July 2026 – Complus

When communities come together they DEFINITELY WIN!

From Approved to Actual: Parsi Wadi’s Long Road to Water Blog by SPARC Last year, we presented a blog titled “When communities come together, they win”, on the water issue in Parsi Wadi, an informal settlement in Mumbai where COMPLUS has created health committees. The blog described the burden of poor water pressure and inadequacy of water and thewoes that it brought to the community, particularly the women. This was the first issue that the committee wanted to resolve. After a long battle, the issue is now fully resolved! Back to some history, the work on the new waterpipeline in Parsi Wadi began on 27 March 2025. For residents, this felt like the end of a long fight. They had spent years asking the Brihanmumbai Municipal Corporation (BMC) to replace the old pipes. The old pipes gave barely enough water fora day’s needs. The letter of approval had come. The digging had started. But this was not the end of the story. It was the end of one chapter. Getting a pipeline approved is one task. Getting it built, connected to every home, and switched on is another. For Parsi Wadi, this second task took more than a year. Each step caused a lot of skepticism around the achievement , “would we finally have water running with good force and in adequate quantities inside our homes?” Following up on the paperwork Approval did not mean the work would move on its own. Residents had to stay engaged with the Municipal Corporation at every step. The committee met the Ward Disaster Management Assistant Commissioner, Sachin Tarkar, and the Deputy Commissioner. They went through tender documents and technical drawings together. This helped them understand what was still pending. For close to three years in total, residents kept returning to the ward office. They met engineers in the Connection Department again and again. Each time, they were told the file was still in process. The pace picked up only after the local corporator got involved. The committee also kept raising the issue in meeting after meeting. Around ten residents, along with committee members, began meeting connection department engineers directly. Slowly, work on the mainline pipe through the settlement started. Disputes within the community The construction work brought its own problems. Some residents disagreed on where the new lines should run. This disagreement stalled the work for nearly three months. Other residents did not want digging outside their homes. This fear was familiar from Part 1, when nearby localities had worried about broken sewer lines and narrow roads. At one point, tensions rose so much that police protection was needed to continue the mainline work. Through all this, committee members stayed involved. They mediated disputes between neighbours. They kept pressure on contractors. They made sure the work did not quietly stall, the way it had for years before. Pipeline complete, water still not flowing By June 2026, the physical pipeline work was complete. But completed construction did not mean water in the taps. At a meeting on 6 June, officials told residents that supply would start once the remaining paperwork was cleared. The committee kept following up. On 10 June, an engineer from the Connection Department confirmed the pipeline work was done. But the water connection had still not been switched on. Residents went back to the Municipal Corporation again to press for this final step. On 12 June 2026, the Municipal staff came to Parsi Wadi to activate individual household connections. This process brought out problems that had built up over years. Some homes had no water meters at all. Others had unauthorized, tapped connections. These had to be regularised before a proper connection could be given. In one case, an existing connection was disconnected and a penalty was imposed. The matter was resolved later through discussion with the residents. Water has reached Parsi Wadi. The inauguration is still to come. By 29 June 2026, the remaining connection work was complete. Water supply to Parsi Wadi began. It has been more than four years since residents first raised the issue of low water pressure. It has been more than a year since the pipeline work they negotiated for, finally began. Today, water has reached the households of Parsi Wadi. The formal inauguration of the new water connection has not happened yet. It is expected to take place soon, marking official recognition of a negotiation that has lasted years. The Parsi Wadi committee’s efforts paid off, after years or negotiation and painstaking follow up. Women walked to the ward office every fifteen days. Committee members mediated between neighbours who did not always agree. The community did not let an approved project quietly turn into a shelved one. The tap runs now. This is the result of everyone who kept showing up until it did.

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NGOs, Community, and the Public Health System

