Implementation of Information, Education andCommunication (IEC) activities of Integrated Housing AndSlum Development program (IHSDP) under JawaharlalNehru National Urban Renewal Mission (JnNURM) toaddress social determinants of health for sustainabledevelopment of underprivileged in Karnataka, India.

Introduction

Urbanization is an index of transformation from traditional rural to modern urban economies.1 Even though cities and towns have a vital role in socio-economic changes in any country, most of them are severely stressed in terms of infrastructure and service availability. The Government of India (GOI) has launched Jawaharlal Nehru National Urban Renewal Mission (JnNURM) to encourage cities to initiate steps to bring financially sustainable improvement in the existing service2 . Integrated Housing and Slum Development Program (IHSDP), a component of JnNURM aims for holistic under privileged area (slum) development, with a healthy and enabling urban environment by providing adequate shelter and basic infrastructure facilities.3 The Karnataka Slum Development Board (KSDB), a state government department, as a nodal agency for implementation of IHSDP projects in Karnataka has the responsibility of improving the quality of life of slum dwellers by providing housing and infrastructural facilities such as drinking water, street lights, roads, drains, community bathroom, storm water drain and community hall wherever possible and ensuring delivery of other already existing universal services of the government for education, health and social security. However, stakeholders in planning and implementation recognise that building houses and infrastructure alone will not uplift the slum-dwelling communities, but Information, Education and Communication (IEC) campaigns are essential for holistic development.4 The IEC activities were directly or indirectly concerned about the social determinants of health for sustainable development. Identifying health as a major instrument of overall socioeconomic development, involvement of health sector in this project ensures attainment of the basic objective of IHSDP. Hence one of these projects was implemented by public health professionals from a medical college and research institute in India with an aim to improve the quality of life of slum residents, to increase the standard of Health, Education and Community life in the slums, to provide sustainable improvements in standards of living, social status, health, and education, to provide skill up-gradation / increase earning potential of people living in slums and to take up health promotional programmes such as maternal and child health (MCH), family welfare (FW) and nutritional programmes.

Materials and methods

The duration for the project implementation was 1 year from February 2015 to January 2016. Kanakapura is the assigned area for execution of IEC activities under IHSDP project. Kanakapura town is one of the block administrative headquarters in Ramanagar District of Karnataka state in India. Kanakapura is situated 55 km from Bengaluru city and on the banks of Arkavathi River. As per 2011 census the population of Kanakapura town is 54, 014. This Kanakapura project has seven slum settlements comprising a total of 707 houses distributed over four areas, as listed below:Malagaal has one slum project with 105 houses ,Kurupete has one slum project with 101 houses,Maharajkatte has two slum projects with a total of 214 houses, Melekote has three slum projects with a total of 287 houses. There are 5 government schools in the project area, of which 4 schools are higher primary schools and one is a primary school. The Mid-day Meal Scheme is operational in all the schools to improve nutritional status, as well as to reduce the school drop-out rate. There are seven Anganwadi centers operating under Integrated Child Development Services (ICDS), providing supplementary nutrition and basic health services to children aged 0-6 years, pregnant women, and lactating mothers. A public hospital in Kanakapura Town caters to health needs of the population. The Socio-economic survey was conducted by visiting allotted houses in each slum area. The survey tool was a semi structured questionnaire, prepared to get the general information of the household as well as the details of individuals in each household. In each house a responsible adult member was identified and briefed about the SE survey before taking their verbal consent for the interview. 

Data analysis

The data was collected in Microsoft excel and was analyzed using appropriate statistical methods in SPSS version 20.0.

Results

In total, 707 households having 2451 residents were visited. Their socio-demographic information is given in Table 1, 2 and 3. All the beneficiaries belonged to backward castes and had Below Poverty Line(BPL) cards. All the houses were constructed by the KSDB and were Pucca5 houses measuring not less than 25 square meters. All the houses were well ventilated. Other basic amenities like water facility, street lights and sanitary latrines were also present, provided by the KSDB.(TABLE :1)

