Draft Summary

Situational Analysis Report of Agra City

for

Guiding Urban Health Program

February 2005

Better Health in Underserved Urban Settlements

Draft Summary Situational Analysis Report of Agra City for Guiding Urban Health Program

December 2004

Key USAID Contact: Dr Massee Bateman, Senior Child Health Advisor

USAID-EHP URBAN HEALTH PROGRAM

Supported by United States Agency for International Development through a contract with Camp Dresser & McKee International Inc.

ii

Acknowledgements
We gratefully acknowledge contribution of many urban health stakeholders of Agra, for their active help, support and insights without which it would not have been possible to compile this short situation analysis report. We wish to express our gratefulness to Shri Nitishwar Kumar, I.A.S, District Magistrate; Dr. Roshan Lal, Chief Medical Officer for providing information on various subjects and supporting the process of obtaining and analyzing information. Many thanks are due to Dr Deoki Nandan, Principal S.N. Medical College for helping start the situation analysis process through the first stakeholders meeting in Agra. Dr. Shamsher Singh, Deputy Chief Medical Officer, Dr. Anita Gupta, Senior Medical Officer and all Lady Medical Officers (Urban), Health Visitors and ANMs were very helpful in understanding the Urban Health Delivery system and analyzing the difficulties and possible options. Shri A.K. Singh, Municipal Commissioner, Shri S.K. Singh, Former Municipal Commissioner, Dr. R.S. Jaiman and Dr. P.K. Agarwal, Senior Municipal Health Officers, Ward Councilors and Sanitary Inspectors are gratefully acknowledged for sharing their perspectives and providing information on different aspects particularly important insights on Agra slums. We would also like to thank District Project Officer, C.D.P.O., Supervisors and Anganwadi Workers of the Department of Women & Child Development; Project Officer - SIFPSA; Project Officer - DUDA; Project Officer - CARE; SMO - NPSP, WHO, Shri Ravi Kashyap, SNBI, General Manager, Jal Sansthan, Director, ESI, Agra, Director, JALMA, Agra Iron and Foundry Association, Dr. P.S Mehra, Relief Hospital, Dr. Irshad, Meena Charitable Hospital, Presidents, Jatav Panchayat, Mahila Utthan Samiti for their active participation during the stakeholders consultations and individual interactions. Learnings gained from these meetings helped in building the situational analysis and are reflected in this document. Our special thanks go to Dr. Massee Bateman, USAID India for his active interest and constant guidance during the entire course of the study. Untiring efforts of EHP colleagues Ms. Kirti Ghei, Mr. Anuj Srivastava, Ms. Madhvi Mathur, Mr. Pravin Jha, Shivani Taneja and Dr. Sainath Banerjee are greatly valued. Support, encouragement and comradeship of Mr. S.K. Kukreja, Arti Bhanot, Sandeep Kumar, Prabhat Jha and Rajeev Nambiar have been of immense value. This report has been prepared by Karishma, Dr. Rajesh Dubey, Anju Dadhwal, Srinivas Varadan, Mani Gupta and Dr Siddharth of the USAID-EHP Urban Health Program team. We hope that this report will be able to extend its reach as it is used by various stakeholders and program implementers. We look forward to comments and suggestions from its readers.

iii

Table of Contents
1.1. City Profile 1.2. Urban Poverty in Agra 1.3. Existing Public Sector Health Facilities 1.3.1. Public Sector Health Facilities 1.3.2. Other Central Government Facilities 1.3.3. Private Health Facilities 1.4. Health Scenario Among the Urban Poor in Agra 1.5. Other Development Programs in Agra 1.5.1. Swarna Jayanti Shahari Rozgar Yojana 1.5.2. Integrated Child Development Services 1.5.3. Early childhood Care for Growth, Survival and Development Project (ECCD) 1.5.4. SIFPSA Supported Projects 1.5.5. CARE 1.6. NGOs and CBOs Working in Agra 1.6.1. Current activities of NGOs and CBOs 1.6.2. Implementations and Existing Options for EHP 1.7. Private Industry 1.7.1. Footwear Industry 1.7.2. Foundries 1.7.3. ESIS Registered Units 1.8. Need Analysis and Pointers for Improving the Health Delivery System 1.8.1. Location of the Health Facilities 1.8.2. Targeting of the Vulnerable slum population 1.8.3. Public private partnership 1.8.4. Strengthen and optimize Use of Infrastructure 1.8.5. Regularity in Services 1.8.6. Integration of development programs in the city

iv

AMC ANM ANC ARI AWW BCG BPL CBD CBO CDS CMO CPR DDK DoMHFW DPT DTHC DUDA DWCUA ECCD EHP ENT ESIS FGD FICCI GoI GoUP HIV ICDS IPPI IFA IFPS LHV LMO MCH MTP NABARD NFHS NGO NHC NHG NSS OPD ORS PPC RCH RCV

List of Abbreviations Agra Municipal Corporation Auxiliary nurses midwife Ante-natal care Acute Respiratory Infection Anganwadi Worker Bacillus Calmette Guerin Below Poverty Line Community Based Organizations Community Development Society Community Development Society Chief Medical Officer Couple Protection Rate Disposal Delivery Kit Department of Medical Health and Family Welfare Diphtheria Pertussis Tetanus D Type health centre District Urban development Agency Development of Women and Children in Urban Areas Early Childhood Care for Survival, Growth and development Project Environmental Health Project Ear, Nose & Throat Employee State Insurance Services Focus Group Discussion Federation of Indian Chambers of Commerce and Industries Government of India Government of Uttar Pradesh Human Immunodeficiency Virus Integrated Child Development services Intensive Pulse Polio Immunization Iron Folic Acid Integrated Family Planning Services Lady Health Visitor Lady Medical Officer Maternal and Child Health Medical Termination of Pregnancy National Bank for Agriculture and Rural development National Family Health Survey Non Government Organization Neighborhood Committee Neighborhood Group National Sample Survey Out Patient Department Oral Re-hydration Salts Post-Partum Centre Reproductive and Child Health Resident Community Volunteer v

RTI SIFPSA SJSRY SLI STD/STI TT UFWC UHC UNICEF UP UPAP USAID

Reproductive Tract Infection State Innovations in Family Planning Services Project Agency Swarna Jayanti Shahari Rozgar Yojana Standard of Living Index Sexually Transmitted Disease/Infection Tetanus Toxoid Urban Family Welfare Centre Urban Health Centre The United Nations Childrens Fund Uttar Pradesh Urban Poverty Alleviation Programme United States Agency for International Development

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Situation Analysis, Agra

1.1 CITY PROFILE

Draft

India is experiencing rapid and unplanned urban growth. Of Indias total population of 1027 million1, 285 million (27.8%) live in urban areas. The percentage decadal growth of population in rural and urban areas from 1991 to 2001 is 17.9 and 31.2 percent respectively. The slum population in 2001 is estimated to be tune of 60 million 2 , comprising 21 percent of the total urban population. However, these estimates do not reflect the true magnitude of urban poverty because of the un-accounted for and unorganized squatter-settlements and other populations residing in inner-city areas, pavements, constructions sites, urban fringes, etc. Undoubtedly, significant proportions of the urban population live in slums or slum like conditions, which seriously compromise health and sanitary conditions, putting them at a much higher morbidity and mortality risk than non-slum populations. Therefore, Urban Health Program for slum is one of the thrust areas in the 10th five year plan, RCH II, National Population Policy and National Health Policy. In continuation to this, GoI identified four cities, Delhi, Agra, Bally and Haldwani to develop sample urban health proposal. In effect, Agra was taken up for the development of urban health plan. Urban population in Uttar Pradesh constitutes 20.78% of the total population. While the urbanization rate of the state is still well below the national average of 27.78%. In absolute terms, this amounts to nearly 35 million people residing in 684 towns and cities3. With nearly one in three city dwellers estimated to be poor, it amounts to approximately 10 million people 4 living below the poverty line in the urban areas of UP. There is increasing evidence that the urban poor, particularly those residing in slums and squatter settlements, have health indicators comparable to or even worse than their rural counterparts. Addressing health inequities within cities and providing quality health care to slum dwellers has emerged as an issue of critical importance for Uttar Pradesh. Agra city, which is spread over an area of 140 sq. km. along the banks of the river Yamuna, is one of the major cities of Uttar Pradesh. The history of the city dates back to 1475 AD when Raja Singh Badal laid the foundation for the city. The post-independence growth of the city was linked to the large scale influx of refugees as well as migration from rural areas. This led to the congestion of the central part of the city, which to date remains highly congested with very poor civic facilities. With planned industrial development in the 70s and 80s, three important industrial areas of Agra, namely Nunhai, Sikandra and Foundry Nagar were established. This led to the further growth of the city in the north-western and north-eastern directions.

1 2

Census 2001 National Commission on Population, 2000, Ministry of Health and Family Welfare, GoI 3 Population Estimate, Census 2001 4 NSS Consumer surveys, Official Poverty Lines and Corrected Estimates from Deaton, 2001

Table 1.1: Population Growth (Census data)

1991 (in lakhs) 27.51 9.43 2001 (in lakhs) 36.11 13.31 Growth rate (1991-2001) 31.27% 41.14%

AGRA District AGRA Urban

The total population of Agra urban agglomeration (which includes Cantonment areas, Swamibagh and Dayalbagh) is 1,331,339; whereas the population under Agra Municipal Corporation as per the 2001 census is about 12.75 lakhs. The city is now growing in the western direction following the Delhi-Agra corridor in a linear pattern. The decennial growth rate of Agra city (1991-2001) is 41.14% which is twice the national decennial growth rate of 21.34%. Population density of Agra is 897 persons per square kilometer as compared to the Indian average of 324. These data indicate the immensely overcrowded habitat conditions in the city. According to the 1991 census, the sex ratio of the city is 852 females per 1000 males (Indian average is 933). Administrative Structure Agra city is governed by Agra Municipal Corporation, Agra Cantonment Board and Dayal Bagh & Swami Bagh Nagar Panchayats. Majority of the slum clusters mainly fall in the area of the Agra Municipal Corporation. The Agra Municipal Corporation was constituted on 30th November 1975. The spatial area of Agra Municipal Corporation is spread over 120.57 sq. km. The remaining area of 20 square kilometers falls within the Cantonment Board and Swami Bagh and Dayal Bagh municipalities. The entire area of the Corporation is divided into 80 electoral wards, while for the purpose of revenue collection the area of Agra Municipal Corporation has been divided into 8 divisions. Each of these divisions has been further divided into several zones. The 8 divisions are Hariparvat, Lohamandi North, Lohamandi South, Rakabganj, Chatta, Kotwali, Ward No. 7, and Tajganj. Various governance functions are carried out by the Administration, Engineering and Lighting, Accounts, Health, and Revenue departments of Agra Municipal Corporation. 1.2 URBAN POVERTY IN AGRA The Census of India 2001 estimates the population of Agra at 13.31 lakhs, while unofficial estimates put the figure over 16 lakhs. The slum assessment process in Agra shows that 8.41 lakh people live in slums, which is about 50% of the citys population5. and squatter settlements. However, official figures reported in the last census (1991) indicate only 9.67% slum population. The official slums list of DUDA in Agra records 252 slums6. During slum assessment only 215 DUDA recognized slums could be found in the city and subsequently assessed. And out of the remaining slums in DUDA list, some were found repetitive, while other could not be located7. As part of slum assessment8 , slum list9 of other departments such as Agra Municipal Corporation, Health Department (1st tear Facilities), Pulse Polio Immunization Campaign, ICDS were also obtained to identify other slums. Other key
5 6

Refer Annex 1 the U.P Slum Areas (Improvement and Clearance) Act, 1962. Refer Annex 2 for Official slum list of DUDA. 7 Refer Annex 3 for list of slums not found in DUDA list. 8 Refer Annex 4 for Vulnerability Assessment process. 9 Refer Annex 2 for official slum list of AMC, pulse polio, ICDS, Health Department.

informants such as the Ward Councilor, ICDS supervisors, Sanitary Inspectors, Medical Officers and ANMs of the 1st tier facilities were also consulted to identify other slum like settlements in the city. The vulnerability assessment exercise carried out in the city revealed a total of 393 slums. There are six areas where these slums are concentrated in Agra namely Lohamandi, Rakabganj, Bundu Katra-Gwalior & Deori Road, Tajganj, Shahganj and Trans-Yamuna area. In addition, there are a substantial numbers of slums, which are scattered. A large majority of these slums are situated along nalas and railway lines. Most slums in the city are characterized by poor sanitation, drainage, and water facilities. Housing structure is pucca (concrete) in most slums of Agra, unlike other cities. Access to basic services in each slum is a major determinant of health vulnerability. The assessment and plotting of slums was undertaken to understand slums from a health perspective and accordingly grade them as per their level of vulnerability. The vulnerability assessment criteria included social conditions, living environment water and drainage systems, sanitation facilities, access to public health services, health and disease prevalence, economic conditions and organized collective efforts at the community level, etc. Status of Vulnerability in Slums10 Most Moderately Less Total Vulnerable Vulnerable Vulnerable DUDA Recognised Slums 90 88 37 215 Unrecognised Slums 93 85 0 178 Total 183 173 37 393 The slum assessment revealed that about 20 % of the slums exist in the Trans Yamuna area and that the slums in this area are largely scattered. In contrast, the slums in Rakabganj area, which is also part of the old city, are highly congested and the density of population in these settlements is fairly high. Areas such as Trans Yamuna and Bundu Katra have settlements that were largely rural and due to the rapid expansion of the city have transformed into new slums of the city. An analysis of the slum assessment findings revealed the following situation: A large number of slums are located near dirty, open nalas. This leads to higher malaria, diarrheal disease incidence in these slums. Slum dwellers have individual sources of water (taps / handpumps) in most slums. However, water supply is generally limited to 2-6 hours in a day. Water quality is poor (yellowish, hard water, smelly) in a few slums. Sanitation is the most pressing issue in a majority of slums with situations varying from existence of individual toilets which lead into open drains to a total absence of individual or public toilet facility. Children defecate in drains in most slums. Drains are open and narrow, which remain blocked due to disposal of solid waste and no regular cleaning. Regular cleaning is done in better off slums where residents pay monthly charges to private cleaning staff.

10 Refer to Annex 5 for list of slums in the three groups - highly vulnerable, moderately vulnerable and less vulnerable.

A majority of slums have kharanja, a few have cemented roads. Kharanjas are broken in places. A few slums also have katchcha roads. Slum dwellers prefer to access private health facilities due to better attention/services or proximity of these services. Deliveries are conducted at home by untrained dais in a large majority of slums

1.3 EXISTING PUBLIC SECTOR HEALTH FACILITIES Health services in Agra are provided by the Public sector, Department of Medical, Health and Family Welfare, and Agra Municipal Corporation and Private sector (hospitals, nursing homes, and clinics). In addition, there are several charitable hospitals, which provide subsidized health services to the poor. Also, there are Central Government health facilities, which include Railways hospitals, ESI hospital and dispensaries and Cantonment hospitals and dispensaries. 1.3.1 Public Sector Health Facilities 1.3.1.1 Department of Medical, Health and Family Welfare 1.3.1.1.a First tier facilities Primary health care in the city is provided through 15 D-Type Health Centers (DTHCs). Of these 15 D-Type health Centers, nine are located in rented buildings of Agra Municipal Corporation and one is located in the Red Cross Building, but all these six are also run by DoMHFW. Lohamandi I, Shahganj I, Jeoni Mandi and Chatta D-Type health centers (located in AMC buildings) also have dispensaries. D-type health centers of the Yamuna Par has a maternity home providing obstetric care services. In addition, there are 2 post-partum centers run by the District Administrator-one located at S.N Medical College and the other at Lady Lyall Hospital and the other at T.B Demonstration Centre and a Medical Care Unit in Trans-Yamuna area, all of which are not functional as first tier facilities. The major services provided by the D-Type health centers include immunization, antenatal care, and family welfare services through OPD and outreach activities. Each of these D-Type Health Centers is headed by a Lady Medical Officer (LMO) and 3-4 paramedical staff. In the five DTHCs located in AMC building, there is provision for a Health Education Officer (HEO) and out of which, HEOs are present in 4 DTHCs, and fifth one in Lohamandi-I has retired. These five D-Type Health centers, which are running from AMC buildings are in very poor shape and have not been repaired for several years due to lack of funds. The other 10 are operating as one to two room units in rented buildings, which may not be the most appropriately located D-Type health Centers are providing maternal and child health and family welfare services to a normative population of 50,000. however, due to substantial increase in the population of the city over time, each health center is now creating to a population of 70,000 to 100,00. Due to shortage of staff vis--vis the catchment area, it is evident that the existing primary health delivery system is inadequate to respond to the health needs of the burgeoning urban population, of which approximately 50% reside in slums or slumlike conditions.

1.3.1.1.b Second tier health care services In Uttar Pradesh, health services are provided in urban areas through district male and female or combined hospitals. In Agra, there are three Governmentrun secondary / tertiary level hospitals. S.N Medical College: This is the main referral hospital, which has 976 bedded capacity offers free of cost services, includes OPD, Laboratory services, X-ray, Ultrasound, etc. District Hospital: It has 118 bedded capacity with 62 doctors and 96 Paramedical staff. Offers OPD, in-patient, Radiology, Pathology, Ultrasound and HIV test facilities. They also undertake occasional outreach activities. District Women Hospital (Lady Lyall Hospital): It has 331 bedded capacity in public and private wards. Gynecology, Obstetrics and Pediatrics services: OPD, conduct deliveries, tubecotomy and MTP.

