CHAPI'ER III

PROFILE OF THE STUDY AREAS AND POPULATION

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?