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Bogotá’s location is in many ways privileged, with mild temperatures and 12 hours of daylight year-round. This location, however, also entails risks: it is a seismic area, and torrential rains can result in serious flooding. The “Niña” weather pattern creates especially dangerous conditions, like the 2010-2011 period when much of the city was left under water – especially, although not only – in the poorer neighborhoods. Read more.

La ubicación geográfica de Bogotá es en muchos aspectos privilegiada. El clima es suave, con temperaturas medias agradables que hacen innecesario el uso de la calefacción o el aire acondicionado. Sin embargo, también encierra amenazas: es una zona sísmica, y las lluvias pueden ser torrenciales, generando inundaciones. Durante el fenómeno de “La Niña” la pluviosidad se dispara, y en el periodo 2010-2011 se desbordó el río Bogotá dejando grandes zonas de la ciudad bajo el agua. Leer más.

Submitted by Jorge Bela — Tue, 03/25/2014 – 00:00

Medellin has undergone a profound transformation. While two decades ago it was a city known for violence, lack of social services and inequality, now it has become a model for all Latin American cities on how to tackle these problems. Urbanism, although not the only factor, has played a crucial role in this process. In Medellin, urban reforms became closely associated with the search for solutions for social problems. They also had a strong pedagogical ambition. Read more.

Medellín ha experimentado una profunda transformación: en a penas dos décadas ha pasado de ser una ciudad castigada por la violencia, la escasez de servicios sociales y la desigualdad, a convertirse en un modelo para toda América Latina de cómo combatir éstos graves problemas. Leer más.

Submitted by Jorge Bela — Sat, 03/01/2014 – 10:22

El agua de Bogotá es potable y deliciosa, algo excepcional en las grandes ciudades de América latina. Esto se debe a su proximidad a abundantes fuentes de agua, especialmente los páramos de Chingaza y Sumapaz, y a una buena gestión del recurso. La mayor parte del agua consumida actualmente proviene de la represa de Chingaza, ubicada a unos 50 kilómetros de Bogotá. Sin embargo, la misma proximidad de la mega urbe supone un riesgo para los frágiles ecosistemas de los páramos: Sumapaz comienza en el mismo término municipal de la capital. Aunque la capacidad de suministro actual se estima suficiente a medio plazo, a largo plazo será necesario construir nuevas represas y canalizaciones, proyectos técnicamente complejos y que probablemente generarán fuertes controversias por su impacto ambiental. Leer más o discutir.

Tap water in Bogota is safe to drink, something that is unusual in most large Latin American cities. This is due to the proximity of vast water sources, in particular the Chingaza and Sumapaz paramos (a particular ecosystem that exists in the Andean highlands), and to good management of the water supply. Most of the water comes from the Chingaza reservoir, located less than 50km from Bogotá. However, this proximity, although beneficial to the mega-city, implies serious threats to the fragile paramo ecosystems. Sumapaz, for example, starts within Bogotá’s city limits and can be reached by urban buses. Although the current infrastructure brings enough capacity for the medium term, long-term demands will require the building of new dams and pipelines. These projects are technically complex and their environmental impact makes them politically difficult. Read more or join the discussion.

Submitted by Jorge Bela — Mon, 02/10/2014 – 00:00

Hay muchas cosas positivas que esperar para el año 2014 en Colombia. Se prevé que el crecimiento económico siga siendo vigoroso, al tiempo que las conversaciones de paz pueden acabar con un conflicto armado que ha durado ya varias décadas. Estas circunstancias presentan un escenario sin precedente para aliviar los problemas de pobreza y desigualdad que sufre el país. Bogotá y Cali, las dos ciudades que seguimos en este blog, tienen iniciativas en marcha que pueden ofrecer soluciones concretas a estos dos problemas. Sin embargo, la incertidumbre es también elevada, tanto a nivel nacional como local. Por un lado, los resultados de las conversaciones son inciertos. Por otro, las elecciones presidenciales que se celebrarán en su primera vuelta en mayo también resultarán en una ralentización de la administración central. Aunque se espera que Juan Manuel Santos ganes la reelección, cualquier cosa puede suceder en la política colombiana, y un cambio en la presidencia puede decelerar aún más el ritmo de las reformas. Leer más o discutir.

