Health camps are a key part of  SPARC and the community federations’ work across informal settlements and relocation sites in India. In this blog, Aryan Iyer reflects on their role in ARISE and in triggering community collectivisation.

Health camps are three-to-five-day long programmes that are held across informal settlements and relocation colonies where federations are active in eleven cities across India. They involve basic diagnostics and the provision of free medicines to the residents. There are two core objectives. First, to create awareness around Non Communicable Diseases (NCDs) and health challenges in locations where public health services and preventative action by state institutions are poor, and second, to build data around these health challenges which can help push community action to demand preventative public health interventions from the state.

Health camps are a valuable tool in developing a broad understanding of health challenges in informal settlements and at the same time, provide avenues for accessible basic healthcare, where access to services, public or private, is highly compromised and encumbered by several barriers. This is an everyday reality for people living in peripheral relocation sites in cities such as Ahmedabad where these challenges are experienced to a great degree.

Debilitating environmental conditions and poor access to healthcare – due to dysfunctional on-site infrastructure and an exclusion from city-wide health programmes – contribute to widespread disease and poor health in these settings. For people for whom material poverty is an everyday experience, centralized public healthcare institutions are often inaccessible due to high transportation costs while private facilities prove prohibitively expensive in general. Under-serviced urban health centers, long wait-times and concerns relating to quality further contribute to this.This is exacerbated by dietary practices, limited access to decent quality food and produce, and poor water and sanitation services.

Health camps are pivotal in two regards:

1. While ethical guidelines prevent them from being used as tools for research, they help develop broad insights which contribute to a better understanding of health and well-being challenges for communities. In turn, they help inform and shape more directed community level efforts towards improving health and well-being by revealing the severity and extent of such challenges and their causes.
2. In contexts where poor access to services are rooted in the absence of governance and accountability structures, camps help encourage wider participation from the residents by setting tangible examples of how collectivization can directly contribute to a betterment of their neighborhoods.

Health camps in Ahmedabad: Organization and response

Funded by ARISE, a five-day health camp focusing on providing general health check-ups and free medicines for basic ailments, was organized in the first week of July 2023 across two relocation sites in Ahmedabad where SPARC is working with the community.

In the first site, where progress has been made in the past eight months with the preparation of a functional office space, the camps were held on the heels of several meetings and an extended period of deliberation which allowed us to better understand community concerns and priorities. In the second site, while our work is still in its infancy, public health concerns repeatedly came up in our meetings and conversations with leaders as urgent priorities. They also mentioned that their efforts to consolidate on-site healthcare services or organize medical camps have thus far been stifled by public opposition and restrictions placed by urban local bodies.

The response across both the sites was both promising and positive. In the first site, we observed active engagement and participation from the residents, from the planning stage of the camps till their conclusion. Their organizational strength was crucial to the dissemination of information relating to the camp. The response in attendance was consistent with this, with all three days of the camps observing 100+ attendees, typically more than what the camps were equipped for in a single day. In the second site, although there was little enthusiasm from the residents at the outset, which in part was exacerbated by ineffective communication from the leaders, the response ramped up by the second day as an increasing number of attendees spread the word around their buildings. Some even organized the mosque in the locality to make an announcement. The response by the last day was unexpected and in the opinion of the leaders, unusual for the residents who thus far had remained inactive. 85 people attended on the first day and this increased almost two-fold on the second day.

Health profile: General patterns and antecedents

Conversations with the attending doctor shed light on the health profile of the sites, the prevalence of diseases and their antecedents in the form of environmental and socio-cultural factors in their context. Compromised basic services, inadequate and imbalanced dietary practices and in some cases, occupational hazards were found to be the main contributors to ill health across the two sites, which observed little variance, as expected due to their socio-demographic similarities.

We did observe differences between the health conditions of adults and children. Symptoms of malnutrition, iron and calcium deficiency were found to be common among children, with many also displaying symptoms of worms. As several residents reported during the check-ups, in addition to potentially imbalanced diets at home, there is little clarity on the quantity and quality of mid-day meals provided to children attending the on-site Anganwadi (childcare and pre-schooling centers which are built and run under the Integrated Child Development Services programme in India). The same was the case for children attending primary or secondary schools outside the locality.

For adults, issues potentially rooted in dietary practices were also common. High blood pressure and high blood sugar was found to be prevalent among men and women, as were respiratory and skin problems although to a lesser degree. Poor water and air quality was suggested as a contributor to the latter. Those who showed possible signs of TB were referred to local hospitals for further testing. Symptoms of Anemia and Thyroid problems were found to be more common among women, with iron deficiency as the primary cause for the former.

