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Experiences in Addressing Health of the Urban Poor: Initiatives from Mumbai Guide for Field Visits


DISCLAIMER

The information contained in this booklet is a compilation of details provided by each organization. It is meant only to serve as a guide for the field visits. All efforts have been made to ensure an accurate representation of each organization. Any errors or discrepancies found are regretted.


At the edge of the Indian subcontinent and the Arabian Sea, nestled within a deep safe harbour, sits the Indian commercial capital Mumbai. Formerly known as Bombay, this vibrant bustling metropolis is the sleepless city of dreams for over 14 million hopeful people, a number that rises every day as hundreds of fortune seekers from across the country squeeze their way into what is already perhaps the most densely populated city in the world. Originally home to Kohli fishermen, the then insignificant seven islands were handed over to England by the Portuguese in the 16th century. The English promptly leased them to the East India Company for a paltry sum of £10. Today, all seven islands of the city and four more in the suburbs have been fused through massive land reclamations to form one narrow 438 square kilometer piece of land, where property prices are amongst the highest and most sought after in the world.

The Mumbai of today is a city of dual and often irreconcilable identities. Here is a city where the swankiest cars can be seen jostling for right of way with bullock carts. Where half naked street urchins can be found selling the latest in electronic and luxury items on street corners. Where iconic Victorian, Gothic, and Indo-Saracenic architectural structures are juxtaposed against shanties and shabbily built constructions. Dharavi, one of the largest slum settlements in the world is less than 20kms away from the construction site of the world’s first billion dollar mansion. Where the sights and smells of gourmet food emerge from roadside eateries and ‘Chinese Bhel’ and ‘Chicken Tikka Masala Pizza’ are fairly common selections on a menu in a restaurant.

• The name of this cosmopolitan is derived from a local incarnation of the Hindu goddess Parvati called ‘Mumba Devi’

From shopping malls to sweat shops, night clubs to night schools, high end eateries to bootleg bars, if you want it you can get it. This city is a paradox, this city is an enigma – a heartless money making machine at one moment and a living being with unbelievable soul the next…

Welcome to Mumbai.

• Mumbai is the home of Bollywood, India’s glitzy and glamorous film industry • The dome of the iconic Taj Mahal Palace Hotel is made from the same steel as used in the Eiffel Tower • Mumbai's suburban rail systems carry a total of 2.2 billion passengers every year • Nobel Laureate Rudyard Kipling, who wrote The Jungle Book, was born in Mumbai • The simple tiffin carriers or 'Dabbawallas' of Mumbai have become famous for their efficiency with Forbes business magazine giving them an incredible Six Sigma rating • Hinduism, Islam, Buddhism, Jainism, Christianity, Sikhism, Zoroastrianism and Judaism are the religions of this diverse city • Mumbai contributes 40% of India's income tax and US$ 9 billion as annual corporate tax

Sources : mcgm.gov.in, en.wikipedia.org, www.mumbai-central.com, www.wordiq.com


Ghatkopar

Bandra (E) Bandra (W) Dharavi Sion Dadar Elphinstone

Mumbai Central Grant Road

Kamathipura

Churchgate

City of Mumbai


About Us

Prerana

Prerana, founded by Pravin and Priti Patkar, is a civil society organization that started working in the red light areas of Mumbai in 1986. Shocked to see the ultimate plight of the children born to red light area based prostituted women victim of commercial sexual exploitation (CSE&T) and their inescapable recruitment in the organized sex trade, Prerana took a view to protect and re-establish the rights and dignity of the women and children victims of CSE&T. In response to the situation, Prerana evolved several absolutely path-breaking interventions, piloted them, evolved success stories out of each intervention, and disseminated them widely for mainstreaming. Prerana’s pioneering programs have been incorporated into government programs nationally and internationally (e.g. United States). It has shared its model work at international forums such as the UN General Assembly and conferences on trafficking. Prerana’s work has been featured and won prizes at international film festivals, including the Cannes International Film Festival 2006. Prerana’s research reports and articles have been published by international organizations, like UNICEF. The expertise of Prerana is used by an endless list of local, national and international groups such as UNICEF, UNDP, UN Office on Drug & Crime, UNIFEM, USAID, International Organization for Migration, National Commission for Women, Maharashtra State Commission for Women, Asian Development Bank, Government of India, Government of Maharashtra, Govt of Andhra Pradesh amongst others.

