CPD-UNFPA
Programme on Population and Sustainable
Development
Paper 13 (Summary )
Defining Pro-Poor Intervention in
Urban Health and Sanitation with
an Emphasis on NGOs Experience:
The Case of Dhaka City
Qazi Towfiqul Islam
INTRODUCTION
According
to the Dhaka Municipal Corporation
there are more than twenty-two thousand
slums in Dhaka City. Rapid urbanisation,
which is the consequence of increasing
migrant population driven by natural
calamity and rural poverty, has
coupled here with rapid a rapid
growth in slums
and increases in income inequality
and poverty. The excessive burden
of the city population has posed formidable
difficulties for the urban public
health, water and sanitation systems
to provide normal services to the
city dwellers in general and the
slum dwellers in particular. These
services are mainly provided to
the slums through some target-oriented
programmes and slum improvement projects
initiated by the Dhaka City Corporation
and some NGOs with financial assistance
from some bi/multilateral development
agencies. The NGO's participation
in health, water and sanitation
programmes has increased significantly
in recent years (for example the
number of NGOs
engaged in this sector has increased
from 9 in 1995 to 25 in 1999). The
type of interventions and approaches
adopted by the NGOs have been lauded
as being much more innovative, effective
and people-oriented than those employed
by the government. This study
was conducted to review and
analyse
the policies and programmes designed
and implemented by the government
as well as NGOs in urban health,
water and sanitation sectors and
to help design policy options and
programmes in the relevant fields
in both the government and NGO sectors.
OBJECTIVES OF THE STUDY
The
study aimed at achieving the following
objectives:
· Documenting the various
types of interventions and approaches
of the Government and NGOs in the
area of urban health, water and
sanitation for the poor in Dhaka
city slums.
· Focusing on the state of
conditions of health, water and
sanitation of urban poor as perceived
by the slum households.
· Highlighting experience/benefits
of the interventions made by NGOs
and government/public agencies in
the service areas mentioned above,
from the perspectives of beneficiaries.
· Suggesting policy options,
programmes and strategies for the
Government and NGOs to effectively
utilise available resources in the urban
health and sanitation sector for
the benefit of the urban poor.
METHODOLOGY OF THE STUDY
The
following methodologies were followed
in the study:
· Relevant institution-level
information was collated following
a set of pre-designed formats and
a checklist from the NGOs implementing
health, water and sanitation programmes
in the Dhaka city slums.
· Interviews were held with
the heads and staff of the selected
NGOs engaged in implementing the
above programmes.
· Relevant documents and
literature available at different
organisations were reviewed.
· An in-depth study of the
perspective of the NGO beneficiary-population
was conducted using a structured
and pre-tested questionnaire administered
amongst different sizes of sample
households in the Agargaon, Tejgaon,
and Lalbag slum areas.
FINDINGS
· NGOs in Dhaka City started
to emerge in the late eighties as
the rapid growth of slums in the city
brought about a focus on health
and sanitation. During the nineties,
their numbers increased with newcomers
initiating diverse activities in
the field of health, water and sanitation
and micro credit.
· NGOs
focusing on health programs,
although smaller in number, tended
to be larger compared to other types
of NGOs engaged on all three fronts
i.e. health, water and sanitation.
However, there was a significant
increase in the number of NGOs of
the latter type over the last five
years with a larger coverage of
the population, indicating the increased
need for better services on these
fronts.· The level of NGO
participation in the relevant fields
was still inadequate compared to
the actual need and problems faced
by the slum dwellers.
· There
was an obvious overlapping of beneficiaries
and areas covered by different categories
of NGOs. This overlapping was higher
where the number of NGOs was also higher.
· The NGOs' programs were
highly dependent on donor assistance,
provided mostly by foreign donors.
Donors' guidelines and priorities
have had important bearings for
the design and implementation of
project activities implemented by
NGOs. The programs in the public
sector, run by the DCC, were also
largely dependent on foreign assistance.
·
There was a lack of coordination
amongst the NGOs resulting in the
wastage of resources as well as
a difference in opinion amongst
the NGO community about the problems
faced by the slum dwellers. This
problem also had a direct link with
the lack of coordination amongst
the donors while they responded
to individual projects.
·
The methods and approaches applied
by the concerned NGOs in the field
of health, water and sanitation
were more or less the same. They
were designed based on NGOs' own
experiences and lessons as well as
those of the donors and the government.
In this context, there has been
a recent trend suggesting that active
community participation in
the operation
and maintenance of service deliveries
is slowly resulting in the formation
of an institutional framework. The
implication of this trend is very
important, notably, with regard
to supply of tap water in the community.