There is much to look forward in 2014 in Colombia. Economic growth is expected to remain strong, and the decades-old armed conflict could be close to its end if the peace conversations now underway are ultimately successful. These circumstances bring an unprecedented opportunity for the country to tackle poverty and rampant inequality. Bogotá and Cali, the two Colombian cities covered on this platform, are working on major initiatives that could have a significant impact on these fronts. However, uncertainty is also quite high, both at the national and local levels. For one, the results of the peace conversations are far from certain. Furthermore, Presidential elections, to be held in mid-year, imply a slowdown of central government activity for most of the year. Although Juan Manuel Santos is expected to win re-election handily, anything can happen in Colombian politics, and a change at the top would also bring the processes of reform to a temporary halt. Read more or join the discussion.

Submitted by Jorge Bela — Mon, 01/06/2014 – 00:00

Colombia no ha escapado del castigo del HIV. Según datos del Sistema de Vigilancia Epidemiológica (SIVIGILA), al que deben ser reportados todos los casos identificados, desde el año 1983 hasta el 2011, último del que se disponen datos completos, se conocen 86.990 casos de HIV/Sida, de los cuales 10.676 han fallecido. En Bogotá se han detectado hasta septiembre del 2013 23.330 casos, un 40 por ciento del total a nivel nacional. Sin embargo, es importante destacar que esto se debe a su elevada población, como lo ilustra que en el 2011 se reportaron 8,7 casos por 100.000 habitantes, mientras 8 departamentos superaban 20 casos por 100.000 habitantes, y los dos en cabeza, Barranquilla y Quindío superaban 30. Leer más o discutir.

Colombia has not escaped the devastating consequences of the AIDS epidemic. According to the Sistema de Vigilancia Epidemiológica (Epidemiology Watch Service, SIVIGILA), there have been 86,990 cases of diagnosed HIV/AIDS from 1983 and 2011, and 10,676 fatalities (reporting HIV/AIDS diagnosis to the SIVIGILA is mandatory). Bogotá registered 23,300 cases from 1983 to September 2013, which is 40 percent of the national total. However, this is due more to the large population of the Colombian capital rather than high rates of infection, as the region recorded only 8.7 cases per 100,000 inhabitants, while eight other departments recorded over 20 cases per 100,000 inhabitants, and two of them, Barranquilla and Quindío, reported over 30 cases per 100,000 inhabitants. Read more or join the discussion.

Submitted by Jorge Bela — Mon, 12/02/2013 – 00:00

Uno de los principales frenos al desarrollo de los asentamientos irregulares es la falta de títulos de propiedad por parte de sus ocupantes. En Colombia, donde los conflictos armados que se prolongan desde hace décadas han sumado un número significativo de desplazados por la violencia a los flujos migratorios observados en toda Latinoamérica, este problema tiene una especial gravedad. Para atajar este problema en el año 2005 se aprobó una ley que permitía la transferencia gratuita de predios fiscales, o de titularidad pública, que hubieran sido ocupados antes de 2001. El alcance de esta ley deja fuera del proyecto de titulación a los asentamientos edificados sobre predios de propiedad privada. Leer más o discutir.

Lack of property titles is one of the most significant barriers to development and poverty reduction in informal settlements. This problem is particularly serious in Colombia, where people displaced by several decades of armed conflict have joined the large number of immigrants for economic reasons in creating the largest number of informal settlements in Latin America. A law enacted in 2005 sought to tackle, at least partially, this problem by allowing for free transfer of property to informal residents. The scope of the law was limited to settlements established on public land before 2001, thus excluding all settlements on private land. Read more or join the discussion.

