Upload
volien
View
217
Download
0
Embed Size (px)
Citation preview
The physical environn1ent and the socio-~conomic conditions
prevailing in Govindpuri and Wazirpur ].]. colony need·, to be seen in
the context of the growth, development and current scenario of slums in
Delhi. It would, therefore, be useful to present a picture of Delhi slums
before providing a detail profile of the study areas and the population.
3.1 PROFILE OF DELHI SLUMS
3.1.1 Growth and Types of Slums in Delhi
The term used to refer to Delhi, the capital of India, is megapolis.
A steady rise in the population of Delhi is clearly evident from the
Indian census figures (as given in fig. 1). The growth of slums in Delhi
and in other metropolitan cities in the country are generally believed to
be the fall out of rapid population growth during the last four decades
and the political callousness in tackling the problem wholeheartedly.
The compelling situation in rural areas such as extreme poverty,
joblessness are among the important sectors which has forced many to
migrate to cities including Delhi, in search of job and livelihood. The
push and pull factors accelerating migration to cities has contributed
subsequently to the growth of slums in Delhi.
Spread over an area of 1,483 sq. kms., Delhi has a densitv of
population of 6,319 persons per sq. km. and approximately 2.00,000
migrants flock to the city annually (Census, 1991 ).
Population Growth of Delhi 1901-91
10000000
9000000
8000000 (!) 0
7000000 ....r 0 N N
6000000 (!)
CX> 5000000 0>
(!) 1.() (!)
4000000 N 0
3000000
2000000 (!) ....r ...... N N
1.() 1.() (!)
1000000 CX> ....r ("') ("') CX> (!) ...... CX>
0 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991
(Source : Census Papers, 1991)
For planning and administrative purpose, Delhi is divided and
administered by three entities, namely, (i) the Municipal Corporation
of Delhi, (ii) the New Delhi Municipal Committee, and (iii) the Delhi
Cantonment Board.
Majority of the urban poor and in-migrants who cannot afford
a decent living place have no choice but to put up in the available
space near railway tracts, construction sites and pavements. The
varying levels of development has made Delhi a city of contrasts of
two worlds, one of the rich and other of the poor. Sky-scrapers,
palatial bungalows and luxurious hotels are found to co-exist with
slum settlements of the urban poor.
For the purposes of understanding and research, the slum
areas of Delhi can broadly be classified into the following categories
(MCD, 1991): (i) legally notified slum areas,· (ii) jhuggi-jhompri
clusters (J. J. colonies), (iii) unauthorised colonies (iv) urban villages
(v) pavement dwellers and the (vi) the resettlement colonies. There
are 33 notified slums, more than 1080 ]. ]. clusters, 1000
unauthorised colonies, 111 urban villages and 46 resettlement
colonies in Delhi (Ali, 1995; Chandra, 1997). The notified slums are
those which have been declared/notified as slum areas under section
3 of the slum areas (Improvement and Cleai·ance) Act, 1956. Such
,. -: ,,,
slums are found scattered all over Delhi rather than being
concentrated at one place. An estimated twenty lakh population is
believed to be living in the area~ which are legally notified as slums.
The term 'slum' even for research purpose gets commonly used
in a loose way to represent areas which are congested, overcrowded,
haphazardly laid out and where the essential civic services are absent
or grossly inadequate. As such, therefore, typology of slums in a
strict sense does not very well hold. This is particularly true in case of
Jhuggi-Jhompri and unauthorised colonies. As the trend has been, J. ].
clusters are formed by low income rural migrants who come to the
city in search of livelihood and are forced to accept any type of
accommodation available or that which can be quickly erected \·vith
materials virtually free of cost on open spaces lying unused. The
process, therefore, involves illegal occupancy or squatting on public
or private lands. NPedless to mention, there has been a steady growth
in the number of squatter households since 195~ ,
----------=-G-:--ro_w_t_h __ o_f_S_q..~-ua tters During the Past Four Dec a df's __ Year Nt!mher 0fSquatter Families 1951 12.749 1961 l971 1981 1991
~nurt"l' • (Quoted from Ali and Singh, 199k; pp 22)
4:2.Xl5 ():2.594 9X.709
2.59.344
As Mr. Manjit Singh (director, slum and J. ]. departn1ent of the
Municipal Corporation) has pointed out "The problem of].]. clusters
is mind-boggling. There is a proliferation of clusters, housing
between 26 to 27 lakh people. Going by the capital's present
population, every fifth person would be a jhuggi dweller~" (Chandra,
1997).
The emergence of unauthorised colonies are also the direct
result of shortage of houses and house plots in planned and approved
residential colonies. Although the name suggests otherwise, such
colonies have generally been given essential services (like water,
electricity etc.) by the DDA and the MCD and in that sense
'regularised'. About 155 of these colonies are being handled by DDA,
44 by the Slum Department of MCD and the rest by the MCD.
Besides, there are 113 Hanjnn bnstit.'s in Delhi. The line drawn bet,-veen
].]. clusters and the unauthorised colonies, in this sense, is quite thin.
The].]. clusters have also over a period of time largely been able to
get essential services sanctioned by the local government. Moreover,
both J. ]. and unauthorised colonies are characterised by relatively
homogeneous groups, with low levels of earnings/ education and
inadequate infrastructure, particularly in comparison to resettlement
~.-olonies, 11•1tified slums etc.
Resettlement colonies came up in Delhi as a solution for
problem of housing for squatter population and pavement dwellers.
However, being located on the periphery of the city, they are not the . . .
first choice of the working population who prefer to be near the
source of livelihood to cut down upon the costs of travelling. Further,
these colonies also suffer from various infrastructural inadequacies
like water supply, sewerage, electricity, hospitals, etc. Resettlement
colonies have generally population of heterogeneous composition of ,.
different castes/ areas and are only marginally better off than
unauthorised colonies in terms of infrastructure or cleanliness.
There is also another part of the squatters who don't even have
a roof over their head and they resort to the pavements of Delhi at
night to sleep. According to the estimates, about 70,000 population of
Delhi live on pavements (MCD, 1991 ). They are found in
concentration near the parade ground, inter-state bus terminals, Jama
Masjid area, and railway station. This strata of the pavement dwellers
are the low paid workers, such as the labourers, coolies, shoe-shine
boys, load carriers, rag pickers etc.
Urban villages, among the different types of slum settlements
m Delhi, occupy an unique position. A mixture of features of both
rural and urban areas characterises the urban villages in Ddhi which
'J()
are also found to be experiencing slum like conditions due to fast
growth of population. In the Master Plan of Delhi, 1962, the term
'urban village' was coined for those villages where rural type of
industries, together with the population engaged in such activities,
were located.
Such villages generally have joint family structure, well
maintained network of relationships and a largely homogeneous
group of people in terms of caste. The lifestyle of the inhabitants,
however, have undergone major changes with often one generation
professing their old traditions and a younger generation (particularly
men) being more educated and urbanised yet retaining their old
associations and practices. Nevertheless, the level of services still
remains poor with hardly any perceptible advantage to the residents
for their village being declared 'urban'. Provision of \Vater supply,
surface drainage, roads and parks, dust-bins, public toilets are some
of the essential facilities that need to be provided adequately to these
villages.
