climate change

Blog, Uncategorized

Heat stress worsens chronic health conditions, residents of informal settlements hit hardest

Heat stress worsens chronic health conditions, residents of informal settlements hit hardest Climate change is increasing the frequency, intensity and duration of heat extremes worldwide. In India, the average maximum temperature increased by ~0.5°C by 2000, and by ~1.0°C by 2020, as per a study published recently. Heat extremes put more individuals, communities and health systems at risk of illness, and death.  People with pre-existing chronic illnesses such as diabetes, hypertension, renal disease among others are more vulnerable to heat-related illnesses. Extreme heat is known to exacerbate health risks of those living with chronic diseases and can trigger hospital visits and mortality risk as the body struggles to regulate itself under heat stress.  Urban SHADE’s Hemanth Chandu and Pavani Pendyala recently wrote an article about informal settlements residents who live with chronic diseases. Urban SHADE’s Menaka Rao spoke to Dr Vivekanada Jha,  executive director at The George Institute for Global Health, India, and a nephrologist and public health researcher. He is Professor, Faculty of Medicine, Imperial College London, and the past President of the International Society of Nephrology. A prolific writer and editor, Dr Jha has worked with many global organisations including the World Health Organisation to develop clinical practice guidelines and advocacy papers. His research interests include understanding the health and societal impact of kidney diseases around the world and the development of affordable, scalable and sustainable primary and secondary prevention tools. Here are the excerpts of the interview: Menaka: How does extreme heat affect persons with chronic diseases such as hypertension, diabetes? In your clinical experience, what changes have you seen among those living with chronic health conditions , especially among poor patients and those living in informal settlements? Dr Jha: Heat affects both basic biology and the response of the body to external stimuli for people with chronic diseases including hypertension, diabetes, cardiovascular disease, kidney disease, etc. As temperatures go up, we sweat more. While the sweating is perceptible when humidity is high, it is not perceptible when the heat is dry. Sweating leads to a loss of water and salt from the body, reducing the total water and salt concentration. This can lead to a reduction in blood pressure. We have seen in clinics that people with well-controlled hypertension suddenly experience low blood pressure during extreme heat. They become giddy and weak. So during the summer months, we have to reduce the number of blood pressure medicines then, especially diuretics, which have the property of increasing urine flow, further worsening fluid and salt loss. We also have to warn our patients to check their blood pressure more frequently and pay attention to how they are feeling. Many people with diabetes require insulin, which is taken in the subcutaneous region. During the heat, the body does not absorb insulin well from that site, leading to uncontrolled blood sugar levels, even if it had been previously controlled. The build up of sugar concentration in the blood leads to spillage in the urine, which draws more water with it, causing dehydration. We ask patients to avoid injecting on the limbs before physical activity in heat. The abdomen is more predictable. They should also monitor blood sugars more frequently during heat waves, especially after meals. Insulin is a protein that denatures in hot weather. It should therefore be stored in a fridge.  Many in informal settlements don’t have access to a fridge. Practical solutions include using insulated pouches with ice bags or clay pot coolers. The effects of heat on kidney function have been extensively studied. When people lose salt and water through sweat, the blood flow to the kidneys decreases, and the kidneys lose some function. Let’s say a manual worker works in extreme heat from morning to evening. By evening, their kidney function becomes lower than normal. The kidney function may recover after the worker returns home and has water for the day, but repeated insults to the organ can result in long-term irreversible injury, which can progress to kidney failure. This has been well documented in many geographies around the world, including rural agricultural communities, outdoor workers such as construction workers, people who work in salt pans, and others. A population that is overlooked is women in informal settlements who have to cook indoors using coal or wood-fired stoves and therefore are exposed to high heat for prolonged periods. The body’s homeostatic mechanisms, which help us adapt to changes in our external environment, such as high heat, are impaired in those with chronic diseases like hypertension and diabetes. A younger person without any of these diseases, for example, will respond much more resiliently to heat stress. Menaka: What is the kind of advice for people with chronic diseases? Dr Jha: We warn our patients with hypertension that their blood pressure may go down during summer and that they should be mindful of any new symptoms that they develop. For example, if they start feeling giddiness or weakness, they should either check their blood pressure wherever they are or come to the clinic, where it can be checked. In that situation, we may need to reduce the number of blood pressure medications. Similarly, when the summer season ends, their need for blood pressure drugs may increase again. People with diabetes who are taking insulin, we have to advise them to keep their insulin in a cold environment, in a fridge, etc. We also tell them that when they are taking insulin, they should make sure they don’t inject it into the same site of the skin every day, especially over the limbs before physical activity. Finally they need to increase the frequency of blood sugar monitoring especially after meals. For people with kidney disease, we tell them to drink extra water and take salt when they step out. Not just one single one-litre bottle, as it’s not sufficient. We also ask them to try to avoid going out during the peak summer hours, so they go out early in the morning. For example, we tell farmers to try to

