Orientation Workshop under DHUP

organized by

Sulabh International Academy of Environmental Sanitation & Public Health (SIAESPH)

supported by

WHO Country Office for India On

Promotion of Healthy CitiesIssues and Concept of Delhi Healthy Urban Project

Dated: 30.08.2011

by

A. K. Sengupta
Director General Sulabh International Academy of Environmental Sanitation & Public Health Mahavir Enclave, Palam, New Delhi - 110045

INTRODUCTION

To sanitize cities following rapid urbanization causing shortage of infrastructure and deterioration of public health conditions and environmental hygiene Developed on the logic of improvement of environmental hygiene and public health conditions to reduce the disease burden Aimed at introducing innovative environmental strategies and to build a local lobby to improve public health conditions Focused on preventive healthcare, especially for the poor

IMPACT OF ENVIRONMENT ON HEALTH

Of the 102 major diseases, disease groupings and injuries, environmental risk factors contributed to disease burden in 85 categories. As estimated 24% of the disease burden (healthy life years lost) and an estimated 23% of all deaths (premature mortality) was attributable to environmental factors. Among children 0-14 years of age, the proportion of deaths attributed to the environment was as high as 36%. An estimated 94% of the diarrhoeal burden of disease is attributable to environment. Household solid fuel use, second-hand tobacco smoke and outdoor pollution cause 42% of lower respiratory infection in developing countries.

HEALTHY CITY CONCEPT

Introduced as a New Public Health Initiative by WHO at Copenhagen in 1986 Adopted the Alma Ata Declaration on Primary Healthcare Is a rebirth of the Health of Towns Association of Exeter of 1844 in UK Not a stand alone phenomenon but a collection of innovative strategies developed over the years at the local level A gradual change from therapeutic to preventive healthcare Introduction of health as a component of city planning

An effort to upgrade utility infrastructure with increasing population and expanding city-size to reduce environmental deterioration

WHAT IS HEALTHY SETTINGS A Healthy Setting is one where its citizens recognize the physical, mental, social and spiritual nature of health and work together to create conditions that promote healthy livings.

KEY PRINCIPLES OF HEALTHY CITY

Health should be an integral part of settlement management and development. Health can be improved by modifying the physical, social and economic environment. Conditions in settings such as home, school, workplace and city profoundly influence health status. Inter-sectoral coordination for health is necessary at local level.

HEALTH CHALLENGES FOR CITIES

Reduce inequalities in health status and in the determinants of health. Develop healthy public policies at local level to create physical and social environments that support health. Strengthen community action for health.

Help people develop new skills for health compatible with these approaches.
Reorient health services in accordance with policy.

MAIN OBJECTIVES

To reduce the disease burden Help the weaker sections of the society

Introduce community participation and promote self-help

Bring awareness on cleanliness and environmental hygiene Link preventive healthcare and city planning

Promote ecological balance and sustainable development

Integrate sectoral planning and management at the local area level

Reorient medical services and health systems away from hospital care towards primary healthcare
Promote physical, mental and environmental well-being of the urban dwellers

HOW TO ACHIEVE

A collective effort to include innovative strategies in environmental planning A movement to build a lobby at the local level to improve environmental hygiene Synergize multi-sectoral and multi-level planning efforts - intra-city, inter-city towards a clean environment and healthy living for better economic productivity Strengthen horizontal and vertical linkages Reduce wastage of resources from duplication and repetition

QUALITIES OF A HEALTHY CITY

A clean and safe physical environment A stable ecosystem that is sustainable A strong mutually supportive and non-exploitative community A high degree of participation and control by the public A diverse, vital and innovative city economy Retention heritage of ethnicity and

High health Status

FRAMEWORK FOR ACTION

Develop Task Forces at city and local levels Build public support and raise awareness Identify key priority issues Obtain approval of the municipal government

Set up an HCP office and appoint HCP

coordinators Prepare and implement the Healthy City Plan Assess and evaluate the Healthy City Plan

ISSUES

What kind of training is to be given? How to reorient health services towards health promotion Under what kind of leadership? activities? Who will fund the local office? How to identify the important Who will coordinate with the different levels of administration? What kind of linkages should be established? How to introduce health promoting strategies? How to create supporting environments? How to strengthen community action? health problems in the city?

The nature of community participation to be developed?

How to solicit support from business, industry and labour for the project? What kind of information to be collected for project development?

DEVELOP AN ACTION PLAN

What actions?
Who will carry out? By when? What resources to be used? Communications?

