Community Engagement to Tackle COVID-19 in the Slums of Mumbai

"Unlike past 'interventions,' an inclusive and respectful approach to participatory development will empower slum dwellers and likely lead to lasting, positive change."

With the objective of informing the work of policymakers, public health officials, funders, and civil society organisations, this rapid study by The Bridgespan Group's India office explores how different community engagement models have played out in the context of the COVID-19 crisis in the major slums of Mumbai, India. Poor living conditions have made these densely populated, low-income urban settlements COVID-19 hotspots. The paper describes activities where communities have been involved in the COVID-19 response, highlighting why this type of involvement is critical. It then synthesises the prevalent models of community engagement and assesses the factors for replicating and scaling them in the slums of Mumbai and beyond, both to tackle the pandemic and to build community resilience for future pandemics or other physical, social, and economic shocks and stresses.

For the study, the researchers interviewed nearly 50 social sector actors, including community leaders, non-governmental organisations (NGOs), philanthropic organisations, government officials, and experts involved in India's COVID-19 response. They also consulted secondary sources, print and online media, and stakeholders involved in supporting the COVID-19 response in urban settlements in China and Kenya to draw any relevant lessons.

Community engagement, defined here as external stakeholders (e.g., government, NGOs, funders) working closely and collaboratively with local actors to understand and address their most pressing needs, is generally deemed important for delivering high-quality, people-centred health care and for building resilient and inclusive systems for development. The study revealed four specific reasons to involve slum communities in preventing the spread of the COVID-19 pandemic:

• Slums vary significantly in terms of their legal/notified status, property rights, demographics, economic activities, access to public goods and social services, and culture. Community engagement enables development of initiatives and solutions that are relevant to the unique characteristics, assets, and constraints of each slum.
• Slum dwellers are experiencing manifold pandemic-related needs and deprivations. The voice and support of communities help to map, prioritise, and address diverse and evolving needs in the context of each slum.
• In these slums, as with elsewhere, there is a social stigma and fear associated with COVID-19. Building trust with communities (e.g., by partnering with local doctors whom community members know and trust) can improve their adoption of and compliance with services.
• Many slum communities are naturally resourceful. Involving communities in the crisis response can develop more enduring and locally owned approaches that are more likely to be sustained and scaled.

The researchers found three principal activities where slum communities had opportunities to engage in tackling COVID-19:

1. Improving awareness and healthy behaviours - Communities are active in creating, contextualising, translating, and/or disseminating COVID-19-related information. For example, Society for Nutrition, Education & Health Action (SNEHA) is working with religious leaders in Dharavi, Govandi, and Malvani to create loudspeaker announcements after prayer times about COVID-19 prevention, symptoms, and control. (Conversations with community leaders revealed that slum communities are more likely to believe and accept information relayed by religious leaders and others with whom they have strong informal ties and deeply trust.)
2. Delivering services - For instance, Swasth Foundation is working with slum communities to identify patients with chronic and acute health conditions and providing in-person consultation, telehealth, and medication services. Working closely with community members helps to streamline their delivery of services so that the households in most urgent need are helped before others.
3. Informing governance - Community members share that the pandemic has exacerbated their unmet needs, such as clean water and waste disposal. In these times, civic action groups and community collectives are coming together and influencing local government to make these facilities accessible.

Exhibit 3 in the paper depicts different models for how slum residents individually and collectively are getting involved during the COVID-19 crisis: as recipients, as partners, and/or as owners. These three models are not discrete classifications, and there is a time dimension to these roles. The community's agency and contributions become more enhanced as they transition from recipients to owners, though there is no universally held best model. In brief:

• Communities as recipients: In this model, which was the most common one in the pandemic's initial stages, it primarily falls upon the government, funders, or NGO partners to assess community needs, to design and implement solutions, and to be accountable for results. However, slum communities are not always entirely passive; in select cases, they may provide input through surveys and/or serve as volunteers to improve the reach of essential services to all residents.
• Communities as partners: Here, the community plays an active role in identifying its needs, co-creating solutions, and contributing to implementation. Conversations with SNEHA and community action groups (CAGs) suggest that their collaboration is working effectively largely for two reasons. First, the active role and input of the CAGs has enabled SNEHA to draft COVID-19 awareness, control, and prevention messages in local languages that are easy to understand, contextualised, and acceptable to the communities. Second, CAGs have enlisted the help of hyper-local community actors like rickshaw drivers and faith leaders to deliver these messages in an understandable way from sources that are trusted by families.
• Communities as owners: In this model, community members identify their own needs, design and implement solutions largely independently, and seek external support only where there are gaps in local resources or expertise. In this regard, Youth for Unity and Voluntary Action (YUVA) has been facilitating the formation, and building the capacity, of people's collectives in Mumbai slums since 1984. Collective members attribute their ability to mobilise resources and lead COVID-19 response initiatives to the training and other capacity-building exercises that YUVA provided. Building these structures in resource-poor settings such as slums takes effort and investment by all stakeholders over many years. Where functional, however, the owners model supports community resilience. Some of the factors that enable its success include strong peer networks, high social capital, a culture of mutual aid, and trusted influencers in the community, such as respected leaders.

In brief, lessons learned from the analysis that could be applied elsewhere include:

• A deep understanding of a slum's historic and current context, as well as its community characteristics - geographic/physical, legal, economic, and socio-cultural - are instructive when developing response strategies and implementation approaches.
• Flexible strategies can better adapt to a slum community's evolving capabilities: Roles can shift significantly during crises, and deploying different community engagement models for different needs and response activities might be necessary, both within and across slums.
• It is important to recognise and respect the fact that, even in times of crisis, communities wish to retain or regain their autonomy, dignity, and self-reliance for survival and development.
• Empowering and enabling slums to own their development agenda by helping them build social capital, cohesiveness, and capacity - only as required - can enable greater community engagement, recovery, and resilience.

In conclusion: "While behavior change has historically been arduous and time consuming, the pandemic presents an opportunity to rally the communities' efforts toward healthier behaviors through awareness building, peer-driven change, and locally grounded initiatives. As our study shows, external stakeholders could serve, partner, and enable the slum communities for this change."