Informal conversations with the residents during the course of the camp revealed a few concerning facts, primarily those to do with community health practices. Many said that a basic health checkup was a rare occurrence and only undertaken when faced with debilitating symptoms. Many were not aware that they had high blood pressure or high blood sugar while some with more visible symptoms were directed towards testing for the first time. For many families who brought their children for testing, malnutrition and the importance of a balanced diet was a revelation, and something that they had not considered before. The quality of water and community hygiene also came into question for several attendees who exhibited symptoms of skin problems.

Health camps as a tool for encouraging community engagement

In Ahmedabad, attempts at organizing communities have thus far been faced with several barriers, with relocation sites in particular suffering from a  form of social disarticulation which has brought about numerous conflicts along the along the lines of caste, class, and religion. Long-standing distrust, in combination with fatigue and a general disinterest on the part of residents in organizing as functioning societies, have precluded any efforts at collectivization. In such a state of shambles, there are large gaps to fill in order for the communities to bring about positive changes to their localities, something that the leaders have brought up repeatedly in our meetings with them.

The response and testimonies that we received in the aftermath of the health camps evidence their effectiveness in bridging these gaps, in what we and the leaders saw as an inadvertent, but welcome outcome. By providing  a stage for collective efforts and active participation from the residents, people have come to believe that their efforts and work with the leaders on their site can have tangible, visible benefits for them and their locality.

In our own observations and in that of the leaders, the camps were instrumental in catalyzing a level of engagement and communication that was unprecedented. The residents, rather than being passive, unaffected observers, came to see themselves as equal stakeholders and beneficiaries of society-wide activities. The health camp at the first site exemplifies this. In the days leading up to it, the residents took the initiative to design pamphlets which helped instill a sense of responsibility and ownership in them, something that continued throughout the duration of the camp itself. Meetings preceding the camp saw greater attendance than usual, and the residents expressed genuine willingness to participate in the camps preparation and further such programmes. Those who were merely spectators until this point, volunteered to help and aide in the preparations of the camp by arranging the tent/space, food, and water while others handled the logistics, including the transportation and storage of medicines. Conversations we had during the camp also hinted at a renewed interest on the part of the residents in engaging seriously with society formation activities. Several residents expressed their willingness to undertake further such work In Ahmedabad to the members of the Mumbai Mahila Milan.

Our observations in the second site were similarly encouraging. In the past, there have been numerous conflicts between the residents and the leaders, to the point of hostility where more recently, all efforts to organize have been futile. The leaders said that the camps helped them to achieve common ground with the residents for the first time in over a decade, something that they had been unable to do thus far. Further conversations with the leaders in the week following the camps suggest that there is a marked increase in communication among the residents and with the leaders, with many requesting that the camps be held again within the calendar year. For them, the camps have facilitated further work in their societies and provided the leaders a foothold with the community that they were previously lacking. With an institutional memory of distrust and ineffectiveness on part of the NGOS which were tasked with ensuring a smooth transition to the displaced families, the camps also helped the residents regain their trust in the leaders and in our own presence and work with communities.

Conversations in the days since reflect how the camp has shaped the efforts of the leaders. In the first site, discussions around improving the quality of open spaces as a key attribute of health and well-being have taken center-stage and the leaders have discussed representations to the municipal corporation to reform the on-site health center which at present is being run by a local religious charitable organization. Additionally, they are also looking into developing a better understanding of the activities and provisions of the on-site Anganwadi and appealing to the ICDS (Integrated Child Development services) to address related issues. In the second site, community members and the leaders are attempting to hold further meetings, using the medical camps as a premise to discuss issues relating to water and sanitation that can be addressed on an immediate basis. They hope to use this momentum to propel further society-related discussions and organize more effectively to the end of making robust representations to the urban local body in Ahmedabad.

Though lasting effects are yet to be seen, it is clear that the camps achieved more than what they originally set out to do. They have set an example as a visible outcome of the community’s efforts to organize themselves, and in doing so, have provided impetus to their efforts, along with ours to address key health and well-being issues in their sites. This has come at a crucial time, when urban local bodies have all but explicitly denied their support to relocation sites, and recent developments concerning the deteriorating state of buildings and health/safety infrastructures have made society formation an urgent need for them.