community empowerment and health programmes, has resulted in extraordinary improvements in the living conditions and health of slum inhabitants. In the slums where Asha works, deaths among young children have been significantly reduced and diseases linked to dirty water and poor sanitation have been greatly reduced.
Dr Ambika Rajvanshi is a doctor who has worked with Asha for two and a half years.
Key Learning Points
- Improving health requires improving the environment, particularly access to safe water and sanitation.
- Mobilised community groups are key to bringing about change, both in individual behaviour and in local authorities, to bring about change in facilities.
- Provide politicians and local authorities with clear ways forward.
- Housing co-operatives which give land ownership to women can transform slum areas.
Case study: Seelampur toilet complex
Seelampur shanty town is home to 25,000 people. For the past seven years the toilet facilities were neglected, dirty and infested by pests. Two years ago both the roof and the floor caved in.
Seelampur’s women’s group (mahila mandal) had been lobbying local authorities for many years to try to get new facilities. During election time in 2003 they increased their efforts. When the local councillor began her campaign, the mahila mandal women told her that she would not receive their support until an agreement was reached about new toilet facilities. A new toilet complex was soon promised. However, the battle did not end there. The women had to visit the councillor and slum department regularly, persistently knocking on doors until work began eight months later.
During the opening ceremony, the new councillor thanked Asha for its support. She also spoke of the persistence of the mahila mandal women’s group in Seelampur. As a Muslim woman, the councillor praised the women for removing their veils and speaking out to provide this improvement for their families. She also promised to construct more toilets and washing rooms.
This sector of the slum now has hygienic facilities that will prevent disease and preserve the dignity of the residents. This achievement is a practical expression of women’s empowerment.