1.3.2 Other Government Facilities 1.3.2.1 Employee State Insurance (ESI) Services Employees State Insurance Scheme is an integrated social security scheme tailored to provide social protection to workers and their dependents for sickness, maternity and death or disablement due to an employment injury or occupational hazard. This is a contributory scheme, which gets contribution from workers (1.75%) and the employers (4.75%). This is applicable in those establishments where 10 workers are employed and electricity is being used or establishments which has 20 work force with electricity not being used. Under the scheme, workers are entitled for medical benefits, cash compensation and holidays. They also get medical facilities for their dependants. Apart from employee and employer contribution, to run the scheme in a particular state, each state government also has to contribute and there is a Corporation, where the entire collected amount goes and thereafter Corporation disburses it accordingly. Therefore, Central and State Governments both together play a crucial role to run this scheme in a particular state along with workers and employers contribution. Under ESI scheme, the state of UP has been divided into 8 zones and each zone has CMO as an in charge. In Agra city, there are 3 dispensaries which are located at Chippi Tola, Nunihai Industrial Area and Fatehabad Road and one Hospital, which is located at Central Jail Road. In addition, ESI also has 3 mobile dispensaries. At dispensaries, regular consultation is given by the doctors. At each dispensary, there is one or two doctors posted. For any major issue or specialized treatment, Insured Persons (IPs) refer to the ESI hospital. In Agra, there is a 100-bedded hospital with all the facilities. There are 4 lady doctors, 1 general surgeon, 1 general physician, 1 Pediatrician, 1 ENT specialist, 1 radiologist, 1 pathologist, 1 Orthopedic surgeon are available at the hospital. Apart from regular OPD service, which functions between 8 am to 2 pm, there are also facilities for deliveries, tubectomy, MTP, general surgery, laboratory, X-ray, ultrasound and physiotherapy. All these facilities are given free of cost.

Apart from this, three hospitals located at Agra Cantt, Idgah Station, and Agra Fort are run by the Railways for the employees and families of the Railways. Beside this, there is one Cantonment Hospital and two Army and Air Force Dispensaries for provision of basic and specialized health services to the families of defence personnel. 1.3.2.2 Central JALMA Institute for Leprosy and Mycobacterial Diseases The central JALMA Institute for Leprosy and Mycobacterial Diseases came into existence on 1st April, 1976 when the India Centre of Jalma was officially handed over to GoI and subsequently to Indian Centre for Medical Research. It was originally established as India centre for Jalma in 1966 and was managed by a Tokyo based voluntary organization, Japanese Leprosy Mission for Asia (JALMA). Recently, the scope of work has been broadened and therefore the word Micro-bacterial diseases has been added with the name of the institute. It carries out research in the following areas: Early diagnosis, Improving and monitoring treatment, Prevention and correction of deformities, study on other mycobacteria, field studies and Operation Research. In addition to its research activities, it does offer OPD service for leprosy patient absolutely free. The timing is 9 am to 3.30 pm from Monday to Friday. The no. of total doctors are 10, which includes 2 general physician, 1 Gynecologist, 1 Pediatrician, 2 Dermatologists, 1 Surgeon etc. It also has inpatient facilities, where there are 60 beds available with all the facilities and there is no charge for any facilities at the institute. It comes under the Indian Centre for Medical Research, Ministry of Health, Government of India and it is being headed by the Director and supported by Deputy-director. For the effective functioning and better management, apart from 10 specialised Medical Officers, it also has over 200 support staff to cater the in and out patients at the institute. 1.3.2.3 Additional Central Government Facilities In the Agra city under the central government jurisdiction, three hospitals located at Agra Cantt, Idgah Station, and Agra Fort are run by the Railways for the employees and families of the railways. Beside this, there is one Cantonment Hospital and two Army and Air Force Dispensaries for provision of basic and specialized health services to the families of defence personnel. 1.3.3 Private Sector Health Facilities 1.3.3.1 Charitable Hospitals In Agra, there are several charitable hospitals and dispensaries which offer services to slum dwellers at the subsidized rate. One of the charitable hospitals, which is located on Fatehabad Road offer first and second tier services at subsidized rate. It is being run by the P. C Mangalick Public Charitable Trust. As an effort to increase in-flow of patients (who receive subsidized health care and free immunization services), the hospital has engaged Health Volunteers who bring in patients from the rural areas. On a smaller scale, this approach is being implemented in selected slums in Tajganj area, where they have person based in those slums, who helped community members to reach to the hospital.

Another charitable trust, Sharan Ashram Hospital located on Dayalbagh Road was established in 1931. It offers only OPD services free of cost. All doctors associated with the hospital work as an honorary and part-time consultants. Since all these doctors have faith in Radha-Swami philosophy therefore they offer their services free of cost. Generally, doctors spare 2-3 hours in a day for 3-4 days in a week. Apart from OPD services, there is no provision for in-patients who come for OPD services also get medicines for common ailments free of cost. All this expenditure is borne by the trust. They 1.3.3.2 Private (for profit) Facilities A large number of slum residents seek medical care from the private sector, which includes a huge network of for-profit institutions. As the information available at CMO office Agra that there are over 450 Nursing homes and private practitioners in Agra. There are few private hospitals and charitable institutions are frequently accessed by the slum dwellers due to their convenient locations and reasonable charges for different services. Existing linkages between health department and private hospitals is limited to receiving free supply of vaccines for the national immunization program as well as partnerships with SIFPSA for family planning services. 1.4 HEALTH SCENARIO AMONG THE URBAN POOR IN AGRA Agra city has been divided into 8 zones. Further, the city has a substantial number of slums, which includes a total of 393 slums. However, the 8 zones were clubbed into 6 areas where Focus group discussions (FGDs) were conducted. FGDs were conducted in randomly selected 25 urban slums11 with groups of mothers to identify current beliefs and practices pertaining to maternal and reproductive child health and with mixed groups (women and men) pertaining to hygiene practices. In-depth focus group discussions were carried out with the target beneficiaries to understand their attitudes, knowledge and values. FGDs in Agra slums provided a qualitative picture and substantiated urban slum data. This information helps the programme personnel to design sustainable program design and interventions12. A. Care during pregnancy FGD findings showed that the slum women perceive pregnancy as a natural process associated with risks, which every woman undergoes in her life. Almost all women think that pregnancy is Gods wish and is beyond their control. On an average, half of the total pregnancies get registered either with the ANMs or private practitioners or D Type Health Centers. Of these registrations, maximum women go to public or private health centers only when there is some complication, routine antenatal checkups is commonly not done. Pregnant women who get TT injections reported to have received their first TT vaccine at the sixth month of gestation and second dose in the seventh month. IFA consumption is found to be very low, and no woman talked about taking additional diet and rest during pregnancy.

Refer Annex 7 for list of Slums selected for Focus Group Discussions Aubel Judi, 1994. Guidelines for studies using the group interview technique. International Labour Office & World Employment Programme
12

11

Indicator

Reanalysis of NHFS-II, Uttar Pradesh Urban Urban Low SLI 78.0 76.7 36.8 61.4 51.7 74.1 63.4 9.1 85.3 26.2

Antenatal Care Percentage of births whose mothers consumed iron-folic acid supplements for 3+months Percentage of births whose mothers received tetanus toxoid vaccines (minimum of 2) Percentage of births whose mothers had ante natal visits (minimum of 3) Safe Delivery Percentage of deliveries at home Percentage of deliveries attended by a health professional at home or at a health facility

Similarly, cross-sectional surveys by NFHS II UP show average figures of 78%, 76.8% and 36.8% for pregnant women in urban U.P receiving Iron folic acid tablets, tetanus toxoid vaccines (minimum of 2) and antenatal care (minimum of 3), respectively. If we look into the break-up of averages derived from the reanalysis of NHFS II U.P., EHP (2004)13, the corresponding figures are 74.1%, 63.4%, and 9.1% respectively. The data makes it clear that as income levels go down, the health realities also change and therefore special focus on the urban poor is required. B. Complications during pregnancy and birth preparedness Oedema, abdominal pain, fatigue and dizziness are the signs of complications reported by the women. During complications, women are generally taken to private hospitals/nursing homes for treatment. Family members do not prefer to take the patient to Government hospitals because of poor quality of services and inadequate attention by hospital staff. Birth preparedness is not considered necessary by the slum women, they said, why should we think negative; when something happens we make immediate arrangements (financial, transport etc) to tackle the situation. In some slums, the women believe that any type of birth preparedness is considered inauspicious for the newborn baby and mother. C. Safe Delivery Practices Most of the deliveries are conducted at home by untrained dais, family members and relatives. A few women call a hospital nurse for conducting delivery at home. Data for urban low SLI, Reanalysis of NFHS II, EHP (2004) shows a similar picture i.e. 85.3% of the deliveries take place at home and of all the deliveries, only 26.2% are attended by trained health professional at home or at a health facility. The trained birth attendant charges are high, ranging from Rs.500/- to Rs.1000/- for conducting a delivery. In home delivery, 100% women reported the use of a new blade for cutting the cord. They also reported the practice using new thread for cord tying and applying coconut oil on cord stump. Even a trained person applies some powder and ointment on cord stump in home deliveries. The selection of persons for assisting delivery depends on the availability of persons and financial resources. Some women told that they would prefer to have delivery in a hospital to avoid last minute rush in case of an emergency. They also mentioned that hospital deliveries prevent the family members from the laborious process of cleaning up the delivery place. Financial constraints compel most of the people to have home deliveries. Women are taken to hospital, when it becomes unmanageable by the birth attendant to safely carry out the delivery at home.

13 Refer Annex 5 for Reanalysis of Uttar Pradesh NFHS II (1998-99) by SLI, USAID-EHP Urban Health Program

D. Complications during delivery Some of the women said that complications usually occur when the woman is weak and incapable of bearing the stress of labour. Complication during delivery is recognized, when a woman has a difficult labour and the dai informs the family about her inability to handle the case. The main complications that were reported were excessive vaginal bleeding, abnormal position of fetus in womb and rupturing of the amniotic sac. During complications, women are immediately taken to the private doctors/ nursing homes for treatment. Very poor people take women to government hospitals during complications. E. Newborn Care Practices Breastfeeding NHFS II shows that only 7.9% mothers start breastfeeding their babies within one hour of birth in Urban U.P. The reanalysis of NHFS II data, EHP (2004) reports more critical condition in Urban Low SLI, U.P. (2.7%). FGD findings revealed that in most families, breastfeeding is initiated usually 2 -3 days after birth. Till this time the baby and mother are considered untouchable because they have gone through the unhygienicy process of delivery. A hindu priest Pandit is called to perform some ceremony after which the baby is given mothers milk (in Hindu families). Almost everyone follows the ritual of initiating breastfeeding after sunset and during late evening in the presence of stars, which is believed to have a cooling effect on the child and the mother for their entire life. Some mothers reported that if the baby is born during morning hours, they start breastfeeding the child after 8-10 hours of birth. Until the baby is put to the breast, prelacteal feeds like jaggery water, jaggery, honey and cows milk are given. They consider yellow thick milk - colostrum to be bad for babys health because it is seen as a stale product coming out of the mothers breast after 9 months of gestation. Therefore, in most of the families, it is discarded. Thermal protection- It was found that in almost all the slums, babies are bathed immediately after birth to remove the greasy substance from his/her skin. This is the norm in all seasons, and is also practiced for low birth weight babies. After bathing, the baby is wrapped up in woolen clothes during winters and in cotton clothes during summers. The baby is usually laid down beside the mother. During winters warmth is given by burning coal/wood in Angithi in babys room. In each family, efforts are made to keep the baby and house warm to the extent, familys resources allow. Prevention of Infection Focus group discussions revealed an interesting fact that in most of the families the mothers struggle to prevent the newborn from any ill effect due to contact with evil eyes (najar lagna) and evil spirits. The community has a deep-rooted belief in black magic. Hence, to safeguard their children from all these, they minimize social contact for low birth babies and avoid exposure to external environment. Almost all the groups told that during infections, like fever, pneumonia, jaundice, diarrhea and vomiting, the newborn is taken to the private practitioners (nearby doctorsqualified/unqualified) for treatment. If the doctors treatment does not result in any improvement in the babys health, then the baby is taken to ojhas- traditional healers for healing.

Indicator

Reanalysis of NHFS-II, Uttar Pradesh Urban Urban Low SLI 7.9 76.0 2.7 89.1 53.2 44.8

Breast Feeding Percentage of infants breast fed within one hour of birth Percentage of infants whose mother squeezed first milk from breast Percentage of children 0-3 months who were exclusively breastfed Complimentary feeding Percentage of children 7-9 months who received breast milk and solid/mushy food

Identification of danger sings Main signs of complications reported in newborn included absence of crying or any movement, very small and weak appearance, yellow eyes jaundice, inability to suck the breast and cold to touch. A baby with any of these signs is taken to a nearby doctor. Most women do not find any health benefits of weighing at birth while a few women told that weighing at birth is a good indicator of babys health. Weighing newborn is not a regular practice in slums. In the case of a hospital delivery, the newborn is immediately weighed after birth. F. Immunization Coverage NFHS II data (urban UP) shows that 32.3 % of the children were fully immunized by 1223 months of age and the corresponding figure for urban low SLI is 29.7% (Reanalysis of NFHS II, EHP 2004). The left-out rate (i.e., the percentage of children who did not receive the first DPT dose) is 24.2% for urban U.P and it is as high as 49.7% for Urban Low SLI. Most of the children have received one vaccine or the other. Some (20-25%) mothers were found to be aware about health benefits of immunization. They told that complete immunization of children can prevent them from diseases. Very few (5-10%) educated parents take their children for vaccination to the Government Hospitals/ D- Type Health Center/private practitioners. Slums which reported regular visits by the ANM also reported incomplete vaccination of children because neither does the ANM bother to visit each and every household of the slum nor are the parents concerned about the immunization status of their children. The slums which are situated at the periphery of the city have very low (almost nil) immunization coverage. Similarly, the slums located around medical college/D type health centers have relatively better coverage as most of the mothers take their children to immunization centers. Almost all the slums were found to have regular administration of polio drops during IPPI rounds. The babies born in the hospital get immunized for BCG and after that very few people take them for immunization.
Indicator Immunization rates Percentage of children completely immunized among 12-23 months children Percentage of children completely immunized among 12-23 months children Percentage of children received measles immunization among 12-23 months children Percentage of children left out from UIP (Children not receiving DPT1) among 12-13 months children Percentage of children dropping out from UIP (DPT1 to DPT3) among 12-13 month children. Reanalysis of NHFS II, Uttar Pradesh Urban 32.3 32.3 50.0 24.2 26.2 Urban Low SLI 29.7 29.7 34.7 49.7 9.7

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G. Feeding Practices among Children The reanalysis of NHFS II, U.P reveals that 53.2% of the children (0-3 months) in urban Low SLI were exclusively breastfed. However, it was found during the FGDs that no single mother practices exclusive breast feeding of her child. In almost every family, the baby is given jaggery, honey, tea, cows milk etc. Giving sweet foods like jaggery, honey is considered auspicious for the baby; as it is believed that the baby will continue to get good food for the rest of its life. Complementary feeding usually starts between 4 to 12 months of age. Some mothers start giving complementary foods as early as four months while some start it around 10- 12 months of age. Similarly the Reanalysis of NHFS II, U.P. shows that 44.8 % mothers begin complementary feeding for their children at age of 7-9 months. H. Family planning practices NHFS II (1998) data for urban U.P shows 44.8% as the usage of modern contraceptives for birth spacing, and 19% for adoption of permanent sterilization methods. The parallel figures reported by Reanalysis of NFHS II, EHP (2004) are 21.3% for modern contraceptive methods among low SLI of U.P and 7.1% for permanent methods.This indicate that there is minimal effort in delaying the first pregnancy or introducing a gap between two pregnancies. The information collected through group discussions showed that most of the mothers are aware of the consequences of repeated and closely spaced pregnancies. They mentioned that it makes the woman weak by draining out all the nutrition from her body, and affects the health and nutritional status of the baby. The community women realize that families with limited financial resources cannot afford to provide good nutrition and education to more children, therefore, they prefer to have small sized families. But a strong preference for more male children in the family was revealed as the foremost driving force behind a large family size of 7-8 members, with 5-6 children. Following are a few reasons that demonstrate the motive behind having at least one male child in the family:
Indicator Reanalysis of NHFS-II, Uttar Pradesh Urban Low SLI 31.3 44.8 36.6 18.0 1.0 19.0 30.9 21.3 13.8 6.4 0.7 7.1

Birth Spacing Birth Interval (median number of months between current and pervious birth ) Contraceptive prevalence rate (any method, currently married women ) Contraceptive prevalence rate (any modern method, currently married women Female Sterilization Male Sterilization Permanent sterilization method rate

In the community, sons are viewed as a sign of social security. A few women quoted that we dont fear from anybody because we have two- three young males in our family. Sons will earn in adulthood and provide support to their elderly parents. Nobody likes to marry a girl who does not have a brother because after marriage there wouldnt be a parental house subsequent to the death of her parents.