Events, Uncategorized

Consulting with stakeholders in Freetown

Consulting with stakeholders in Freetown Starting this February, the Urban SHADE team in Sierra Leone conducted meetings with various stakeholders to discuss the interventions of the project. The Urban SHADE Sierra Leone partners include Sierra Leone Urban Research Centre (SLURC), Institute of Gender and Children’s Health Research (IGCHR) and The Centre of Dialogue on Human Settlement and Poverty Alleviation (CODOSAPAH).  The teams engaged with institutions mostly government-based that work directly with climate risk management, disaster preparedness and health systems in Sierra Leone at national and city-level. The Urban SHADE team presented the findings of the project on how extreme weather affects people living in informal settlements, particularly their health. The Urban SHADE team will co-design interventions with communities and stakeholders to find interventions that are practical, scalable and sustainable.  The organisations the team met are: Sierra Leone Meteorological Agency (SL MET), National Disaster Management Agency (NDMA), Ministry of Health, National Public Health Agency (NPHA), District Health Management Team (DHMT), Freetown City Council (FCC), National Early warning and Response Mechanism Coordinating Centre (NEWRMC) and National Fire Force (NFF).  While the Urban SHADE team appealed to the stakeholders for their support in further activities, it also became increasingly clear that effective responses to climate-related health challenges require strong coordinated multi-sector collaboration. The Urban SHADE team is gearing up to form a Stakeholder Working Group which will include representatives of these stakeholders and will aim to coordinate effectively in the future.  The Urban SHADE team will share these research findings and proposed interventions with the three communities (Susan’s Bay, CKG, Moyiba) and seek suggestions from the community as well, and representatives and leaders from these communities will also be part of the Stakeholder Working Group. The Urban SHADE team will have workshops with the Stakeholder Working Group where the interventions can be co-designed, and particular roles and responsibilities of different stakeholders during extreme weather events (extreme rainfall and extreme heat) can be clarified. The team is currently in the process of formalising partnerships with these stakeholders through Memoranda of Understanding (MoUs). 

Events

Community meetings in Kenya on proposed interventions

Consulting the community on proposed interventions in Kenya The Kenya team of Urban SHADE project is having community meetings explaining the findings, and talking about possible interventions.  The intervention proposed for all three communities– Tudor Moroto and Matopeni in Mombasa and Mibuyu Saba in Kilifi is co-designing training modules and protocols for health workers and community health workers with the health department on flood and extreme heat management.  One of the additional proposed interventions for Mombasa’s Tudor Moroto is the establishment of a community resilience hub which is intended to serve both as a community health facility, as well as a community centre. The proposition is that this hub can help increase access to healthcare during extreme weather events as well as become a hub for community meetings, support community activities and interventions and also serve as a rescue centre during disasters. The Urban SHADE team had several meetings with the community members starting with the local administration and village elders in February to get their buy-in on the interventions and support in mobilizing and organizing the community meetings. In the community meeting at Simitini village in Tudor Moroto, there was a discussion on the access road to the identified building for the resilience hub. The access road is currently narrow, and rudimentary. The access road to this building also becomes too muddy after the rains. The community members said that if they have the right material, such as cement, they can fortify the access road. They were unsure about involving the government as there were worries that the government could ask people to move out of their homes, without compensating them. On developing modules for health workers to tackle health-related issues of flood and heat, the community members from all three settlements said that they would like community members to be also involved in the training workshops and other activites related to disaster management, and health-related interventions. The Urban SHADE team will discuss this further in stakeholders meetings which are underway.

