|Year : 2007 | Volume
| Issue : 3 | Page : 189-191
Vulnerability assessment in slums of union territory, Chandigarh
BT Rao, JS Thakur
School of Public Health, Department of Community Medicine, Post Graduate Institution of Medical Education and Research (PGIMER), Chandigarh, India
|Date of Submission||02-Jun-2005|
|Date of Acceptance||11-Aug-2007|
J S Thakur
School of Public Health, Department of Community Medicine, Post Graduate Institution of Medical Education and Research (PGIMER), Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
Keywords: Vulnerability, slum, immunization, Reproductive and Child health
|How to cite this article:|
Rao B T, Thakur J S. Vulnerability assessment in slums of union territory, Chandigarh. Indian J Community Med 2007;32:189-91
The word vulnerability means 'able to be easily hurt'. Vulnerability itself implies the extent to which individuals are incapable of making and implementing free and informed decisions about their life. Societal vulnerability focuses directly on the contextual factors, such as governmental structure, gender relationship, and attributes towards sexuality, religious beliefs and poverty.  The ultimate aim of vulnerability reduction is to expand people's capacity to exert control over their own health. By identifying the larger social issues that constrain or promote this ability, contextual analysis stresses the need for positive and synergistic interaction between the individual services, programmes and other collective initiatives and the social environment.
Vulnerability assessment is defined as the systematic examination of a system to identify those critical infrastructures or related components that may be at risk from an attack and the determination of appropriate procedures that can be implemented to reduce that risk.  Risk and vulnerability assessment is a multi-step process, which includes analyses like hazard identification; critical facilities, societal, economic and environmental vulnerability; and mitigation opportunities. This helps to identify people, property and resources that are at risk of injury and damage. This information is important to help in determining and prioritizing the intervention measures.
About 25% of Indian poor population currently live in slums, which often lack even the most basic health and infrastructure services.  Maternal and child health indicators among slum people show that their health is 2-3 times worse than 'average' urban areas. It is estimated that agencies are only reaching about 30% of the urban poor and those being served belong to the comparatively 'better off' slums. Participative methods for ranking urban poor populations according to selected health vulnerability criteria are needed.
It is estimated that one-third of urban population of Chandigarh reside in slums. There have been conflicting reports about the number of slums. However, as per the health department report of 1998, there were 13 slums with a total population of 2,30,000. Due to the conflicting figures about the number and population in slums, it was decided to undertake mapping and health vulnerability assessment of slums for resource allocation under RCH-II in Union Territory, Chandigarh.
| Materials and Methods|| |
This cross-sectional study was carried out in Chandigarh, adjoining sectors and villages. A rapid survey method was used for estimating the existing slums in Chandigarh. Four field investigators were assigned this activity. All the investigators were native of Chandigarh, and had exposure of more than three years in field work at Chandigarh. They were divided into two teams and provided vehicles for this rapid survey.
A questionnaire was used to collect information for assessing the socio-demographic factors and vulnerability status of the slums. Initially, the field workers administered this questionnaire to key informants like local leaders, NGO representatives, health workers and anganwadi workers in one slum for pre-testing, and few modifications were made. From the existing list of slums provided by Municipal Corporation and health department, and on the basis of information received from other sources, the team visited each slum and interviewed the key informants in the area to find out the number of houses, expected population and vulnerability status. In each slum, seven children were chosen in the age group of 12-23 months to assess immunization coverage. For this purpose, the first child was selected randomly, and other children were selected consecutively by the standard cluster technique.
Vulnerability criteria developed on the basis of experience and by reviewing the current literature available from country.  We considered a total of 16 variables under seven subheadings - social, economic, infrastructure, morbidity, land status, access and usage of health services, and history of collective efforts - as shown in [Table - 1]. Each variable was assigned a score, and cumulative score for each slum was calculated. For each variable, the maximum score assigned was 3, and the minimum score was 1. If the condition was good, then it was assigned a score of 3. Those in between were assigned an intermediate score of 2 as perceived by the key informants. According to this vulnerability criterion, a slum could fall between a maximum score of 48 and a minimum score of 16. On the basis of this score, slums were categorized as high, moderate or low vulnerable slums. If the score was <26, it was categorized as high vulnerable, 26-35 as moderate vulnerable and >35 as low vulnerable. A slum was defined in the study as any area designated as slum by Chandigarh Administration, or a compact area of at least 300 population or about 60-70 households of poorly built, congested tenements in unhygienic environment usually with inadequate infrastructure and lacking proper sanitary and drinking water facilities or a resettlement colony. Children who have completed primary immunization were taken as fully immunized.
| Results|| |
The data from Chandigarh Administration revealed that a population of 2,31,415 were living in 13 slums in 1998. After a rapid survey, it was estimated that about one-third of urban population of Chandigarh resides in slums. A total of 41 sub-slums were identified in 17 main slums with a population of 3,17,053. There were 7 sub-slums in Dhanas area and 8 sub-slums in Khajeri area. The largest slum was found to be colony no. 4 with a population of 48,500 followed by colony no. 5 with a population of 44,000.
On the basis of vulnerability criteria, it was observed that 15 slums (36.6%) were highly vulnerable, 21 (51.2%) were moderately vulnerable and 5 (12.2%) were low vulnerable. The proportions of population in high, moderate and low vulnerable areas were about 49,000 (15.5%), 1,39,253 (44%) and 1,28,800 (40.5%), respectively. The highest concentration of slums is in periphery of the city and adjoining the villages. The families living in slums are migrants from different states like UP, Bihar, etc., and are primarily part of unorganized sector (labour, family help, rickshaw pullers).
A total of 282 children in the age group of 12-23 months were evaluated for primary immunization. Some of the smaller slums had less than seven eligible children. The highest numbers (25.3%) of unimmunized children were found in highly vulnerable areas as compared to 5.6% and none, respectively, in moderate and low vulnerable area. The immunization coverage was 91.7% in low vulnerable, 82% in moderate vulnerable and only 58% in high vulnerable areas.
| Discussion|| |
Even though Chandigarh is considered a clean and green city, it is not without the problem of slums. A survey conducted in Chandigarh (1997) revealed that it had about 26 slums with a population of 2,20,000. The common problems including poor living conditions were highlighted for urgent intervention among residents.  The number of slums as well as the population has increased by about one-third over the last decade.
It was observed that the number of unauthorized slum settlements had increased in Chandigarh due to migration. There were no specific guidelines for the allocation of resources to these areas by administration. It has been observed that moderately and highly vulnerable slums have either been poor in health service provision or are inhabited by communities who have no access to services due to several reasons. The vulnerability assessment status of slums was used as a measure of intervention for differential resource allocation under RCH-II. Provision was made for camps to be conducted fortnightly in high vulnerable areas and on a monthly basis in moderate and low vulnerable areas. It was recommended that 224 link volunteers be identified and recruited in high and moderate vulnerable areas. The budgetary provisions for the same were made in project implementation plan (PIP) of RCH-II.
In order to ensure effectiveness and access, the frequency and nature of outreach activities need to be more intense in moderate and high vulnerable areas. Low vulnerable slums are mostly resettlement colonies that have access to health facility but need to be mobilized for utilizing the services. The limitation of the present study is that the information provided by key informants may not be robust, but it has provided fairly good inputs for planning RCH-II and differential resource allocation. It is concluded that the health vulnerability assessment of urban slums could be used as a measure for planning of interventions and prioritizing scarce resource allocation in health system.
| References|| |
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[Table - 1]