Hardly any mothers were found to practice birth spacing. Contraception is usually practiced through natural methods and depends entirely on the willingness of their 11

husbands. A few newly wed couples reported to use temporary contraceptive methods like oral pills and condoms. In some slums, where the ANM does not visit, the women were found to be keen to have access to family planning devices. They said, It would be good if these methods are available free of cost as nobody has extra money to spend on such things. Middle aged women adopt sterilization methods, only after having desired number of children (usually 4-5 children). Family planning methods are not adopted by the minority community owing to religious taboos. Children are looked upon as Gods gifts. Only 2-3% educated male members of the slums give importance to adopting family planning methods. Decisions pertaining to the adoption of the family planning methods are usually taken by both husband and wife. The decision regarding family planning is greatly influenced by elders of the family especially by mothers-in-law. I. Hygiene and Sanitation Practices Diarrhea management practices- The Reanalysis of NHFS II, U.P. shows that in urban low SLI, 25.9 % children suffered from Diarrhoea in the two weeks preceding the survey and only 2.1% were treated with ORS or a recommended home fluid. Diarrhea incidence was quite high and frequent among young children. Some of the women told that the malnourished children suffer more frequently with diarrhoea as compared to normal children. The most common causes reported for diarrhea were eating in excess, problem with the digestive system and eating spicy and hot food. During diarrheal episodes, the ailing child is given homemade salt-sugar solution, ORS solution, rice water, weak tea etc. Very few people had the understanding that diarrhoea occurs frequently among children due to the consumption of contaminated and unsafe drinking water, prevailing unhygienic conditions, etc. When suffering from diarrhea, the child is taken to a nearby doctor for treatment. Safe disposal of feces- NHFS II, U.P. reported that 83.4% households using sanitary facilities for safe disposal of feces whereas in Urban Low SLI it is only 33.6% (Reanalysis of NHFS II, U.P. EHP, 2004). The group discussions revealed that very few (10-20%) people have household toilets. Consequently majority of adults go to open field for defecation. Young children defecate in any empty space in and around the house, by roadside or near drains. The condition of some slums in Agra was appalling, because some adults use the open drains for urination and sometimes even for defecation. Some slums have community toilet complex, but are not being used as people cannot afford to pay the monthly charges. In some slums, sweepers are hired to clean pathways. Each family gives Rs.15/- (monthly) and one chapati per day, to the sweeper.
Indicator Reanalysis of NHFS -II, Uttar Pradesh Urban Urban Low SLI 49.2 55.2 83.4 16.5 68.0 17.3 17.7 76.7 33.6 69.8 52.2 2.1

Environmental health conditions Percentage of households with access to piped water supply at home Percentage of households accessing public tap/hand pump for drinking water Percentage of households using a sanitary facility for the disposal of excreta (flush/pit toilet) Percentage of households not having any toilet facility Diarrhoea related Percentage of children taken to health facility for diarrhoea Percentage of children treated with ORS or recommended home fluid

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Protection and treatment of drinking water- NHFS II, U.P. reported that 55.2 % or nearly half of the total number of households have access to public tap/ hand pump for drinking water and 76.7% in the urban low SLI of U.P. (Reanalysis of NHFS II, U.P. EHP, 2004). Only 17.7% (Reanalysis of NHFS II, U.P. EHP, 2004) households belonging to the Urban Low SLI have access to piped water supply at home. FGDs showed that in Agra slums, ground water taken out with hand pump (public and private), is the main source of drinking water. The slum residents told that water that is clear and clean appearance and not salty in taste is good for consumption. Nobody practices any type of water treatment. Handwashing with soap -Hands are washed mainly after defecation, before cooking food, before eating food, after disposing off childs feces, cleaning the house, washing clothes etc. 60% people wash their hands with soap after defecation and cleaning childs bottom, while the rest use ash/mud to wash their hands after contact with feces. By and large, people are not aware of the importance of handwashing with soap, although soap is available and affordable. Protection of food from fecal contamination- Food is kept covered in almost all the community households to prevent it from contamination by flies and dirt. Food left after eating is stored either in a utensil covered with a plate or in tiffin boxes. Some people keep the food on an elevated surface to protect it from animals like pigs, dogs, cats, rats etc. 1.5 OTHER DEVELOPMENT PROGRAMS IN AGRA 1.5.1 Swarna Jayanti Shahari Rozgar Yojana

Swarna Jayanti Shahari Rozgar Yojana is an Urban Poverty Alleviation Programme (UPAP) of the central government, with the objective of increasing employment opportunities for below poverty line population in urban areas. A key feature of the SJSRY that aims to fulfil its community organization agenda is the formation of Community Development Society (CDS), which aims to organise women in low-income communities to plan for their own development, thus ensuring that poverty-focused programmes reach their intended target groups, without diversion or leakage. The active participation of women in the process is achieved through a three-tiered structure of Neighborhood Groups, Neighborhood Committees and a Community Development Society. The scheme has several components 14 for fulfilling the objectives. The community structures component constitutes of Neighborhood groups (NHG) of 10 40 women who nominate one of their members as a Resident Community Volunteer (RCV). Neighborhood Committees (NHC) of 10 15 RCVs. Development Society (CDS) comprising 10-15 NHC Community representatives. In Agra city, DUDA is implementing the Swarna Jayanti Shahari Rozgar Yojana and has facilitated the formation of about 25 CDSs (Community Development Society) in the slums of Agra. Apart from it, there are 16 DWCUA (Development of Women & Children in Urban Areas) groups in 12 slums. However, CDS structure in Agra had been discontinued in early 2004 and is now being reconstituted. Once it gets constituted, it
14

Refer Annex 9 for relevant portions of the SJSRY scheme, and case study in reference to CDS.

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could serve as an effective community level platform for promoting RCH services in the slums. 1.5.2 Integrated Child Development Services Community-based health and nutrition interventions for women and children through ICDS are being implemented in one Urban Block of Agra. Of the 95 ICDS centers, only 43 are located in slum areas. There is a proposal for expanding the reach of the ICDS to cover additional 180 centers (approx.)15. Among the key health related services supported by ICDS are immunization activities and supplementary nutrition through weekly takehome rations. The immunization activities are being organized in coordination with the Health Department. Yet there is a need for improving coordination and convergence with Health Department to ensure effectiveness of the immunization camps.

1.5.3 Early Childhood Care for Growth, Survival and Development Project (ECCD) This was initiated in December 2001 in 80 DUDA-recognized slums. The project was supported by UNICEF, and is implemented by Department of Social and Preventive Medicine, S. N Medical College in collaboration with ICDS, DoMHFW. The 80 slums of the project area were divided into four clusters of 20 slums each, which were further grouped into sub-clusters of 5 slums. The main objectives were to promote six key care practices, which include care of women during pregnancy and lactation, feeding behaviour, psychosocial care, food-preparation practices, hygiene and sanitation, and home management of childhood illnesses for improving survival, growth, and development of children. The methods adopted in eighty slums were selected in 3 phases, and 7 women comprising two socially-active women, one Anganwadi Worker (AWW), an ICDS functionary, one traditional birth attendant, one health worker (female), and two women members of neighbourhood committeewere identified from each slum, who were then trained for 3 days on 6 key care practices. Further on, in each slum, one AWW and two socially-active community women were identified as peer educators for communicating the key messages in their respective communities. This team covers 300-350 households in their slum and contributes to improving the existing practices and creating demand for health services. At the end, it suggested that cluster community approach, i.e. participation of community members to decide and fulfill their own health needs, has been an effective tool to minimize the communication gap among different caste community clusters of urban slums. The learning could be utilized for improving the health status of children and women in the community.

1.5.4 State Innovations in Family Planning Services Project Agency (SIFPSA)

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ICDS, Agra has already proposed for additional 180 AWCs for slums.

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The IFPS project in UP is a unique endeavour dedicated to expansion of Family Planning Services in Public and Private Sector. Under the joint auspices of Government of India, GoUP and USAID, SIFPSA has been created as autonomous society to implement IFPS project. The purpose of the project is to assist the State of UP to significantly reduce the total fertility rate and to improve womens reproductive health through a comprehensive improvement and expansion of family planning and related reproductive health services. To achieve this purpose the IFPS project identified three main objectives: 1. To improve the Quality of family planning and other reproductive services through a client focus. 2. To increase Access by strengthening Public and Private Service delivery systems 3. To increase Demand through broadening support of leadership Group and increase public knowledge on health and welfare benefits of family planning One of the important innovations of SIFPSA is its Decentralized District Approach. The rationale of District Planning is to develop a critical mass of program inputs in select district level programming exercise carried out to identify and prepare strategy for strengthening public and private sector participation. Agra is one of the districts in which decentralized district approach has been initiated. Agra District Action Plan (AGRA DAP) was launched in the month of December 2000. Agra DAP aims to reduce the Total Fertility Rate (TFR) from 3.74 in 1999 to 3.42 in 2003. To achieve the desired reduction in TFR, the Contraceptive Prevalence Rate (CPR) has to go up from 29.1 percent in 2001 to 32.8 percent in April 2004. SIFPSA supported Community Based Distributors (CBD) Project was targeted for expanding contraceptive usage in urban area and DUDA was implementing it in 50 slums of Agra. Resident Community Volunteers were used as CBD workers, Neighborhood Health Groups provided the forum for RCH activities, linkages with the urban health posts (D type centers) were promoted as referrals. The objective of the project was to increase CPR by providing family planning services, provide ANC to pregnant mothers & provide immunization through outreach camps, door to door counseling & referrals to DTHCs. Integrated Family Welfare Project The UP Chamber of Industry and Commerce has in the past supported a FICCI-SIFPSA collaborative Integrated Family Welfare project in Agra. The aim of the project was to motivate the industry to undertake family welfare programs for industrial workers and extend these programs to the population around the industry. Ten industries participated in the project, wherein 15 workers and 1 supervisor in each factory were trained to promote use of family planning methods amongst fellow workers and the mohallas / bastis they belonged to. Supplies such as condoms were procured from the DoMHFW for distribution to the workers and the community at large. Training to the worker motivators and coordinators was provided by FICCI as well as SIFPSA. The project was implemented for nearly 3 years, and it came to an end when there was a threat of closure of several industries due to pollution control measures. With the majority of the workers residing in slum settlements of Agra, there is a potential for revitalizing the efforts of this Family Welfare project. Based on the learning from this initiative, there can be possibility 15

of involving corporate sector towards family welfare and also can be used as a platform to build partnership with the corporate sector. 1.5.5 CARE PPP Medical Health Care Trust, U.K supported Improving Reproductive Health Status and Reducing STD and HIV Transmission among Female Slum Dwellers of Agra City was started in July 2001 and concluded in July 2004. This three year project on reproductive health was implemented by CARE in 40 slums spread over three red light areas (Kashmiri Bazar, Malka Bazar and Shiv ka Bazar) and reaching 20,000 women in the reproductive age group, with the technical assistance from S.N Medical College. In the project area, 80 female peer educators and 40 male peer educators were trained to counsel families on safe motherhood, family planning, RTI/STI, HIV/AIDS, and adolescent and infant care. In addition, the peer educators also acted as depot holders for condoms, pills, and DDKs. 1.6 NGOS AND CBOS WORKING IN AGRA 1.6.1 Current Activities of NGOs and CBOs During slum visits and interaction with the community, it appeared that there have been civil society initiatives towards improving and strengthening health care services among slum dwellers in Agra. However, their intensity of activities and its numbers were rather found reasonably limited in number. When we compare the community based initiatives, it was evident that it is not a dominant trend in the city, unlike many other places, where such activities appear foremost and also contribute in a significant way in the entire gamut of community development activities. It was noticed that there were few civil society groups, include community based groups, non-government organizations, social trusts and charitable institutions etc. engaged in some or the other form in order to make qualitative improvement and wider coverage in the slums. However, most of the activities by these social trusts and charitable institutions are not a regular feature in nature. Whereas, NGOs having experience in working in urban area were also appeared limited in number. Some of those NGOs are based in Agra city itself, while others are based in nearby district and work in Agra. However, most of them have been engaged in some or the other health program in rural areas and very few of them have been active in slums of Agra. Having experience in community level health program, some of these could be the potential partner for strengthening community linkages under the Agra Urban Health Program. A brief profile of their major activities, priorities and key contact is annexed16. In addition, some of the community based groups were also identified. In Agra city, Jatav is the biggest community groups in terms of its number, who for economic motive, primarily engaged with shoe or leather related activities. According to an estimate, they constitute between 9-10 lakh of the total city population. Among this community, there are several formations based on their social identity. For instance, one of the formations, which has wider coverage and also has maximum number of members and sympathizers in slums, is known as Jatav Mahapanchayat, formed in December 1990 with the objective to safeguard the interest of Jatav community and make them aware of their rights, strengthen their position in the society and also to aware and enhance their
16

Refer Annex 10 for list of potential NGOs

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knowledge about old practices and beliefs, which make them more vulnerable and subject to exploitation, and therefore they work towards overcoming these practices. Their main concerns are as follow: They organize campaigns to address social evils like anti-liquor, anti-dowry system, caste based discrimination. To organize Bhim Nagari (Dalit meet on 14th April of every year) .This, Bhim Nagari (Dalit meet) is being organized every year and wherever it takes place, government ensures all basic services and all infrastructure related support. Off late, they have expressed their interest in infrastructural development in their habitat. Another group, which was identified during interaction with the community members, is known as Mahila Utthan Parishad, an affiliate to Jatav Maha Panchayat, also considered as a women wing of Mahapanchayat. However, its structure appears not fully developed and in the absence of clear cut mandate for regular membership, it has got mainly sympathizers in over 300 slums settlements. Their major concerns also include anti-dowry, anti-liquor campaign, community based conflict resolution mechanism etc. However, in the recent times, they have started taking interest in health activities and participated in pulse-polio campaign and have organized health camp through DUDA. In response to the existing public sector facilities, they remarked that since they do not have faith and trust with the existing system, in effect, they are heavily rely on the private sector facilities. Further, a group of women also stated that however they have been accessing services at the private sector but it has become difficult to bear the higher cost of services. They also lamented that owing to the existing state of public sector facilities, even extremely poor people; forced to go to private sector facilities. Apart from above-mentioned voluntary efforts, under the centrally sponsored Swarna Jayanti Shahari Rozgar Yojana, 25 slum based community groups were formed, which is known as Community Development Society (CDS). It aims to organise women in lowincome communities to plan for their own development, thus ensuring that povertyfocused programmes reach their intended target groups. The active participation of women in the process is achieved through a three-tiered structure of Neighborhood Groups, Neighborhood Committees and a Community Development Society. In addition, there are 16 DWCUA (Development of Women & Children in Urban Areas) groups in 12 slums. However, CDS structure in Agra had been discontinued in early 2004 and is now being reconstituted. Once it gets constituted, it could serve as an effective community level platform for promoting RCH services in the slums.

1.6.2 Implications and Existing Options for EHP Focus on strengthening community linkages: There are groups that are placed at a lower level. These groups could be strengthened and gained voices through different support mechanism to fulfill child health priorities in their respective slums. However, importance should not be given only to health indicators, but also to institutional capacities of the groups to ensure sustainability of this program and also to enhance their identity and bring social confidence among them. 17

Implementation through locally entrenched Community groups: As it has been observed that community based institutions do not have adequate amount of experience in dealing health issues, however, considering their community mobilization capacity and skill, they can be involved to further the objectives of urban child health in most and moderately vulnerable slums. Therefore, all help and efforts should be made including financial support in order to enable the environment where these social groups and local institutions can grow, multiply so that community members start articulating their due rights and entitlements. Skill and Capacity building: With appropriate facilitation and exposure, regular meetings, capacity, perspective and knowledge building efforts would enable these organizations and institutions to work towards their health need and also to take the ownership of the entire process. Such initiatives would become effective when we work more closely with the poorest in a participatory and effective manner. Cross learning and promotion of group identity would also be helpful mechanism to enhance their skills and strengthen such institutions. In the long run, such initiatives can be networked for influencing policies so that policies should become pro-poor in rhetoric and serve the interest of the urban poor. Participatory and Inclusive Approach: The planning process of urban health plan in Agra was done through consultations with all stakeholders government institutions, CBOs, NGOs and slum dwellers etc. Each such consultation and discussion contributed to build and construct the program. Since this method turned out to be a successful and effective approach therefore it is being recommended that the program should continued with this approach during implementation phase as well. A centralized and top-down fund-driven intervention strategy may not capture the need and aspiration of the urban poor and consequently it may not serve the interests of the urban poor in effective and efficient manner. In the process of community groups strengthening, the existing groups and learning would be involved and utilized for learning. Long term commitment: In pragmatic terms, reaching the most vulnerable has not been a priority or an easy task in most programs that goes beyond service delivery or are not incentive-based. With funding agencies having limited time commitments and a pre-requistie of showing results, difficult areas are often not ventured into. It is therefore critical to understand at the beginning that not much can be achieved within two-three years spans in such populations, and requires a longer commitment from the implementing agencies and donor community.

