Observations from Two Urban CommCare Deployments

In some ways Mumbai isn’t too different from any huge city in India. There are people everywhere and a large portion of the population has migrated from outside the state. The official state language here is Marathi, but on any given day I will easily hear Marathi, Hindi, Bhojpuri, Kannada, Gujarati, and of course English, all quite distinct languages. One thing that I think sets Mumbai apart is it is much more expensive to live here, relative to other Indian cities, and is much more densely populated. The first short-term available room I could find here cost more than I used to pay living in downtown Washington, DC. And this price bind affects everyone up and down the pay scale- which is why there are so many “slums” interspersed in this super-dense city. Some of them, such as Dharavi – one of the slums we’re working in—are in good locations and are a relatively affordable housing choice. “Slum” is a bit of a misleading term, because while some of these areas are in very bad shape, many others are pretty nice. I was talking with one CHW about all the satellite dishes visible on the roofs in the slum areas and she just smiled and said “TV is compulsory.” You don’t get much space, as most families have one small room, but people often have very clean, organized rooms and avoid hours of commuting every day. But these areas are definitely lacking in key infrastructure and resources like sanitation and clean water supply, which perpetuates the spread of diseases.  For example in Dharavi, as of 2006 there was one toilet per 1,440 people, which leads to rapid spread of disease, particularly during the monsoon.

Complexity in Diversity

The Good and Bad of Neighbors

When people live in such high-density environments it is difficult to keep too much private. This can sometimes be very helpful if a CHW is looking for a family as in many cases the neighbors will know if they’ve gone temporarily out of the city or have moved away permanently.  People often also know if someone has become pregnant or a child is ill and will tell the CHW of the new development while they are wandering in the winding alleyways trying to find their clients.

• Electricity: While having access to electricity to charge phones is a real consideration in a lot of our projects, in our experience even people who live in what would be considered “slums” generally have ample access to electricity. In most of Mumbai power cuts are relatively rare.

• Network Coverage: While not universal, coverage by almost every network in and around Mumbai is not a huge concern.

• Transportation: An ASHA in rural India could have a catchment area that is very spread out and visiting a particular beneficiary could be logistically or physically very demanding. Here, a “beat” is usually pretty small and dense and most CHWs have pretty good access to all the houses they need to visit once they get to the general area.

• Literacy/Education of CHWs: Not that this is a non-issue in Mumbai but there is a big pool of people to draw upon to fill CHW positions so organizations and governments can be a bit picky. The Mumbai area has higher than average literacy. So most of the CHWs I’ve gotten to work with are sharp, relatively educated, and at least bilingual.

• Time: People in rural areas have a lot of work/things to attend to, but our partner organizations here in the city can be particularly busy- they’re involved in lots of projects, travel a lot, and operate at a bit city speed. The CHWs’ clients are also very busy as many of them may have jobs that take them away for the house for at least part of the day.