Urban Health Resource Centre in a nongovernmental organization that addresses health, nutrition and wellbeing of the disadvantaged urban dwellers through demonstration programmes, technical support to government and no-government sector, research, advocacy and knowledge dissemination through a consultative and partnership based approach. UHRC started through support from USAID under the Environmental Health Project during 2004-05.

Urban Health Resource Centre implements demonstration health programs in diverse cities (Indore, Agra, North-East Delhi) such that these may be adapted, replicated and/or up-scaled by government and non-governmental agencies. These programmes help better understand which strategies are more effective and feasible, and more importantly the how-to of implementing these strategies. With a focus on strengthening the social fabric in slums and address gender inequity, there is a concerted effort towards empowering slum-level women’s groups and their federations, developing community-based health and development funds and building capacity of slum women to enable them take charge of processes that affect their health, nutrition and wellbeing.

These demonstration programs focus on the one side on community engagement for enhancing demand for services and simultaneously working with the service providers to improve responsiveness of the supply side to meet the increased demand. Slums are usually not connected to the mainstream population and they have to be reached out proactively to facilitate their linkages with the healthcare providers, both Primary-level Health Centres and hospitals. The program teams also put in effort to educate them that how they can negotiate with the healthcare providers to obtain health services and entitlements.

Through empowered community groups, coordination with providers and synergizing efforts of stakeholders, and steadily building linkages of community groups with providers, programs facilitate access of services and entitlements/rights to the vulnerable, socially backward sections of society. These demonstration programs have provided valuable learnings on the operational aspects of training and utilizing services of health volunteers in slums, involving NGOs in social mobilization, service delivery, and training women’s groups to track health coverage and manage community-level health and social development collective savings. These cogent lessons have been instrumental in guiding policy directions and shaping governmental and non-governmental programs in other cities.

Research undertaken by UHRC and its publications inform policy development and urban health programming approaches of the government and other stakeholders. UHRC undertakes primary quantitative and qualitative research as well as secondary-research including re-analysis of large data sets such as NFHS. UHRC’s publications include over one hundred articles in in national and international journals, magazines, web-based media, newspapers and reports. With the objective to better appreciate the actual slum scenario in different cities of India, the team gathered data from a number of cities items such as the number of people living in slums, squatters poverty clusters, rising population of the urban poor, health and nutrition services available for slum dwellers and other associated aspects regarding services in the cities. This effort was complemented by development of spatial maps for these cities, steadily facilitating policy attention for the inclusion of the non-notified slums in government of India programs. UHRC team undertook the analysis of the urban component of the National Family Health Survey –phase -3 (NFHS -3) datasets by Wealth Index. The NFHS (National Family Health Survey) reports which present health indicators disaggregated by urban and rural areas mask the inherent inequities which exist within urban areas. The Wealth Index is a summary measure which reflects the economic status of the household by considering the household amenities and assets. The outcome of the analysis revealed a number of urban inequities in health, nutrition and environmental conditions and in access to services and entitlements. For example infant mortality rates were 54.6 per 1000 live births among the urban poor, compared with 35.5 among the rest of the urban population. Nearly 50% of urban poor children less than 5 years were underweight for their age (under-nourished), which was significantly worse than the urban average of 33%. The World Health Organisation published this research carried out by UHRC in its global report “Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings” released in November 2010. Utilizing this analyzed data, other data from slum-based research in Indore, Agra, Meerut and Delhi, first hand data and maps of cities, and voices of slum-dwellers as well as civil society organizations, academics, UHRC endeavors to enhance policy attention to the urban underserved population. This involves organizing events which highlight the importance of focusing on health, nutrition and well-being of the urban poor and the key strategies which could be adopted to improve their health and living conditions.

UHRC website is a service for programmers and academia. The website has extensive information on social empowerment, urban health issues, challenges faced by disadvantaged social groups and serves as a ready reference for many. The UHRC website receives approximately 50,000 hits every month.

The organization provides technical support on health, nutrition and related issues to National, State, and District Governments, urban local bodies and other NGOs. UHRC has provided technical assistance for the Governments of Uttarakhand, UP, MP, Rajasthan, Maharashtra, Jharkhand and Delhi for developing Project Implementation Plans and strengthening urban health approaches and capacities. It has also developed sample city health plans under RCH-II for four cities of diverse sizes and situations. These cities include Delhi (Mega city), Agra (Million plus city), Bally (less than 1,000,000 population) and Haldwani (around 100,000 population). It has also supported GOI for preparing national guidelines that provide policy guidance to cities and states undertaking urban health programs. UHRC team members represented UHRC at “National Task Force to Advise NRHM on Strategies for Urban Health Care” (2005-06) and also facilitated GOI for preparing framework of the proposed National Urban Health Mission. The Task Force in its report (May 2006), available on the Ministry of Health and Family Welfare website, had strongly recommended launching of an exclusive National Urban Health Mission.
Some key learning’s from UHRC’s journey so far are:
a) Spatial Maps serve as very useful tools to identify both listed and unlisted slums as well as health facilities in the cities. The focus should be on spatial data rather than GIS. Such an approach enables less technology literate city officials and municipal bodies to adopt this useful toll.
b) Empowerment of slum-level community organisations to build capacity of human resources at the grassroots level.
c) Multi-sectoral convergence at the ward level or alternative feasible level facilitates complementary utilisation of resources, provisions of different government and non-government stakeholders.
d) Engagement of and partnership of public sector with civil society organizations/NGOs as helpful to the cause of urban health.
e) It is crucial to keep in mind that the urban poor population in India is growing at a fast pace, hence at the time of budget forecasting activities it is better to overestimate the numbers.
f) Many urban slum families consists of migrant labour working at construction sites, working as casual labour and those engaged in unskilled labour with uncertain livelihood. It is difficult for these voiceless and vulnerable families to negotiate with the authorities and obtain a Ration Card (whether the ‘below poverty line’ or BPL type or the ‘above poverty line’ or APL card). As a result of which many urban poor families do not have any form of ‘Identification document’ (ID) which compromises their ability to access entitlements and services, availing which requires possession of an ID. Those poor families who are unable to obtain a ‘BPL’ and are consequently not able to avail health, food subsidy benefits, subsidised housing benefits and other social schemes that are mandated for BPL families. Since the BPL card based service-entitlement system is actually not able to cater to a significant proportion of urban poor, evolving an alternative approach where decision to provide the subsidy does not get limited to BPL card holders is required.

Current field programs include a) Women’s empowerment, enhancing negotiation skills and improving access to services in Indore and Agra; b) “Gender Resource Centre” and Enhancing Negotiation Skills of Community Volunteers in North-East Delhi; c) District Resource Centre in North District, Delhi d) technical support to Govt. of Uttarakhand where State Health and Family Welfare Society in partnership with five NGOs is running its urban health program serving urban slums in four cities - Dehradun, Haridwar, Haldwani and Roorkee This technical support included facilitation of partnership including MoUs with NGOs, developing urban health plan for all four cities and city maps, development of practical guides/’How-to-modules’ on different aspects of programming, thematic strategy documents and conducting capacity building workshops and study tour to Agra program.