1.7 PRIVATE INDUSTRY Agra boasts of a vibrant private industry, and is one of the main trade and industry hubs of Uttar Pradesh. There are 12 major and medium scale industries and 7200 small scale units in Agra which produce a variety of goods including pipes and cast iron fittings, electrical goods, leather goods and shoes, automobile and engine parts, etc. Crafts such as stone carving, toy making, and zari making are some of the other economic activities in Agra. With the presence of the Taj Mahal and other important mughal monuments, an average of 8-10,000 tourists visit the city every day resulting in a flourishing tourist industry. The industry can be loosely divided into the organized and the unorganized sector. 18

 The organized sector includes the various large scale, medium scale, and small scale units of which the major ones are the foundries and the footwear producing units. Home-based workers and petty workshop owners involved in footwear production form the bulk of the unorganized sector in Agra. 1.7.1 Footwear industry Agra is one of the biggest footwear producing centers in India employing about 2,00,000 people17. 1.7.1.1 Unorganized footwear industry The industry predominantly exists in the form of cottage and home-based industries which employ between 5-15 people. It is estimated that there may be 5000 to 7000 such units in Agra, which are located in slums and peri-urban areas. 1.7.1.2 Organized footwear industry There are around 200 large-scale export-oriented units, each of which may employ upto 500 people. Each factory employs approximately 100-200 labor directly. In addition, the services of as many or more home-based labor, particularly women, are utilized through contractors. Because of the exposure of the exporting industry to stringent international labor laws, the working conditions of these workers is much better than those who work from small workshops in slums and the small scale industries catering to the domestic market. 1.7.1.3 Bearing of footwear industry on slum growth and health Agra is an epicenter of footwear production in the country and one-sixth of its population is engaged in this activity. It is likely that the increased slum growth of the city is linked to this economic activity.

1.7.2 Foundries There are over 150 foundry units which produce cast iron pipe fittings, motor and tractor parts, weights and measures, machinery for glass and textile factories, diesel engines, pumping sets, generators and agricultural implements, etc. All the foundry units in Agra are located within the Agra Municipal Corporation limits in three primary locations at Foundry Nagar, Nunhai and Sikandra. Most of the labours employed by the factories are residents of nearby bastis or villages.

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www.agra.nic.in 19

1.7.3 ESIS registered units In Agra, approximately 1000 factories and establishments are registered with ESI Scheme18 providing social security benefits to approximately 20,000 employees and their employees. Health services through the ESI Scheme are provided to insured persons through facilities described earlier. The hotel and restaurant industry and the footwear industry constitute the bulk of the factories and establishments covered under ESI scheme. The major constraints in optimal utilization of the Scheme for improving the health conditions of the employees and their families lies in the under-reporting of employees by owners of factories and establishments to evade contributions to the scheme. Unorganized footwear industry, which involves a mix population of workers are not being covered by ESIS, and are largely dependent on other public and private health care facilities.
1.8 NEED ANALYSIS AND DELIVERY SYSTEM POINTERS FOR IMPROVING THE HEALTH

In the above situation of Agra, there remain issues of how the existing provisions could be used to further the benefits to specific un-reached populations and also sustain what is visible today. 1.8.1 Location of the health facilities The analysis of existing first tier services suggest that a substantial number of health centre are located in central part of the city and therefore there are many slum pockets/ peri urban area, which are either being catered by the Primary health centre or not been covered regularly for MCH services except during some immunization program like Pulse-Polio campaign. The description of existing health facilities suggests several points of service-delivery for the city. There are four first tier centres which are located in all three main hospitals (Public Sector) of the city in a distance of 3-5 km. For instance, two post-partum centers run by the District Administration, one located at S.N Medical College and the other at Lady Lyall hospital and two Urban Family Welfare Centers (also providing first-tier health care facilities) are located at District Hospital and T.B Demonstration Center, which all are quite close to each other and are do not offer outreach activities to their nearby slum population. Therefore, since several units function from the same premises, and thus do not make as much difference as they could have, if located separately at appropriate locations. 1.8.2 Targeting the vulnerable slum population In the city, there is an urgent need for the community about the RCH services. The focus group discussion and slum visits/ transect walk suggests that vulnerable slum population should be targeted. Taking account of the existing low antenatal care, it becomes vital to improve service coverage by government health functionaries and awareness level of
Employees State Insurance Scheme is an integrated social security scheme tailored to provide social protection to workers and their dependents, in the organized sector as per the following criteria: Non-seasonal factories using power and employing 10 or more persons Non-seasonal and non-power using factories and establishments employing 20 or more persons.
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community members to facilitate increase pregnancy registration, early tetanus toxoid vaccination, regular antenatal check ups and compliance rate of IFA tablets. In addition, very few mothers realize health benefits of complete immunization of child. Therefore, mass campaign to increase their awareness level and service delivery would help in minimizing the drop-out and left out rate. During slum visit and interaction with the community members in slums, it revealed that the average family size was large and therefore efforts are required to promote large scale adoption of family planning methods. Related to this, the issue which appears is that poor slum dwellers having fragile economic condition would find it hard to afford contraceptives for use. In a given situation, it becomes imperative to ensure easy availability of contraceptives through a variety of channels which would provide its regular usage. In-depth health vulnerability assessment of slums in Agra has suggested most and moderately vulnerable slums pockets, which would be taken up on a priority basis to address their health need and therefore the findings should be incorporated in the new urban health program under RCH II. 1.8.3 Public Private Partnership It is increasingly acknowledged that lack of service delivery capacity, especially of human resources, is responsible for the limited coverage of health services in many countries. The reasons behind this are many and complex. Public sector services where available remain a) underutilized, largely, owing to weak community-provider linkages, inadequate quality of services; b) inadequate since there are far fewer personnel and facilities than are required to serve the urban slum population. At the same time there is in many cities a largely untapped potential in form of many private especially the not-forprofit agencies, which are engaged in primary health care activities in urban areas. Ministry of Health and Family Welfare, Govt. of India is increasingly making concerted efforts to work with the private sector, especially the private not-for-profit sector, in order to build up capacity for service provision and to improve access to care. Pursuant to GoIs Guidelines for Development of City-level urban Slum health Projects, Govt. of UP has decided to partner with the not for profit Private sector agencies for the Agra Urban Health Program for a) provision of 1st tier services in select zones; b) provision of 2nd tier services in identified areas; and c) strengthen community linkages of Public sector services through partnership with NGOs having experience in social mobilization

1.8.4 Strengthen and optimize use of infrastructure As it has already been discussed in the previous section that considering the existing health facilities and health conditions of the slum dwellers, it becomes necessary to need human resources at different levels, right from paramedical staff to community level workers, where on the one hand paramedical staff would make an effort to cover all needy slums and on the other hand, community level volunteers would be useful for awareness generation and in effect it would increase the access to the services.

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1.8.5 Regularity in services The decentralized services through health volunteers, change agent/ community mobilizers at doorsteps would ensure the regularity of services as well as would also help to increase access to the existing services. Further, to make it a regular affair, community volunteers can be identified for bridging the gap between health system and communities. Whereas, local support mechanism (either by community or through NGOs/CBOs) may be useful to organize facilities for immunization camp. With the help of decentralized service delivery system, it will be helpful to restore trust in public health facilities.

1.8.6 Integration of Development Programs in City The sustainability of the program depends on the extent of increase in capacities and the wider the spread of capacities and services. This is the critical challenge that lies in the Agra Health Program the need to integrate activities with ongoing development programs.

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ANNEXES

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LIST OF ANNEXES

Annex No. 1 2 3 4 5 6 7 8 9 10

Description The U.P. Slum Areas (Improvement and clearance), Act 1962 Official Slum Lists Official Slums Missing from DUDA List Process of Vulnerability Assessment List of Slums and Vulnerability Status Existing Public Sector Health Facilities (1st and 2nd tier) Agra List of slums selected for focused group Discussion Reanalysis of Uttar Pradesh NHFS-II (1998-99) by Standard of Living Index-USAID-EHP Urban Health Program Relevant Portions of SJSRY Scheme and Case Study w.r.t. Community Development Profiles of Potential Non-government Organizations Working in Agra City

Page No. 01 02 03 04 05 06 07 08 09 10

24

Annex 1 The U.P. Slum Areas (Improvement and Clearance), Act 1962 (U.P. Act No.18 of 1962 as amended up to U.P. Act of 1986)

1. Declaration of slum areas: Where the competent authority upon information received or otherwise in its possession is satisfied as respects any area that a majority of the buildings in that area are (a) by reason of dilapidation, over crowding, faulty arrangement of design of such buildings or faulty arrangement of streets, lack of ventilation, light or sanitation facilities, or any combination of these factors, detrimental to safety, health or morals of the inhabitants in that area; or (b) otherwise in any respect unfit for human habitation; it may, by notification in the official Gazette, declare such area to be a slum area. 2. Clearance or Eviction: UP Slum Areas (Clearance and Improvement) Act empowers Competent Authority to declare slum area to be clearance area in accordance with the provisions within the Act. All buildings in the clearance area have to be demolished in pursuance to the provisions of section 12 by the owner or occupier as the case may be, failing which the Competent Authority has the power to demolish the same and offer temporary alternative accommodation to the occupier of the building. Competent Authority has the power to re-develop the clearance area in accordance with the Plan prepared by it. Where the Competent Authority is not able to re-develop a land within a period of 2 years, the State Government may require the redevelopment of the land to be completed within a specified period. 3. Acquisition of land: Where the competent authority upon information received or otherwise in its possession is satisfied that acquisition of any land or building or both in a slum area is necessary for the purpose of executing any work of improvement in relation to any building or land for carrying out any order of demolition of building in that area or for the purpose of re-development of any clearance area or rehabilitation of the residents of slum areas, it may by notification in the official Gazette, declare its intention to acquire such land or building or both.

Annex 2 DISTRICT URBAN DEVELOPMENT AGENCY, AGRA LIST OF MALIN BASTI

Sl No. BASTI 1 15 QRT. NAI ABADI 2 20 QUARTERS 3 AHIR PADA 4 AJAD NAGAR 5 AJAM PADA 6 AJAM PADA NAI ABADI 7 AJIT NAGAR 8 ALAM GANJ 9 ALBATIYA 10 AMBEDKAR NAGAR 11 ANAND NAGAR 12 ASAD GALI 13 ASHOK SINDHI COLONY 14 BADA CHARAN SINGH 15 BAGH KALA 16 BAGH MUZAFFAR KHAN 17 BAGH NANAK CHAND 18 BAGICHI 19 BAI KA BAZAR 20 BAZIR PURA 21 BALKESWER 22 BALMIKI BASTI 23 BAPU NAGAR 24 BASAI KHURD 25 BAUDH NAGAR 26 BEECH KA BAZAR 27 BHEEM NAGAR 28 BHOGI PURA 29 BHOLA KA NAGALA 30 BILLAUCH PURA 31 BODLA SARAY 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 CHAKKI PAT DALHAI DAYAL NAGAR DERA SARAS DHAKRAAN DHOLI KHAR DHULIYAGANJ GANDHI BANGAS GADHI BHADORIA GADHI HUSSAIN GADHI CHANDINI GADHI JIVAN DAS GAILANA GARIB NAGAR GHATI MAMU BHANJA GHATIA GOBAR CHAUKI GOKUL PURA GOPAL PURA GOPI NAGAR GUDIYAI GUMMAT TAKHT PAHALWAN GYASH PURA HAMID NAGAR HANUMAN NAGAR HARJU PURA HAVELI BAHADUR KHAN HOLI HUKMI NAGAR IDGAH KATGHAR IDGAH KUTUL PUR INDRA NAGAR 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 J.P. NAGAR JAGJIVAN NAGAR JAGAN PUR JAGDISH PURA JANTA COLONY NAI ABADI JAI NAGAR JHUMMAN KHAN JHOPARI JOGI PADA JONES MILL LINE K. K. NAGAR KABIR NAGAR KACHI PURA KAHNDARI KAJI PADA KAKRATA KALA BHAIRON KANGAL PADA MANTOLA KARBAN KARIM NAGAR KESAR BAGH KHAIRATI TOLA KHANDARI KHANDELWAL COLONY KHARAGJEET KHATAINA KHATIK PADA KHIDKI KALE KHAN KHINCHI KA BAGH KISHORE PURA (JAGDISHPURA) KOLAHAI KOTLI BAGICHI KOYALA WALI BASTI 96 KUNCHA SADHU RAM 97 LAKSHAR PUR 98 LAL DIGGI 99 LAXHIPURA 100 M.P. PURA 101 MAHAVIR NAGAR 102 MAHOUR NAGAR 103 MAITHAN 104 MANSINGH KI BAGICHI 105 MANTOLA 106 MASTA KI BAGICHI 107 MAURYA NAGAR 108 MAYA PURI 109 MIRA HUSAINI 110 MOHAN GARH 111 MOHAN NAGAR 112 MOHAN PURA IEDGAH 113 MOTI KATRA 114 MOTI MAHAL 115 MOTIA KI BAGICHI 116 NAGLA AJITA 117 NAGLA BALCHAND 118 NAGLA BASI 119 NAGLA BHARTI 120 NAGLA BHAWANI SINGH 121 NAGLA BHRATI 122 NAGLA BIHARI 123 NAGLA CHANDAR BHAN 124 NAGLA CHHAUA 125 NAGLA CHIDDA 126 NAGLA DEEM 127 NAGLA DEV JEET

128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158

NAGLA DEV JEET NAGAR NAGLA DHANI NAGLA FAKIR NAGLA GANGA RAM NAGLA GAUTAM NAGAR NAGLA KA TEJA NAGLA KACHHIYAN NAGLA KHERIA NAGLA KHUSHALI NAGLA KISHAN LAL NAGLA KISHAN LAL NAGLA LAL DAS NAGLA LAL SINGH NAGLA LATOORI SINGH NAGLA MAHADEV NAGLA MEVA RAM NAGLA MOHAN LAL NAGLA NAI ABADI NAGLA PADI NAGLA PARAMA NAGLA PASWATI NAGLA PEMA NAGLA PRITHPI NATH NAGLA PULIYA NAGLA RAMBAL NAGLA RAM BHAWAN NAGLA RAM LAL NAGLA SEVA RAM NAGLA TEK CHAND NAGLA BIDHI CHAND NAGLA VIJAY NAGAR

159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189

NAGLA WASI NAI ABADI BODLA NAI BASTI NAI KI SARAI NAKHASA NAL BANDH NALA BURHAN SAYYAID NALA GOKUL PURA NALA MANTOLA NAMAK KI MANDI NAMNER NAND LAL PUR NAND PURA NARAICH NARI PURA NAUBASTA NAWAB SAHAB KA BADA NAYA BASHRAJ NAGAR NAYA GHER NEEM DARWAJA NEWALA SARAI NUNHAI SABJI MANDI PACHKUIYAN PAK TOLA PANCHWATI PANJA MADARSA PATEL NAGAR PATHWARI PATTHAR KA GHODA PEER KALYANI PHATAK SURAJ BHAN

190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220

PRAKASH NAGAR PREM NAGAR PUL CHINGA MODI PULIA HIGARA MOTI PURA GOVERDHAN PURANI SABJI MANDI RABHU KI JHOPADI RAJ NAGAR RAJIV NAGAR RAKESH NAGAR RAM NAGAR RAM NAGAR NAI ABADI RATAN PURA RAVALI RAVI DAS NAGAR RUI KI MANDI SAYYAID PADA SANJAY COLONY SANTOSH NAGAR SATI NAGAR SATYAM NAGAR SATYAM PURAM SEWA KA NAGLA SEWALA SEWLA JAT SEWLA KA NAGLA SHAHDARA SHAHJADI MANDI SHAMBHU NAGAR SANKAR PUR SANTI NAGAR

221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252

SHEKH BULAKI SHIV NAGAR SHIV NAGAR (JAGDISHPURA) SHIV SAHANI NAGAR SHYAM NAGAR SHYAM VIHAR SHYAM VIHAR NARAICH SIBDSANI NAGAR SIHO KA NAGALA SINDHI COLONY SIR KI MANDI SITA NAGAR SOHALLA SONATH KI MANDI SUBHASH PURAM NAGAR SUNDAR PADA SUSHIL NAGAR TAJ GANJ TAJ KHEMA TAL FIROJ KHAN TAMOLI PADA TARI PURA TEDI BAGIYA TEELA AJMERI KHAM TEELA GOKUL PURA TEELA SHEIKH MANNU TEJA KA NAGLA TELI PADA TOP KHANA TUND PURA VIKRAM NAGAR ZHUMMAN KHAN GHOPADI