Our Work Prerana’s work has the following objectives: • Eliminate Second Generation Trafficking of the children Victims of Commercial Sexual Exploitation & Trafficking (VOCSET). • Prevent Commercial Sexual Exploitation (CSE) of children, minor, under-aged girls and young women. • Prevent Trafficking of women and children for CSE • Work towards proper Social Reintegration of the VOCSET • Provide an Optional Dignified Life to the children of women VOCSET through comprehensive social intervention in their situation. More particularly, to give inputs like education, shelter, health, nutrition, recreation, vocational training, personality development, value education, counseling etc. • Create awareness among the VOCSET of their human and civil rights and to Empower them. • Encourage and empower the victims of CSE to establish their Human Rights including their rights vis-à-vis the HIV/AIDS problem. • Advocacy work on behalf of the VOCSETs wherever required. • Capacity Building and facilitate a broader social involvement in the situation of the VOCSET for positive social intervention. More particularly encourage other NGOs to take up red light area intervention work. • Make consistent efforts for effecting appropriate Changes in the Legislation, Policy, and Programmes pertaining to trafficking and prostitution domestic, and international. • Undertake Research & Documentation and provide Consultations in the field of CSE&T. • Undertake Sensitization and Training Programmes (STP) for GOs, NGO, INGOs, and UN agencies, the Police and other agencies to further the anti trafficking work. • Set up and run a Clearing House of information in the field of CSE&T. • Establish and run a Network of organizations working for the cause of the VOCSET and against Trafficking

Today, Prerana is active on most dimensions of the anti CSE&T work including protection, prevention, early intervention, vigilance, searches & rescue, recovery, post rescue operation, victim care services, prosecution, empowerment of victim women, economic rehabilitation, repatriation, HIV/AIDS, advocacy & lobbying, legal, policy level and administrative reforms, rehabilitation & social reintegration, generating social awareness, research, documentation, sensitization & training of special functionaries, networking, and capacity building of fellow organizations. Prerana has programs on all counts and many of them work on 24X7 basis. Aptly accredited with starting and running successfully a large number of activities and for socializing the process of intervention in CSE&T situation, some of its activities and programs are detailed below.

Anti Trafficking Centre (ATC) This is a specialized centre in research & documentation, policy consultation, sensitization & training, clearing house of information, producing IEC material, library, information dissemination, social awareness, advocacy and networking on trafficking problems and anti trafficking initiative. Prerana has published several items at all levels – global and local – and thus has an impressive collection of documents on CSE&T in its attempts to fill the information gaps between the macro and the micro levels internationally. On issues of CSE&T, Prerana has conducted the largest number of training programs for diverse audiences and its advocacy efforts have led to many achievements, such as the Government of India's Plan of Action 1998 using the term "Victims of Commercial Sexual Exploitation" instead of the earlier term "Prostitute" and becoming India's first official policy on the victims of CSE&T. Its social awareness work involves campaigns, audio songs, posters, TV spots/fillers and newspapers articles.


Prerena Networks Prerana has facilitated the formation of a network of voluntary sector organizations NACSET (Network Against CSE&T) that is very active on the anti CSE&T front in the state of Maharashtra, the first Indian collective exclusively of VOCSET women called NISHANT (End of the Night) and the first Indian collective EKTA (Unity) of children of red light areas. The Community Animator’s Project – linked to NISHANT aims at gradually involving these women in a broader anti trafficking mission. Women of NISHANT have formed flying squads for preventive intervention against trafficking visiting the main outstation bus stand as well as the terminal rail stations in Mumbai to keep vigilance on trafficking of children and young women.

