India's bid to boost healthcare in slums

In this small commercial city, two worlds sit side by side. One side is the comfortable middle class. The other - tucked into alleyways or barren lots - are slums that look like a scene out of Mad Max: low-roofed tin huts; wild-haired children walking naked.

For centuries, these two worlds have been symbiotic. Slums provide housecleaners, cooks, and drivers for the middle class. The middle class, meanwhile, tolerates the slums as a source of cheap labor.

But this system is buckling under the pressure of India's burgeoning urban population, particularly over issues of health. Urban slums are the fastest-growing sector of India's population, expanding five times faster than rural areas. How the government deals with this problem could have widespread implications, both for the country's ability to attract foreign investors and to convince upwardly mobile citizens that life is safe enough to remain in India.

"When you analyze the urban slums and the statistics that slums will be growing at faster rates than other [areas], this is a serious concern," says Prasan Kumar Hota, secretary of family welfare in the Indian Health Ministry.

Urbanization is a global phenomenon. In wealthier nations, most citizens already live in major urban areas or suburbs. But for poorer countries, the epic migration of villagers to cities is straining clean water supplies, sewer systems, and hospitals. Of the roughly 2 billion people to be added to the world's population over the next 30 years, more than 90 percent will be living in the cities and towns of poor countries, according to The Challenge of Slums, a recent report by the UN agency Habitat.

In India, there is a cruel twist. Decades of rural programs have brought clinics and healthcare to villagers. But now villagers are often leaving behind better healthcare in search of better jobs. In a recent survey in the state of Gujarat, for example, researchers found that 60 percent of surveyed villages had vaccinated their children, compared with 30 percent of slum dwellers.

A small collection of government bureaucrats, private volunteer groups, and feisty community leaders are starting to address the imbalance, one slum at a time. Here in Indore, an innovative pilot program - funded by USAID and run by private healthcare advocacy groups - is helping slum dwellers improve their own health conditions. With limited funding, this program chose 75 of the most vulnerable slums (out of 543), and focused first on education.

"The most important thing is to deal with the sense of resignation that you find among most Indian slums," says Siddharth Agarwal, executive director of Environmental Health Project (EHP), a private aid group in New Delhi leading the Indore project. "These people should be the implementers. We may be wonderful doctors, but we will disappear one day, so if a program is able to train five people in that community, then the effort can be sustained."

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