LIST OF MALIN BASTI, AGRA MUNICIPAL CORPORATION

Sr. No. 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 NAME OF AREA SHAHADARA MAU MAHARANA PRATAP NAGAR RAJ NAGAR CHOTA UKHARRA KOLIHAI BADA UKHARRA GOBAR CHAUKI GALI ASAD RAM NAGAR, KEDAR NAGAR SUBHASH NAGAR BOD KA SARAI AJAMPADA NAI ABADI PRAKASH NAGAR & HAMID NAGAR GAILANA NAGLA BHILAI MOHAMMADPUR NAGLA RAMBAL GARI BHADAURIYA SHIV NAGAR SOHALLA BODLA BASAI KALA NALA ROSHAN MOHALLA KHIDKI KALE KHAN POPULATION 9655 2698 5100 9900 787 1254 2098 7693 1278 7200 2000 3580 2742 1470 2106 1142 2141 2910 6341 9057 1270 2830 1931 1920 NO. OF HOUSES 1287 385 692 1296 98 157 262 962 182 1410 235 717 548 214 421 228 428 582 857 1033 312 572 242 303 Sr. No. 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 NAME OF AREAS VIDHYA NAGAR NAGLA BUDHI PARPARI VIDHYA NAGAR NAGLA GOKUL CHANDRA BEECH KA UKHARRA SAHEED NAGAR GOBAR CHAUKI NAGLA MEVATI PREM NAGAR KESAR VIHAR ALBATIYA AJAMPADA, PRATHVINATH ALIPUR SANJAY NAGAR, NEAR BAPU NAGAR GARHI CHANDANI NAGLA MOHAN KAKRETHA GULAM NAGAR NARIPURA GULAR KA NAGLA BASAI KHURD KHAIRATI TOLA NALA MOTI KATRA TEELA GAJ SINGH POPULATION 6497 5820 2000 3000 792 511 3093 1500 6726 800 5200 7009 676 640 803 1705 915 1500 6420 760 4240 610 5677 1923 NO. OF HOUSES 926 728 380 375 113 64 287 166 1245 115 699 1402 135 128 162 341 183 295 910 152 626 70 709 290

Sr. No. 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99

NAME OF AREA TILA MUNNA LAL SITA NAGAR TEDI BAGIYA PURA GOVARDHAN KACHPURA NAGLA DEVJEET SEVALA JAAT PRAHALAD NAGAR RAVIDAS NAGAR GOPAL PURA KSHVAS PURA JAGDAMBA NAGAR GARHI JEEVAN DAS HANUMAN NAGAR NAGLA PRATHVI NATH ASHOK NAGAR SINDHI COLONY JOHANS MILL PATTHAR GHODA BASTI GAUTAM NAGAR NAGLA KACHIYAN BAUDDHA NAGAR DAYAL NAGAR SIV SHAHANI NAGAR ALBATIYA JHOPADI V.K. PURAM SHEKAR GARH

POPULATION 2829 3221 2083 2200 2100 1430 6384 353 860 272 5000 1500 2100 2500 4850 1700 1900 1600 6830 2100 1850 1850 1900 780 582 920

NO. OF HOUSES 385 511 348 388 315 311 883 101 107 32 712 215 288 519 427 310 308 232 621 318 328 328 388 55 65 158

Sr. No. 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 100

NAME OF AREAS NAGLA CHAANA NARAYACH JAGJEEVAN NAGAR GARHI HUSAINA KACHPURA NAI ABADI SEVALA SARAI JASSE KA NAGLA SHANTI PURAM SHASTRI NAGAR PREM NAGAR RAJPUR CHILLI PADA NAGLA RADHEY BARAH KHAMBA NAGLA SIYAAL LAL JOGIPADA MAHEER NAGAR MOHAMMAD NAGLA AJITA SIKANDAR BAIPUR HASTINAPUR TAAL FIRO KHAN SARAI MALUK CHANDRA NAGLA CHIDDA BALAJI PURAM RAMPURI NAGLA PEMA

POPULATION 582 9077 3080 668 2800 1507 810 1150 996 2100 2100 2250 5720 1800 2650 2320 1200 3210 2310 1605 2150 1200 2300 800 1800 673

NO. OF HOUSES 81 1390 597 116 381 131 238 114 125 292 305 323 897 425 511 485 156 621 348 185 397 238 402 150 297 135

Sr. No. 101 103 105 107 109 111 113 115 117 119 121 123 125 127 129 131 133 135 137 139 141 143 145 147 149 151

NAME OF AREA DALIHAI BALMIKI BASTI BAH NAGAR NEAR SATYAVAR CHITRA NEAR KHATIYANA NALA TEELA JORI GANJ NALA MANTOLA BHOGIPURA FAKIRON KI BASTI SHAIKH BULALI BAPU NAGAR NABAB SAHAB KA BADA KHATEEK PADA FREE GANJ NAGLA SOLA BHOLA SITA NAGAR NAGLA BER BHEEM NAGAR NAUBASTA TOPKHANA DALIYA BASTI MOHAN PURA KATGHAR IDGAH NALA KHAS KHAN KULLUPUR SARAI VENGA SIR KI MANDI VADA CHARAN SINGH

POPULATION 456 653 362 905 3938 3821 1151 277 687 172 7600 223 1716 2947 4579 660 815 561 416 771 3688 2399 2950 1154 431 2829

NO. OF HOUSES 91 131 45 113 467 487 230 60 321 34 761 98 306 223 370 90 102 70 52 135 506 300 790 278 54 385

Sr. No. 102 104 106 108 110 112 114 116 118 120 122 124 126 128 130 132 134 136 138 140 142 144 146 148 150 152

NAME OF AREAS TAJ MAHAL UTTARI ABADI MENG KI MANDI LOYAR KHATIYANA TEELA AJMERI MANTOLA ABADI NAGLA KOSANI GALI ASAD TAJGANJ GOPI NAGAR PEER KALYANI NALA BUDHANI SAIYAD BAGH MUJAFFAR KHAN BALMIKI BASTI KALYAN BASTI NAGLA MAHADEV RAM NAGAR JAGDISHPURA SAYYAID PADA SATNAM NAGAR RAJEEV NAGAR KODIYAKHAR DERI SARAS DAKRAN SUNDAR PADA SARAI RUSTAM KHAN KUMHAAR PADA GHATVASAN MANMOHAN NAGAR GOKULPURA PUL CHINGA MODI NAGLA GANGARAM

POPULATION 190 2607 724 3088 3738 831 455 867 431 4000 328 664 245 483 888 1470 724 2756 1000 710 1360 5292 2810 4689 2829 2263

NO. OF HOUSES 38 320 91 386 467 202 83 102 50 592 41 115 60 62 112 196 90 157 52 135 245 674 310 592 385 283

Sr. No. 153 155 157 159 161 163 165 167 169 171 173 175 177 179 181 183

NAME OF AREA TEELA PACHKUIYAN BALMIKI NAGAR CHAURAHA MEERA HUSSAINI TALAIYA KAJIPADA DHOLIKHAR SADAR BHATTI TAKIYA MAULANA PANJA MADARSA NAGLA MAHADEV TELI PADA SUREJ PUR NAGLA HAVELI KOTLA BAGICHI CHALESAR JORAWAR NAGAR TAAL FIROJ KHAN

POPULATION 463 833 2189 1441 2940 524 1200 928 1150 1400 1106 1015 598 6165 2425 2870

NO. OF HOUSES 57 104 350 285 380 96 148 127 142 192 530 203 86 213 491 -

Sr. No. 154 156 158 160 162 164 166 168 170 172 174 176 178 180 182

NAME OF AREAS NAYA BAANS RAJ NAGAR TEELA GOKUL PURA KAJI PADA TEELA SAIKH MANN KATRA KADRIYAAN RAWALI BHAD GALI NAGLA DEENG NAI ABADI NUNIHAI SABJI MANDI TAJGANJ NAGLA BHARDI RUI KI MANDI GARHI BASANG J.P. NAGAR MAU NAGLA KISAN LAL NAGLA CHAUAA

POPULATION 761 905 760 1144 644 4250 600 1100 980 1405 5020 1085 760 2555 2065

NO. OF HOUSES 92 113 115 195 93 648 648 132 118 281 1004 420 152 511 413

LIST OF SLUMS COVERED BY HEALTH DEPARTMENT FOR PROVISION OF PRIMARY HEALTH SERVICES
Sr.No. 1 NAME OF HEALTH POST D.TYPE HEALTH CENTRE BUNDU KATRA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 2 3 4 5 6 7 8 9 10 11 NAME OF SLUMS NAGLA DEV JEET SEWALA SARAI SEWALA SEWALA JAAT JASSE KA NAGLA PRAHALAD NAGAR SARASWATI NAGAR GOPAL PURA NAGLA KACHIYAAN HASTANAPURI CHAWALI BAUDDH NAGAR TAAL FIROJ KHAN SARAI MALUK CHANDRA KOTALI BAGICHI TAAL FIROJ KHAN II HASTANAPURI CHAWALI II NAGLA BHAWANI NAGLA LATOORI NAGLA TEK CHANDRA TUNDPURA KOT KI BAGICHI SAINIK PURAM VIDHYA NAGAR MAU NAGLA BOODI PARPARI VIDHYA NAGAR MANMOHAN NAGAR NAGLA HAWELI J.P. NAGAR MAU NAGLA PADI NAGLA HAWELI KAUSAL PUR NAGLA BOODI NORTH POPULATION 1430 1507 6384 810 353 996 272 2100 1605 2500 2150 1200 598 2870 3300 3500 9060 3500 3900 434 6497 2698 5820 2000 2810 1015 152 3210 3193 4000 5000

D.TYPE HEALTH CENTRE NAGLA PADI

Sr.No. 3

NAME OF HEALTH POST VIBHAW NAGAR 12 1 2 3 4 5 1 2 3 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 1 2 3 4

HARI PARWAT (EAST)

HARI PARWAT (WEST)

RAKABGANJ (NORTH)

RAKABGANJ (SOUTH)

NAME OF SLUMS DAYAL NAGAR CHOTA UKHARRA BEECH KA UKHARRA BADA UKHARRA TAJGANJ PREM NAGAR RAJPUR GOBAR CHAUKI BER KA NAGLA LASKARPUR FAZIATPUR ABBU LALA KI DARGAH BODH KA SARAI GAILANA NAGLA BHILAI MOHAMMADPUR KAKRAITHA RAVIDAS NAGAR PATTHAR GODA BASTI SIKANDARA BAIPUR GOPI NAGAR BAPU NAGAR SATNAM NAGAR SARAI BEGA KHANDARI WALI GALI KAJI PADA TALAIYA KAJI PADA TEELA SAIKH MANNU DHOLI KHAR CHAKKI PAT, BUDDHA VIHAR TEELA NAND RAM BUDDHA VIHAR MOHANPURA SUNDAR PADA KATHGHAR IDGAH SARAI RUSTAM KHAN

POPULATION 1850 787 792 2098 511 2500 3860 3310 3580 2106 1142 915 860 1600 2310 867 687 1470 1154 12000 760-4831 1441-5775 1144-3058 2940-5649 7990-9748 3380-4124 3180 771 710 3688 1360

Sr.No.

NAME OF HEALTH POST 5 6 7 8 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 2 3 4 5 6 7 8 9 1 2 3 4

SHAHGANJ II

LOHAMANDI II

10

SHAHGANJ I

NAME OF SLUMS KULLU PUR NAGLA CHAUA BAGH NANAK CHAND NAGLA FAKIR CHAND KUTUL PUR SHIV NAGAR NARI PURA SOHALLA KHWAS PURA BARAH KHAMBA SHIV SAHANI NAGAR NAGLA CHIDDHA ALBATIYA JHOPADI RAMPURI BHOGIPURA FAKIRON KI BASTI NAGLA SOLA BHOLA NAGLA SEVA RAM NAGLA LAL SINGH GULAR KA NAGLA GARHI BHADAURIYA BODLA NAGLA AJITA RAM NAGAR JAGDISHPURA NAGLA BER BHIM NAGAR JAGDISHPURA BALMIKI BASTI RAM NAGAR KEDAR NAGAR BHIM NAGAR PREM NAGAR KEDAR VIHAR ALI PUR PRAKASH NAGAR HAMEED NAGAR

POPULATION 2950 413 6540 6341 6420 9057 5000 5770 1900 2300 780 1800 1151 1710 3470 620 760 2910 1270 3210 483 4579 2910 5200 7200 600 6726 850 676 1670

10

Sr.No.

NAME OF HEALTH POST 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6

11

LOHAMANDI I

12

TAJGANJ

NAME OF SLUMS SHANTI PURAM NAGAR CHILLI PADA ASHOK NAGAR SINDHI COLONY RAJEEV NAGAR NAGLA KHAS KHAN TEELA PACHKUIYAN RUI KI MANDI ALBATIYA AJAMPADA PRATHVINATH AJAMPADA NAI ABADI SANJAY NAGAR NAGLA PRATHVINATH JOGIPADA PRATHVINATH BALAJI PURAM V.K. PURAM SUBHASH NAGAR RAJ NAGAR NAGLA GOKUL CHAND SHAIKH BULAKI SAIYYAD PADA NAUBASTA NALA KINARA SIR KI MANDI PUL CHINGA MODI NAYA BAANS RAJ NAGAR TAILI PADA TAILI PADA NAI ABADI KOLIHAI GOBAR CHAUKI I GOBAR CHAUKI II NAGLA MEVATI GALI ASAD BASAI KHURD

POPULATION 1150 2100 1700 724 2399 463 5020 5200 7009 2742 640 4850 2650 800 502 2000 9900 3000 277 888 815 431 2829 761 1400 1260 1254 3093 7693 1500 1278 4240

11

Sr.No.

NAME OF HEALTH POST 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 2 3 4 5 6 1 2 3 1 2 3 4 5 6 7 8 9

13

JIVANI MANDI

14

CHATTA

15

JAMUNA PAAR

NAME OF SLUMS BASAI KALAN KHAIRATI TOLA KACHPURA KACHPURA NAI ABADI NAGLA CHOMA DALIHAI BALMIKI BASTI TAJ MAHAL UTTARI ABADI GALI ASAD TAJGANJ NUNIHAI DALIYA BASTI NAGLA DEEM & NAI ABADI NAGLA MAHADEV BASAI KALAN KHURD NAHAR GANJ NAHAR GANJ MAHARANA PRATAP NAGAR JOHANS MILL BASTI KALYAN BASTI NAGLA MAHADEV JIVANI MANDI BALKESHWAR NAGLA ROSHAN MOHALLA PEER KALYANI FREE GANJ SHAHADARA GARHI CHANDINI NAGLA MOHAN NAGLA RAM BAL GULAB NAGAR SATI NAGAR NARAYICH TEDI BAGIYA JAGJEEVAN NAGAR

POPULATION 2830 610 2100 2800 673 456 190 455 416 1100 1150 2950 2950 1500 5100 1900 664 245 4750 150 1931 431 223 9655 803 1705 2141 1500 3221 9077 2083 3080

12

Sr.No.

NAME OF HEALTH POST 10 11 12 13 14 15 16 17 18 19 20 21 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 1 2 3

16

LADY LYALL

17

T.B.D.T.C.

18

DISTT. HOSPITAL

NAME OF SLUMS PURA GOVERDHAN GARHI HUSSAINI JAGDAMBA NAGAR HANUMAN NAGAR GAUTAM NAGAR SITA NAGAR PANJA MADARSA NUNIHAI SABJI MANDI NAGLA KISHAN LAL PRAKASH NAGAR NAGLA TEJA PRAKASH NAGAR CHALESAR NALA MOTI KATRA KHIRKI KALE KHAN TEELA GAJ SINGH TEELA MUNNA LAL SATYABAR CHITRA KE PAAS NABAB SAHAB KA BADA GOKUL PURA BADA CHARAN SINGH BALMIKI NAGAR TEELA GOKUL PURA TEELA AJMERI TEELA JORI GANJ MANTOLA ABADI NALA MANTOLA ABADI TOP KHANA DERA SARAS DHAKRAAN KUMHAAR PADA CHAURAHA MEER HUSSAINI RAWALI

POPULATION 2200 668 150 2500 6830 2947 928 980 511 2500 5180 6165 5677 1920 1923 2829 362 172 4689 2829 833 905 3088 2968 3738 3821 561 2756 1000 5292 2189 4250

13

Sr.No.

NAME OF HEALTH POST 4 5 6 7 8 1 2 3 4 5

19

S.N. MEDICAL COLLEGE

NAME OF SLUMS KATRA KADARIYAN SADAR BHATTI TAKIYA MAULA SHAH BHAR GALI BEHIND BALUGANJ TO TILL BIJLIGHAR NALA BUDAAN SAIYYAD KHATEEK PADA BAGH MUJAFFAR KHAN BALMIKI BASTI LOWER KHATIYANA NALA KHATIYANA

POPULATION 644 524 1200 600 4000 4000 7600 328 724 905

14

PULSE POLIO IMMUNIZATION CAMPAIGN SENSITIVE AREAS: AGRA URBAN

Sr.No. 1 SERIAL NAME BUNDU KATRA NAME OF AREA TUNDPURA NAGLA LATOORI SINGH GUMMAT TAAL FIROZ KHAN BUNDU KATRA NAGLA TEK CHAND NAGLA JASSE SEWALA ABBU LALA JAGAN PUR MONOHAR PUR KHANDARI BASTI PATTHAR GODA BAI KA BAZAR SARAI BEGA TRANSPORT NAGAR (SURAJ PUR) SUBHASH NAGAR NAGLA FATOORI GEETA NAGAR BALKESHWAR PEER KALYANI GAREEB NAGAR MOTIYA KI BAGICHI MOTAN GARH SWEEPER COLONY BALMIKI BASTI BALKESHWAR BALMIKI BASTI SHIVPURI NAYA BAANS PULCHINGA MODI KATGHAR REASON FOR BEING SENSITIVE MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MUSLIM BASTI MALIN BASTI FAR FLUNG AREA MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI A.F.P. CASE POSITIVE WILD VIRUS MUSLIM BASTI MALIN BASTI MALIN BASTI SWEEPER COLONY SWEEPER COLONY MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI

HARIPARWAT (EAST)

HARIPARWAT (WEST)

4 5

JAMUNAPAAR JIWANI MANDI

LOHAMANDI I

15

Sr.No.