The community is assured of having
tap water on a sustainable basis,
while the government is also earning
revenue from the water supply.
·
The privately managed systems, however,
were not accountable to anybody,
and were being operated illegally
in most cases. It was learned during
the survey that recently WASA had
connected some of the illegal water
taps with meters and had permitted
certain individuals to sell water
in the same way to
minimise revenue/system
loss in the water supply. However,
in this arrangement under-dealing
with the revenue collectors to pay
less to the authority by under-billing
was reported. The loss of revenue
to the authority was jointly shared
between the revenue collectors and
the private connection holders.
This kind of operation had an adverse
effect on the popularity of Community
Managed water points in some areas
as long as the services of the latter
appeared to be costlier to the users.
·
The long-term sustainability of
NGO programmes critically depended
on their capacity to coordinate
amongst themselves as well as integrate
the programmes with
those of the government
to get much needed institutional
and infrastructure support.
·
The health, weather and sanitation
needs of the slum dwellers were
not adequately satisfied in spite
of the efforts of NGOs and others.
This was because the basic service
deliveries for the poor did not
have the benefit of well-formulated
policies, strategies, and concrete
steps at the macro level.
·
Slum dwellers' problems became much
more complicated and serious as
they have always been exposed to
evictions sponsored by the government
and local interest groups.
·
The purely government institution-based
services in the field were not target-oriented.
This was true for the population
living in the slums. Only the DCC
had the mandate and operated a few
target programs for the slum dwellers.
The services provided by them were
not responsive to the need of the
population either in terms of coverage
or in the quality of services provided.
· Hitherto, the DCC's efforts
in addressing slum dwellers' problems
were on an ad hoc basis with some
support from multi- and bilateral
donors. There was no serious thought
or a well-designed plan to respond
to the needs of slum dwellers in
the relevant fields. Government
attitude and actions, no doubt,
had a bearing on this situation.
· Despite many limitations
and low coverage in terms of inputs,
services of the NGOs in health,
water and sanitation areas for the
beneficiaries had, indeed, benefited
them to a great extent and impacted
positively on their health improvement.
· The accessibility to NGO
health services by
the poor was much
better than to those provided by
the government sector. However,
due to the scale and institutional
strength of government services
they were still covering a larger
segment of the population for all
types of health services. With regard
to water supply, public organisations
like DWASA could still provide better
services, if they plan and jointly
implement the services with the
NGOs. In sanitation, the level of
public sector intervention is negligible.
· The magnitude and diversity
of the problems associated with
health, water and sanitation facilities
in the slums were so vast that any
kind of partial and isolated efforts
by any organisation would not have
a significant impact on overall
improvement of the prevailing situation.
In this regard, the question of
ensuring bold and effective community
participation, emphasising women,
was considered very critical.
·
In the overall context, it was revealed
that people living in slums would
be seriously affected if obstacles
were created by the implementation
of NGO activities.
POLICY RECOMMENDATIONS
·
There should be a national consensus
on the broad policy framework of
urbanisation in the country. In
this regard, opinions and experience
need to be shared with different
stakeholders, including NGOs and
community
representatives.
·
Based on long-term policies, concrete
steps in consultation with the participation
of the community, notably of women,
and other stakeholders, including
NGOs, should be developed and implemented
for resettlement of slum
dwellers as well
as other displaced and floating
population of the country.
·
Policies, programmes and strategies
in the field of health, water and
sanitation targeting the urban poor
should be formulated based on meaningful
dialogue and coordination amongst
the public sector organisations,
donors, NGOs and other private organisations
willing to contribute to the sector.
The same spirit should also prevail
during the implementation of programme
activities. As stated above, active
community participation, emphasising
women, is
crucially important
to determining appropriateness and
sustainability of the programme
activities in the long run.
·
Government machinery should view
NGO activities to be complimentary
to government target programmes
and utilise existing NGO networks
to deliver services efficiently
at the grass roots level.
· Inter-NGO collaboration
and cooperation should be developed
with more emphasis on general principles
and specific activities to be carried
out in the field.
·
To be guided by pragmatic policies
and programmes, NGO interventions
in the fields of health, water and
sanitation for the benefit of poor
population across the country
should be placed in their true perspective
at the national level where the
appropriate coordination has to
be achieved.
To
obtain the full text of this report
please contact:
Centre for Policy Dialogue
Dialogue
and Communication Division
House No 40/C, Road No 11, Dhanmondi
R/A, Dhaka-1209
GPO Box 2129, Dhaka-1000, Bangladesh
Tel: (+880 2) 8124770,9141734,9141703;
Fax: (+880 2) 8130951
E-mail: cpd@bdonline.com
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Pages: 39
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