Submitted by Jorge Bela — Mon, 10/21/2013 – 00:00

La situación de los habitantes de la calle se considera como uno de los problemas más complicados de resolver en las grandes ciudades latinoamericanas. Según un censo elaborado en 2011 por la Secretaría de Integración Social (SIS), en Bogotá se identificaron 8.385 habitantes de calle, un 86.9 por ciento de los cuales son hombres, y el 8.4 por ciento son menores de 18 años. El 17.9 por ciento son jóvenes entre 19 y 25 años, y el 38.9 por ciento son adultos entre 26 y 40 , quedando un 32 por ciento, de adultos mayores. Otro dato interesante de este sondeo es que el 58 por ciento se dedica a la recolección de objetos de reciclaje, el 34 por ciento a mendigar, el 28 por ciento a servicios no cualificados y el 10.7 por ciento a delinquir. Aunque es posible que estas cifras no recojan el número total de habitantes de la calle, quizá en una proporción considerable, sí que son reveladores en su estructura demográfica y en sus ocupaciones. Leer más o discutir.

Homelessness is one of the most complex and difficult to address problems in all large Latin American cities. A census led in 2011 by the Secretaría de Integración Social (SIS), found 8,385 homeless people in Bogotá. Of those, 86 percent were male. 8.4 percent were under 18 years old, 17.9 percent between 19 and 25, 38 percent between 26 and 40, and 32 percent were older than 40. As for their occupation, 58 percent were garbage recyclers, 34 percent begged, and 10.7 percent stole and robbed as a form of living. Although it is almost certain that this survey did not register much of the homeless population, it is still quite revealing regarding the population’s demographics and occupation. Read more or join the discussion.

Submitted by Jorge Bela — Mon, 10/07/2013 – 00:00

Bogotá ha ganado el premio a liderazgo urbano en su categoría de transporte. Los premios, de los cuales este año se celebra su primera edición, son otorgados por el grupo C40 y por Siemens, a través de su fundación Crystal. El premio de liderazgo en transporte busca identificar proyectos o iniciativas que mejoren la situación medioambiental, medidos en términos de fomento de cambio en los modos de transporte y de la reducción de la emisión de gases causantes del efecto invernadero. Leer más o discutir.

Bogotá just won the City Climate Leadership Award for transportation. The award, still on its first edition, is sponsored by the C40 group and Siemens, through its Crystal Initiative. The leadership award in transportation seeks to identify projects or initiatives aimed at improving the environmental quality of the cities for which they are intended. The methodology used to measure such improvement is based on modal shift or the reduction of greenhouse gases (GHG). Read more or join the discussion.

Submitted by Jorge Bela — Mon, 09/30/2013 – 00:00

La concesión de subsidios a las poblaciones más desfavorecidas, sobre todo en el ámbito de los servicios públicos, es un mecanismo ampliamente utilizado en América latina para combatir la fuerte desigualdad social. En Colombia se ha utilizado un mecanismo singular: la división de las ciudades en estratos. Esta idea, que se empezó a considerar en los años 80, se comenzó a aplicar en las grandes ciudades a partir de la aprobación en 1994 de la ley de Servicios Públicos. Aunque el marco legal es estatal, las ciudades tienen un amplio margen a la hora de escoger los criterios concretos para determinar la estratificación dentro de sus perímetros urbanos. Bogotá se dividió en 6 estratos, el máximo permitido por la ley. El estrato 6 refleja un mayor poder adquisitivo, y el 1 el menor poder adquisitivo de la ciudad. Los residentes de los estratos 5 y 6 pagan una sobretasa en los servicios públicos, que se utiliza para subsidiar, de forma decreciente, los costes de los servicios para los residentes en estratos 1 a 3. En el estrato 4 los residentes pagan el precio real de los servicios. También se aplica una sobretasa si se supera un volumen máximo establecido. Leer más o discutir.