SERIAL NAME

LOHAMANDI II

NAGLA PADI

RAKABGANJ (NORTH)

10

RAKABGANJ (SOUTH)

NAME OF AREA NAUBASTA JATPURA BILLOCHPURA KARWAAN TELI PADA RAJ NAGAR SIR KI MANDI KHATI PADA SAIYYAD PADA RAM NAGAR JAGDISHPURA BALMIKI BASTI JAGDISHPURA GARHI BHADAURIYA BODLA JAGDISHPURA NAGLA BER NAGLA AJITA BHIM NAGAR MAU KAUSHAL PUR SARLA BAGH ENCLAVE BASERA ENCLAVE CHAKKI PAAT MANTOLA TAMOLI PADA TEELA NAND RAM TEELA AJMERI GHATIYA MAMU BHANJA NAI BASTI NALA MANTOLA KAJI PADA DHOLIKHAR TEELA SHAIKH MANNU KATGHAR

REASON FOR BEING SENSITIVE MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI RESISTANT COMMUNITY MALIN BASTI, UNAWARENESS, ILITERACY NOMADIC POPULATION FAR FLUNG AREA MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MUSLIM BASTI, MALIN BASTI

16

Sr.No.

SERIAL NAME

11

SHAHGANJ I

12

SHAHGANJ II

13

TAJGANJ

14

VIBHAV NAGAR

15

DISTT. HOSPITAL

16

LADY HOSPITAL

NAME OF AREA KUTUL PUR BAGH NANAK CHAND NAGLA CHAUA NAGLA FAKEER CHAND SANJAY NAGAR HAMEED NAGAR KHUSHALI NAGAR CHILLI PADA BARAH KHAMBA RASOOLPUR KHWASPURA KAMAAL KHAN SHIV NAGAR ASD GALI NUNIHAI TEEN KA NAGLA BASAI KHURD NAAHAR GANJ MURALI NAGAR DALHAI KOLAHAI SAHEED NAGAR POORVI GATE & GARHI BALL GOBAR CHAUKI RAJEEV NAGAR PAKKI SARAI KACCHI NAGAR KAREEM NAGAR TEELA HUSSAIN CHEEL GARH KUMHAAR PADA CHOTA GALIB PURA

REASON FOR BEING SENSITIVE MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI, RESISTANT COMMUNITY MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI, FAR FLUNG AREA MALIN BASTI MALIN BASTI MALIN BASTI MALIN BASTI, FAR FLUNG AREA MALIN BASTI, FAR FLUNG AREA MALIN BASTI ILLITERACY ILLITERACY ILLITERACY ILLITERACY MUSLIM CONGESTED POPULATION CONGESTED AREA CONGESTED AREA PROHIBITED TO USE MEDICINE

17

Sr.No.

SERIAL NAME

17

RAILWAY AREA

NAME OF AREA BADA GALIB PURA BAADA CHARAN SINGH BALMIKI BASTI NALA AHEER PADA NALA DHAKRAAN AGRA CANTT STATION RAJA MANDI AGRA CITY STATION

REASON FOR BEING SENSITIVE RESISTANT COMMUNITY MALIN BASTI NEAR NALA MALIN BASTI NEAR NALA MALIN BASTI NEAR NALA MALIN BASTI NEAR NALA FLOATING POPULATION FLOATING POPULATION FLOATING POPULATION

18

SLUMS IN ICDS LIST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Punia Pada Raj Nagar Sir ki Mandi Naya Bans Katghar Khatipada Kansgate Balka Basti Pul Chinga Modi Naubasta Khatena Telipara Bhim Nagar Shiv Nagar Anand Nagar Pachkuiyan Prakash Nagar Kolihai Bhiogipura Ram Nagar Garhi Bhadauria Krishna Nagar Prithvinath Indra Colony Moti Katra Sheetla Gali Nala Buddhan Sayyed Mantola Nai ki Mandi Sadar Bhatti

19

Annex 3 List of Slums Missing from DUDA List 1. 15 Quarter 2. Bagh Kala 3. Bagichi 4. Khandelwal Colony 5. Kharjeet 6. Maurya Nagar 7. Mohan Nagar 8. Nagla Chandra Bhan 9. Nagla Lal Das 10. Nagla Mewa Ram 11. Nagla Nai Abadi 12. Nagla Paswati 13. Nagla Ram Bhawan 14. Nagla Ramlal 15. Nagla Sewa Ram 16. Nagla Vijay Nagar 17. Kala Bhairon 18. Kareem Nagar 19. Taj Ganj 20. Satyam Pura Names of slums that have been repeated in the DUDA list 1. Nagla Wasi 2. Sewala 3. Sewla ka Nagla 4. Khandari 5. Nagla Bharti 6. Nagla Devjeet 7. Nagla ka Teja 8. Nagla Kishanlal 9. Nagla Gokulpura 10. Puliya Hingara Moti 11. Shiv Sahani Nagar 12. Tari Pura 13. Zumman Khan Ghopdi Slums that have been mentioned as two different settlements and have now been clubbed in our list 1. Shyam Vihar Naraich 2. Azampada

20

Annex 4 Process of Vulnerability Assessment The Vulnerability Assessment of slums and slum-like areas in the city from a health perspective was undertaken to identify beneficiaries and better target the program. The following process was undertaken:
Identification & listing of slum and slum-like areas Development of Vulnerability Criteria Data Collection through visits and Consolidation & verification of 10% data by core team By 2 member teams of a local NGO reporting on a checklist, after training Validation of results Mapping of slums and health facilities

Available lists People knowing slums Visits

Slum visits Discussions Refinement

Presentation and discussion with different groups & Slum visits

Indicating slums and facilities with appropriate colors, triangulation during stakeholder meetings

1. Identification and listing of all slum and slum-like areas in the city All slum and slum-like areas in the city were identified through the following methods. i. Collection of available slum list from the AMC, DUDA, Health Department, Pulse Polio Campaign, ICDS. ii. Meetings with different categories of grassroot workers, existing staff of UHCs (MOs, ANMs, LHVs), ICDS Supervisors, Ward Councilors and individuals having an experience of slums. iii. Visits to different parts of the city and slums. All the areas identified through the above process were compiled together to form a ward wise slum list. 2. Development of Vulnerability Criteria The vulnerability criteria against which the areas were to be assessed was developed in the following manner: a) Field visits The core team19 visited different slums to understand what were the specific issues pertaining to the city and were affecting the vulnerability of the population living in these areas.

19

The core team is referred to the EHP team that was supervising and coordinating the work.

21

b) Review of literature The team reviewed the list of criteria used in Dehradun, Haridwar, Haldwani & Bally. Keeping this as a base, the team considered the local situation in Agra and customized the list of criteria. c) Training session with study team20 A two day training workshop was organized with the study team to impart the knowledge of data collection for the vulnerability assessment. The training workshop included finalisation of the vulnerability criteria. Disparity amongst slums was widely discussed in the workshop. This group discussion led to finalization of criteria to be used for the vulnerability study. The training workshop also covered sessions on participative methodology on how the information on different themes should be gathered in the slums. Vulnerability criteria: The criteria used in the study were Land ownership, river / railway line vicinity, eviction or resettlement Economic status Income patterns, nature of employment, credit facilities, status of ration cards and BPL cards Social factors Education, gender equations, alcoholism Access and usage of health Presence of facilities, usage of facilities services Morbidity in the slum Vaccination coverage, illness burden, health practices Infrastructure Housing, drainage, sanitation, water, electricity History of collective efforts Strong Community based organization 3. Data Collection The data was collected from all slum sites of the city. Simultaneously, the data was entered by volunteers into the scoring matrix. 4. Consolidation of data A ranking key was developed denoting the levels of conditions within each criteria. A score of 1-3 was given to each criterion, with a score of 3 on the criteria denoting an extremely bad condition, and a minimum score of 2 showing a fairly better off condition. The total scores were distributed in three categories: less vulnerable slums, moderately vulnerable slums and highly vulnerable slums. Slums were thus consolidated in the above three categories. 5. Validation and Mapping of Vulnerable Slums and Health Facilities Subsequent to the consolidation and analysis of the data collected, slums in Agra were categorized on the basis of their vulnerability and a map indicating slums as per their
20

Land status related factors:

The study team includes the volunteers of a local NGO.

22

vulnerability and with facilities marked was prepared. This data was then shared and refined in separate meetings with Ward Councilors, Health Department officials and field staff, Anganwadi workers and supervisors, Sanitary Inspectors of Agra Municipal Corporation and other key people having knowledge of Agra slums. The vulnerability mapping of the slums was finalized after this rigorous exercise.

23

Annex 5 Ward No. 19 LIST OF SLUMS & VULNERABILITY STATUS Slum Ward Name Slum Population Category Id Nai ki Sarai 1 Pura Goverdhan 1,509 Most (Foundary Nagar) 2-ur 3 4 5 6 7-ur 8-ur 9-ur 10-ur 11 12-ur 13-ur 14-ur 15-ur 16-ur 17-ur 18-ur 19 20 21-ur 22-ur 23-ur 24-ur 25-ur 26-ur 27-ur 28-ur 29-ur 30-ur 31-ur Jagjeevan Nagar Tedi Bagia Nagla Kishanlal Nai Ki Sarai Nand Lal Pur Indra Jyoti Nagar Krishna Bagh Colony Shyam Nagar Nehrapuram / Nehra ka Nagla Azad Nagar Ashok Vihar Vikas Nagar Gautam Nagar Vidhya Nagar Vinod Vihar Colony Prakash Puram Swaroop Nagar Gadhi Jeevan Das / Ghadi Jeevan Ram K.K.Nagar Shobha Nagar Sanjeev Nagar Bhagwati Bagh Radha Nagar Gokul Nagar Islam Nagar Yamuna Vihar Ganesh Nagar Sainik Nagar Pavan Vihar
Vidya puram/Jagdamba Nagar

1,200 2,761 3,000 3,000 800 900 900 2,000 210 300 1,500 1,080 500 1,080 2,000 1,500 1,200 2,100 1,000 1,200 700 1,500 600 600 4,000 300 600 300 300 450

Most Most Most Most Moderate Most Most Most Most Most Moderate Moderate Most Most Most Most Most Most Most Most Most Most Most Most Most Most Most Most Most Most

24

32 33 34 35 36 37 38-ur 39-ur 40-ur 41 42-ur 43-ur 44-ur 45-ur 46-ur 47 48-ur 49-ur 50-ur 51-ur 52 53-ur

Shyam Vihar (East and West) Nagla Rambal Rakesh Nagar Santosh Nagar Nagla Mohanlal Sati Nagar Gulab Nagar Nagla Jamani Siddharth Nagar Satya Nagar Nagla Dhamoli Sudama Puri Shobha Nagar/Vihar Chandan Nagar Shyam Nagar / Shyam Nagar Teela Shambhu Nagar Rajeev Nagar Nagla Chaua Narayan Vihar Nagla Chanda Naraich Moti Bagh (Khaliyayi
Mandi, Anathalay Wali Gali, Nagla Pench, Kuen Wali Basti)

800 3,000 1,800 400 420 4,500 600 1,200 1,000 750 240 700 600 600 2,200 2,100 900 800 500 1,200 6,000 5,000

Most Most Most Moderate Most Most Moderate Most Moderate Most Most Moderate Most Most Most Most Most Moderate Most Most Most Moderate

17

Naraich

28

Etmaddola

73

Sita ka Nagla

54-ur 55 56 57-ur 58 59-ur 60 61-ur 62 63 64 65-ur

Katra Wasir Khan Sita Nagar Nunihai Ram Bagh Hanuman Nagar Nagla Faturi Nagla Balchand Nawal Ganj Moti Mahal Nagla Devjeet (including
Abbas Nagar)

2,700 4,000 5,000 750 3,000 1,400 1,500 1,800 4,200 5,000 500 3,500

Moderate Less Less Moderate Less Moderate Less Moderate Moderate Most Most Moderate

12

Nawal Ganj

Indra Nagar Kachpura (Old & New)

25

61

Shahdra

54 52

Gali Asad Tulsi Chabutra

66 67 68 69 70-ur 71-ur 72-ur 73 74 75-ur 76-ur 77-ur 78 79 80 81 82-ur 83-ur 84 85 86 87 88-ur

Shahadra (Old & New) Sushil Nagar Gadi Chandni Gadi Hussani Chhlesar Gautam Nagar Prakash Nagar Shanti Nagar Nagla Bihari Beech Ka Chhlesar Bangara Chalesar Peela Khar Asad Gali Tajganj Taj Khema Shekh Bulaki Daliyahi Basti Telipara Navada Gudiyahi Khairati Tola Gadi Bangas M.P.Pura Gummat
(including Nagla Mahadev)

7,500 2,700 803 668 3,000 2,477 2,400 1,200 2,100 1,800 420 480 1,278 240 1,050 2,000 1,000 1,500 1,800 610 600 2,940 3,000 3,000 2,000 800 3,000 1,000

Most Most Most Most Most Most Most Most Most Most Most Most Moderate Less Most Moderate Most Moderate Less Less Most Less Moderate Moderate Most Moderate Less Most

60

Purani Mandi

Malko Gali (including

Aap ka Mazaar)

65

Hajju Pura

89 90-ur 91 92 93

Paktola (including
Diwanji Mohalla, Bagichi Patiram)

Billochpura Nunihai - Sanjay Colony / Nagar Hajjupura Purani Sabzi Mandi

(Including Balmiki Basti)

26

16

Dhandhu Para

94-ur 95-ur 96-ur 97 98-ur 99 100 101-ur 102-ur 103-ur 104

Nahar Ganj Nagla Teem / Nagla Pyarelal Koliyahi Basai Khurd (Old & New) Nagla Mewati Nagla Deeng Prema ka Nagla Saeed Nagar Natha Nagar Dhandhupura Gober Chauki (including
Siddharth Nagar, Jyoti Nagar, Baldev Nagar, Abbas Nagar, Dinesh Nagar, Roshan Nagar, Nasim Nagar Johri Nagar, Tulsi Nagar, Ameeta Nagar, Rathore Nagar)

2,400 3,500 1,692 4,000 4,500 974 673 511 550 4,000 8,350

Moderate Most Most Moderate Moderate Most Most Most Most Moderate Most

53

Bagh Rajpur

68

Ukhara

20

Bundu Katra

105 106-ur 107 108-ur 109 110-ur 111-ur 112-ur 113-ur 114-ur 115-ur 116 117 118 119 120

Bagh Khinni Pakki Sarai Rajeev Nagar Rajpur (New & Old) Lachichi Pura Kachi Sarai Bagh Rajpur Ukhara Bada Ukhara Beech ka Ukhara Chota Premnagar Nagla Bhawani Singh Sinho ka Nagla Nagla Laturi Singh Nagla Tek Chand
(including Shanti Nagar)

2,500 3,000 2,400 6,500 800 3,000 1,800 3,000 792 787 1,500 2,400 700 2,400 3,000 600

Most Most Most Moderate Moderate Moderate Moderate Most Moderate Most Moderate Moderate Moderate Moderate Moderate Less

Balmiki Basti (Bundu Katra)

27

Takhat Pahalwan

121 122 123 124 125 126

Nandpura Tundpura (including

Purani Abadi, Nai Abadi, Shyam Nagar)

4,200 5,000 3,900 5,000 1,500 8,000

Most Most Moderate Most Most Most

Gopalpura Gummat Takhat Pahalwan (including

Balmiki Basti)

Mayapuri (including
Balmiki Basti)

Kotli Bagichi (including

Naya Nagla, Bhim Nagar, Gautam Nagar)

127-ur 24 Sewla Jat 128 129 130 131-ur 132-ur 133 134-ur 135 136 137 138 139-ur 140-ur 141-ur 142-ur 143-ur

Madhu Nagar - Jhopdi ilaka Sewla Jat (including

Radha Nagar, Tyagi Nagar, Tota Nagar)

600 6,000 5,700 1,405 1,200 2,400 600 1,500 2,500 700 2,150 8,000 2,100 600 1,000 1,500 800

Most Moderate Most Most Moderate Most Most Most Most Most Moderate Moderate Moderate Moderate Most Most Most

Sewla Sarai (Nai and Purani) Nagla Bharti Sarai Malukchand Nagla Jassi Ambedkar Nagar Parsoti Nagar /Parsoti ka Nagla Nagla Vidhi Chand Rampu ki Jhopri Taal Firoz khan Sohalla Chawli Pyara ka Nagla Afoi ka Nagla Shiv ka Nagla Parmahans Pura

50

Nagla Bhoja

28

Cantonment Area

144-ur 145 146 147 148 149-ur

Naulakha (Balmiki, Jatav)

1,500 1,800 2,400 400 100 600 1,800 2,100 1,000 3,300 2,400 12,000

Moderate Less Less Most Moderate Most Moderate Less Moderate Moderate Most Moderate

