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International Journal of Science Medicine Engineering & Technology IJSMET-2015-107 www.ijsmet.com

INSTITUTIONAL INTERVENTION FOR THE

DEVELOPMENT OF HEALTH CARE, A

CONTEMPORARY APPROACH FOR UP-

LIFTMENT OF URBAN SLUMS: A CASE

STUDY OF RAGHUNATHPUR SLUM,

DUMUDUMA MOUZA, BHUBANESWAR

Partha Pratim Karmakar

1, Ratnamala Misra

2

1 College of Engineering Technology, Bhubaneswar 2 CUTM, Bhubaneswar

ABSTRACT: The developing countries like India presently trying to sol ve the hazardous

growth problems of slum settlements. Rapid urbanization and employment

of unskilled labour force in informal sectors give rise to growth of slum and

squatter settlements. Migration from urban fringe and rural area makes the

capital life miserable. Migration is one of the driving force for city’s rapid

population growth. The unplanned growth of slums and uncaring attitude of

slum dwellers towards health services spoil the overall growth of the city.

Bhubaneswar has a long history of migration. This study assesses the access

to health services of the migrant population settled in of Unit-4 and Unit-5

slum. For the purposes of this report, the urban poor population is de fined

as those persons belonging to the lowest quartile on this wealth index.


Introduction:

Bhubaneswar, the planned city was designed by the German architect Otto

Königsberger in 1946, with grid –iron road network pattern. One of the

characteristics of growing Bhubaneswar is to have parallel growth of slums and

squatter sett lements along with planned growth. These slums and squatters

developed on vacant government lands. In the process, small slums appeared and

developed in many places of the city. The slums preferred to settle preferably

beside the busy traffic corridors or rail tracks in search of livelihood and civic

amenities. Social exclusion and substandard infrastructure forces the poor to

adapt the conditions beyond his or her control. Poor families that cannot afford

transportation, or those who simply lack any form of affordable public

transportation, generally end up in squat settlements within walking distance or

close to the place of their formal or informal employment. Migration is emerging

as an important phenomenon from economic, poli tical and public health point of

view. The processes of migration and health are inextricably linked in complex

ways, with migration having an impact on mental and physical health of

individuals and communities. Health itself can be a motivation for moving or a

reason for staying, and migration can have implications on the health of those

who move, those who are left behind and the communities that receive migrants.

Thus, at the macro-scale, migration may influence population health, although

the effects may be quite difficult to disentangle.

Many of the health problems in urban slums stem from the lack of access to or

demand for basic amenities. Basic service provisions are either absent or

inadequate in slums. Lack of drinking water, clean, sanitary environment and

adequate housing and garbage disposal pose series of threats to the health of

slum dwellers, women and children in particular, as they spend most of their

time in and around the unhygienic environment. The demands for basic services

are lacking, because there is no agency or institution (state or central) that is

willing to assess the needs and on that basis identify and fulfi ll the demand.

http://en.wikipedia.org/wiki/Otto_K%C3%B6nigsberger

http://en.wikipedia.org/wiki/Otto_K%C3%B6nigsberger

International Journal of Science Medicine Engineering & Technology IJSMET-2015-107 www.ijsmet.com Different Categories of Slum in the city of Bhubaneswar

Item Authorised slum Unauthorised slum Total

Number of slum pockets 59 131 190

Population 58,485 132,380 1,90,865

Households 11,607 38,173 49,780

Source: Bhubaneswar Municipal Corporation, Project office 2001 - 10

Growth of Slum Pockets: Bhubaneswar (1971 -2009)

Urban services in Bhubaneswar:

Bhubaneswar city is regulated primarily by Bhubaneswar Municipal

Corporation, which is the local government and lo oks after the Solid Waste

Management, collection of property Tax, street lighting, cleaning of drains etc.