Residential Care Institution Prerana started, globally the first ever, Night Care Centre (NCC) in 1987 for the protection of the children of red light areas from the traumatizing and undesirable night life of the brothels. NCC is the first initiative to de-link a child from the undesirable influences and trauma of the flesh trade without de-linking it from the mother. The NCC provides a safe and warm sleeping place and protection to these children with 3-4 meals provided including an evening snack. Today, Prerana runs 3 NCCs in the red light districts of Kamathipura, Falkland Road and Vashi. The Centres shelter over 260 to 280 children every night. For children who are too young to go to school and the others who have the afternoon session at school, Prerana runs a Day Care Centre (DCC) facility at all its centres to extend the protective cover to these children. The DCC serves four meals everyday and is a 24-hour centre. These young children who do not have anyone to take care of them practically live in the DCC. In 1987, the organization started the first Institutional Placement Programme in India for children of red light area based women VOCSET to place them in institutions for long term residential care. This is to delink the child from the red light area and to help the mothers consider the option of shifting the child away from the red light area into a place that can provide long term residential care and development. Prerana runs Naunihal, a shelter home for girl children from red light areas, and Pratishtha (Dignity), a residential vocational training centre for rescued minor girls, both at Kharghar, Navi Mumbai. Pratishtha is Prerana’s wing for recovery and social reintegration of girl victims of trafficking for commercial sexual exploitation. Under the rehabilitation programs developed for minor girls, the girls are trained and placed in the job market – some by corporate like Hotel Taj Mahal. Prerana has also begun a new venture ‘Group Homes’ for girls who have passed out of institutional life on completion of 18 years of age. Prerana also started the first Comprehensive Educational Support Programme in the country for the

children of red light areas to ensure a child’s right to education. It provides complementary & remedial education, sponsoring for vocational training, life skills education, and personality development inputs through its Non-Formal Education program. It was the first organization in the continent that took comprehensive care of children and their mothers who were infected and affected by HIV through its Care of AIDS Affected Children program as early as 1986-87. In January 1999, Prerana formally started India's first Project on Post Rescue Operation (PRO) with judicial mobilization at the Mumbai High Court seeking reforms in the PRO phase. After many legal battles, it was granted to set up a Guidance & Monitoring Committee (GMC) on the state run shelter home for rescued victims. The state accepted the directive to set up the GMC – the first ever experiment of co-management of state run homes in India. Prerana extended its Post Rescue Operation services to several other state run as well as civil society run shelter facilities in Mumbai.

Other Programs Prerana is working as a mentor for a few project partners of CRS India on a project called Jagruti, which aims at mainstreaming the Minimum Standards of Care & Support for the Victims of Trafficking and Other Forms of Violence. The Legal Training Programme, Human Rights Initiative, and Legal Intervention for Rescued Girls programs come under this umbrella. Course Curriculum for Police Training is also carried about by Prerana. Prerana coordinated the evolution of the first Software-based Victim Registry for tracking the trafficked victims and piloted it in collaboration with the Government of Maharashtra. The Government of Andhra Pradesh in 2010 requested and received from Prerana the Registry for wider application in the state. Other projects that Prerana runs are: Nutrition Project for Victim Women, Project for Runaway Girls, Child Guidance Clinic, Drop In Centre for Expelled Girls, Social Reintegration Programme, Health Intervention Project including HIV/AIDS, Rationing and Banking Project, Self Help Groups and Childline Support Organization. Prerana has reached out to over 7500 such children, shifted over 1,200 from the red light areas to children’s welfare institutions for long term residential care and protection and follows them up professionally, shelters 250 children on any given night in its 3 Night Care Centres in the midst of red light districts, and covers 8800 children through a comprehensive educational support program. Challenges that Prerana faces include: the appropriately skilled staff, lack of infrastructure, sometimes hostile communities and establishments, local political and anti-social dynamics, catering to children with special needs, lack of non-institutional services, and being vigilant that rights of these mothers and children are not violated.