Subsidies are one of the most widely used tools in the fight against social inequality in Latin America. Utilities are often subsidized in one way or another. Colombia adopted a unique formula for the distribution of subsidies: the official stratification of housing. Under this system cities are legally divided in different layers or estratos (strata, in a literal translation). This idea originated in the 1980s, and was implemented with the enactment of the 1994 Ley de Servicios Publicos (a law regulating the utilities in Colombia). Under this law cities have considerable say in determining the specific criteria by which stratification is implemented. Bogotá was divided into six different layers, the maximum number allowed by law. Layer 6 represents the wealthiest areas in the city, while layer 1 represents the poorest sectors. Under the system, residents in layers 5 and 6 pay a surcharge in their utilities bill. This surcharge is used directly to subsidize the utilities to residents of layers 1, 2 and 3. Residents in layer 4 areas pay the real cost of the services. There is also a surcharge for heavy users of resources, to be paid once they reach their monthly maximum allowance. Read more or join the discussion.

Submitted by Jorge Bela — Mon, 09/23/2013 – 00:00

Bogota’s historic center is spectacular. Beautiful and surprisingly well-preserved colonial buildings flank the narrow, cobbled streets. At the end of the steep ascent one can see the Cerros Orientales, the imposing mountains that rise abruptly 600 meters above the city. This sight is unusual in a city that, despite being located in the Andean range, tends to focus its attention on the flat savanna where most of its urban sprawl is located. Unfortunately, the historic district has suffered from gradual but steady decay during the last few decades. The main colonial and republican landmark buildings are generally well maintained, but most of the area suffers from problems such as severe lack of economic development, crime, near total lack of green spaces, degradation of low-income homes, and strong social inequality. Read more or join the discussion.

Submitted by Jorge Bela — Mon, 09/09/2013 – 00:00

Carlin Carr, Bangalore Community Manager

The AIDS crisis continues to loom large in India, with more than 2.5 million people infected with HIV. The country has taken steps toward addressing the issue, including launching a National AIDS Control Program. Still, the virus has taken the lives of millions of mothers and fathers, and UNICEF estimates that there could be as many as 4 million children affected in India, including those living with HIV — estimated to number nearly 100,000 — those orphaned by AIDS, and those whose parents are living with HIV.

Critics say that there has been a major lapse in the focus on children in addressing HIV/AIDS. An article in the journal Lancet says that while the National AIDS Control Program places special emphasis on “medical treatment and after care, access to schooling, and adequate nutrition, government interventions for AIDS orphans are conspicuous by their absence in any area other than pediatric ART.” Children often drop out of school to care for their sick family members, and if they are orphaned, they often face severe social stigmas against them.

In the absence of comprehensive government interventions, NGOs and civil society have stepped in to address the needs of, and care for, these children. Milana, a Bangalore-based organization, provides support for people living with HIV in the city, many of whom are children. In the Lancet article, Jyothi Kiran, founder of Milana, says, “Children are the worst affected by the problems that HIV brings with it. They suffer severe stigma and neglect and are very often abandoned. Orphaned children are denied even basic necessities like food and nutrition by their extended families. If they are themselves HIV-positive, the situation becomes worse and their very existence is threatened.”

Milana gives families and children a safe and supportive meeting place to share information, learn how to access proper care, and discuss the difficulties of living with the virus. Classes and sessions on nutrition are also given to help affected clients live healthier lives with the challenges they face. Children who have tested positive for HIV are often malnourished and underweight.

One of the biggest unmet challenges is lack of shelter for AIDS orphans. In Bangalore, another NGO, ACCEPT, runs a 35-bed facility for HIV-positive patients as well as a separate home for orphans. Eighteen children stay at the home with two full-time care staff, a teacher, and other counseling and support. All the children attend the local school — a big step, given that even the schools often discriminate against these children.

While NGOs such as Milana and ACCEPT address one of the most devastating gaps in the fight against AIDS, so much more needs to be done. These children deserve the right to appropriate care as well as to all the necessary services and support so they can live happy and healthy lives free of stigma and judgment.

Photo credit: Lydur Skulason

• Lagos
• Nairobi
• Mumbai
• Jakarta
• Mexico City
• Rio
• Dhaka

Olatawura Ladipo-Ajayi, Lagos Community Manager

The lack of access to health care information, such as treatment options and preventative measures, as well as the dearth of affordable treatment relevant to the urban poor have been the focal points of the Lagos State Government’s awareness programs. It has been ascertained that some of the health information issues arise due to insufficient communication channels, or the use of inappropriate channels for target audiences. For example, television commercials tend to be ineffective, as most urban poor do not have access to such devices, and general illiteracy levels are high. With information materials usually in English, the message is lost on the majority of the populace that need it.