Bhubaneswar Development Authority looks after development plan, building

plans, housing, parks including land uses planning etc. Housing and Urban

Development Department is responsible for preparation of policy frameworks

International Journal of Science Medicine Engineering & Technology IJSMET-2015-107 www.ijsmet.com and guidelines. The government land of the city is regulated by general

administration department, which on requisition gives lands on lease basis to

Bhubaneswar development authority, Bhubaneswar Municipal Corporation and

other institutions like public works department, irrigation department, roads and

building department and national highway authority. Water supply to the city is

looked after by public health engineering organization functions under the

housing and urban development department. CESCO is responsible for the power

supply to the city and street lights are looked after Municipal Corporation.

Hypothesis:

The proposed study will test the followings:

Insti tutional intervention to develop the health care facilities at the newly

allocated site.

Maintenance of health care centre and health awareness campaign for

slum dweller.

Availability of civic facili ties and access to physical infrastructure.

Development of l iving conditions of the slum dwellers after

rehabilitation.

Periodic infrastructure development and overall growth pattern of the

colonies.

Participation of different stake holder for settlement of health services.

Availability of emergency healthcare like medic ine, ambulance service,

mother and child care facili ty.

Research Methodology:

a) The questionnaire had separate sections for each of the pucca house

owners, semi-pucca house owners and kutcha house owners.

b) Questionnaire was made for the slum dwellers those who are still residing

in previous or close to previous encroached slum area where from they

were brought.


c) Question and answer also covers the ways and means to develop their

living conditions.

d) Insti tutional facilities extended time to time for developing health care

facili ties

e) Questionnaire was made for – Doctors, other Stake holders and

f) Primary data collection

g) Data analysis

h) Improvement assessment indicator

i) Beneficiary Institution Partnership Model(BIPM) development

j) Recommendations

Data analysis

We are focusing here one of the rehabili tation schemes initiated by Government

which is Sastri Nagar(Unit -4 and Unit -5)slums to house the government quarters

at the centre of the city. These Sastri Nagar slum dwellers were shifted to

Dumuduma Mouza, which is 12 km away and exactly opposite side of the city.

Unit-4 and Unit-5

Dumudum

a

N


Data of previous settlement

Location : unit -4 and unit-5

No. of Household : 462

Population : 2623

Nearby Infrastructures : Kalinga stadium, Sri Ram temple, B.D.A City

Centre, 120 Battalion,Unit -4 Government

hospital

Health Care Facilities : Unit-4 Government hospital – 1Km., Kar Clinic –

1.5Km., Sheetal Ayurvdeic Health Care &

Research

– 2Km., Unit -6 Capital hospital – 4Km. (during

1965-1993)

Govt. aided Health Care centre: There is not any institutional intervention for

slum dwellers.

N

Encroached Land at Unit-4 and unit-5


Data of new settlement

Location : Dumuduma

No. of Household : 631

Population : 3784

Nearby Infrastructures : Kanungo institute of diabetes specialt ies,

AIIMS, Cashew factory, BIju Patnaik State

Police Academy, Raghunath U.P.

School,EWS

and LIG housing colonies.

Health Care Facilities : Kanungo institute of diabetes specialt ies –

1Km., AIIMS –2.3Km.,AMRI Hospital – 3.5

Km.,

IMS sum Hospital – 6Km., Unit -6 Capital

Hospital – 12 Km.

Govt. aided Health Care centre: One Govt. aided health care centre is there

where one doctor, one nurse, one att endant

is

there and two staff are there forcleaning

purpose. One Anganwari Kendra is ther

where

polio and other vaccination are done

0

10

20

30

40

ACCESS OF PHYSICAL INFRASTRUCTURE

% of Development(access of physicalinfrastructure)

0%

35%

65%

HOUSING STATUS

Pucca House

Semi-Pucca House

Kutcha house

Till-

1990


N

RAGHUNATHPU

R

010203040506070

ACCESS TO PHYSICAL INFRASTRUCTURE

% ofDevelopment(access tophysicalinfrastructure)

1%

10%

89%

HOUSING STATUS

Pucca House(owned bynon-slum dwellers)

Semi-Pucca House

kutcha house


After 24 yrs of migration to Dumuduma (During -2010-1014)

Major Findings:

01020304050607080

ACCESS TO PHYSICAL INFRASTRUCTURE

% ofDevelopment(access tophysicalinfrastructure)

65%

15%

20%

HOUSING STATUS

Pucca House(owned bynon-slum dwellers)