Musings, Uncategorized

The Combermere nalla

The Combermere naala Inayat Singh Kakar The Combermere naala is one of the five natural streams that flow down central part of Shimla city. These streams are natural drainage channels that carry excess water down the mountainsides. The Combermere naala originates mid-way on the Jakhu hill, making its way down the hillside to form the Eastern boundary of our field site, Krishna Nagar and ends at Lal Pani where taxi drivers use the water to wash their vehicles. Old pictures of Shimla city show the naala flowing down pristine hillsides. Now when you hear the gushing of the water, you see a channel choked with garbage. The water tumbles over the garbage, desperately makes its way down, slowly changing its path as it cuts through the hillside. As the naala reaches Krishnanagar it becomes even more choked with garbage. Krishnanagar’s residents whose houses are constructed along the naala describe it as a health and safety hazard. In the summer, the wet garbage cooks in the harsh sun and becomes a swampy breeding ground for flies and mosquitoes. In the rains, the water thunders down the hillside, gushing so loud that it keeps nearby residents awake from the anxiety of flooding. Ramu, whose house is built right next to the naala says that he is afraid it will one day sweep his house down with it. He says that infrastructure built by the Municipality has created choke points in the path of the naala, instead of towards the end of its course at Lal Pani (near where the 2023 landslide took place) where it could be cleaned regularly. Right now, the choke points which are inaccessible to human beings. The naala is built in a way that it gets obstructed, and damages the hillside where Krishnanagar is located, increasing risk of landslides. With a sigh, Ramu says that the story of the naala is emblematic of a cruel irony faced by the residents of Krishnanagar, home to the majority of city’s sanitation workforce.

Musings

Nowhere to go

Nowhere to go Dr. Abu Conteh It’s 12pm on a bright beautiful Monday morning, and the sun is beginning to get ahead of me. I am visiting the Soja town section of the Moyiba community to talk to Sia, whose house was recently destroyed by a mudslide. Moyiba is one of the most deprived informal settlements in Freetown, which is also exposed to multiple hazards including mudslides. Sia is a single mother of three who makes a living from stone mining. As I ascend the over 600-meter-high hill, I couldn’t help but wonder how women in this rugged part of the community deal with climate hazards and access healthcare. In the past years, women in this section of the community have had to deliver babies by the side of the road as they couldn’t make it to the only government health clinic in time about 3 kilometers away. Transportation here is a challenge, as motor bike riders complain of rugged roads. As I arrive at Sia’s home, she greets me warmly and offers me a seat in her delipidated single bedroom mud house that was destroyed by a huge boulder (in 2025). The house is now a relic of the original two-bedroom house built by her husband who died two years ago. “The destruction of the house has changed my life so badly”, she said. She recounted her daily horrors of having to live in a leaking house or rebuilding it withher meagre income. “I can barely feed by children, let alone rebuild this house.” As I looked around, I could see that most houses here are built with mud bricks, which makesthem vulnerable to extreme weather events such as flooding and mudslide. Sia recounts she is not the only woman affected. ‘‘Last year, one woman lost two children because of a mudslide,” she said. While she feels the community is not safe, she is worried about having to leave a whole life behind that she has built for over a decade. ‘‘I have nowhere to go. We are not offered any help by the ‘’big ones.’ No one has helped me since my house got destroyed,” she said.