In an effort to increase knowledge about health care, the state government devised an awareness program which includes campaigns in Local Government Areas (LGAs) of Lagos state, which are geared towards arming the poor with health care information for common ailments. The program’s approach is to segment the market, focusing awareness efforts on each of the prominent ailments and targeting groups (students, women, etc.) with relevant information. Because it’s a targeted campaign, information is provided in dialects common amongst the urban poor, such as “Pidgin English” and Yoruba. Radio jingles, print materials, and billboards are also used, since the radio is more readily available to the urban poor and billboards more visible. The State Ministry of Health often plans events that provide health care information, like a “health week,” and informational visits in schools. Although information about reach is not readily provided, it seems that these various awareness programs are helping to ensure that health care options are made available to the public.

One of these programs includes the Eko Free Malaria Program. According to the State government, malaria is responsible for 70 percent of out-patient visits, 15 percent of hospital admissions, and 20 to 30 percent of deaths in children under five. The Eko Free Malaria Program is a free health program which disseminates information on treatment options and preventative measures. The program distributes free malaria drugs, and print information on preventative measures in local communities, schools, and facilities.

The State’s breast cancer awareness program was established in response to increasing numbers of late-stage cancer patients reported at hospitals, due to lack of awareness and information on available treatment options. The program propagates information through educational lectures and the regular distribution of communication materials through grassroots mobilization efforts in Local Government Areas within the State and on a senatorial basis (Lagos West, Lagos East, etc.) and divisional basis (Agege, Ikorodu, etc.), ensuring a wider reach. The program also includes referrals to hospitals for screenings, wellness talks, and aggressive television and radio campaigns on cancer in relevant dialects and languages. This initiative also makes use of communal activities, like watching informational videos on breast self-examination, screenings, and counselling. Such sessions are also held with existing groups, like associations, churches, and societies. A total of 12,693 women have already benefited from the screening program.

The campaigns implemented by the current government are aimed at removing the barriers to information that exist amongst the urban poor, and at increasing awareness of health care options. The hope is that these efforts continue to yield fruit as more people take advantage of them, and a decrease in ailments is recorded.

Submitted by Editor — Mon, 04/08/2013 – 00:00

Katy Fentress, Nairobi Community Manager

On the 27th of May 2012, the Kenyan LGBT news agency Identity reported that two men were caught having sex in the night in Kayole, a north Nairobi slum. According to the article, the men were attacked and stoned. One of them got away, but the other succumbed to his injuries; his body was later found at a dumpsite near where he had been caught.

The incident highlights a difficult reality for Men who have Sex with Men (MSM) living in Nairobi slums. Sleeping in cramped quarters, with privacy a luxury that few can afford, and forced to conceal their sexual identity for fear of repercussions, MSM hide in the shadows and often lack access to the medical services the rest of the population enjoys.

Homosexuality is illegal in Kenya, and people caught in the act can face up to 14 years in jail. That said, Nairobi is one of the better places in the region for LGBT people to live their lives. There are few cases of people actually ending up in court, and a number of NGOs and community organisations work for gay rights, advocacy, and outreach.

In September 2011 the LGBT group Gay Kenya hosted the first Gay Film festival; an openly gay candidate almost ran in the recent elections, the country hosts LGBT awards and the media is open to some amount of debate on the issue – which is more that can be said about most of Kenya’s neighbouring countries. Nevertheless, there remains the challenge of how to get important health information and services to gay men who do not have the benefit of being educated and computer literate.

According to a report by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR): “MSM in low- and middle-income countries are on average 19 times more likely to be infected with HIV than the general population”. Ignorance as to how HIV is contracted is one of the main causes for such a high prevalence of infection.

In Kenya, the stigma attached to being open about one’s sexual orientation extends to talking about sex in general. So in what way does essential health-related information for MSM find its way to the heart of the slums? How do men, some of whom may have come straight from the rural areas and know little about STI and HIV transmission, become informed?