Prerena A Story... SVJ, age 20, began attending Prerana’s Night Care Center (NCC) in June 1993 when she was 6 years young. In August 1993 Prerana helped SVJ’s mother enroll SVJ in Shraddhanand Mahilashram, Mumbai Two years later in 1995, SVJ’s mother passed away. SVJ passed her 10th standard in 2003 with 50% and passed both the 12th Standard and Bachelor of Arts in second class. After that, SVJ worked as an assistant lab technician in a laboratory in Mulund, Mumbai and then at a center in Vile Parle (both suburbs of Mumbai). At that time, she resided in a Group Home at Vashi Naka set up and run jointly by Prerana and Our Children. In 2006, SVJ moved to another Group Home at Dockyard Rd. close to South Mumbai. Currently, she lives independently with a few friends in a rented house. In June 2008 she enrolled herself for Masters in Social Work at the S.N.D.T. Women’s University, Mumbai. She has successfully completed her Masters in social work and is working in a non profit making organization.

Keys To Our Work Some of the innovations and best practices of Prerana are as follows: • Pioneered, standardized, and popularized several victim care services many of which were started for the first time globally: - Comprehensive Educational Support Programme - Night Care Centre - Institutional Placement Programme - Post Rescue Operation - Co Management of State Home -Guidance & Monitoring Committee - Minimum Standards of Care & Support Services for Victims of CSE&T - Software-based Victim Tracking Registry - Anti Trafficking Centre (ATC) - NACSET (Network Against CSE&T) – network of voluntary sector anti trafficking organizations - NISHANT (End of the Night) – collective exclusively of VOCSET women - EKTA (Unity) – collective of children from red light areas - Day Care Centre - Drop In Centre - Anti CSE&T E-mail News Service - Community Animators' Project - Sensitization of special functionaries • Selected & documented as globally one of the best 7 approaches to work with persons affected by HIV/AIDS by SYNERGY-USAID • Challenges the decisions, practices and policies of the state in the court of law through a number of cases and Writs • Publishes documents on CSE&T • Success lies in working together with the U.N. agencies, international organizations, victims' collectives, the central and the state governments, National and State Commissions for Women, state bureaucracies, professional associations, media, and a large number of voluntary sector agencies world over

Our Future

Contact Us

New initiatives: • Scaling up by widely socializing the intervention • Mentoring other social organizations • Capacity Building of the positive stake holders • Technological infusion e.g. Software based solutions • Advocacy • Legal / judicial mobilization • Evolve best practices in different fields • Sensitization & Training

Contact person

Priti Patkar, Founder Director Preeti Iyer, Project Director Aparna Dhopeshwarkar, Head–Child Protection

Address

Project Office: 7th Lane Kamathipura Municipal School Shuklaji Street, Kamathipura, Mumbai 400 008, Maharashtra, INDIA +91 22 23053166/23007266 Anti Trafficking Centre M.V.R. Shinde Rd. Municipal School Bhandup (W), Mumbai 400 078 Maharashtra, INDIA +91 22 25948296

Email Address

pppatkar@gmail.com, preranaatc@gmail.com

Website

www.preranaatc.com


About Us

Salaam Bombay

Salaam Bombay Foundation was started on the belief that educating children is the most enduring way of shaping India’s future. The Foundation has been fighting a crusade to guard the next generation against tobacco. It works towards empowering children through life skills training, confidence building and personality development initiatives. Established in 2002, Salaam Bombay Foundation works primarily with municipal schools, with children from the weakest section of the socio-economic strata. The Foundation also works with private schools and other communities and it has furthered its reach into rural Maharashtra as well. The Foundation currently runs the largest preventive program in tobacco control which has already reached out to over 500,000 children in Mumbai and Navi Mumbai. Vision To create a tobacco free world for every child Mission To eliminate the threat of tobacco for all children empowering them to become confident adults to lead tomorrow’s India

Our Work Salaam Bombay Foundation’s objectives are: • To build a tobacco free India • To provide information on tobacco and its ill effects on children in a child friendly manner • To build child ambassadors and encourage them to be positive role models for their peers • To provide a platform to children to present their skills and knowledge in diverse activities • To help students identify their strength and weaknesses and improve them as individuals • To encourage children to develop confidence and a positive self image • To equip children with the qualities of leadership and decision making which in turn gives them a sense of belonging and better self-image The Foundation adopts a holistic approach in designing its developmental projects. It believes that tobacco addiction is a result of low self-esteem, lack of refusal skills and inability to deal with peer pressure. Hence, all programs are designed to address such problems. All activities are focused around creative processes and sports; hence, they encourage children to think in an out-of-the-classroom format. The programs are engaging, interactive and difficult messages are conveyed in a non-threatening and child-friendly manner. The major aim of projects are to initially create awareness and facilitate mindset change. Modules are built in a manner where youth work at several levels to create