The explosive growth of population in the National Capital
Territory of Delhi mainly on account of migration fron1 all over the
country has, thus resulted in sprouting of different types of slun1
settlements all over the city. The differences observed among these
')I
slums are, however, essentially on a relative basis. On a broader
plane, residents of these slum areas share in much more similarities -
they are the urban poor who lack bargaining power and often get
exploited (by those holding power) in the process of their struggle to
improve upon their life.
Urban slum dwellers are, therefore, essentially from the lower
socio-economic strata of the society who are unable to untie the knot
of poverty largely due to low levels of education and rampant
unemployment. Poverty or low levels of income, apparently the
major cause of their sufferings, is itself the product of low wages,
limited skills, irregular work, lack of opportunities, lack of knowledge
about rights/ privileges/ entitlements, poor health and nutrition,
which in turn is the direct consequence of insanitary living conditions
and inadequate earnings.
It is in the light of these features of slums and slum dvvellers in
Delhi that the physical and the socio-economic environment of
Govindpuri and Wazirpur J. ]. colony should be understood. A detail
profile of the study areas and its population follows in the next few
sections.
3.2. PROFILE OF THE STUDY AREAS: GOVINDPURI AND WAZIRPUR J. J. COLONY
3.2.1 Origin and Spread of the Slum Areas
Govindpuri slum comprises of Navjeevan Camp, Bhumiheen
Camp and Nehru Camp which are adjoining to each other, one
extending into the other. This slum has grown since 1977 and covers
an area of approximately two acres of land, the original purpose of
which was to construct a bus terminal. But the area turned into a J. J.
colony with the incoming of migrant people, in search of jobs, from
different states.
The initial clustering was formed by small groups consisting of
kinsmen, relatives, fellow-villagers or those intimately knmvn to each
other. With time other groups arrived and occupied the vacant areas.
In Wazirpur area, the J. J. colony was set up in 1965 by the
government as part of its scheme to provide authorised land to slum
dwellers to build their own houses. As a consequence slum dwellers
from different states constructed houses (mainly puccn) on the allotted
land. However, many of them instead of living in those houses, gave
it on rent or sold them off and themselves settled in jhuggis set up on
nearby empty lands, park area, or even on either side of the roads.
The Wazirpur slum is spread over an area of about 2-3 acres of lands.
l
LAYOUT OF GOVINDPURI SLUM AREA
NUIRU CAMP
Navjccvan
camp
CASP PLAN TB CENTRE
GOVINDPURI SLUM
ALAKNANDA ~-
KALKAJI DDA FLATS (Market Place)
DA Health Disp.
GOYINDPURI
1 AIIMS Centre
Sulabh DESU Shauchalaya ASHA Centre office
Garbage Dump
BHUMIHEEN CAMP
GOVINDPURI SLUM
-~HAMDARD
TUGHLAKABAD EXTENTION
(Market Place)
t
~
~ ;:;JJ :::::
0::: I- ..... ro .....
....c -o > s:::
ro ~ 0 (!)
....c <:/)
<:/) ro <t: ....c
0...
LAYOUT OF W AZIRPUR J. J. COLONY
ASHOK VIl-lAR
Park Park • Water Tank
IT B CENTRE I : SHOPS
WAZIRPUR J. J. COLONY
Park Park
NAZAFGARH CANAL
TRI NAGAR
SHAKTI NAGAR (Market Place)
GULABI BAGH
SHASTRI NAGAR
INDLRLOK (Market Place)
N E+\\ s
')~
As per list of Food and Supply Department, Delhi governmen~
1990, (the latest survey conducted till date) the number of jhuggies in
Navjeevan Camp, Bhumiheen Cam~ an.d Nehru Camp are 3122, 2244, and
1711 respectively. However, according to the Pmdlum (headman) of the
area the nun1bers have increased over the years, with Navjeevan Camp at
present having 5428 jhuggis, Bhumiheen Camp having 4175 and Nehru
Camp being comprised of 2262 jhuggis. Therefore, according to rough
estimates available from the Pradhan, senior residents of the slum area and
health workers of nearby health centres, Govindpuri slum comprises of
around 11,865 households. The camps are divided into different blocks,
with Navjeevan Camp having six blocks (alphabetically named from A to
F) and four blocks each in Bhumiheen and Nehru Camps. Navjeevan and
Nehru Camps are adjoining to each other while Bhumiheen is across the
road, as can be seen from the map of the area.
For Wazirpur ]. J colony, the list of Food and Supply Department,
1990, provides a fairly low estimate of the number of houses in the area,
putting it around 4,831. But according to the Pmdhmz and senior residents
of the slum area, the number of jhuggis in Wazirpur ]. ]. colony were
around 10,000. This estimate was corroborated by officials of ATC and
private practitioners of the area. These households \Vere distributed over
fourteen blocks, alphabetically named. Hovvever, in both GO\·indpuri and
Wazirpur slums, one does not find a neat arrangement of jhuggis rather
one comes across haphazard numbering of houses and their placement in
different blocks.
3.2.2 Housing Pattern
The housing pattern was found to exhibit striking similarities not
only between Navjeevan, Bhumiheen and Nehru Camps, but also between
Govindpuri and Wazirpur slum areas. In both the areas, majority were
found to live in dwelling units made up of brick, plastered with cement
and roofs of stone or concrete or were forced to live in huts with walls of
mud, mortar, broken bricks and with thatched roofs (or roofs made of
tarpaulin used tin sheets and other sundry materials). The percentage of
slum dwellers living in pucca houses were observed to be slightly higher
in Govindpuri slum as compared to Wazirpur ]. ]. colony (around 80 per
cent in case of Govindpuri and 60 per cent in case of Wazirpur).
In Bhumiheen Camp (Govindpuri), before 1991, most of the
dwelling units were of the hut types, that is kuc/zlza houses. But in 1991,
residents of Bhumiheen Camp suffered from a major outbreak of fire,
when most of the jhuggis were gutted. Following this, majority of the slum
dwellers, with government assistance, build semi-puccn and puco1 houses
to protect themselves from future similar incidents. However, a certain
section of tlw· population could manage only kucii/w houses since
government assistance failed to reach them. It has been alleged by this
section that most of the financial assistance given by the government were
cornered by the local powerful men and distributed among their mvn
groups.
In the Govindpuri and Wazirpur slum areas, it was observed that in
the kuchha houses there was no separate ventilation other than the door ..
Even in the semi-pucca and some of the pucca houses, there was no
provision for chimney or windows. This sometimes turns out to be the
cause of health problems for the inmates of the house. Most of the houses
have only one tiny room where the whole family has to eat, sleep and live
together.
One could notice few puccn double storey houses, having two or
three small rooms in the ground floor. These houses were found to be
owned by relatively well off big families, often by local headman and his
relatives. However, there were some double storey houses, with only one
tiny room in the ground floor and these houses were generally given on
rent, while the owner occupied only one-two rooms.
In almost all of the households in the study areas, there was
electricity and many families owned some type of consumer goods like
radio, television, table fans etc. The difference in the two stud~· areas
~1 rimarily arises from the fact that while in Wazirpur J. ]. colony electricity
'!;\
is taken illegally from overhead wires, with no payment being made to
any agency for its consumption, in Govindpuri slum area majority pay
rupees fifty for obtaining an electric connection and rupees twenty per
month for regular consumption. This money was found to be collected by
a contractor who in turn paid a fixed sum to the DESU. However, in both
the slum areas, it was observed that people had dangerously hooked wires
to the nearest electricity poles and there was compete lack of any proper
wiring system.