Semi-Pucca House

Kutcha house

After migration to Dumuduma (During-1993)

3%

15%

3%

4%

4%

3% 6%

3% 3%

43%

13%

Percentage of Slum Population Affected by Different Diseases

Disease of Heart andCirculatory System

Diseases of DigestiveSystem

Diseases of Ear,Nose AndThroat

Diseases of Eye

Helminthic Disease


Cause of Death

%

Accident Suicide and Poisoning 6.4

Diseases Circulatory System 9.1

Diseases of Digestive System 26.1

Bacterial and Parasite, Excluding

Tuberculosis

5.6

Metabolic Diseases, Nutritional and

Vitamin Deficiency

5.0

Neoplasm- Malignant 9.7

Diseases of Respiratory 11.4

Tuberculosis 6.7

Other 12.5

Unknown Diseases 7.5

Total 100.00

The sett lement pattern at the newly made colonies is very geometric with

grid iron pattern road network with regular residential plot arrangement of

20’ x 30’

The slum dwellers did not have sufficient money to construct their houses

nor did they get sufficient help from government either in terms of money

or in terms of material.

There was no public toilet -block in the slum colonies, the slum dwellers

used to go the government land besides the mosque.

NGOs at later period felt the necessity to construct the toilet of (4’ x5’)

on individual plot as basic facility.

At the entrance to the colony a health care center had been constructed for

the services of the slum dwellers. But the unhygienic condition and poor

facili ty at the health care center did not attract the slum dwellers to take

service.


The poor maintenance of the health care center and absence of trained

nurses and qualified doctors compels the slum dwelle rs to go other health

centers but not to use the locally available one.

Since last one year, mosquito repellent spray has been stopped.

The absence of proper road and drainage facility made it difficult to

approach at different zones of the huge slum area resulted negative

growth of the colonies.

Poor drainage facility of the colony at times makes the whole settlement

area flooded with unhygienic waste which results in negative growth of

the colony.

The drainage facil ities in the slums -

o No Drainage: 85.4 %

o Open Drainage: 6.9 %

o Covered Drainage: 7.7

Road network Open drains


Healthcare centre flooded with Unhygienic waste

Analysis of major findings under following heads

Housing status

Sanitary system

Drainage and sewage system

Awareness & educational campaign

Occupational convenience

Public facilit ies and health care centre.

Beneficiary’s social responsibilities

After evaluating the findings of the questionnaires shot to the beneficiaries we

have developed the Improvement Assessment Indicator (IAI) the slums/EWS

intervened by institutions.

.

International Journal of Science Medicine Engineering & Technology IJSMET-2015-107 www.ijsmet.com The assessments made as follows…

Sl

no.

Parameters Pre

Intervention

Participation

(in %)

Institutional

Participation

(in %)

Beneficiaries’

Participation

(in %)

Final

Outcome

after

5yrs

(in %)

Socially

accepted

feasibility

ratio

(institute :

beneficiary)

1. Housing Status 0 85 0 65 85:1.5

2. Sanitary System 0 60 10 55 9:1

3. Awareness &

educational

campaign

0 80 0 40 8.5:1.5

4. Occupational

Convenience

0 75 0 30 9:1

5. Public facilit ies

And healthcare

centre

0 60 0 10 9:1

6. Beneficiary’

social

Responsibility

0 60 30 80 9:1

Beneficiary Institution Participation Model (BIPM) has been developed by

assessing the beneficiary’s capacity to spend, social obligation, mindset to

participate and proportionate intervention of institutions in overall development.

From the analysis it is found that beneficiary’s participation in terms of money,

labour and social involvement is very much necessary for the development and

long term maintenance. Hence , the derivation of BIPM based on the

Improvement Assessment Indicator (IAI) in relation to develop the health care

facili ty in slums.