awareness and build on life skills. Salaam Bombay strives to provide youngsters opportunities to enhance their skills and feed their passions through sports and arts.The programs are intensive and interactive, engaging children for 5 years making them strong tobacco control advocates and confident peer leaders. In order to achieve its objectives, the Foundation has developed the following projects that targets children from 5th to the 9th Standard and impacts 500,000 children. SUPER ARMY This is an innovative program wherein the students sign up to be ‘soldiers’ of the ‘Super Army’ that wages a war against tobacco using unique weapons like art, theatre and music . Starting out as an awareness program it goes on to teach students the fundamentals of advocacy. Every year over 60,000 children sign up to work towards better advocacy and implementation of laws to protect themselves from tobacco. The young soldiers of the Super Army realize that each individual has a role to play and through the program they urge citizens to dedicate their lives to saving children. Bahadur desh par jaan deta hai… tambaku par nahin (Heroes lay down their life for the nation …not for Tobacco) is the premise they operate on. Posters, skits and songs that emerge from this project travel around the city to spread the message against tobacco. Soldiers are trained to understand the tobacco menace in detail and are introduced to the various concepts that help build refusal skills. The focus in the first year is on development of leadership skills, group representation and impact of decisions taken by individuals. The project attempts to give children a strong sense of belonging and self esteem, both of which are core issues in substance abuse. The second year program is designed to take the message a step forward towards advocacy. During the course of this year students are encouraged to create awareness among citizens by using different mediums and methods of persuasion. The students work on sensitizing and networking with different systems operating in the city. The aim is to get appropriate policies and laws in place that will make the world a tobacco free place for children. Students continuously work with government departments like the Police force and Food & Drug Administration, various media and health organizations and several like minded people. Salaam Bombay helps children realize their uniqueness, hidden potential, capability and work to inculcate a sense of responsibility towards society in them.

ADVOCACY PROGRAMME School students in the 8th and 9th Standard are trained to become tobacco control advocates and are encouraged to work with different stakeholders including the police, Municipal Corporation, Brihanmumbai Electric Supply & Transport (BEST), Health and Education Department of the Government and the media to bring about change and protect children from tobacco. Children also get involved in local cultural and religious events to spread the message on various platforms.


Salaam Bombay SPORTS AGAINST TOBACCO Sport is a very effective method to build life skills with children. It also reinforces the message against tobacco for good health. The program aims to seek talent in municipal school children to give them a lifetime opportunity to be part of a world-class sporting experience. The children not only train in sports at high standards but also learn life-skills like focus, leadership, stress management, concentration, emotion management and teamwork that will help them as sportspersons but more importantly through life. Sports Against Tobacco has two major initiatives: o Salaam Bombay Cricket Academy – This project helps recognize talent in a different section of society and trains them in a world-class format. Currently the Academy has 280 students, from 26 schools, playing across 5 centers in Mumbai. o Salaam Bombay Hockey Academy – This initiative is especially targeted to encourage participation of girls in sports. We have started off at one centre with 120 girls from 4 schools.

ARTS AGAINST TOBACCO Theatre Academy – This unique program is designed to focus around theatre techniques including scriptwriting, direction and technical aspects of production. Children and adults, alike, like to get engaged at an emotional level before they can learn and imbibe values or morals. Professionals work with children to improve performance skill on stage while building their confidence and grooming their personality. Theatre Against Tobacco is one of the most popular, topical and interactive 30-minute slapstick comedy enacted in Hindi. This play serves to be an excellent ice-breaker and carves the way to a long term relationship with children in the war against tobacco. The play was developed and experimented by the Surgical Oncology Outreach Program of the Prince Aly Khan Hospital. The show has been running for over ten years and has completed over 1,200 shows across Mumbai. This comedy has enabled Salaam Bombay to unlock the imagination of students as well as the teachers. The play employs topical humor, songs and dances to convey its underlying message about the evils of tobacco. Dance Academy - A dance academy professionally run under the guidance of a Kathak (a classical form of Indian dance) expert and award winning artist has 100 girls and boys learning Kathak. Music Academy – A very well known musician is training children to learn the art of singing and appreciating classical music.