3.2.3. Basic Services
The physical environment of a slum is harsh and presents many
obstacles to growth and development, especially when compared to the
planned areas of the city. The most obvious disparity is the gross
inadequacy of public utilities and services.
Water
Slum dwellers of the study area were mainly supplied water
through tubewells and handpumps, installed in most cases by MCD but in
a few cases by NGOs (as in Govindpuri slums) or even sometimes made
available by the residents themselves. In Govindpuri slum area, there were
around nine tubewells and six handpumps installed but frequently they
were not in working condition causing lot of inconvenience to the slum
population. In Wazirpur J. ]. colony there were five tubewells and six
<)()
handpumps but their functional capacity was also similar to Govindpuri
area. Municipal Corporation had laid down water lines for the residents of
both the slum areas but there was l~ck .of adequate number of taps. Quite
often one could witness people taking water directly from the line itself
which was at or below the ground level (by digging a sort of a cubicle
hole). Frequently one could find a garbage heap next to the water source,
thereby increasing the possibility of water contamination.
The few handpumps and water lines found in the slum areas,
therefore, had to supply water to all of the households for their basic
domestic chores such as cooking, washing, cleaning and bathing and were
clearly inadequate for meeting the needs of the population they meant to
support. Some household chores could be carried at the water source itself,
but several gallons of water a day still had to be carried back to the jhuggi
and stored. This was normally done by the women of the household
(sometimes assisted by her children) and generally were required to wait
in long queues for considerable amount of time. The struggle to get some
water often led to heated arguments and even to fights (causing
sometimes injury to women folk).
Particularly during summer, the entire slum population of both
Govindpuri and Wazirpur area faced water crisis, with often no \\'ater
supply for two-three days. It \Vas reported that during the summer
IIIII
months, most of the hand pumps went dry. The slum dwellers then had to
face extreme difficulty in collecting water from far off places. But there
were no serious complaints regarding the purity of water supply. Some of
the slum dwellers of Govindpuri area stated that often health officials
came and gave them water purifying tablets to put in the water storing
containers.
Drainage and Garbage Disposal
There is no proper drainage system existing m the slums of
Govindpuri and Wazirpur area. There are open kuclzha drains made by the
residents and most of the time they are cleaned by locally hired sweepers.
In Wazirpur ]. ]. colony, there were a few covered drains, build either by
the residents themselves or by the MCD. The slum dwellers in both the
areas usually were found to throw their refuse here and there, inside and
outside the slum. But most of the residents disposed their garbage in front
of their hutments or at the corner of their gali (lanes). However, in the two
slum areas, there were enclosed area for garbage disposal but only some of
the slum dwellers were found to throw their refuse directly there. Once or
twice a week the sweepers too removed the garbage from the slum locality
itself.
However, the common complaint of the slum dwellers were found
to be that the sweepers were highly irregular and as a result, garbage
I ill
including children's excreta would collect in the uncovered drains,
attracting flies and becoming a natural source of infection and disease. But
quite often residents of each 'gali' pooled in some amount of money to
ensure regular service by the sweeper. On the whole, there seemed a
tendency among the residents to entirely depend on the municipal
sweepers to clean the drains and collect garbage from the various corners
of the blocks. Only sometimes officials from National Malaria Eradication
Programme would come for spraying necessary chemicals in the drains.
Toilet and Bathing Facilities
In both the slum areas, there exists the 'Sulabh Shauchalaya' system
which provides latrine and bathing facilities for slum dwellers. It is more
frequently used by women and children and a charge of 25 paise is levied
on their every visit (or rupee three on a monthly basis) while 75 paise is
demanded from men. Due to inadequate number of latrines, they were
inevitably overloaded and poorly maintained, thus becoming health
hazards themselves rather than promoting a hygienic environment. Some
of the slum dwellers then resorted to gong to open field and nearby parks
for defecation. Children were found to defecate anywhere they felt like,
very often in front of the jhuggis itself.
It was observed that sewer lines in the public latrines got defective,
with sewer water flowing into the slum and very often near the source of
drinking water, creating serious hea~th ~azards.
3.2.4 Market Facilities
The study areas are surrounded by pucca roads and well connected
to various important places. Okhla industrial area is approximately three
four kilometers away from the Govindpuri slum, where many slum
dwellers were getting their employment. Market places surround the
Govindpuri slum area from both the sides. On the one side is the Kalkaji
DDA flats market and on the other side is the Govindpuri market area.
These markets have different shops selling all possible goods. A few small
shops of daily needs were also present inside the Govindpuri slum
locality.
The Wazirpur ]. ]. colony is also surrounded on all sides by major
roadways. Wazirpur industrial area is around two kilometres away from
the slum and provides a source of employment for many residents of the].
]. colony. Further, the slum is only one kilometre far from major market
places of Ashok Vihar and small market areas like Bharat Nagar market.
There \Yere also few shops selling items of daily necessity inside the
VVazirpur). ]. colony, just like Govindpuri slum.
111 ~
3.2.5. Educational Institutions
Wazirpur J. ). colony was found to be also well connected to various
educational institutions, with two. high schools on either side of road
outside the slum area (Maharaja Agarsain Public School and a government
school). A couple of other public and government schools are within a
kilometre from the slum area and two college institutions (Satyawati
college and Lakshmibai college) are also about two kilometres away from
Wazirpur slum. However, there was found to be complete lack of any kind
of educational institutions inside the slum area run either by government
or any NGO, to meet the needs of slum dwellers. Further, it \Vas found
that no voluntary organisation were in operation in the area and there was
dearth of social welfare schemes for the slum population.
In Govindpuri area, the situation was found to be different, with
slum population having more opportunities available within their means
to educate their children. There was one government high school in
Kalkaji DDA flats area near the slum, where children of many slum
residents were found to be studying. There were also two Balwadis being
run by CASP PLAN (a non-governmental organisation) and these
accommodated around thirty children daily in one shift. Thev took
children aged between four to seven years, taught them few basics and at
I ill
lunch break gave them some food like banana, dnl/n, clrnnno etc. to eat.
Once a year the children were provided with uniforms.
The Balwadis employed twenty women who were paid around
rupees three hundred monthly. These employees were mostly slum
women, with few trained teachers from outside. It was found that mostly
women of some influence who were likely to get employed by the Bolwodi.
A fee of rupees twenty per month was charged from each student, which
the slum dwellers often found quite difficult to pay. They complained that
the fee had been gradually increased over a period of time \Vhich had
compelled many of them to withdraw their children. The parents of these
children reported that quite frequently they did not receive the free
uniforms meant for their children. It was further pointed by a fe,v that
sometimes even the food meant for their children were eaten partly by the
slum women employed by the 'Balwadi'. Hence it could be observed that
quite a few parents were not satisfied with the functioning of the Bolwndis.
3.2.6 Health Services
Health services are available for the people of Govindpuri slum
through the government run centres, private sector and the non
governmental institutions. For Wazirpur slum dwellers, health services are
provided mainly through government health centres and private medical
practitioners only. Provision of medical services for slum dwellers comes
IO'
under the purview of Delhi Administration and the MCD. The facilities
are provided through a two-tier system with the dispensary at the local
level and referral to the nearest gove_rnrnent hospital for serious ailments.