Musings, Uncategorized

Bahari

Bahari Bessie Sarowiwa She’s big, she’s blue, she’s bold. She’s Bahari. For many years Bahari gave life to many and offered refuge to many more in Tudor Moroto, like a mother. She’s watched us grow up and was always there when we needed her. We played with her when we were kids and learned to swim in her cool waters. She gave us a place to relax when the heat was unbearable. She provided food for us when our parents came back with nothing. She liked having us around and never complained. But not anymore. She has changed. She doesn’t seem happy these days and the glow that she once had is no longer there. The beautiful blue she once had is now more of a blue green. And the cool breeze she would give us when heat was unbearable is now just hot air and a stench. The food she shared with us has dwindled and it appears that all the fishermen catch now are plastic bags and used diapers. The places we would go to play with her are now places we warn visitors about because they never know what they may step on. All the people that relied on her for their basic needs are now struggling to even get through the day. It breaks my heart. How did we end up here? Bahari, did we do this to you? That’s what everyone is saying. That our actions are what made you this angry. We cut down the trees that fed you and kept you clean to build houses. You were nice to us but instead we paid you back with food and sewer waste. You’re now threatening to leave us.   Please don’t give up on us, Bahari. We’re trying to do better. We’re learning from our mistakes. It might be a little late but it’s the least we can do. 

Musings

Battered and bent, but still standing

Battered and bent, but still standing Desta Ali Down the long, steep, steps of Susan’s Bay stands a tall, green five-storey building. It looks weathered and worn, but it stands stubbornly and quietly. During the day it is virtually empty, but I’m sure it houses more than hundred people at night. There is a lot of cracks in its concrete; its roof is made of rusted metal sheets. The building tells a story of time. Every time I look at it, I hear it say, “I have survived many floods, yet I am still standing. I am a survivor.” It almost makes me fall in love with it, because it reminds me of myself, standing tall in the midst of trials, keeping my head high, and trying very hard not to crumble. The glasses on the windows are broken, yet the bars are still holding on, almost as if fighting hard to maintain security. The top floor of the building is unpainted. That means it has been added recently to create more space for more people. The bottom floor is incomplete and wrapped with tarps and more rusted metal sheets. It was possibly built as a garage but is now being used as an accommodation for a desperate family. This tells a story of greed, because someone has decided that making money from rent is more important than the safety of people. I admire the building for all it has gone through and all that happens within its walls. But I also feel sorrow and dread. I know it’s only a matter of time before it crumbles. The land it is built on is a coastal land and not meant for buildings. I am sure its foundations were not made to carry that much weight. I always ponder how many more floods can it survive? How much more erosion can its foundations take? My only hope is that when that day arrives, it will happen during the day, when no one is home.

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शिमला की बस्तियों में सर्वेक्षण करने का अनुभव