OUTREACH PROJECTS In its constant endeavor to spread awareness and advocate a tobacco-free future for children, the Salaam Bombay Foundation reaches out to large sections of society by launching initiatives and conducting projects with NGOs and youth as well as employees of the Mumbai Police and BEST on a regular basis.

Halla Bol, the newsletter by the children, for the children was launched in 2008. It was created to give the children a voice to share their thoughts, views, experiences and ideas with their peers. The quarterly newsletter reaches out to more than 65,000 children across Maharashtra currently. Halla Bol is an opportunity to inspire readers to work towards a tobacco free future for children. It also serves as a medium to highlight the achievements of the children in the Super Army programme. It showcases their aspirations and passion to the cause and tends to encourage their peers to participate. Halla Bol has now evolved from merely being a mouth piece of our soldiers to becoming a tool for learning and understanding newspapers as a medium, such as learning editorial and design work. Hero Ya Zero, is a unique interactive awareness Poster exhibition. It spreads awareness about the ill effects of tobacco and encourages children not to be misled by media and advertisements. It has helped educate the children in tobacco related laws. Due to lack of exposure to vocational options, Municipal school children have a limited view of what they can do after finishing school. Moreover, they lack the motivation to complete their schooling, as they perceive no direct benefit from the education imparted. Understanding this problem Salaam Bombay Foundation initiated a life-skills training program called Vijaypath (Road to Success) to work with students in their graduating year to give them a direction for the future. In the year 2007-8, Salaam Bombay Foundation furthered its reach into rural Maharashtra. In the pilot project a survey was conducted to understand the extent of the tobacco problem in the district following which a training of trainers was conducted. The trainers were provided with all the necessary information and material to conduct the sessions in the 10 villages of Chandrapur district. Based on the successful implementation of the activity in Chandrapur today, the project has been extended to four other districts. Some of the challenges that the Foundation faces in conducting these programs are: acquiring permission from schools for holding these sessions, ensuring no clashes with the academic schedule, and disciplining some children in classes.


Salaam Bombay A Story... During the first interaction with the children at Borivali Municipal School, it was clear that there were a number of kids who were consuming tobacco. Therefore, during the second session the facilitator spoke about being tobacco free. He urged all children to become tobacco free and then attend the session. He was in for a surprise in the third session with the same class. Before he could begin the class, two students came forward and told him that they have now given up eating tobacco and have become tobacco free. The facilitator in-charge felicitated the two children and asked everyone to clap for them. When such dedication is given to create “A tobacco free world for every child” bears fruit, the zeal to work increases many-folds!

Keys To Our Work The successful, best practices of Salaam Bombay Foundation are: • Super Army • Advocacy Program • Sports Against Tobacco – including the Salaam Bombay Cricket Academy & Salaam Bombay Hockey Academy • Freedom Run • Arts Academy: 1) Theatre 2) Dance 3) Music • Halla Bol

“We work with a number of children from different areas and come across many incidents. But my experience at Borivali Municipal School has so far been the best. I was overwhelmed when two of my students gave up tobacco and had the courage to come and admit that they were earlier consuming it. They have set such a good example for other kids, especially their juniors. It is a very positive response, after which I motivated the children to make their class tobacco free. I am sure that if we continue in the same way we will be able to make the entire campus tobacco free.” -Salvardo Miranda

Our Future At Salaam Bombay Foundation, the belief is that children grow as their horizons grow; the broader their horizon, the greater their hopes and the higher their aspirations. Projects are based on the belief that educating children is the most enduring way of shaping India’s future. Thus, working with children between 10-17 years of age from the weakest sections of the organized socio economic strata, the objective is to empower children to overcome the obstacles of their environment and guard the next generation against tobacco.