For Govindpuri slum dwellers, there is one Maternal and Child
Health Centre run by MCD in Kalkaji and one Delhi Administration
dispensary which is within a couple of kilometre;sfrom the slum. In case of
serious health problems, the patients were generally referred to Safdarjung
hospital and sometimes to All India Institute of Medical Sciences (both
located at a distance of about eight kilometres from the slum). For
residents of Wazirpur J. ]. colony also there is one MCD dispensary in Tri
Nagar (about two kilometres from the slum) and a Delhi Administration
dispensary which is located within the slum area itself. In this case too, for
serious ailments patients were referred to the nearest government hospital,
Bara Hindu Rao hospital, which is located at a distance of about four
kilometres from the slum.
Under Maternal and Child Health programme, these government
dispensaries (in the study areas) provide ante-natal care to pregnant
women and on a fixed day (once a week) provide immunisation facilities
to children. The dispensary timings are from 8.00 a. m. to 3.00 p. m. , with
a short break of half an hour around 1.00 p. m. for lunch. People seeking
treatment start queuing up from morning and mostly \VOmen
!11(1
accompanied by children are seen. Majority of the slum dwellers of
Govindpuri and Wazirpur area, however, approach private allopathic
doctors, who are available within quarter to two kilometre distance from
the study areas.
Wazirpur slum dwellers were found to be deprived of any health
care facilities provided by voluntary organisations as there was no
voluntary organisation working for improvement of health of the slum
population in the area. This was not so in case of Govindpuri slum area.
ASHA (Action for securing Health for All), a non-governmental
organisation, runs a MCH centre just across the Govindpuri slum area,
where pregnant mothers go for ante-natal care, and immunisation of their
children. The organisation employs women from the slum and train them
to be health workers. These female health workers were supposed to
provide health education to the slum dwellers (specifically relating to
hygiene, sanitation etc.), motivate slum women to adopt family planning
methods and were trained to do the work of birth attendant. HO\vever, it
was observed that these health worker were not very committed to their
work. This could be seen from the fact that very few slum chvellers were
a\\'are of such female health workers and those aware werL' ones who
lived in their neighbourhood.
107
Next to the ASHA health centre, another centre manned by AIIMS
staff provided treatment to children below six months. Doctors from
AIIMS treated the health problems of infants and also provided
immunisation facilities. They also visited homes of infants (below six
months) and gave them medicines for fever, diarrhoea etc. It was reported
by the residents of Govindpuri slum that a mobile health van from AIIMS
used to come once a month, which they had found very useful. However,
for the last couple of months it had stopped visiting the area, causing
inconvenience to the slum dwellers.
In close proximity to both the study areas, one finds number of
private hospital catering to the needs of particularly those slum dwellers
who preferred private health services over government facilities. While
Jivodaya hospital and Sunderlal Jain charitable hospital are within three
kilometres from Wazirpur J. J. colony, Hamdard institute and Vidyasagar
private hospital are within eight kilometres of distance from Govindpuri
slum area. Within the slum areas only quack doctors are available. They
were generally those who had in the past worked with private doctors and
had now opened their own 'clinic'. There were also untrained birth
attendants to be found in the study slums, who had learnt the delivery
practice by day to day experience. Maximum slum dwellers approached
these untrained traditional birth attendants for delivery help. These birth
illS
attendants' often worked in collaboration with the quacks and called them
to give injections during labour pains to dull the intensity of the pain or to
induce the labour.
3.2.7 Tuberculosis Treatment Seroices in Delhi
To understand the kind of tuberculosis treatment services available
for the study population, it is necessary to have an idea about the
incidence of the disease and its control programme in Delhi.
Problem of Tuberculosis in Delhi
Delhi has the typical picture of the TB problems like any other city
of India. In the National Capital Territory of Delhi, on the basis of National
Sample Survey, it is estimated that at any point of time, there may be over
1.4lakhs active TB cases of which about 1/4 may be smear positive cases.
Incidence of active TB cases in Delhi is estimated at around 20,000 per year
(Special Committee Report on Management of TB in Delhi 1996).
Reported number of newly registered cases of TB in Delhi has
shown a significant increase in absolute terms over the last ten years.·.
111'1
Reported Number of Newly Registered Cases in Delhi Year Newly Registered TB cases 1982 36,200 1987 43,760 1992 54,585
Source: State TB Control Officer- 20 Point Programme Report
Gulabi Bagh Chest Clinic (North Delhi) where RNTCP has been
implemented since 1993, covers 10 lakh population of both slum and non-
slum areas. In this Project Area, the new TB cases and relapses reported
over the year 1994 were as following:
Table. 1.. R epor e ew ases anL e apses m t d N TB C j R 1
0
1994 City Project Area Year Quarter Smear Positive
Delhi Gulabi Bagh New Relapse
M F T M F 1994 I 55 27 82 31 12 1994 2 107 40 147 64 14 1994 3 106 46 152 67 25 1994 4 76 22 98 47 17
344 135 479 209 68 Source: Workshop on Revised National Tuberculosis Programme, DGI-15, 1995.
Further NIHFW study of four slum areas of Delhi in 1983-84
(Bhatnagar et. al, 1986) revealed that 10 per cent of those chronically (more
than three months) sick in the combined slums, were suffering from
tuberculosis. In the above study which covers the].]. colony of Seelampur,
out of 1406 persons interviewed, 80 were found to be chronically sick and
of these 16.7 per cent were tuberculosis patients.
I Iii
From the available scarce data on Delhi slums, therefore, it seen1s
clear that tuberculosis is widely prevalent in the slum areas and the
numbers suffering from the disease may be on increase over time. The
manner in which TB control programme in Delhi operates in given in the
following section:
Tuberculosis Control Programme in Delhi
Tuberculosis control prograrr.m2 in Delhi Corporation limits 1s m
operation since 1962 under the administrative control of the
Commissioner, MCD. Tuberculosis treatment services m Delhi are
provided through a network of TB clinics. All Chest Clinics have uniform
pattern of staff, treatment and record keeping system. The state TB control
officer functions under the supervision of Additional Commissioner
(Health) and Municipal Health Officer.
For followup of treatment of TB patients and defaulter action, TR
Health Visitor (TBHV) have been employed by the MCD and posted in all
Chest clinics, including those managed by voluntary organisations.
At the time of introduction of NTP in 1962, Delhi had seven TB
clinics and two TB hospitals. The city was divided into seven zones and
each clinic was made responsible for offering tuberculosis treatm.enl
services to patients free of cost in the zone in which it was situated.
ORGANISATIONAL SETUP FOR DELHI TB CONTROL PROGRAMME
ADVISORY COMMITTEE
TB DIVISION CENTRALMINISTRY
OF HEALTH
jTB ADVISOR (DHS) I
L.R.S.