“It is definitely a challenge,” says Wyclif Abasi (not his real name), Health and Program Officer at Ishtar, an organisation that has been offering consultation and outreach to MSM in Kenya since 1997. “We cannot just walk into slums and distribute safe sex information, condoms and condom compatible lubricants to MSM… we would be putting ourselves at incredible risk; anyway, I doubt anyone would come forward for fear of being singled out.”

The solution, says Abasi, comes in the form of informal networks through which information can be passed along and which hopefully reaches the most vulnerable of MSM: sex workers.

“MSM in slums have meeting points and develop support networks,” Abasi tells us. “Through these and a combination of SMS messaging and peer education and other outreach activity, we aim to inform men about health-related issues.”

Abasi explains that nightclubs are the main places where MSM meet, and that it is here that peer educators share important health-related knowledge and advise people to visit VCT (voluntary counselling and testing) centres. Ishtar has free drop-in centres where, he tells us, they offer free medication sponsored by the Liverpool VCT, SASA centres run by Ishtar in partnership with other local organizations.

When it comes to medical services, Nairobi boasts a number of centres that treat MSM without questions or stigmatization. According to Abasi, Kenyatta hospital (one of the main hospitals in the city) is one of these, a significant step in a country in which same sex relationships are technically illegal.

“As long as the criminalization of MSM continues to be prevalent,” Abasi concludes, “it will remain an impediment towards successfully tackling the spread of HIV/AIDS in Nairobi and beyond. To get the message out, we need to be free to step up our advocacy and sensitization efforts and create more awareness amongst MSM and society at large.”

Submitted by Katy Fentress — Mon, 04/08/2013 – 00:00

Carlin Carr, Mumbai Community Manager

Millions of people across the globe die of tuberculosis each year. Tragically, nearly all of these cases could have been cured. The public health threat hits hardest in the developing world, where 98 percent of TB deaths occur. Even short of death, the illness takes a massive toll, especially on the livelihoods of the poor: a TB patient loses three to four months of work, equivalent to 20-30 percent of a family’s annual income, and is most prevalent among the “working age” group, ages 15-54. Perhaps most unfortunate is the fact that a cost-effective strategy, DOTS (Directly Observed Treatment, Short-course), has been available for years, yet its promise remains unfulfilled. In Mumbai, the government has gone so far as to make treatments available for free. Yet TB continues to affect the city’s poor and vulnerable. For Mumbai’s progressive program to have a greater impact, it will need to be accompanied by a comprehensive awareness campaign that targets not only the public, but care providers as well.

Public awareness campaigns

The most widely known public campaign against TB is on the back of Mumbai’s ubiquitous rickshaws. Bumper stickers plastered across the back of thousands of the black-and-yellow three-wheelers declare: “Don’t Spit! Spitting spreads TB!” and “TB is Curable. Use DOTS.” However, the discovery of TB cases starts with making pharmacists more aware of the symptoms, detection processes, and free treatment options. An article in the Hindustan Times for World TB Day on March 24 said that infected persons will often visit a pharmacist and ask for cough medicine, not knowing that they could potentially have something much more serious. If pharmacists are not trained to detect potential TB cases, then patients will receive the wrong treatment, increasing their risk of spreading the disease (an untreated TB patient will infect, on average, 10 to 15 people per year) and putting the infected person at risk of death.

In a ground-breaking public-private partnership (PPP) program launched in 2006, the Indian Pharmaceutical Association (IPA) collaborated with local chemists in Mumbai under a program called Lilli MDR TB Partnership. The program trains chemists in detecting TB cases and referring patients to local clinics. The program is now being adopted by the Union Health Ministry’s Central TB Division, elevating the initiative to the national level. In order to carry it out across Indian cities, the IPA has created a training manual for community pharmacists.