शिमला की बस्तियों में सर्वेक्षण करने का अनुभव साहिल कुमार 2021 में, मैंने अपनी ग्यारहवीं और बारहवीं लाल पानी स्कूल, कृष्णा नगर से की थी। मुझे मेरे घरवालों ने बताया था कि किसी के साथ काम से हटके बात नहीं करनी है, और किसी से लड़ाई झगड़ा नहीं करना है। घर के बड़े मानते हैं कि वहां लोग जल्दी लड़ाई झगड़े में उतर आते हैं, पर मेरे साथ स्कूल के दौरान कभी ऐसी कोई घटना नहीं हुई। सितंबर महीने में जब मैंने Urban SHADE प्रोजेक्ट में काम करना शुरू किया, तभी यही धारणा मेरे मन में थी। मेरी टीम का काम था कि घर-घर जाकर सर्वेक्षण करना। हम पूरे सात लोग ये काम पर लगे थे। इस प्रोजेक्ट में काम शुरू करने के बाद, कृष्णा नगर के लोगों और जगह के बारे में मेरी धारणा और अनुभव में आया बदलाव।  हमने Urban SHADE प्रोजेक्ट हिमाचल प्रदेश के शिमला की अनौपचारिक बस्तियों में घरेलू स्तर पर सर्वेक्षण से संबंधित आँकड़े एकत्र करना शुरू किया। हम दो बस्तियों – कृष्णा नगर और ईदगाह कॉलोनी – में काम कर रहे थे। घरेलू सर्वेक्षण का उद्‌देश्य अनौपचारिक बस्तियों में रहने वाले लोगों के स्वास्थय पर पड़ने वाले प्रभावोंऔर कमज़ोरियों को समझना है। साथ ही चरम मौसम की घटनाओं के दौरान और उसके बाद सार्वजनिक स्वास्थय सुविधाओंमें उपलब्धता को भी समझना  है।  यह मेरा पहला काम था। मेरा, शुरुआती अनुभव बिल्कुल ना के बराबर था लेकिन पहले ही दिन से नई चीजों को सिखने पर ध्यान दिया। जब पहले दिन हम अपने क्षेत्रों में पूरी टीम  के साथ गए तो हमने देखा कि कृष्णा नगर में रास्ते सीधे नही है और बहुत सी सीढ़ियाँ है। यहाँ पर लोगों के घर बहुत पास-पास है, और भारी बारिश के दौरान लोगों के घरो के जल निकासी की स्थिती बहुत खराब है। कृष्णा नगर के लोगों का कहना यही था कि बहुत से लोग आते-जाते है और सर्वे कर के चले जाते है। परंतु कोई हमारे लिए कुछ भी नहीं करता।  मैपिंग की समस्याएं हमें ट्रेनिंग के दौरान मैपिंग के बारे में बताया गया। सर्वे के पहले मैपिंग जरूरी थी ताकि कृष्णा नगर की भौगोलिक स्थिति के बारे में और घरों की स्थिति के बारे में अच्छे से पता चले।  दोनों क्षेत्र- कृष्णानगर और ईदगाह पहाड़ी क्षेत्र हैं,और रास्तों में उतार चढ़ाव बहुत है।  मेरे सीनियर्स और टीम मेंबर्स को भी कृष्णा नगर में मैपिंग के दौरान ऊपर नीचे चढ़के थकान का सामना करना पड़ा। हम सोच में पड़ गए कि यहाँ के लोग, विशेष रूप से बुज़ुर्ग लोग, कैसे रोज चलते फिरते होंगे। सर्वे के दौरान हमें बुज़ुर्ग बताते थे कि उन्हें नीचे से कार्ट रोड पहुँचने में बहुत समय  लगता है। बहुत से बुज़ुर्ग डंडा पकड़कर, बीच में बैठ-बैठ कर धीरे-धीरे ऊपर तक पहुँचते हैं। मैपिंग में मुझे कई जरूरी चीजों का ध्यान रखना पड़ता था। कोई घर छूट ना जाए। लोगो से रास्ते को पूछना या कौनसा घर किस से जुड़ा है। कृष्णानगर में पालतू और आवारा कुत्तों का डर बहुत ज्यादा था। हमें डर था कि ये आवारा कुत्ते