Ill
STATE MEDICAL COLLEGE
STATE TB CONTROL OFFICER (DHO)
INSTITUTEOF TB & ALLIED DISEASES
I APO
PROGRAMME OFFICER CHEST CLINIC
MUNICIPAL/NGO/ AUTONOMOUS
TRAINING INPUTS
r APO l I
TREATMENT ORGANISER LAB SUPERVISOR
TREATMENT ORGANISER LAB SUPERVISOR
I TB
UNIT
I TB UNIT=
I\11CROSCUPIST-I
FOR 5 LAKH POPULATION
I I
I
I
I
I I
'
T~ TB ~B ______ : __,
UNIT UNIT UNIT I .-----_L.._------,
OTHER HEALTH FACILITIES
TB SYMPTOMATICS r-----------'
TB llFALTII \'lSI lOR TBIJV)-1
~I Ak II P<Wl 1 .. ·\TI<)N
ILLUSTRATIVE DIAGRAM DETAILING THE SCHEME OF DIAGNOSTIC AND TREATMENT ACTIVITY IN llRBAN AREAS
CHEST SYMPTOM A TIC
I
I
J
jDISPENSAR ~I I
I !CHEST CLINIC' 'MICROSCOPY CENTRE I
I
DIAGNOSED BY SPUTUM MICROSCOPY
TREATMENT CARD MADE AND TREATMENT STARTED
I
SUPERVISED DRUG ADMINISTRATION BY TB HEALTH VISITOR (T.B.H.V.)
SOURCE :OPERATIONAL GUIDELINE FOR REVISED NATIO":\L TUBERCULOSIS CONTROL DGHS. 1995: Annexure- I
II:'
II.'
A new net work of voluntary organisations called 'Care and After
Care Committees' (in cooperation with Delhi TB Association) was already
functioning with the objective of ameliorating the social and economic
problems of the patients being treated in the homes, if those interfered
with the treatment in anyway. The responsibility for organising
tuberculosis treatment services in the entire city was gradually then taken
over by the Delhi Municipal Corporation as five out of a total of nine TB
institutions in the city were already under its control.
Since 1962 the population of Delhi has increased tremendously and
more importantly, not uniformly in all zones. New TB clinics have been
coming up over the years and the number of beds in TB hospitals have
also been increasing. Today there are 14 Chest clinics covering the entire
population of National Capital Territory of Delhi. These Clinics are
functioning as District Tuberculosis Centre (DTC) - ten under MCD, two
under Voluntary Organisations and one under New Delhi Municipal
Committee (NDMC). Beside these, one clinic is run by the Employees State
Insurance Scheme (ESIS) for their beneficiaries, the defence services
personnel, their families and the small civilian population of the Delhi
Cantonment area is being looked after by the Army Hospital (Special
Committee on Management of TB in Delhi, 1996 ).
II l
For overall administration, MCD has divided the city into -11 zones,
but for TB control programme Delhi is divided into 14 zones with one
Chest clinic in each zone. Each clinic! having an earmarked population and
area, is equipped with radiological and laboratory facility and provides
free tuberculosis treatment services to all TB patients diagnosed in their
specified area.
Besides TB clinics, there are two major TB hospitals in Delhi:
(i) Lala Ram Swarup Institute of TB and Allied Diseases, Aurobindo Marg:
The hospital has a bed capacity of 520 beds and has an attached TB Clinic
(OPD). The hospital has been upgraded by the Ministry of Health as an
apex training, teaching and research institute of the country in order to
assist NTP and also to provide diagnostic and treatment facilities to the
masses.
(ii) Rajan Babu TB Hospital, Guru Tegh Bahadur Nagar : The hospital has a
bed capacity of 1155 and an attached OPD. The hospital is equipped with
all diagnostic and treatment facilities, including surgical. It is a teaching
hospital for Post Graduate students.
II'
3.2.8 Tuberculosis Treatment Seroices in the Study Areas
Govindpuri slum is one of the many ]. ]. clusters in Delhi where
NTP was in operation in the period of data collection. Govindpuri falls
within the specified area of Nehru Nagar Chest Clinic (NNCC) which has
14 TB Centres functioning under it. All TB Centres provide free
antitubercular drugs (as per NTP directives) to registered patients of a
given population and closely monitor their progress under supervision of
N.N.C.C. . The TB Centre responsible for treatment of patients of
Govindpuri slum was located in N.N.C.C. itself and hence being about 8
kilometres away from the slum . As a consequence only a few patients of
the slum area visited this centre for TB treatment, generally going there
for diagnosis tests.
However, residents of Govindpuri slum had access to the services
provided by a Voluntary Organisation's (CASP PLAN) TB Centre \vhich is
located in Navjeevan Camp itself, thereby minimising the need to travel
some distance for TB treatment. This Centre provided free TB medicines
(under NTP) and milk to slum patients. For diagnosis tests, they were
referred to Vidyasagar private hospital, located behind N.N.C.C. . Majorit~·
of slum dwellers were found to be utilising the TB treatment services of
CASP PLAN'S TB Centre. Another Voluntary Organisation, ASHA, \vas
d l~u im·olved in providing TB treatment to slum Lhvellers though on d
i ih
smaller scale and not being a totally free service. ASHA is located across
Bhumiheen Camp and involved more in providing maternal and child
health services to the slum population.
As mentioned earlier, in all these Centres NTP was in operation
during the period of data collection, that is, Short Course Chemotherapy
treatment regimen (SCC) without Directly Observed Treatment - Short
Course (DOTS) being administered to registered patients. However, since
January 1996, RNTCP (that is, SCC with DOTS) has been introduced in
N.N.C.C. and gradually extended to its various TB Centres serving
population of different areas. Recently, in February 1997, CASP PLAN has
handed over its centre in Navjeevan Camp to N.N.C.C. and RNTCP was
proposed to be implemented in this slum area.
As stated earlier, the Revised strategy for T. B. control (i.e. RNTCP)
was tested as Pilot Phase (I) in 1993 in five project areas in the country,
including Delhi. In Delhi, the Project Area identified for Pilot Phase I of
RNTCP was the area covered by Gulabi Bagh chest clinic involving a
population of one million. Gulabi Bagh chest clinic has ten microscopy
centres (TB centres) functioning under it, each catering to the population
of a specified area. Wazirpur ]. J. colony falls within the earn1arked area of
Gulabi Bagh chest clinic. The Microscopy Centre (No. VII) sen·ing the
study population is located ,,vithin VVazirpur slum itself and RNTCP is in
operation here since October, 1993.
The TB centre for Wazirpur slum dwellers is located in a building
which has two offices, one for Malaria and other for TB. This building is
situated in a park, right amidst the slum. There are two workers in TB
centre, one is the Tuberculosis Health Visitor (TBHV) and the other is the
Ia bora tory technician. TBHV gives free medicines and injections to the
registered TB patients of the area and the laboratory technician collects
and tests sputum samples of the patients and gives them the report. In this
centre, patients are treated under DOTS so they have to take medicines at
the centre itself for first two to three months depending on whether they
are Category I (new patients with sputum positive or severe symptoms
with sputum negative) or Category II (relapse cases) patients. During this
time they are not given any medicine for home. After that, for remaining
four to five months patients take medicines for home.
In initial phase (first two to three months) patient comes everv
alternate day and brings with him/her the card and a tumbler (to fill it up
with water from the centre for consuming the medicine). The card is
issued to patients only after observing their regularity and sincerity after a
week or ten days. The patients shmv their cards, get the entry· for that day
h\' the TBH V and take their medicine. In continuation phasL' (lc1st four to
II:-;
five months) the patient comes with his card, is given medicine for 15 days
for home, and entry is made on his card which he takes back with him.
