Observations from Two Urban CommCare Deployments
To my knowledge, the majority of Dimagi’s work in India has been in rural areas. Indeed, the part of our mission that is focused on “resource-poor” environments conjures the image of an isolated village. I’ve worked briefly on a couple of Dimagi’s deployments in rural India and on balance have spent more time in rural India. However, I have had the fortune to work on two very different yet very exciting projects in Mumbai, and its sister planned city, Navi Mumbai. Based on my admittedly limited experience over the past several months I thought I would share some observations from working on two urban CommCare deployments. Some of these may be things that I just think are specific to urban projects but are actually more general—or are actually specific to these projects. But here they are, for what they’re worth.
A Bit about Mumbai
Migration is a Significant Issue
The summer months are difficult for a CHW in Mumbai. A large portion of the inhabitants in the areas we’re working are from rural Maharashtra, Uttar Pradesh, or Bihar and during the summer months they make their trek back to their home village. On some days I have been in the field upwards of a third of visits the CHW tries to make are fruitless because the houses are locked and the women they are looking to speak with are gone for the next two months. If you are trying to track “timely follow-up” then this is an added level of complexity. Do you allow a longer follow-up lag? Do you create a question that captures if the CHW went to visit the individual but they weren’t there? Besides just making data collection difficult, it also makes interventions a bit complex. Maybe a particular CHW has helped a family get a severely malnourished child extra sustenance and provided training such that the child has become normal. But they can be knocked back to malnourished status after a short visit to the village where they have different water, food, and lack of access to the same resources they were provided back in Mumbai under the intervention.
Complexity in Diversity
The mixture of people from all over India makes for some unanticipated linguistic issues. While Dimagi has definitely done projects where a single CHW has to deal with a lot of languages, here a CHW has to deal with several languages in the course of a couple hours of work in one small cluster.
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.
One unexpected issue we had was with SIM card activation. After the terror attacks here in 2008 regulations on issuing SIM cards got strict across India, but particularly in Mumbai. In one project almost all of the SIM cards were deactivated due to “documentation issues” within one week of deployment. It is a big burden to get the CHWs to take time and money to travel to a provider outlet to discuss documentation. Plus, many people do not have “proper” addresses which makes presenting proper documentation even more difficult. In the end we developed a system of SIM sharing. Each CHW whose SIM doesn’t work has a “partner” CHW with a working card, and they switch the SIM periodically to send unsent forms.
Having spent so much time in the big city, when I recently went to a rural site I found I had forgotten about some considerations in project design that are quite significant in rural settings:
- 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.
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