The houses under the IHSDP schemes are not provided free of cost. A minimum contribution of 10% of house cost is borne by the beneficiary. Beneficiary Contribution is being charged in order to inculcate a sense of ownership among the beneficiaries. The guidelines of the scheme recommend that the Title of land should preferably be in the name of the wife and alternatively, jointly in the names of husband and wife. In the given project area, 571 women had the houses in their names. We found that in 256 (36.21%) out of 707 households, all the family members were in the habit of open defecation in spite of having sanitary latrines. These households were concentrated in two of the four project areas, namely, Melekote, where 27% of the in-house latrines remained unused, and Maharajkatte where a striking majority of 80% practiced open defecation. The latrines in these houses were closed and used as storerooms, because the householders were not comfortable having a latrine inside their house, and they were used to open defecation. Another infrastructural issue that hampered the inculcation of sanitary habit was that possibly due to a certain degree of mismatch in communication and coordination between different departments during the construction phase, the toilets had not been connected to underground sewage lines. Inhabitants of Melekote would use vacant plots of land near their houses, or empty roadsides in the early hours of the morning, to relieve themselves. Residents of Maharajkatte, which is on the outskirts of the city, went to the hilly areas and disused quarries bordering the settlement.

Our survey also showed that only 27% of households used LPG as fuel for cooking and the rest were still using either kerosene or firewood. On observation of project area we noted indiscriminate waste disposal, which was substantiated by our survey results (Table 2). 

A 20 page information booklet was prepared in consultation with experts and designed for distribution to all households, schools and Anganwadis. The information emphasised preventive family health care, environmental sanitation and solid waste management. IEC activities were conducted in the project area as per project guidelines. A summary of activities and number of beneficiaries is given in TABLE 4.

Discussion

Even though the project duration was 1 year but the actual time given for implementation was 6 months which was too short a period to fulfil the objectives of the project. During this short time we have succeeded in generating interest among women to actively participate in the programs. Following are the observations and opinion on some of the activities.

Duration of the project: It is important for any agency implementing IEC activities to understand local community dynamics, community problems and available local resources and then plan the project execution under broad guidelines. This exercise of community diagnosis followed by developing sustainable acquaintance and confidence among members of community itself will take 6 months to 1 year. It takes a minimum of 3-5 years to show evident change in behaviour of community.

Health activities: It was felt that instead of occasional health camps, effort should be made to provide care to all beneficiaries and organize regular health camps once in 4-6 months and data should be maintained with appropriate follow-up services. Household health cards can be maintained. A doctor (ad-hoc) appointed by the project should visit the area once a week to give services.

Awareness programs: Reaching male members of the community was the major difficulty faced by us as most of them were at work and not available during IEC program.

Convergence program: A few government departments like health, women and child development, and education were actively participating in IEC activities to reach the community. In spite of repeated approach other departments never took interest in addressing community regarding their program. This may be due to lack of time and manpower.

Skill development training: This is a long lasting intervention but surprisingly people’s attitude was not encouraging. Many of the beneficiaries, after initially enrolling for skill training, dropped out during training. This was partly due to gender bias where women were not allowed for training and also because of a belief that after training, there would be few opportunities for continuing work because of a lack of continued material and marketing support in the project.

Community participation: It is the final and most important step towards making people aware of their roles and responsibilities in sustained development and progress. Unless the community realises its importance in its own development any number of government initiative will not be successful. Community will not survive on transient financial and material support from the government. All individuals should participate actively towards sustainable, self reliant community development. IHSDP encourages formation of community based citizen welfare associations which signifies that the community is receptive and is ready to shoulder the responsibility for sustained development which is the ultimate objective of IEC activities. However, our repeated efforts to start citizen welfare associations in the project areas did not meet with success. There were statutory hassles involved in registering the associations, and the people feared expenses in running an office. There was also a concern of political transformation of the welfare association. The people were more interested in their personal benefit from the association rather than community welfare. Expense, political interference and the lack of a sense of ownership were the main hurdles.

Finance: With respect to financing, when a project is handed over to a government institution, the conditions pertaining to security deposit and instalment payments ought to be removed. There was a lack of synchronization between sanctioning of funds and deadlines for completing various stages of the project, and because there was no flexibility in these deadlines, the project officers had to spend out of pocket for the activities. At times the activities were delayed due to lack of funds.

Recommendation

India is a country with a dynamic population, and a diverse political, cultural and economic background. It is a challenge to accomplish satisfactory development goals equally at every level of a community. We commend the government of India for this targeted effort towards sustainable development of underprivileged areas. Our recommendation, for the success of a program aimed at holistic development of a community are program should be implemented by both dedicated and competent agencies having social concern , adequate resources with respect to finances, and flexible guidelines creating opportunity for innovation and Duration of the project should be at least a minimum of 5 years instead of one year.