हमें ही काट न दें। हम लोगों को पूछ कर ही गालियों में जाते थे। जिन घरों में पालतू कुत्ते होते थे वह उन्हें पकड़कर या बांधकर रखते थे। हमने सुरक्षित होकर मैपिंग का काम चालू रखा । मैपिंग में हमें एक ही गली में कई बार आना जाना पड़ता था। शुरुआत में थोड़ी थकान के साथ समय वाला काम लगता था। फिर मुझे इसकी आदत होने लगी। मैंने मैप के  चित्र का  ज्यादातर काम खुद ही किया है। मैप को पहले मोटे तौर पर बनाया और फिर उसे बड़े चार्ट में लैंडमार्क लिखकर तैयार किया।यह काम मुश्किल था क्योंकि  गलीयाँ कहीं न कहीं एक दूसरे से मिलती हैं। इस दौरान, मैं और मेरी टीम घंटों वाल्मीकि मंदिर में बैठकर काम करते थे। वहाँ का माहौल अच्छा था और लोगों को हमारे काम के बारे में जानने में दिलचस्पी थी। मुख्य घरेलू सर्वे की शुरुआत पायलटिंग के दौरान मेरी एक परिवार से बात हुई।  इन लोगों ने 2023 में स्लॉटर हाऊस के हादसे को अपनी आंखों से देखा। उन्होने अपने घर के साथ लगती नालियों और बुरी जल निकासी  (drainage) के बारे में बताया। उन्होंने बारिश के दौरान अपने घर को छोड़ने की स्थिती और अनुभव को मेरे साथ साझा किया।  एक और दुखी परिवार के अनुभव को भी मैने सुना था। उन्होनें कुछ साल पहले नया घर खरीदा था जो कि 2023 के स्लॉटर हाउस क लैंडस्लाइड (landslide)  हादसे में तबाह हो गया।आज उस परिवार को किराए के घर में अपना जीवन यापन करना पड़ रहा है। सर्वे के पहले दिनों में मेरा अनुभव ठीक रहा और लोगो से बात करके अच्छा लग रहा था। सर्वे के तीसरे दिन, जब मैं एक आदमी से सर्वे के सवाल पूछ रहा था, उन्होंने घर के संबंधित सवालों के बारे में बुरा मान लिया। उनका व्यवहार मेरे प्रति बहुत अच्छा था परंतु उनको सर्व के कुछ प्रश्नों से थोड़ी परेशानी थी। उन्होंने  सर्वे रोकने को कहा और उन्होंने मुझे डेटा टैबलेट से मिटाने को भी कहा। कुछ देर के लिए उन्होंने टैबलेट मेरे हाथ से लेकर उसमें कुछ देखने भी लगे। इसके बाद में हमारे टीम के सीनियर ने कृष्णा नगर के वाल्मीकी मंदिर वहाँ के निवासियों के साथ बैठक की । उन्होंने सर्वे के बारे में अच्छे से समझाया। इस बैठक से लोगों को समाधान मिला और सर्वे सामान्य तरीके से चल पड़ा। और उसके बाद वाल्मिकी सभा के लोगों ने हमें सर्वे के लिए और ज्याया प्रोत्साहित किया।  लोगों को दिक्कत व परेशानियाँ लोगो का मेरे प्रति व्यवहार अच्च्छा रहा। लोग जानकारी देने के लिए पूरा समय देते थे और अपने पूर्व प्रभावो को हमारे साथ साझा करते थे। लोग अपनी गंभीर बीमारियों के बारे में भी हमारे साथ जानकारी साझा करते थे। लोगों ने  बताया कि कार्ट रोड तक आने-जाने  से जोड़ों में दर्द होता है।यहाँ का नाला कूड़े से भरा रहता है, और जो लोग नाले के पास रहते हैं वे इससे ज्यादा परेशान रहते हैं। इससे वर्षा के मौसम में समस्या आती है और बीमारियाँ पैदा होती हैं। कृष्णानगर में ऐबुलेंस की सेवा भी ना के बराबर है। मौसम के कारण

