Resilience (as described in the Oxford Dictionary) is ​the ability of people or things to recover quickly after something unpleasant, such as shock, injury, etc. The COVID-19 pandemic tested this ability of people and communities. As a result, it brought to the limelight the vast inequities in access to healthcare due to factors like poverty, lack of space, and access to basic facilities like shelter, clean drinking water, food and medicines.

The pandemic also forced Governments to rethink their strategies and put healthcare a priority for their citizens. The United Nations’ Sustainable Development Goal 3.81 outlines the need to ‘achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and safe, effective, quality and affordable essential medicines and vaccines for all.’ As of 2019, on a scale of 0 to 100, India ranks 61 in the UHC index of service coverage indicates significant challenges remaining in the achievement of the indicator2.

The Ideal: Health Equity
Strengthening Primary Healthcare is the most vital step towards achieving Universal Health Coverage. SNEHA has been working towards Health Equity for more than two decades, focusing on community-level interventions to improve the health of mothers and children in informal urban settlements. SNEHA is a bridge between the public health system and vulnerable communities, ensuring a broader reach of health services provided by the Government while promoting health-seeking behaviour among families. We also have a cadre of trained community volunteers who boost the efforts of our on-ground teams, benefitting from their familiarity with the area and the people.

Complexities of Working in informal urban Settlements
Sana Ansari, a 21-month-old child from Dharavi, was categorised as Severely Malnourished during our monthly anthropometry activity in the area. Her parents were completely unaware of her condition and were reluctant to visit the Nutritional Rehabilitation, Research and Training Centre (NRRTC) to avail further treatment for Sana. As we began counselling the parents, Sana’s mother shared that she was facing violence from her husband. Our experience has shown a strong linkage between the health of a mother and a child.

Here, our interventions included convincing the parents to visit the NRRTC and seek treatment for the malnourished child while counselling the couple to make the home environment more conducive for the mother and child’s physical and psychological growth.Sana’s case reflects some of the unique challenges that SNEHA encounters while working towards improving the health of mothers and children in the slums of Mumbai and the Mumbai Metropolitan Region (MMR).

Achieving the Ideal:
Urban informal settlements bring unique challenges like a migratory population, lack of support system, lack of awareness and the daily struggle of navigating the issues of those living on the margins. In Mumbai, where SNEHA works, the problems get compounded by the lack of space, hygiene, addictions etc. Hence, to achieve health equity, we need to find solutions to mitigate all these challenges posed by the geo-socioeconomic environment that makes the people living in these settlements vulnerable. For example, as an organization that worked on issues related to the health and nutrition of women and children, SNEHA ended up distributing fresh fruits and vegetables in informal settlements of Mumbai during the pandemic between April and June 2020, when communities were isolated due to strictly-imposed lockdown, an activity that the organization had never undertaken. In the three months, 30,000 boxes of fresh fruits and vegetables were distributed to Dharavi (one of the largest slums in Asia) residents.

The three dimensions of UHC include service, finance and population coverage which keep altering not only with changes in demographic, epidemiological and technological trends but are also affected by the expectations of the people3. The solutions need to be context-specific, where an organization like SNEHA plays a vital role. We use quantitative and qualitative research methods to ascertain the issues affecting women's health-seeking behaviour in the settings we work in and measure the impact of our interventions. Our programmes are designed based on the research findings, ensuring we create tailor-made solutions for every community we work in.

This blog is based on the article  ‘Role of civil society in health care: Mechanisms for realizing universal health coverage in vulnerable communities of India’ by Dr. Armida Fernandez (Founder, SNEHA) & Dr. Anuja Jayaraman (Director, Research and Information Management, SNEHA)

About the organization:
SNEHA (Society for Nutrition, Education and Health Action) is a non-profit organisation that works with women, children and families in communities; and with public health and safety systems. Its innovative work in vulnerable settlements aims to reduce maternal and neonatal mortality and morbidity, improve the Infant and Young Child feeding practices and immunisation among children and reduce gender-based violence – all key determinants of health equity for the family and the community at large. SNEHA works in slum communities in Mumbai, Thane, Kalyan-Dombivali, Vasai-Virar, Mira-Bhayandar, Ulhasnagar and Bhiwandi-Nizampur directly reaching 342,778 women and children and indirectly reaching over 1 million population.

References:
1https://www.un.org/en/observances/universal-health-coverage-day#:~:text=UHC%20means%20that%20everyone%2C%20everywhere,promotion%2C%20prevention%2C%20and%20treatment.
2 Sachs J, Lafortune G, Kroll C, Fuller G, Woelm F. Sustainable Development Report 2022, 1st ed. Cambridge: Cambridge University Press (2022). Avilable online at: https://www.cambridge.org/core/product/identifier/9781009210058/type/book (accessed November 6, 2022).
3 Ketevan G,Mamuka N, Triin H. [Can People Afford to Pay for Health Care? New Evidence on Financial Protection in Georgia]. Copenhagen:World Health Organization (2021). Regional Office for Europe. Available online at: https://apps.who.int/iris/handle/10665/342814 (accessed November 6, 2022).