Every time patient takes medicine for home, TBHV explains in detail every
step to the patient that is, how to take the medicine, in what dosage, which
medicine on which day etc. There were no voluntary organisations m
Wazirpur area providing TB treatment services to the slum population.
Given the level of essential services, including health, available for
the slum population of the study areas, let us now look into the profile of
the study population. As has been mentioned before, the present study
was conducted among both patients and non-patients in the two slums.
While in-depth interviews of patients were done, non-patients were taken
in groups and informations were obtained through focus group technique.
In Govindpuri, the study population comprised of 48 non-patients
(6 groups of 7-8 individuals) and 89 TB patients (total of 137 slum
residents) and in case of Wazirpur ].].colony, there were 44 non-patients
(6 groups of 7-8 individuals) and 82 tuberculosis patients (a total 126 slum
residents). It is necessary to understand the socio-economic characteristics
of the study group in order to analysis their health behaviour, particularly
tmv a rds tuberculosis.
II<!
3.3 PROFILE OF THE STUDY POPULATION
In both Govindpuri and Wazirpur J .]. colony, the slum population is
essentially composed of migrants in search of jobs from different states
like Uttar Pradesh, Bihar, West Bengal, Rajasthan, Madhya Pradesh and
Haryana and is predominantly Hindus, followed by Muslims. The ratio
being roughly estimated to be 70 per cent Hindus, 25 per cent Muslims, 5
per cent Sikhs in Govindpuri slums and 75 per cent Hindus, 15 per cent
Muslims, 10 per cent Sikhs and Christians in Wazirpur ].]. colony. The
following pages highlights some of the socio-economic features of the
study population. Certain probing questions like those related to income,
family size etc. were limited to only TB patients.
3.3.1 Religion
The study areas being cosmopolitan in nature, the study population
consisted of persons belonging to different religion and states of India. In
both the slums, the study population was predominantly Hindus, around
78 per cent in Govindpuri and 82 per cent in \,Yazirpur ]. ]. colony and the
rest were Muslims.
3.3.2 Place of Migration
Table 3 shows the distribution of study population on the basis of
their state-wise origin, that is, the state from which they have migrated to
the particulM slum area.
D. ·b Istn ution o fSt d P u ty
UP Study P+ NP+ T+ p
Table 3 I . A o_E_u at10n
Bihar
NP T
I.'()
ccor d" m_g to s tate o fO .. ngm States
Rajasthan Others* p NP T p NP T
Population . Govindpuri 61 28 89 9 7 16 10 )
(percentage) (o8.o) (~83) (64.9) (10 I) (14 6) (II 7) ( 112) (104)
Wazirpur 47 27 74 9 4 13 X ' (percentage) (57 3) (613) (~8.8) (10 9) (91) ( 10 3) (9'1) (o8J
*Others mclude West Bengal, Madhya Pradesh, Haryana and PunJab +P=Patients; NP= Non-patients, T=Total
I~ () 8 17 (10 9) (101) ( 16 7) (125)
II IR J() 28 (8 7) 121 <)) (22 X) 122 2)
It can be seen from the above table that in Wazirpur and
Govindpuri, majority (around 70 per cent) were from Uttar Pradesh, the
latter being an important neighbouring state of Delhi and being
responsible for high proportion of influx into Delhi. In both the study
areas, Bihar and Rajasthan share almost equally in the sample the
importance of being a supplier of migrants to Delhi. It was observed that
people belonging to the same linguistic and religious community were
living close to each other in the same or adjoining block in each slum area.
This could be attributed to a large extent, to the tendency of each small
group of early settlers to occupy some extra space to accommodate future
additions to the group.
3.3.3 Reason of Migration
People who take up residence in slums are generally people of rural
origin and lmv socio-economic status who have been forced by economic
factors to look beyond the village for a means to sup~~ort their family.
\\'hen tlw patients in the study were asked why they had left their village
Total
137
126
home, around 89 per cent in Wazirpur and 93 per cent in Govindpuri
replied that they had left the village as either they could not support
themselves (and family) in the v~llage or for the betterment of their
economic conditions. Adverse agricultural conditions or simply lack of
work in the rural area were primarily the factors responsible for pushing
these people into the urban slums.
The remaining respondents gave varied reasons for choosing Delhi
as a city for migration. Women generally carne to Delhi after marriage
with their husband and had less say in the selection of place of the
migration. There were few respondents who claimed to have reached
Delhi in order to avail better health facilities and till date do not feel let
down.
Parmilla Prasad, an illiterate woman from Bihar came to Delhi to
"bear sons" and she has been "successful". In her village she
experienced twice pregnancy loss in the first trimester which \vas
followed by a long period (seven years) of no conception. Parmilla
had tried all means (traditional healers) in her village and after nine
years of marriage, she finally came to Delhi to seek help from the
"good" doctors available here. Within one vear of reaching Delhi,
Parmilla conceived again and this time she immediate]~· consulted
a nearbY doctor and was under his ad\·ice till the delivcn tonk
place. She is now the proud mother of a healthy boy and is grotdul
to her brother who had suggested her to migrate to Delhi ond
found her a place in Bhumiheen Camp (Govindpuri), where he was
staying.
Vijay Kumar, an unmarried youth of 23 years, working in a small
garments factory at Ashok Vihar (near Wazirpur), came to Delhi
from Saharanpur (UP) specifically to get himself treated for
tuberculosis. In his own words: "/don't feel lonely, only snd since I
ha11e friends who /zape stood by me throughout 7uhen my .ftwzily nzcnzlwrs
had deserted me. I lost my parmts at a young age and liz,ed with my tlzree
elder brothers and two younger sisters. We lzad a small shop in the l'illagc
market. I was suffering from cold and cough .fiJr long and took treatnzcnt
from tlze nearby lzakim for fe7l' 7Peeks. Wizen there was no rcli£:{ and my
condition worsened, I went to a gouemmmt hospital close to my Z'illagc.
Some tests were performed and the doctor said that I l111d
tuberculosis. Since tlznt day IZOIU' of my family member lzm'c spoken to nzc
cordially or lwPe been supportiz'e. At this critical stage of my lz.fi', 1111'_11
instead asked me to make separate armngeme11ts and to lean' the house.
They .kit that I must hal'c taken to dmgs, alcohol etc. and thcrefim'
acquired the disease. My disease luould prolmbly he a hurdle f[v fht'
llltlntal prospect of my sisters too. I fl'lt hurt and disillusiollcd. Then I mel
11111 ti·zcnd, 1\m'i, 71'ho 7Pf7S ll'orkuzg 111 Delhi and lll7d conze home 011 ~onze
' '' I---
I';
social occasion. 'v'Vhen I fold him about my disease, lze infonucd /III' that TB
could be cured co111pletely and that he hinise~f hnd taken treatniciit for it in
Delhi one year back. I cmue with him to Delhi, got myse(f registered at the
Wazirpur TB centre and started do{ng some petty jobs. Nmu, I hnPf lll'l7rly
regained my health and hm1e got a te111pomry ;ob at the 11l'l7rby .ftu·tory. I
will remain eternally grateful to my _{l·iflld Rm'i and nmu Ocllu is lll_ll
home."