While the pharmacist awareness campaign has shown great promise, public awareness needs to be raised beyond what can be achieved with bumper stickers. Operation ASHA, a Delhi-based organization, uses local community members to raise awareness in their own communities, mostly slums in northern Indian cities. The organization runs clinics in community shops and temples and keeps them open for long hours. Most importantly, they recruit trusted community members to act as counselors, spreading messages about TB and walking patients through the treatment process.

Who’s being left out?

Local engagement can be a very effective approach to working with communities at risk of TB. In addition to leading to more effective outreach, support services, and follow-up, communities “may also be able to influence national policy and help leverage more support for health systems and TB services,” says a report on TB. While these on-the-ground systems work well in slums, they may still leave out the most marginalized populations, such as people living with HIV, drug users, or those in prison — all of whom face a high risk of TB. Given the highly contagious nature of TB, Mumbai’s no-cost drug initiative can only work on a widespread level if all populations are targeted in the campaign. Otherwise, even programs with the best of intentions will continue to fall short.

Submitted by Carlin Carr — Mon, 04/08/2013 – 00:00

Widya Anggraini, Jakarta Community Manager

Encouraging communities to engage in healthier habits is vital to creatating more livable cities. In Jakarta, a variety of different dissemination techniques exist, starting with the Ministry of Health’s online “Clean and Healthy Living” campaign. Within the private sector, the “1000 Hygienic Toilets” and “21 Handwashing Days” initiatives both encourage hygiene and cleanliness habits in schools. Another important dissemination strategy is to empower existing local community health centers to reach out to the urban poor — for example, through movie screenings followed by a dialogue on effective health and hygiene practices.

Perilaku hidup sehat dan bersih di kota besar seperti Jakarta memang belum sepenuhnya menjadi kebiasaan. Orang masih suka membuang sampah disembarang tempati, mencuci di sungai, makan makanan tidak sehat, buang air besar di sungai dan perilaku tidak sehat lainnya yang cenderung mengundang penyakit dan mengotori lingkungan. Contohnya adalah kebersihan sanitasi yang kurang terutama di daerah-daerah miskin. Jumlah penduduk yang terus bertambah tidak diiringi dengan tersedianya sanitasi yang memadai mengakibatkan munculnya beragam penyakit seperti diare, disentri, hepatitis A dan lain sebagainya. Untuk itu perilaku hidup sehat dan bersih harus secara terus menerus disosialisasikan kepada masyarakat.

Perilaku Hidup Bersih dan Sehat pada dasarnya merupakan gerakan bersama sebagai upaya pemberdayaan anggota rumah tangga agar sadar, mau dan mampu berperilaku hidup sehat, dengan demikian anggota keluarga menjadi sehat dan masyarakat bisa hidup lebih tertib dan terjaga lingkungannya. Advokasi hidup sehat telah dilakukan oleh pemerintah melalui Kementerian Kesehatan Republik Indonesia secara online untuk memudahkan masyarakt mengakses apa dan bagaimana untuk hidup sehat.

Pihak swasta juga juga dengan aktif melaksanakan sosialisasi pola hidup bersih dan sehat seperti yang ditunjukkan oleh Pt. Unilever Indonesia melalui dicanangkannya Gerakan 1000 Toilet Higienis di sekolah-sekolah termasuk di Jakarta. Gerakan ini berawal dari keprihatian melihat kondisi toilet yang kotor dan masih rendahnya kesadaran untuk menjaga kebersihan toilet. Program edukasi dan sosialisasi toilet sehat ini juga memberikan Training untuk guru, siswa dan orangtua akan pentingnya hidup sehat. Selain itu, juga diberikan booklet dan komik edukasi agar memudahkan anak mencerna pesan menjaga hidup sehat dan kebersihan toilet dalam buku tersebut. Pt Unilever juga mengadvokasi murid dan komunitas sekolah melalui Gerakan 21 Hari Cuci Tangan dengan harapan mereka akan terbiasa mencuci tangan menggunakan sabun sebelum dan sesudah makan serta setelah dari toilet sebagai langkah preventif mencegah masuknya kuman. Dilakukan selama 21 hari sebab mencuci tangan harus dilakukan secara terus-menerus untuk menciptakan kebiasaan. Minggu pertama adalah masa pengenalan dan informasi, minggu kedua adalah menciptakan kesadaran dan minggu ketiga adalah masa pembentukan kebiasaan.