BIPM = ∑ [ (8.5i + 1.5b)HS + (9i + 1b)SS + (8.5i + 1.5b)AE + (9i +

1b)OC + (9i + 1b)PH + (9i + 1b)BR ]/6

Where i denotes the institutional intervention

b denotes the beneficiaries’ participation

= ∑ [ (8.5 + 9 + 8.5 + 9 + 9 + 9 ) i /6+ (1.5 + 1 + 1.5 + 1 + 1+

+ 1 ) b/6] N

{ N = parameters of IAI (Accessibility and Road Network development (AR),

Service Infrastructure related to Sanitary system, sewage disposal, electricity

etc. (SI) , Development of Education facility (ED), Social infrastructure and

Healthcare (SH), Social development and overall maintenance (SD), Social

security (SS), Housing standard and (HS), Beneficiaries’ Social

responsibility(BR ) }

BIPM = ∑ [ (8.83 i + 1.17 b) N

]

As BIPM is developed based on institutional intervention and beneficiaries’

capacity to spend, social obligation and mind tracking rating

BIPM = ∑ [(8.83 i + 1.17b) N ] varies with respect to time and place.

Recommendations:

Major thrust should be given to develop healthcare centre

There should be one sizeable healthcare centre having at least 3 doctors , 3

nurses and 2 attendants for the population of 3784 with immediate effect

and consequently as per the requirement the health care centre, doctors

and nurses service will be develop ed.


There is an urgent need of maternity ward, minor O.T, mini blood ban k

and an ambulance.

There should be quality awareness campaign for educating the slum

dwellers to take care of basic health problems.

Insufficient sanitary system is a chronic problem to the slum dwellers as

they stay in an unhygienic ambian ce with a big family. As there is no

drainage or proper sanitary system available, the slum dwellers preferred

to sell the property and again settled in central zone of the city.

Efficient Sanitary system should be developed to control health hazards.

More of institutional intervention is required to strike a balance between

institutions and beneficiary’s participation.

Improving effectiveness of existing legal framework by strict enforcement

and compliance to eliminate practice of manual scavenging.

Crystallizing role, responsibility and functions of the implementers.

Education and awareness programme play a major role in sanitary system

development and health care facili ties. As long as male members of

housing unit are not aware of the fact that female members should n ot go

out of the house premises for toilet, there will no real heath care

development in slum settlement.

Participation in “Swachh Bharat Abhiyan” and “ Mahatma Gandhi Clean

India Programme” should be encouraged to slum dwellers as

beneficiary’s’ social responsibility.


References:

1. Abraham (1999), The Making of Indian Atomic Bomb, Science, Secrecy and

the post colonial state, New Delhi: Orient long Man

2. Acharya, P. K. (2004), A case study of Patharabandha Slum in Bhubaneswar,

Nabakrushna Choudhury Centre for Development Studies, Bhubaneswar

3. Agnihotri, Puspa(1994), Poverty Amidst Prosperity: Survey of Slums, New

Delhi: M.D Publications Pvt ltd

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sixties”Economic and Political Weekly, Vol(8), 4 -6

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Economics-JETRO, Japan

Prof. Partha Pratim Karmakar has completed his undergraduate (

B.Arch ) course with first class in the year 1987 and stood first in

post graduate , M.Arch. in 1989 from jadavpur University,

Kolkata,west Bengal.

He has been professing in the Department of Architecture, College

of Engg. & Tech, B.P.U.T , Odisha since last twenty five years.

Currently he is Head, Department of Architecture, C.E.T. He is an

active member of Council of Architecture (COA) and also Indian

Institute of Architects (IIA). He was honored for his research works

on housing and Urban Design discipline and he also won many

national level design competitions and executed the projects

successful in India & abroad. He is one of the pioneer architects to

spread green building concept in India and also a qualified green

building evaluator of the country.


Prof. Ratnamala Misra presently Principal at School of Architecture,

Planning & Design, CUTM, Bhubaneswar, was Professor at PMCA,

Cuttack from 2009 – 14.

With Bachelor of Architecture from Jadavpur University and Master

of city Planning from IIT, Kharagpur, She served in different

capacities at various Odisha State Government Organizations-

Public Works Department, Directorate of Town Planning,

Bhubaneswar Development Authority and Odisha State Housing

Board. She won a TCTD scholarship from the British Council to

pursue a course on “Site Planning and Housing” at University of

Nottingham, UK in 1986. Her area of interest is urban planning and

mass housing.

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