One can observe that while economiC reasons may primarily
determine the decision to migrate, there are often other factors which arc
at play. However, one can state without doubt that ties of kinship, caste
and village is the most important factor in shaping the direction of -migration streams from the village to the city.
3.3.4 Duration of Stay in tlze Slum
The number of years for which the study group has been staying in
the slum areas is given in Table 4.
Table 4 Distribution of Study Population According to the Number
0 f Y f St . th St d Ar ears o aym e UIY eas Number of Years of Stay
Less than 5 5- 10 10- 15 A bon T
Study P* NP* T* p NP T p NP T p NP T Population
Go\'indpuri 13 X 21 7 ~ 12 17 12 2'! ~~ ~·' 7' I ; -
(percentage) II~ h) ( lh 7) 1 I~ 3) (7 9) (IO.J) IX Xi (I'll) ~~ ~) 1212) I ~X~ I ,rc~, ( -~ 71
Wazirpur I; l) 22 00 II ·'-' IO ~ I~ ,, ~~~ .:;-:- l~h --( percl'll tage) I I' 'l I (~II~ I ( 17 ~) (2h X) (2 ~) (2h 2) ( 12 2) ('Ill I II II I~' II I~' 'I I~' 21
*P=P,llll'nts; \:1'= l'\on-patll'nts, T=Total
It can be observed from the table that the study population covers
respondents staying for varying number of years in the slum, that is, right
from less than a year to above fifteen years. However, in both the study
areas, around half of the respondents were found to be living in the slum
for more than fifteen years. This is an important feature of the study group
as the duration of stay in slum environment determines to some extent the
behaviour of people. The number of years for which a migrant family is
exposed to city life has an important influence on their potential job
opportunities, their awareness about the availability of various services
(including health care) and their attitude towards life. The greater the
number of years in the urban set-up, the more a slum dweller is likely to
accept new ways of life giving up or at least modifying the traditional ones
and be more assertive as well as informative about rights and privileges.
ln the present study, around half of the study population are, therefore,
urban slum dwellers who are well aware of life in a big city and in the
slum area where they live.
3.3.5 Age-Group Distribution
The distribution of study population according to their age is given
in Table 5. Slum dwellers who were more than fifteen years of age \vere
included in the study. Age of the study population has been classified in
broad groups for a better understanding of the data and also to n1inimize
any discrepancy that may have occurred in reporting of age by the slum
dwellers.
Table 5 Age-G roup o· tr"b r f th Stud P IS I U IOn 0 e ly I f opu a IOn
Age Group in years
15- 25 25-35 35-45 Above Total
Stud~' p NP T p NP T p NP T p NP T p NP T Population Govindpuri 34 8 42 17 16 33 24 16 40 14 X
,., X9 .JX 1.\7 (percentage) 38.2 16.7 30.7 19.1 33.3 24.1 26.9 33.3 29.1 15.8 16.7 16.7 \Vazirpur 19 7 26 24 14 3X 2-l 16 40 15 7 22 X2 44 126 (percentage) 23.1 15.9 20.7 29.3 31.8 30.1 29.3 36.4 31.7 llU 15.9 17.5
P=Pat1ents. NP=Non-pat1ents. T=Total
Tuberculosis is a disease that can strike men and women in any age.
Therefore, patients in both the slum areas in the present study \vere found
to belong to different age groups, as seen from the table. It has been stated
earlier that non-patients were interviewed with focus group technique and
in each slum, six focus group discussion were conducted. These groups
were formed with persons of similar ages. In Govindpuri, two groups each
(of 8 persons each) were drawn from the age groups 25-35 and 35-45 years
while one group each from 15-25 years and 45 - 55 years. In \Vazirpur
slum also, a similar pattern was adopted though number of individuals in
the group varied between seven to eight. By including persons of different
ages in the study, it becomes possible to get variations in experiences and
attitude about life.
3.3.6 Educational and Occupational Status of tlze Study Population
' Table gives the ('ducationallevels of slum dwellers included in the 1\
o· tr"b r IS I u wn o f th Stud P e ty Table 6 If A opu a IOn ccor d" t Ed Ing o
Education f uca wna IS tatus
Illiterate Literate Primary Middle Secondary Study P* NP* T* p NP T p NP T p NP Population Go\indpuri 33 19 52 31 15 46 4 6 10 12 4 (percentage) 37.1 39.6 37.9 34.8 31.3 33.6 4.5 12.5 5.8 13.5 8.3 Wazirpur 49 "),
_.) 72 10 8 18 10 5 15 6 4 (percentage) 59.7 52.3 57.2 12.2 18.1 14.3 12.2 11.4 11.9 7.3 9.1
*P=I'aticnts; NP= Non-patients, T=Total
o· t ·b r IS ri u wn o f th St d P e u ty Table 7 If A opu a Ion ccor mg t 0 0
Occupation Factory worker Self Employed Service Rikshaw/Auto driver
Study I' NP T p NP T p NP T p NP T
Population
Co\·ind pu ri 9 8 17 37 12 49 12 5 17 7 8 15
(percentage) 10.1 lf>.7 12.4 28.1 2.5 J5.!! IJ.5 I 0.4 12.4 7.9 16.7 10.9
\\'azirpur !) 6 15 20 1J JJ 7 4 II 1.1 10 2:1
(pt·n·t·ntagl') I 0'! 1.\. 7 II'! 24.4 2'!.5 ::>r,2 X.5 <J I X. 7 15R 22.7 I X.:>
T p NP T
16 9 4 13 10.9 10.1 8.3 8.7 10 7 4 II 7.9 8.6 9.1 8.7
ccupatwna I St atus
Skilled worker Labourer p NP T p NP
19 9 28 5 6
21.3 18.7 20.4 5.6 12.5
7 9 16 13 2 X.5 20.5 12.7 15.X -1.5
Total p NP T
R9 4R J) 7
8~ 44 I~(,
i
Total
I I' Nl' I
II X'J -IX I I 7 I X. I
15 X2 1-l 121· II 'i _l
I .'-:-
The above tabh:~highlights an already well-known fact, that is,
the prevalence of high levels of illiteracy among the slum dwellers.
As is established by now rural migrants with limited knowledge,
skills, and capital resources are engaged in economic activities where
the incomes are low. It was observed that all males of present study
(and husband/ father of female patients under study) were engaged
in some income-generating activities and that some females (in the
study) were also helping in sharing the economy of the family. The
slum men and women in the study population were asked about
their (or their husband's or father's) occupation and the same has
been presented in table 7.
Self Employed include tailors, shop owner, astrologers, those who
press clothes, street hawkers etc.
Skilled workers include car mechanics, electricians, carpenters,
cobblers, iron smiths, gardeners, glass cutters, painters etc.
Service men include those employed as peon, chowkidar, cook, etc.
in some government office/private company.
As can be observed from the table 7, the menfolk of the slum
areas \\'ere engaged in different types of job, though on a temporary
basis. These slum men, with their limited skills and capital resources,
engage themselves in any economic activit\ (for however short
period of time) which provides them with some income for the
subsistence of their families. It was observed that majority of slum
women in the two areas we:e ~ousewives which eventually help
them to look after their children and the household. Hence in most of
the households, one finds only a single earner of cash income. There
were, however, some households (particularly in Wazirpur ). ).
colony) where women were engaged in home based economic
activity like tailoring, embroidery and making buttons and thus were
also earning members of the family.