46

Railway Colony

150 151 152 153-ur 154 155

Shehzadi Mandi Kachipura 20 Quarter Beech ka Bazar Lal Kurti Kachchipura Janata Colony - Nai Abadi Nagla Kachiyan Jhuman ki Jhopdi Shiv Nagar Nagla Puliya Nari Pura (Old & New
Abadi) (includes Akhand Nagar, Rohit Nagar, Sri Nagar, Bhim Nagar, Bhagwati Nagar)

34

Nagla Pulia

156 157-ur 158-ur 159-ur 160-ur 161-ur 162-ur 163-ur 164-ur 165 166-ur 167-ur

13

Sewa ka Nagla

Mahavir Nagar Kamal Khan Rahul Nagar Barah Beegha Rasul Pur Khwaspura (New & Old) Kidwai Nagar Akbarpur Nagla Lal Singh Sewa ka Nagla (Old Barakhamba) Khwaja ki Sarai Nagla Garib das

900 1,400 1,500 750 1,500 7,500 7,000 3,000 1800 1,200 900 330

Moderate Most Moderate Most Moderate Moderate Moderate Moderate Moderate Most Most Most

29

Chanakya Puri

168 169 170 171 172 173-ur 174-ur 175-ur 176-ur 177 178

Nagla Baasi Nagla Chauaa Nagla Fakir Chand, Balmiki Basti Bagh Nanak Chand Kheria ka Nagla Yadav Nagar Dev Nagar (Old & New) Krishan Garh Nagla Mohan Lal Diggi Koliyahi

720 2,700 4,500 6,000 1,200 500 1,000 210 3,000 720 3,000

Moderate Moderate Moderate Moderate Most Moderate Moderate Moderate Moderate Most Moderate

18

Nagla Mohan

39

Ramnagar (Shivajinagar)

179-ur 180 181-ur 182-ur 183-ur 49 Rui ki Mandi 184 185 186 187-ur 14 Gyas Pura 188 189 190 191 192-ur 193 194 195 196

Chillipada Namak ki Mandi Sora Katra 24 Quarter, Charbagh 36 Quarter, Charbagh Rui ki mandi Dayal Nagar Bhogipura Bhogi Pur (Phakiron ki Basti) Gyaspura Sindhi Colony Ajit Nagar Gopinagar Tamoli Pada Nagla Prithvinath Jogi Pada Ajampada (New and Old) Jay Nagar

2,100 3,000 1,200 400 600 5,020 1,850 2,500 1,154 2,000 2,000 240 500 2,000 4,850 2,650 10,783 800

Most Moderate Moderate Most Most Moderate Less Less Moderate Moderate Moderate Most Moderate Moderate Moderate Most Most Most

38

Azampada

30

74

Kedar Nagar

197-ur 198 199 200 201-ur 202 203 204 205-ur 206 207 208-ur 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228-ur 229-ur

Satya Nagar Kesar Vihar Shankerpuri Albatiya Jhopdi Albatiya Bodla Sarai Panchwati Mahaur Nagar Satnam Nagar Hukmi Nagar Vikram Nagar Geeta Puram Nai Abadi Bodla Subhash Puram Bhola ka Nagla Premnagar Hamid Nagar Sidh Sahani Nagar Khushali ka Nagla Ram Nagar Nagla Teja Prakash Nagar Garhi Bhadauria
(including Hanuman Nagar & Gopalpura)

1,200 1,800 600 1,500 780 2,218 1,000 720 1,470 1,000 900 1,200 1,200 2,600 500 10,000 2,400 1,900 831 3,600 1,500 5,400 6,000 2,527 2,289 5,025 2,400 766 660 2,900 3,300 400 3,000

Most Most Moderate Less Most Moderate Less Most Most Most Moderate Most Most Moderate Most Moderate Most Most Most Most Moderate Most Less Most Moderate Moderate Moderate Moderate Moderate Most Moderate Moderate Moderate

23

Nagla Khumani

43

Bodla Sikandra

Prem Nagar

Garhi Bhadauria Raj nagar

11

72

Joshiyan

Baudh Nagar Nagla Ganga Ram Raj Nagar Sir ki Mandi Naya Bans Jagjeevan Nagar Pul Chinga Modi / Pul Hingara Moti Ahir Para Ghas ki Mandi (Muslim Ilaka) Puniya Pada (Balmiki
Basti)

31

57

Gujjar Top Khana

230 231-ur 232-ur 233-ur 234-ur 235 236-ur 237

Gujjar Top Khana Koliyon ki Basti (Khati Para) Gali Rangrejan (Purana
Raja Mandi Bazaar)

2,400 1,000 900 600 1,500 6,600 3,400 8,000

Moderate Moderate Moderate Most Moderate Moderate Moderate Moderate

Bada Baada (Nawab ka

Baada)

32

Jat Pura

Besan ki Basti Khatena Jat Pura Naubasta (including

Nagla Gatta, Rajiv Gandhi Nagar & Peer Bhaduri/Babuddin)

42

Sayyed Para

238 239 240 241 242-ur 243 244 245-ur 246-ur 247 248 249 250 251 252 253 254 255 256-ur

Teli Para Sayyed Para Karwan Alamganj Jattu Bazar Sonth ki Mandi Billochpura Nagla Ber Surjepur (Transport Nagar) Kabir Kunj / Kabir Nagar Ram Nagar (Old & New) Shyam Nagar Nagla Ajeeta Jagdish Pura Bhim Nagar Shiv Nagar Kishore Pura Anand Nagar Nagla Gokulchand

4,200 2,000 3,000 1,000 800 900 2,100 1,800 697 600 2,800 780 3,210 4,200 5,300 900 6,193 5,100 3,000

Moderate Moderate Less Most Moderate Less Moderate Most Most Most Moderate Less Less Moderate Moderate Moderate Moderate Moderate Moderate

27

Nagla Ajeeta

Kishore Pura

32

48

Sikandra

78 45 55 22 26

Kakreta Gailana Khandari Nagla Padi Nagla Haweli

257 258 259-ur 260-ur 261-ur 262 263 264 265 266-ur 267 268 269-ur 270-ur 271 272 273-ur 274-ur 275-ur 276 277-ur

Bai ka Bazar Pattar Ghoda Sarai Bega Mohammedpur Baipur Kakreta Bapu Nagar Gailana Khandari Wali Basti Nagla Budhi Nagla Padi JP Nagar Mau Nagla Haweli Mau - Malin Basti Jaganpur Lashkerpur Karbala Sultanganj Maharana Pratap Nagar Nagla Dhani Manoharpur

1,800 1,600 1,154 2,200 2,000 915 4,000 2,106 1,920 8,000 3,300 760 2,400 1,000 1,500 1,800 3,000 5,932 3,222 3,000 1,000

Most Moderate Moderate Moderate Moderate Moderate Most Moderate Moderate Most Moderate Most Moderate Most Moderate Less Most Moderate Moderate Most Most

31

Ghatwashan

66

Kamla Nagar Extension Balkeshwar

79

278 279-ur 280-ur 281-ur 282-ur 283 284-ur 285 286

Balkeshwar (Jaswant ki
Chatri)

1,800 1,500 600 1,800 1,500 1,020 750 3,000 900

Moderate Most Most Most Moderate Moderate Moderate Most Less

62

Lohiya Nagar

Balmiki Basti, Shivpuri Thipri Rajwada Lal Masjid Chida ka Nagla Langde ki Chauki Haweli Bahadur Khan Phatak Suraj Bhan

Nagla Harmukh

56

Krishna Colony

33

25

Jeoni Mandi

287 288 289 290 291 292 293-ur 294-ur 295 296 297 298 299 300 301-ur 302 303-ur 304 305 306 307 308 309-ur 310 311 312 313 314 315 316

Motiya ki Bagichi John's Mill Line Gareeb Nagar Parma ka Nagla / Prema ka Nagla Patel Nagar Koyla Wali Basti Bhero Bagichi Nagla Shola Bhola Nagla Mahadev Mohangarh Ratanpura Mansingh ki Bagichi Masta ki Bagichi Naya Gher Chimman Lal ka Baada Peer Kalyani Sweeper Colony Ghatiya-Padi Tola Nawab Sahab ka Baada Dhuliya GanjDhobipada Neem Darwaza Holi Chauraha - Nagla Beni Prasad Gihara Basti Bajirpura Nala Budhan Saiyad Nakhasa Khatikpada Khatikpada (Bagh Muzafar Khan) Bagh Muzaffar Khan (Balmiki Basti) Teela Gokulpura Gokulpura

1,200 1,900 4,200 1,200 1,200 2,400 1,200 1,997 900 1,200 1,200 420 1,500 1,200 750 1,800 480 900 900 600 1,200 900 750 3,000 4,000 1,000 1,400 1,500 1,000 6,000

Less Most Most Moderate Moderate Less Moderate Moderate Moderate Most Less Most Less Moderate Moderate Most Moderate Less Moderate Less Moderate Moderate Most Most Moderate Most Moderate Most Moderate Less

15

Freeganj

35

Vijay Nagar Colony Ghatia Azamkhan

33

70

Bajirpura

Charasu Darwaza Bagh Muzzafar Khan Teela Gokulpura

10

64

34

44

Moti Katra

75 77 63

Nuri Darwaza Maithan Dhankot

317 318-ur 319 320-ur 321-ur 322-ur 323-ur 324 325 326 327-ur

Moti Katra Nala Moti Katra Khirki Kale Khan Man Singh Wada Teela Joshiyan Nala Choon Pachan Balmiki Nagar Teela Maithan Kuncha Sadhu Ram Ka Nai Basti Takiya Bajir Shah / Maulah Shah Panja Madarsa Chandra Pan Wali Gali Pathwari Bhand Gali Teela Gaj Singh Nala Roshan Mohalla Teela Munna Lal Mantola Nala Mantola Nala Kans Khar Kangalpada Dera Saras Galib Pura Bada - Nai ki Mandi Mira Hussain (Choti Hatai, Badi Athai, Darbar Shahji, Darjipada) Gher Kale Khan Ashok Nagar Sindhi Colony Charan Singh Baada Teela Panchkuiyan Nal Bandh

Most 5000 Most 1,500 Most 500 Moderate 1,200 Most 1,000 Most 1,800 Moderate 900 Less 2,000 Less 3,000 Less 1,200 1,800 1,200 2,700 600 1,923 1,931 2,829 3,738 3,821 3,000 3,000 2,756 4,000 2,189 Most Less Moderate Less Moderate Moderate Moderate Most Moderate Most Most Most Most Moderate Moderate

1,000

36

Belanganj

328 329-ur 330 331-ur 332-ur 333-ur 334-ur

76 69

Chatta Road Seth Gali

41 37

Mantola Nala Kans Khar

335 336 337-ur 338 339 340-ur 341

67

Halka Madan

58

Ashok Nagar

342-ur 343 344 345 346

600 1,700 2,829 1,800 540

Moderate Less Moderate Most Moderate

35

29

Munda Pada

347 348-ur 349-ur

30

Dholikhar

Kaji Pada

350-ur 351-ur 352-ur 353 354 355 356 357 358-ur 359 360 361 362-ur 363-ur 364-ur 365 366-ur 367 368-ur 369-ur 370-ur 371-ur 372-ur 373-ur 374-ur 375 376-ur 377-ur

Dhakran Teela Nand Ram Gola Hata (Sadar Bhatti, Balmiki Basti Maveshi Khana) Nagla Dhakran Solah Kotri Munda Pada Dholikhar Ghatia Mammu Bhanja Tila Ajmeri Khan Tila Sheikh Mannu Tamoli Para Budh Vihar Kaji Pada Chakki Paat Ravi Das Nagar (Shivaji Market) Tallaiya Kaji Pada Nala Kaji Pada Telipara
Gautam Nagar (Chakki Pat)

1,740 3,600 1,800

Moderate Moderate Most

3,300 900 900 2,500 3,000 4,000 4,500 1,500 800 1,153 8,000 860 3,000 3,000 700 2,700 300 3,000 840 1,961 1,500 750 3,000 3,500 600 1,800 600 240

Moderate Most Moderate Most Most Most Most Most Moderate Moderate Moderate Most Most Most Moderate Moderate Most Moderate Moderate Moderate Most Most Most Most Moderate Most Most Moderate

Tila Hussain Khan

Sayyed Wali Basti Rawli Tila Hussain Khan Katra Gadrayan Swaroop Nagar Bagichi Radha Ballabh Misri Sayyad (Near Bagichi)
Pani Wali Basti (Kaji Pada)

Tila Lokayan Sundar Para Ghera Basti Nagla Kachi

36

40

Balu Ganj

378-ur 379-ur 380-ur 381-ur 382-ur 383-ur 384-ur

Chilgarh (Oliya Crossing) Nala Pratappura Teela Balu Ganj (New) Teela Balu Ganj (Old) Oliya Road Basti Nala Beni Singh (Near School) Adarsh Nagar (Balmiki Basti, Behind Distt. Hospital) Charhat Dargaiya Kumhar Para Kutlupur (Old and New) Nagaria Namner (Jatav Basti) Katghar Idgah Sarai Rustom Khan Mohanpura

1,800 1,800 2,500 1,800 2,700 1,000 240

Moderate Moderate Moderate Moderate Moderate Most Moderate

21

Kumhar Para

385-ur 386-ur 387-ur 388 389-ur

1,800 200 5,292 7,122 1,200 4,200 3,000 1,000 1,700

Moderate Most Moderate Moderate Most Moderate Moderate Most Moderate

47

Idgah

390 391 392-ur 393

37

Annex 6 Existing Public Sector Health Facilities (1st and 2nd tier), Agra
Deptt. of Medical Health and Family Welfare D type health centre: 9 Municipal Corporation First Tier Facilities: 7 1. Lohamandi I 2. Shahganj I 3. Chatta 4. Jeoni Mandi 5. Jamuna Par 6. Tajganj 7. Medical Care Unit 1. Halwai ki Bagichi Railways Hospitals 1. Agra Cantt 2. Idgah Station and 3. Agra Fort Army and Airforce Health Facilities 1. Cantonment Hospital 2. Two Army and Airforce dispensaries Central Government ESI Dispensaries: 3

1. 2. 3. 4. 5. 6. 7. 8. 9.

Bundu Katra Bibhav Nagar Nagla Padi Rakabganj (North) Rakabganj (South) Hariparvat (East) Hariparvat (West) Lohamandi II Shahganj II (Red Cross Building)

1. Nunhai 2. Jeoni Mandi 3. Chippi Tola.

ESI Hospital

Urban Family Welfare Centres (UFWCs): 2 1. District Hospital

2. T.B Demonstration Center

Post-Partum Centre: 2 1. S.N Medical College

2. Lady Lyall hospital

Second tier/ Referal Services 1. District Hospital 2. Lady Lyall Hospital

38

Annex 7 LIST OF SLUMS SELECTED FOR FOCUSSED GROUP DISCUSSIONS S.No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Name of the Slum Asad Gali Gyaspura Khushali Ka Nagla Nagla Lal Singh Baasi ka Nagla Ram Nagar Subhashpuram Baudh Nagar Khatena Taal Firoze Khan Rampu ki Jhopadi Islam Nagar K. K. Nagar Prakash Nagar Shobha Nagar Garhi Chandni Khirki Kale Khan Tila Ajmeri Khan Sundar Pada Nagla Haweli Nagla Bhawani Singh Gopalpura Shiv Nagar Lachchipura Karban Area Tajganj Shahganj Shahganj Shahganj Shahganj Shahganj Lohamandi Lohamandi Lohamandi Budu Katra Bundu Katra Trans Yamuna Trans Yamuna Trans Yamuna Tran Yamuna Trans Yamuna Rakabganj Rakabganj Rakabganj Nagla Padi Bundu Katra Bundu Katra Shahganj Tajganj Lohamandi Vulnerability Status Moderate Moderate Most Moderate Moderate Most Moderate Most Moderate Moderate Most Most Most Most Most Most Most Most Most Moderate Moderate Moderate Moderate Moderate Less

39

Annex 8
Reanalysis of Uttar Pradesh NFHS-II (1998-99) by Standard of Living Index USAID-EHP Urban Health Program URBAN MEDIUM HIGH 47.8 76.5 104.5 22.9 29.7 37.3 RURAL MEDIUM HIGH 56.2 85.1 119.3 41.4 56.9 65.9

Health Indicator Mortality Neonatal Mortality (for the five-year period preceding the survey) Infant Mortality (for the five-year period preceding the survey) Under-5 Mortality (for the five-year period preceding the survey)

LOW 43.7 79.0 130.6

Total 38.3 60.4 85.8

LOW 61.5 110.7 159.4

Total 56.6 91.7 129.5

Malnutrition
Percentage of children under 3 years underweight for age Below 2 SD (includes children below 3 SD) Percentage of children under 3 years underweight for age Below 3 SD Percentage of children under 3 years undernourished (stunted) for age Below 2 SD (includes children below 3 SD) Percentage of children under 3 years undernourished (stunted) for age Below 3 SD Child Health Determinants 58.3 44.4 35.6 42.6 61.7 52.4 33.8 53.6

36.2 64.4

18.6 53.7

7.3 32.0

16.3 46.7

28.7 62.2

21.6 56.9

11.5 44.0

23.1 57.3

46.7

26.1

8.8

21.8

38.4

32.4

16.9

32.9

Breast feeding
Percentage of infants breast fed within one hour of birth Percentage of infants whose mother squeezed first milk from breast 2.7 89.1 6.1 79.2 12.3 66.7 7.9 76.0 5.1 76.6 6.1 75.0 10.9 74.1 6.2 75.6