Contact Us Contact person

Ms. Devika Chadha

Address

Salaam Bombay Foundation, 5/6 Rewa Chambers, 31 New Marine Lines, Mumbai 400 020 Mahrashtra, INDIA

Telephone

(+91 22) 22034808 / 22034809 / 22034810 / 66391500

Email Address

nfo@salaambombay.org

Website

www.salaambombay.org


Society for Nutrition, Education and Health Action (SNEHA)

About Us Society for Nutrition, Education and Health Action (SNEHA) is a voluntary, secular, non-profit organization which addresses the health needs of women and children in the slums of Mumbai. Founded by a group of medical professionals and social workers in November 1999, SNEHA (love in Sanskrit) was the brainchild Dr. Armida Fernandez who is a leading neonatologist in India. They wanted to address and prevent the concerns they witnessed at a public tertiary level hospital, namely the vulnerability of newborn life and their mothers who were often malnourished or frail themselves who came from Dharavi (one of Asia’s largest slums). Thus, SNEHA embraces the belief ‘Healthy Women and Children for a Healthy Urban World.’ Vision To dedicate our energies, expertise and resources to ensure quality nutrition, education and health care of women and children. Mission To work in partnership with communities and health systems building effective and replicable solutions, empowering women and their families in urban slums to improve their health. Appreciative Inquiry (AI) – working to realize dreams based on possibilities, capabilities and assets – has become the core philosophy at SNEHA, a way of being and a way of facilitating change. SNEHA uses AI successfully in building rapport and working with the slum communities as well as building and strengthening collaborations and multi-sectoral partnerships. The use of AI has greatly contributed towards behavior change in 200 slum women’s groups and creating energy towards a movement for Quality Health Care Delivery in over 40 health care facilities covering more than 1000 staff.

Our Work SNEHA focuses on four programs themes to strive to achieve its goals working with underprivileged urban communities and existing health systems. Thus thrust is to improve current practices by establishing standards of care and to make systemic, sustainable and replicable models of change. On-going efforts are made to evaluate all projects through a rigorous and ethical review. In this manner, SNEHA establishes impact of innovative practices and seeks to influence public policy.

1. Maternal and Newborn Health (MNH) SNEHA works to improve the maternal and neonatal morbidity and mortality rates in underprivileged communities in Mumbai. The City Initiative for Newborn Health (CINH) worked with vulnerable urban communities to improve care practices and care seeking in maternal and neonatal health and with municipal health services to ensure provision of routine antenatal and postnatal care at health posts, standardize care at all levels, facilitate timely and appropriate referrals of mothers and adoption of partography. CINH is a unique multi-sectoral partnership with MCGM, ICICI Centre for Child Health and Nutrition, Centre for International Health and Development, University College London, Wellcome Trust and Life Foundation. Working across eight Mumbai Wards, the project covered a slum population of 283,000. The trial results are awaited by the end 2010.

The SNEHA Sure Start project, in partnership with PATH, works to increase individual, household and community action to improve MNH through home visits, group sessions, and Community Resource Centers. The project seeks to enhance health provider capabilities for sustained improvement in MNH through standardization and improved care with clinical protocols, clinical training, formation of antenatal / postnatal / neonatal care clinics, and establishing a formal referral system. The initiative covers 200,000 urban poor in four vulnerable communities in the N-Ward, Mumbai.


SNEHA 2. Prevention of Violence against Women and Children The four major components concurrently running are: 1) counseling and crisis intervention services for survivors of violence, 2) community organization for prevention of violence, 3) city initiative on advocating violence against women and children as a serious public concern and 4) research on understanding violence against marginalized women in South Asia. The crisis intervention services are a mix of social work and psychotherapeutic interventions to rebuild self-esteem of victims, and create healthy, functional families. It further networks with allied systems to facilitate a coordinated response to survivors of violence. The community component works closely with the 650,000 population of the slums of Dharavi and deals with prevention of violence against women and children through community organization strategies. The city-initiative aims at strengthening the current model of intervention, building strategic alliances with public and private sector to advocate the issue and enhance their involvement in addressing the concern. The research has been undertaken with University College London and CREA, Delhi to understand the magnitude and nature of violence faced by lesbian women, women with disability and women sex-workers with an aim to expand the scope of counseling services. The project envisages increasing the visibility of such groups and integrating them into the mainstream.