3.3.7 Household Income
No matter how poor they are, most slum dwellers try to earn
income not simply to survive but improve their position. An attempt
has been made to get an idea about the monthly household income
of patients in the study and the same has been presented in table 8.
Table- 8 Distribution of Monthly Household Income (in Rs.) of Study Patients
Household Income (Monthly) Slum 500-1000 1000-1500 1500-2000 2000-2500 Above 2500 Total
l'_atients Govindpuri 2 13 26 22 26 89 (£_ercentage) (2.2) (14.7) (29.2) _(_24.7) J29.2) Wazirpur 18 31 19 9 5 82 (percentage) (21.9) (37.8) (23.2) (1 0.9) (6.1)
It is evident from the above table that \Vhile around half of the
patient households in Wazirpur earned less than rupees 1500, m
Govindpuri 53.7 per cent earned between rupees 1500-2500. A
possible reason for this finding could be that as Govindpuri slum is
located in South Delhi, surrounded by posh residential colonies and
Okhla industrial area, the exposure of slum dwellers to city life and
availability of job opportunities is more as compared to Wazirpur
slum population.
However, it is necessary to say a word about the reliability of
income data. It was not so much difficult to ascertain the income of
the daily wage earners and salaried workers, though there was a
tendency among them to report the income on the lower side. But in
case of those engaged in petty business retail trade and hawking, it
was quite difficult to estimate their earnings since they themselves
were not sure about the exact amount of monthly income and also
they were reluctant to reveal the exact figures (and a tendency for
under reporting was observed). To avoid such difficulties to
maximum possible extent, the monthly household income was
calculated keeping into account such factors as the quality of
housing, ownership of consumer durables, etc. and further the
monthly income of the study households were classified in broad
income categories. The aim of this exercise was to simply get an idea
about the monthly income of the households of the patients under
studv.
I .~I I
3.3.8. Family Structure
In the slum, joint families are rare. In fact, 82 per cent of study
patients in Wazirpur and 91per cent patients in Govindpuri were
living in nuclear family structure. In this study, nuclear family is
defined as married couple living with their unmarried children and
often a single kin staying too. It could be argued that one reason for
the predominance of nuclear families could be lack of space. Another
factor is that in-laws often stay back in the village, and thus the basis
for a full fledged joint family is not always present, even if money
and space would allow.
The trend observed is that of a single kin (generally husband's
brother) living with couple and their children. Out of the classified
nuclear families in the study group of the two slums, around 20 per
cent in Govindpuri and 31 per cent in Wazirpur had a single kin
staying with the couple and their children. In quite a few cases in
both the areas, husband's mother stays with the couple while the
father manages whatever property is left in the village.
Further, it was noted that out of the classified joint family
household of study patients in the slums, some of them actually
occupied two or more jhuggis (and these ,,vere not alway~
contiguous) although thev shared expenses and ate together. The
I .~ I
remammg joint families of patients lived together in one house
having two or three rooms and with more than one earning member.
3.3.8-f.Family Size
Most of the slum studies have found that the slum family size
was smaller, reflecting the fact that majority of the slum dwellers
lived in nuclear families as they belonged to active \Vorking force
generally migrant and young. The distribution of study patients in
the slum areas according to family size is given in table 9.
TABLE-9 o· tr"b r IS I u IOn o f Stud P ty If A opu a IOn d. t F ·1 s· ccor Ing o amlly IZe
Number of Family Members Slum patients 2-3 4-5 6-7 8-9 10 or more Total Govindpuri 7 25 34 19 -! R9 (percentage) (7.9) (28.1) (38.2) (21.3) (4.5) Wazirpur 19 23 30 8 2 -
(percentage) (23.2) (28.0) (36.6) (9.8) (2.-!)
The above table shows that in both the slum areas around half
of the patient households were having more than six family
members. While in Wazirpur about 48.8 per cent studied families
had more than six members, in Govindpuri the percentage \Vas little
higher being 64. Since nuclear family structure (i.e. couple with their
children, and often a single kin staying together) is found to be
predominant in the study areas, this indicates that majority of
vvomen m these slums were mother of at least 3-4 children at the
time of the study. Such incidence of large households rna~' mean the
need for extra hands to earn for the familv and also lack of
awareness and motivation to adopt family planning methods. This
implies that women of lower socio-economic group spend a
considerable span of their life in pregnancy and nursing infants.
3.3.9 Links with Village
Out of the patients interviewed in the study areas, it was
observed that around 40 per cent in Govindpuri and 25 per cent in
Wazirpur continue to have very good social and economic link with
the village from where they come. They regularly visit the village
(every year) and send money 'home' for the support of the other
family 1nembers, who continue to live there. In times of emergency,
they can depend on financial assistance from the village or can go
back to them. During pregnancy (especially in case of first
pregnancy), and child birth and on special occasions 'Nomen go
home. These families are here for purely economic reasons and the
village continues to be their real home.
For another 35 per cent of patients in Govindpuri slums and
around 40 per cent in Wazirpur J. J . colony, the link vvith the village
is limited to the extent that they may visit it once in 2-3 years, for
social occasions and religious festivals. For the rest of the study
patients in the two slums (25 per cent in Govindpuri and 35 per cent
I;;
in Wazirpur), they have little or no contact with their village and for
them Delhi is the permanent home for better or worse.
3.4 SOCIAL ENVIRONMENT OF GOVINDPURI AND WAZIRPUR SLUMS
Day to day life of slum dwellers m the study areas was
observed to be striking similar. At any time of the day when one
walks through the maze of lanes it appears as though a large chunk
of the essential domestic activities are being conducted either on the
door step or on the lanes in front of the house. Which ever time of
the day one goes there is a constant hum of activity which gave a
feeling of being alive throughout this time. Early hours of the
morning finds women washing vessels, cooking food, filling water,
men bathing and getting ready for day's work. As the day advances
mostly women, children and older people are to be seen. One can
witness a lot of gossiping among women while doing their domestic
chores like fetching water and washing clothes near the water taps.
Some of the women who are engaged in home based economic
activity such as tailoring, embroidery, making buttons etc. get ready
for it. Vendors come around selling vegetables, clothes and other
household items and one can see groups of women bargaining with
them at different corners of the slum. The occupational life of the
majority of the slum dwellers is such that they go out to vvork in the
morning and come back home in late evenings. They feel exhausted
after long hours of work and there is not much time available for
leisure in the daily routine of their life.
Although as stated earlier most of the day to day activity is
carried out on the lanes in public view, inevitably leading to some
social interaction with neighbouring households, in time of real need
families seek help from their own relatives or people belonging to
their communities. In many of the cases, the neighbours too belong
to the same caste and kinship group because of the tendency of slum
dwellers to settle down together. Caste and kinship (who are most
often neighbours), thus give the needed social support to an
individual varying from giving loans, helping in childbirth and child
care, accompanying sick people to hospitals/ dispensaries or
intervening in family quarrels.
In the light of the physical and social environment of the study
population, let us now see how they perceive a disease like
tuberculosis. How far has the urban environment and health
infrastructure been able to influence their level of awareness and
their health seeking behaviour?