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Experiences of co-creating survey with communities facing climate health risks

Experiences of co-creating survey with communities facing climate health risks In late October 2025, the Urban SHADE project in India will start on data collection related to the household level survey in the informal settlements in Shimla in Himachal Pradesh, Vijayawada and Guntur in Andhra Pradesh. The household survey aims to understand health impacts and vulnerabilities of people living in informal settlements, as well as the extent of care available to them in public health facilities during and following extreme weather events. The Urban Shade Project, aims to strengthen  health services for people living in urban informal settlements, to respond to impacts of extreme weather events. The enumerators in both states underwent an extensive training programme in September, which covered the details about the project, ethics of data collection, mapping and use of survey software. The project has involved the community in every step of the way.  The design of the survey tool – Household Survey: Social and Health Vulnerability Assessment related to Extreme Weather Events– was led by a member of the research team, Malini Aisola with extensive inputs from research and field team members. The survey includes social demographic profiles of household members, access to utilities and infrastructure, access to health services, housing, past impact of extreme weather events, people’s perceptions, awareness and responses on extreme weather events. The survey will be conducted in informal settlements in Vijaywada-Guntur, and two informal settlements in Shimla. The two extreme weather events we are looking at in the project are extreme heat and extreme rainfall/flooding.Through the household survey, the team aims to generate context-specific data about a variety of indicators of social and health vulnerability, and provide insights about how they shape experiences of extreme weather events. For example, those living in the poor quality houses, and do informal work may feel the impact of extreme heat more.The survey would enable granular descriptions at the settlement-level of prevailing conditions that could inform government policies and local preparedness planning including provision of health services. Consulting the community on survey tool The Urban SHADE research teams had fortunately worked with some of the settlement sites in the project earlier in another project called Accountability for Informal Urban Equity (ARISE), an action research project focussing on health and wellbeing of sanitation workers. In some other communities, efforts were made to engage with the community in a meaningful way before data collection. In Eidgah colony, a public meeting was organised with support from key stakeholders including the Maulvi of the mosque, the ward councillor, community leaders, an official from National Health Mission and ASHA workers in the settlement.  Anmol Somanchi, a developmental economist and member of the research team in an advisory capacity, helped the team develop a conceptual framework for measuring vulnerabilities. After developing a basic draft with inputs from research and field team members, our team presented it to the members and stakeholders of the settlements in Vijayawada, Guntur and Shimla.  The workshops included residents, community leaders, elected officials, health workers, civil society members of these settlements we are studying in including Krishna Nagar, and Eidgah colony in Shimla, Vambay colony and New Raja Rajeswari Peta (also called RR Peta) in Vijaywada, and Sarada colony in Guntur. The one-day workshop was organised by the research team of Inayat Singh Kakar and Yetika Dolker in Shimla, and Pavani Pendyala and Hemanth Chandu in Vijayawada in May.  Apart from talking about the survey, key questions were read out and displayed in the workshop to the community members to discuss their relevance, the way they are worded, as well how the data could be relevant to the community for advocacy. Community members gave suggestions on improving the questions as options to click to elicit an appropriate answer.  Mahesh aka Shiva who lives in RR Peta gave suggestions to simplify the Telugu questions, making it closer to spoken language rather than very Sanskritised. “In the workshop, you  (Urban SHADE team) asked us whether we were able to understand the language or not, and modified the questionnaire based on the language we were able to understand,” said Mahesh.  The workshop helped the research team to overcome engagement challenges in one of the settlements in Andhra Pradesh who were unfamiliar with the research teams’ work and helped familiarise them with the research. These members helped facilitate community engagement for the researchers. Reena Chauhan, Accredited Social Health Activist or ASHA worker works with the community in Eidgah colony. ASHA workers work closely with the communities and link them up with services in the public health facilities. Asha workers used to conduct government-related surveys.  “For the first time, someone has asked us anything before conducting any kind of survey. Usually we are just asked about our targets related to our work in taking pregnant women for check ups or checking on newborns, or motivating tuberculosis patients to take their medicines,” said Reena Chauhan, ASHA worker in Shimla Taking feedback from the community is in line with participatory action research methodology which this project is committed to. It also adheres to the principle laid down in the Human Rights Approach to Data, that talks about including means for active, and meaningful participation of relevant stakeholders, especially the most marginalised population groups during the entire data collection process including planning before the survey roll outs.  Deciding boundaries of the settlement For the project and particularly for the survey, it was important to determine the boundaries of the settlement- what part of the settlement will be covered for the survey, and what will be left out. The boundaries then determine where the enumerators and researchers 1can move around and conduct the survey.  In Vijayawada and Guntur, there were some areas adjoining the informal settlements where the middle class families lived in visibly well-made houses. The project’s Vijayawada-based researcher, Hemanth Chandu sat with community persons, Madhavi, Kosamma, Mahesh and Shiva in RR Peta and Vambay Colony, Vijayawada and Akkamma and Shiva Parvati in Sarada Colony, Guntur. Of these, Madhavi and Shiva Parvati are community

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