3. Child Health and Nutrition In efforts to decrease child malnutrition, SNEHA works with the community to improve care seeking practices and livelihood capacity of mothers and women, reduce malnutrition in children aged 0-3 years old, and improve feeding practices of mothers. This is achieved through forming Self Help Groups (SHGs) that provide sessions on feeding, government services, and illness management; and working with government health posts and programs to improve quality of services provided in these related areas. SNEHA also works towards early identification and management of malnourished 0-3 year olds and prevention of under-nutrition in age group. This is done through Day Care Centres (DCC) run for Grade I & II malnourished children. DCCs provide children with four wholesome meals a day and monthly weight assessments and monthly parent meetings are in place to implement behavior change in feeding and care-seeking practices.

4. Sexual and Reproductive Health (SRH) SNEHA has recently begun work on Family Planning in Dharavi. Adolescent sexual and reproductive health is another area of focus. Since May 2008, Girls Gaining Ground has worked to empower groups of adolescent girls to become confident, well informed and responsible decision makers. In collaboration with Bhavishya Alliance 500 girls have undergone training on health, nutrition, life and vocational skills. The project has been extended to another 500 girls and to adolescent boys. In addition to an intervention focus on issues, SNEHA has dedicated resources in Research, Networking & Advocacy and Training to work across these issues.


SNEHA A Story... Manisha is a member of our Aahaar Women's Group #5. She has an effervescent personality and an endless level of energy. Manisha makes a meager living by selling brooms and utensils and lives in the Kunchikorve Society with her husband, mother-in-law and an 8-month old daughter. Because of pressure from her mother-in-law, Manisha continued to exclusively breastfeed her baby despite her demanding work schedule. This not only put a stress on Manisha physically, but also compromised the nutritional needs of the baby. After attending one of our educational classes focusing on food and nutrition, Manisha recognized the importance of adding complementary feeds to the baby’s diet. Despite strong opposition from both her mother-in-law and husband, she insisted upon providing the child with complementary feeds in addition to breast milk. Manisha now takes her baby with her to work. With her new found knowledge on nutrition, she feeds the child every 3 hours with foods like khichadi (rice) and other semi-solid foods. Manisha is confident and happy in her ability to keep her daughter healthy and well-fed.

Keys To Our Work Some of SNEHA’s best practices and innovations are: • Working to empower women and slum communities to be catalysts of change • Working in close partnerships with existing systems to create sustainable change • Facilitating behavior change and building relationships through Appreciative Inquiry • Working in partnerships with the government, corporate sector, and NGO sector • Developing clinical protocols in maternal and newborn health • Developing a Quality of Care model for maternal and newborn health • Developing a Community Resource Center model • Developing the Nutrition Community Action and Day Care Centre models • Working both in communities and with existing health systems for bringing about changes in health • Establishing referral systems and antenatal, postnatal, neonatal care clinics in partnership with the MCGM • Establishing strong monitoring and surveillance systems for programs and interventions

Our Future SNEHA currently works intensively with 200,000 people and hopes to reach a million people by 2013. Community Resource Centres, which will form the hub of all community engagement, will be set up in over 20 vulnerable slum pockets to ensure sustainability and community ownership. SNEHA envisions moving to other urban hubs to encourage the scaling of its models for change in maternal and neonatal health and empowering women to prevent violence.

Contact Us Contact person

Dr. Wasundhara Joshi Executive Director

Address

SNEHA – Society for Nutrition, Education and Health Action 310, 3rd Floor, Urban Health Center 60 Feet Road, Dharavi Mumbai 400 017 Maharashtra, INDIA

Telephone

(+91 22) 2404 2627 / 2408 6011

Email Address

snehamumbai@snehamumbai.org

Website

www.snehamumbai.org


ACKNOWLEDGEMENTS SNEHA—Society for Nutrition, Education and Health Action for organizing the field visits and developing this guide • WHO Country office for India •

Collation and Edit Design Printing Conceptual Inputs

Ashifa Sarkar Nadine Pereira Girija Screen Printers Anagha Khot & Sunil Nandraj



World Health Organisation