Authors – Shayari Nag, Sweta Dash and Pushpa V – The George Institute for Global Health The Mahila Arogya Samiti (MAS) platform was envisioned under the National Urban Health Mission (NUHM) as a space for community participation in urban health systems, encouraging urban poor women to become active participants. Policy dictates that these committees be established under the Primary Health Centre (PHC) and involve strong collaboration between the community, the frontline health workers – Accredited Social Health Activist (ASHA), the Medical Officer (MO), and other urban departments. Yet, in practice, the MAS often remains under-supported. ASHAs receive no financial incentive for MAS-related work, and PHC staff are frequently unaware of the platform’s mandate or at times even of their existence and their continued functioning. Even basic procedural elements, such as registration or the release of the ₹5000 fund, are inconsistently implemented and inadequately understood by the stakeholders associated with MAS. In Bengaluru, our team of researchers from TGI has been working in close ties with our community mobilisers and our partner organisations, under the ambit of the COMPLUS project to address these systemic gaps by strengthening collaboration between the community and the public health system. Our experiences from the 17 MAS groups that we have been working with illustrate that the vacuum created by weak institutional engagement required NGOs to provide services, guidance, and facilitation. However, owing to the nuanced nature of community participation in urban health systems, the role of NGOs has not been a straightforward one; instead, it has been proven to be one of a double-edged sword. Filling Systemic Gaps In several MAS areas, NGO-run clinics have emerged as accessible alternatives to overstretched public facilities. Their low-cost consultations, community outreach, and follow-up mechanisms have made them popular, especially among migrant populations facing language barriers and discrimination in government hospitals. For instance, one MAS member explained how the NGO-run clinic works: “First, when we go (to the Clinic), we pay 20 rupees as a fee (where other private practitioners take around 100 – 200 rupees for consultations). They check our BP, height, weight, and blood sugar. Then the doctor asks us what is wrong. If they can solve it, they will give us a prescription for medicine.” These clinics often act as intermediaries, referring patients to higher-level government facilities and ensuring smoother navigation through bureaucratic systems. Our interactions with community members in the MAS meetings as well as our experiences from the 21 IDIs we conducted between July and September of 2025, show that the referrals from the NGO-run clinics typically include a clear diagnosis, medical history, and the specific support required. This information allows the overwhelmed hospitals to allocate time and resources more effectively for the patient’s needs. In some instances, these intermediary roles extend into the internal functioning of hospitals. Community accounts describe specific individuals, such as multilingual reception staff connected to NGOs, who facilitate patient navigation by translating, organizing documents, and guiding patients through administrative processes. These forms of mediation reduce bureaucratic friction and make public institutions more accessible in practice. A significant part of the effectiveness of NGO interventions lies in their community outreach. Local health workers, often referred to as “Akkas,” act as trusted points of contact. Beyond outreach, their role also includes proactive engagement, follow-up visits, and emotional support. Community members approach them with a wide range of concerns, and their responses often extend beyond strictly medical issues. A MAS member said, “No matter what (any problem), they (community members) come and tell Akka.” This “Akka” also reinforces the low-cost benefit of the clinic: “Our Sir has a hospital, go there. Why do you want to waste your money?” This sustained, relational engagement builds trust and reinforces the perceived reliability of NGO-linked services. For vulnerable and marginalised households, especially those navigating precarious social and economic conditions, NGOs bridge critical gaps in access and trust that the public system does not consistently address. Reconfiguring Accountability Yet, this same mediation can subtly weaken the very foundation of community participation. As NGOs become central to service delivery and system navigation, communities begin to rely on them as primary points of contact for healthcare, information, and grievance redressal. This shifts the locus of accountability away from PHCs and ASHAs, altering the intended structure of community participation under MAS. Within MAS meetings, NGO staff often take on facilitative or directive roles that are formally assigned to ASHAs. Their participation, even when informal, influences the direction of discussions. Conversations may be steered toward topics aligned with NGO programmatic priorities rather than emerging organically from community concerns, thereby creating a top-down dynamic into what is intended to be a participatory platform. Instances from our field observations in MAS meetings illustrate how this dynamic operates. Discussions raised by community members can be curtailed or redirected if they fall outside the thematic focus of NGO activities. We have heard statements such as “Oh no, this is not the right meeting for this conversation. We talk about contraception in our NGO health meeting next week.” In such cases, the boundaries of what can be discussed are not determined the needs articulated within the group. Additionally, when community concerns are dismissed or addressed in a manner perceived as condescending, the space ceases to function as a forum for collective problem-solving. For instance, the MAS members wanted to seek a peaceful solution to the issue of the Aanganwadi worker sending their children back home since the children were not able to clean up after themselves. In response, the worker from the NGO promptly reprimanded them and said they should have worked better to teach their children to clean up. In doing so, she did highlight the overburden of the Aanganwadi workers, but her tone left the community members feeling unheard and ignored. Such exchanges can silence participants and discourage the articulation of concerns. Concerns also emerge regarding the quality and accuracy of information disseminated by NGO field staff. In the absence of supervision and/or standardised training, some health advice shared during MAS meetings

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