Reflections on Participation and Knowledge-Making as Part of India's National Urban Health Mission Technical Resource Group Recommendation Exercise.

Abstract

India's urbanization, though precipitous, is undirected, random, and opportunistic, shaped more by pressures than by policies. This has resulted in inequitable access to health services and adverse health outcomes for the urban poor. Late 2013 saw the launch of India's National Urban Health Mission, a broad scheme aimed at prioritizing urban health in the country with an emphasis on the poor. Acknowledging both the diversity and complexity of urban poverty across India's cities, a Technical Resource Group was convened by the Ministry of Health and Family Welfare to support the process. We describe the context surrounding this effort and the procedure followed, which entailed in-depth interactions with the urban poor themselves and with officials, health system actors, civil society, and other stakeholders. Even as recommendations were accepted, given the meager allocation for health in the country, only piecemeal implementation is underway. Thus, policy processes are often a dialectic involving shifts that a range of stakeholders may variably resist or embrace. The most important lesson, however, is that it is both feasible and desirable to engage directly with the community, implementers, and researchers and to negotiate and connect their knowledge in the crafting of public policy.