40

Percentage of children 0-3 months who are exclusively breastfed

53.2

27.1

33.8

65.5

63.1

39.2

Complementary feeding
Percentage of children 7-9 months who receive breast milk and solid/mushy food 44.8 73.3 64.5 59.0 57.7 70.3 -

Immunization rates
Percentage of children completely immunized among 12-23 months children Percentage of children receiving measles immunization among 12-23 months children Percentage of children left out from UIP (Children not receiving DPT 1) among 12-23 months children Percentage of children dropping out from UIP (DPT 1 to DPT 3) among 12-23 months children 29.7 34.7 49.7 27.6 41.7 23.8 38.7 64.9 14.5 32.3 50.0 24.2 11.0 22.7 57.1 21.4 31.5 43.7 34.0 65.5 17.7 19.2 31.7 46.2

9.7

28.4

30.1

26.2

22.2

22.2

28.6

22.9

Vitamin A
Percentage of children 12-35 months of age who have received at least one of vitamin A Percentage of children 12-35 months of age who have received at least one of vitamin A within last 6 months 12.3 10.4 15.3 10.6 30.8 19.0 21.1 14.0 9.4 6.7 13.2 8.9 20.7 14.9 12.5 8.7

Morbidity
Percentage of children suffering in past two weeks from:
ARI Fever Any diarrhoea Percentage of mother who know about ORS Percentage of mother who know two or more signs for medical treatment of diarrhoea 19.7 28.9 25.9 73.6 34.2 20.5 23.2 20.5 74.8 27.8 17.1 20.9 15.8 83.4 30.8 18.9 23.1 19.4 78.0 29.9 21.4 29.6 23.2 47.8 36.2 21.7 28.2 25.2 58.8 38.5 21.0 28.4 21.8 70.8 39.8 21.5 28.7 24.1 55.4 37.6

41

Percentage of children taken to health facility for diarrhoea Percentage of children treated with ORS or recommended home fluid Care seeking Percentage of children taken to health facility for symptoms of ARI (fever, cough, rapid breathing) Antenatal care Percentage of births whose mothers consumed iron-folic acid supplements for 3+ months Percentage of births whose mothers received tetanus toxoid vaccines (minimum of 2) Percentage of births whose mothers had ante-natal visits (minimum of 3) Birth Spacing Birth Interval (median number of months between current and previous birth) Modern Contraceptive prevalence rate (any method, currently married women) Permanent sterilization method rate Female sterilization method in proportion to total modern contraceptive prevalence method (percentile)
Safe delivery Percentages of deliveries at home

52.2 2.1

73.0 17.4

68.1 26.7

68.0 17.3

59.0 18.3

60.0 17.8

70.3 18.5

61.2 17.8

86.4

64.6

71.9

70.2

54.2

61.0

70.2

59.7

74.1

72.6

81.7

78.0

69.9

70.6

79.2

71.7

63.4 9.1

68.6 27.3

87.7 59.0

76.7 36.8

36.2 5.9

49.3 10.4

72.8 30.7

46.5 10.6

30.9 21.3 7.1 51.4

31.1 40.1 17.4 53.7

31.9 54.0 22.7 50.1

31.3 44.8 19.0 51.9

30.2 19.6 11.8 79.6

30.3 23.7 14.9 81.0

29.9 36.1 20.6 72.3

30.2 23.9 14.7 80.3

Percentages of deliveries at a health center (public/private/NGO)

Percentage of deliveries attended by a heath

85.3 13.1 26.2

71.7 26.2 29.9

39.3 59.8 76.0

61.4 37.1 51.7

93.0 6.3 9.6

85.7 12.6 17.6

65.6 33.7 42.3

87.6 11.3 16.7

42

professional at home or at a health facility Anaemia Among women

Any anaemia Mild anaemia Moderate anaemia Severe anaemia

Among children

55.1 34.9 19.2 1.1 89.2 25.5 62.0 1.7

48.9 33.8 14.0 1.1 75.9 21.9 46.0 8.0

41.2 29.2 11.5 0.6 66.9 23.6 37.8 5.5

46.0 31.9 13.3 0.8 74.1 22.7 45.0 6.5

52.8 35.5 14.7 2.6 75.8 19.7 49.9 6.1

49.2 33.9 13.9 1.3 74.6 19.0 48.5 7.1

43.1 29.2 12.5 1.3 70.0 16.9 45.4 7.7

49.4 33.9 13.8 1.7 73.9 18.8 48.4 6.7

Any anaemia Mild anaemia Moderate anaemia Severe anaemia

Environmental health conditions Water Supply and Sanitation

Percentage of Households with access to piped water supply at home Percentage of Households accessing public tap / hand pump for drinking water Percentage of Household using a sanitary facility for the disposal of excreta (flush / pit toilet) Percentage of Household not having any toilet facility

17.7 76.7 33.6

33.4 64.5 82.7

59.5 39.6 97.8

49.2 55.2 83.4

3.4 74.7 3.9

6.1 77.7 10.7

8.9 85.0 49.8

5.5 76.7 11.1

69.8

17.3

2.2

16.5

95.9

89.0

49.9

88.6

43

Annex 9 Relevant Portions of SJSRY Scheme and Case Study w.r.t. Community Development Societies

The Swarna Jayanti Shahari Rozgar 21 (SJSRY) was launched in December 1995 and reviewed and amended in 1997. The aim of the program is to assist individual or groups of urban poor beneficiaries to get gainful employment through the provision of credit and training. This program is applicable to all towns in India. The program directly targets the people below the poverty line (BPL) in urban India. 30 % beneficiaries of the program should be women, while 3 % should be the disabled. The proportion of beneficiaries belonging to the SC/ST must be in proportion to their strength against the total population. The program aims at the following: Skill development for income generation activities Group formation aimed at organizing communities Community leadership development Empowerment of Women Formation of thrift and credit societies aimed at promoting income generation activities, fulfilling emergency needs, improved sanitation etc. Community action towards local issues

The CDS system

A key feature of the SJSRY that aims to fulfill its community organization agenda is the formation of Community Development Society (CDS), which aims to organise women in low-income communities to plan for their own development, thus ensuring that povertyfocused programmes reach their intended target groups, without diversion or leakage. The active participation of women in the process is achieved through the three-tiered structure comprising: a) Neighborhood Groups (NHGs) An informal association of 10 to 40 women living in close proximity. This NHG selects one or more women volunteers from amongst themselves as their representatives. These representatives are known as Resident Community Volunteers (RCV). The functions of the RCVs include: a. Serve as two way channels of information and communication among the families in the cluster. b. To foster and encourage participation in community improvement. c. To motivate the community for being members of thrift and credit society and to contribute to community development fund. d. To support planning, implementation and monitoring of activities at the neighborhood level. e. To represent the views of the groups in the Neighborhood Committees

21

Source: Working for Poverty Alleviation A Practitioners Handbook on Swarna Jayanti Shahari Rojgar Yojana, All India Institute of Local Self-Government (2001)

44

b) Neighborhood Committees (NHC) A formal association of all women from various Neighborhood Groups, with the RCVs as their representatives. The functions of the NHCs include: a. To assist and carry surveys in accordance with the programs guidelines. b. To develop capacity through training in association with CBOs, NGOs and all other sectoral departments. c. To develop community based thrift and credit system as well as neighborhood development fund d. To support local action with the partnership of responsible agencies including community contracts. e. To identify local problems and priorities and prepare micro plans. f. To provide suggestions for groups involvement in meeting needs and goals. g. To provide feedback to agencies of program effectiveness and outreach especially for women and children. h. To facilitate recovery of loans. c) Community Development Societies (CDS) It is a federation of NHCs sharing common goals and objectives at the ward or city level. The CDS is the nodal agency through which all scheme based and institutional finance is channeled. The functions of the CDS includes: a. Liaise and link up with agencies and departments to promote action in the community towards fulfillment of their needs. b. To identify specific training needs of NHCs and NHGs and link them with relevant training organizations.

Administrative Structure of SJSRY

Community Organizer Full time appointment preferably woman for 2000 identified

Project Officer In charge of the town level Urban Poverty Eradication Cell (UPE). The UPE coordinates all the activities of CDS & CO, convergence between CDS and urban local body.

District Project Officer In charge of the District Urban Development Agency

Senior Officer of the State Government In charge of the State Urban Development Agency Monitors, provides policy directions & state level convergence

45

c. To prepare communityEmployment proposals and mobilize resources from plans, & Poverty Alleviation Ministry of community, city and otherGovernmentdepartments. sectoral of India d. To facilitate community surveys to be carried out to identify beneficiaries. e. To extend assistance to banks for ensuring repayment of loans by the beneficiaries. The CDS finances mainly come from the centrally allocated budget through the SJSRY. The GoI provides seventy-five per cent of the budget for these programmes and the state government provides the remaining twenty-five per cent. Case Study22: Kerala Community Development Society, Alleppey The Kerala Community Development Society in Alleppey is a CDS that has emerged as a successful example of this program. The Kerala CDS has initiated several developmental programs. They include: A micro credit program, supported by NABARD, that promotes thrift societies Specific programs to improve water supply, sanitation, housing and access, generate income and improve health Management training for members of the CDS; Training of trainers in the NHGs; The NABARD (National Bank for Agricultural and Rural Development) has come forward and coordinates efforts to attract funds from banks and other financial institutions and participating communities to make small contributions in kind, cash or labour. The CDS in Alleppey has gained recognition for its apolitical approach to community upgrading. The Alleppey Municipality has increasingly used it as a vehicle for implementing a wider portfolio of programs. As a result, a substantial list of activities that have traditionally been the responsibility of the health, education and engineering departments of the local municipality now fall under the umbrella of the CDS. The CDS thus provides a mechanism for the convergence of various government programs, at the same time reducing delays and leakages through the hands-on involvement of beneficiaries in the schemes implemented through these programs. The success of the CDS within the SJSRY program in Kerala has been largely driven by the government. At the outset itself the government of Kerala understood the need for information dissemination about the functions of the CDS, the way in which it was intended to work, the benefits that might be expected from it and what might be expected of NHG/NHC members etc. The government as part of its participatory planning
22

Department of Poverty Alleviation

Source: Seane de Cleene, (abridged by Kevin Taylor), Community Learning Information and Communication Case Study Kerala Community Development Society, Alleppey, The Development Planning Unit, University College, London

46

approach took care of the major capacity building needs. It was felt that the NHG had its own information needs that required to be channeled through the RCVs. These include information on the operation of the CDS system, methods for assessing and responding to the needs of the urban poor, key CDS functions such as the maintenance of the thrift societies and the services and infrastructure that can be provided through the CDS process. Other capacity building related to coordination and communication, for instance how to speak in public, how to access municipal departments etc. was also undertaken. In the initial stages of CDS, elected representatives and municipal officials needed to know about the CDS process and the needs of the urban poor. As the organization took shape, the information needs of the municipality shifted and focused more on individual CDS projects. Councilors sought information on activities in their own wards, at least partly in the hope of using any positive local impact to their own political advantage. In the case of health education, it was felt that the CDS should be used widely as a channel for the dissemination of information.

Advantages of being part of the Government

The CDS experience highlights the advantages of being a government-approved organization, located under the general municipal umbrella. In particular: Its place within the municipal system enables it to be used to bring about convergence of various programs. This allows a more focused use of municipal resources than was previously possible and enables the community to draw on municipal skills more readily. The fact that CDS has legislative support allowed it to be used as a vehicle for wider government-led initiatives particularly in the health sector and for projects that are implemented under the Kerala Governments Peoples Planning Campaign. It facilitates formal links between civil society and government.

Health Communication & the Kerala CDS

Health was probably the area where in terms of formal information requests, the response from the community was the most obvious and the most positive. The information and communication needs of the community could be broken down into several categories; health education, diagnostic, access to medicines and finally access to facilities. Initially, the health education camps were general in nature but as time has gone on and the womens exposure grew they have had more specific requests. These have included asking for more specific camps related to particular diseases or on issues relating to particular areas of concern such as mother and child health. This also applies to the medical camps where the emphasis is on a physical check up and the handing out of medicines. The Health aspect of the CDS program is probably one where the communication and information flows are the strongest and more apparently going in both directions.

47

Health Education camps are one of the main forums used for the exchange and transfer of information to poorer communities. Camps can be specifically requested through the action planning process or are initiated by the health authorities themselves and then promoted through the CDS network. Initially, the flow of information was much more directed from the Health sector down to the communities through the health workers. In the initial stages of the CDS program, there was the transfer of suggestions through CDS planning, up to the Health sector but these still represented general needs and the method of implementation was still very much Municipality led. As CDS has developed as an organization there has been increasing awareness of its capacity to initiate more specific program requests, to target areas of more acute need and to a much lesser extent, to have an input into the nature of the implementation itself. Some of this has come with increased awareness among the women themselves as to their wider health needs and their desire to use the microplanning exercise to ask for more specific interventions. Learnings As opposed to income generation programs or the provision of services and infrastructure where there were often visible tangible benefits and the acquisition of identifiable skills, with health, the benefits were not as visible, yet equally important. As a result, skills and lessons learnt in this regard could potentially be harder to acquire and to subsequently develop. Yet for the Kerala government as the program has developed, it is in this area where there has been the greatest shift in emphasis. Nearly all information now points to health education and awareness as being one of the most obvious contributions that CDS has made to peoples lives. The fact that health issues can be linked into a variety of other areas such as environmental sanitation, work safety issues and childrens welfare means that the learning in regard to health is continually being reinforced, as it is applied to these different contexts. It was observed that the women had rarely discussed their health issues with other women before, but through regular contact significant peer learning had taken place. This has been important in reducing the tendency for partial medical truths or superstitions to be interpreted as fact by individuals within the group. The process of prioritization has been learnt fast by the CDS members. They now determine which groups should participate in the Health Camps and Health Education Camps based on where the need is perceived to be the strongest and also where the distance to existing health services is the greatest. The health authorities used knowledge gained through CDS to start up six Mother & Child Health Centres in areas where the need was perceived to be the greatest.

48

Annex 10 Profile of Potential Non-government Organizations

Name of the organization Contact Details 1. Shri Nirotilal Buddhist Institute (SNBI) Mr. Ravi Kashyap, President 19/3 B, Khatena Road, Loha Mandi, Agra- 282002 Ph: 0562-3093983, 3116744. 2. Naujhil Integrated Rural Projectfor Health and Development (NIRPHAD), Mathura Dr. E.B Sudaram Branch Office: Raunchi Bangar Bad, Distt: Mathura: 281005, U.P Telefax: 0565-243 1165, Ph: 0565-243 1164 Head Office: NIRPHAD 14, Boulevard Road, Delhi-110054 Ph: 011-239 44364, Telefax: 01123932280 1979 Society At Management level: Full time: 15, Woman Worker: 03 At Supervisory level: Full time: 25 Voluntary: 10 Woman Workers: 06 At Grassroots level: Full time: 100 Woman Workers: 150 Volunteers: 50 Rural and Urban RCH, Education, Income generation, Micro-credit, IEC/ BCC/ Awareness camps, Water and Sanitation, Environment, Training and Advocacy Education, AIDS awareness, Family Planning 4. Mahila Shilp Kala Kendra Mr. S.D.S Ghai Swami Bagh, Agra Ph-0562-2570200 (o) 5. Samaj Kalyan Avam Prashikshan Kendra Dr. P.S Mehra Manager #37, Ayodhya Puram Colony, Deori Road, Agra 0562-2411920, 3097986, 94120-10239 (M) 3. Family Planning Association of India (FPAI) Mr. O. S Chauhan Project Manager (Local Contact, Agra) #145, Manas Nagar, Agra Ph-0562-2512416, 2114416 (o), 3104552 (M) Fax: 0562-2110555 Head Office: Mumbai. 1949 Trust and Society At Agra Office: Full time staff: 35

Year of Registration Nature of organization Number of workers

1994 Society At Management level: Full time: 08, Part time: 01 Voluntary Member: 06 Woman Member: 02 At Supervisory level: Part time: 22, Woman Members: 14 At Grassroots level: Woman Member: 190 Male members: 10 Volunteers: 200 Urabn Slums Health (RCH camps) and Primary education, Awareness building on AIDS and health practices. RCH camp in Urban slums

1983 Society NA

1992 Society Full time: 9 Administrative staff: 4 Volunteers: 20

Work Area Focus Areas of work

Rural and Urban Rural Marketing, Infrastructure development plannind NA

Urban and Rural Health and Education

Rural and Urban Family Planning, Mother and Child Health, HIV/AIDS

Background in urban programming

No

NA

49

Background in health programming Linkages with government programs Additional information Partnership area in Urban RCH

RCH camp in Urban slums Pulse-Polio Campaign, SIFPSA-RCH Camp Can be explored for awareness building, community mobilization

RCH, AIDS awareness RCH Program

NA NA

Have worked in 30 slums of Agra SIFPSA sponsored RCH work NA Outreach work, Awareness generation work

HIV/AIDS, Family Planning Method NA

They have been running hospital in Mathura. Can be explored for community awareness/ strengthening, may also take up one UHC (in Peri-urban, Bichpuri)

NA NA

NA NA

50