Establish Structures
Form working groups

Community groups
Coordination committees Partnership involvement

Disseminations?
Building networks to coordinate and implement

HEALTHY CITIES EVALUATION IN INDIA

Healthy Cities Project (HCP) was initiated in 1994, in 3 cities/areas of India, namely; Trans-Yamuna Area, New Delhi, Mirzapur of UP and Kottayam of Kerala. Evaluation of HCP in India was conducted in 2001. The results of the evaluation show some improvement in intersectoral collaboration among healthy schools, markets, food handlers, traffic, police and NGO.

Lack of sense of ownership and still dependence on financial support from outside.

EVALUATION OF HEALTHY CITIES IN THE REGION FINDINGS STRENGTHS/OPPORTUNITIES

Political will mobilized even though more at the initiation stage The idea/concept of Healthy Settings as potential for intersectoral action is catching on evidenced by the increased numbers of such settings and WHO and ESCAP resolutions There is increasing inquiry by levels of policy and academia Managerial capacity of coordinators and settings managers have improved Committed mayors (ownership) have made intersectoral collaboration possible NGO involvement in capacity building and service delivery seen Incorporation of HC as a operational mechanism for urban development into national plan in one country including budget (Thailand 9th National Development Plan 02-06)

FINDINGS WEAKNESSES

Involvement of the poor and women were limited. Predominantly male leadership in HCPs Decentralization remained poor in larger programs (city and even municipality level) Very limited change in written policies and processes of the local government because of HC Deeper roots of healthy cities where cooperatively written plans and separate HC management structure exists. Political leadership takes too much of the ownership leaving others players reactive. Networking among cities minimal Too much banking on image, power and charisma of the leader Although new resources are being mobilized, scanty evidence of re-programmed local resources

LESSONS

Participation was greater when the community was well aware of the program Degree of involvement of stakeholder was influenced by the economic status of individual and by type of activity. Output was better in smaller settings (school, ward, township, island, building, etc) than in city wide action Well prepared plans and management processes are needed for success inclusive community involvement for sustainability

DELHI HEALTHY CITY PROJECT

TABLE SHOWS THE DISTRICTS AND SUBDIVISION OF DELHI

S.No. 1 2 District Central Delhi North Delhi Dary Ganj Sadar Bazaar Subdivision Pahar Ganj Kotwali Karol Bagh Civil Lines

3
4 5 6 7 8 9

South Delhi
East Delhi North East Delhi South West Delhi New Delhi North West Delhi West Delhi

Kalkaji
Gandhi Nagar Seelampur Vasant Vihar Connaught Place Saraswati Vihar Patel Nagar

Defence Colony
Preet Vihar Shahdara Najafgarh Parliament Street Narela Punjabi Bagh

Hauz Khas
Vivek Vihar Seema Puri Delhi Cantt Chanakya Puri Model Town Dwarka

EAST DELHI

NEW DELHI

NORTH DELHI

NORTH EAST DELHI

NORTH WEST DELHI

SOUTH DELHI

SOUTH WEST DELHI

WEST DELHI

METHODOLOGY
Sulabh proposes to initiate the pilot project in all the 9 districts of Delhi covering 80,000 population for developing the localities into Healthy Settings in the overall perspective of promoting Delhi as a Healthy City. Step 1: A orientation workshop will be conducted to the officials of Delhi Administration, Elected Representatives, Government Officials, etc to provide a over view of the Healthy Cities, its importance and significance, benefits of being a Healthy City, approach towards achieving the result, role and responsibilities of the stakeholders, fiscal and physical policies, etc Step 2: In each of the district, two localities are identified covering 5,000 population from each locality: 1. Locality covering middle and high income group population, industrial areas, commercial centres, etc; 2. Locality covering weaker section and low income group population, slums and shanty colonies, etc.

METHODOLOGY
Step 3: Identification of the key stakeholders in the locality including NGOs, CBOs, etc. Step 4: In each of the locality, a sample of 100 households are drawn by stratified random sampling method and household survey will be conducted using a structured questionnaire designed for this purpose. Step 5: Compilation, validation and analysis of the data drawn from the interviews and prioritization of the developing needs of each locality. Step 6: District-wise analysis and prioritization of the developing needs of the District.

METHODOLOGY
Step 7: Conduct of one workshop for each district to discuss and formulate the Health Setting Action Plan (HSAP) for each Locality. Step 8: Formulation of Draft HSAP for each District. Step 9: Conduct of workshop for all stakeholders involved in the Project to finalize district-wise draft HSAP recommendations. Step 10:Consolidation of finalized district level Action Plans. Step 11:Preparation of Healthy City Action Plan (HCAP) for Delhi. Step 12:Submission of Report.

Thank You