Salah satu metode yang juga efektif untuk meningkatkan jangkauan sosialisasi dan advokasi hidup sehat adalah dengan memberdayakan puskesmas yang merupakan ujung tombak pelayanan kesehatan masyarakat yang terpadu dan menyeluruh. Akses dan tarif puskesmas yang terjangkau menjadi pilihan utama bagi penduduk miskin Jakarta. Dengan jaringan puskesmas yang tersedia di setiap kecamatan dan Puskesmas Pembantu (Pustu) di setiap desa serta keberadaan Puskesmas Keliling, Pondok Bersalin Desa dan Posyandu maka pada dasarnya untuk menjangkau masyarakat miskin kota dalam hal sosialisasi hidup sehat adalah bukan perkara sulit. Hingga kini jumlah puskesmas di DKI Jakarta mencapai 340 dan posyandu sebanyak 4.237 pos. Potensi besar ini harus dimanfaatkan seperti yang dilakukan oleh Posyandu Melati di Mampang Prapatan, Jakarta Selatan bersama Tim Penggerak Pemberdayaan Kesejahteraan Keluarga (TP PKK) DKI Jakarta. Kegiatan edukasi dan sosialisasi diramaikan oleh para artis pemeran film Tanah Air Beta, hal ini sesuai dengan tema Gebyar Posyandu Tanah Air Beta Bersih dan Sehat. Pemutaran film dilanjutkan dengan sosialisasi dan dialog langsung oleh para pemeran film tersebut kepada sekitar 300 pengunjung. Kegiatan penyuluhan menggunakan metode audio visual dirasakan cukup efektif dan diharapkan kegiatan tersebut dapat direplikasi oleh posyandu maupun puskesmas lain di wilayah Jakarta. Puskesmas Melati juga secara aktif mendatangi masyarakat secara periodik untuk memberikan penyuluhan, kunjungan dan pembinaan kesehatan lingkungan masyarakat.

Submitted by widya anggraini — Mon, 04/08/2013 – 00:00

María Fernanda Carvallo, Mexico City Community Manager

El cáncer de mama (CaMa) es el tumor maligno más frecuente en el mundo; de acuerdo a la Fundación del Cáncer de Mama (FUCAM), en México este padecimiento es la segunda causa de muerte. La Fundación Tómatelo a Pecho afirma que la tasa de mortalidad ha aumentado en los últimos cincuenta años; en el año 2012, 130 mil mujeres lo habían vivido.

El CaMa se encuentra relacionado estrechamente con el envejecimiento de la población y con mayor prevalencia de factores de riesgo en las mujeres, entre ellos la residencia en zonas urbanas. Así mismo, la pobreza es otro de los factores que inciden, debido a la falta de acceso a los servicios de salud y programas de prevención.

Una de las problemáticas del CaMa es la detección oportuna, pues bien un alto porcentaje de mujeres que lo padecen son diagnosticadas en etapas avanzadas, con probabilidades de curación de sólo 35 por ciento y la muerte del 65 por ciento de los pacientes. Esto se debe a la falta de información oportuna, un bajo nivel cultural de la población y la falta de recursos técnicos para efectuar estudios de prevención con mastografía a las mujeres en riesgo. Ante esta situación, el método de elección para hacer un diagnóstico oportuno de CaMa es a través de un tamizaje, llamado “pesquisa”, por medio de la mastografía en el grupo de mujeres sanas mayores de 40 años.

En este contexto, la Asociación Civil FUCAM busca fomentar la educación sobre detección oportuna del cáncer de mama, en especial en los grupos socio-económicos más desprotegidos y marginados de México, así como procurar diagnóstico, tratamiento especializado, seguimiento e investigación del cáncer de mama. Para ello se implementa un programa que consiste en realizar mastografías en unidades móviles que se acercan al lugar de trabajo o de vivienda de las mujeres. En especial a zonas de bajos recursos y marginadas para ofrecer la oportunidad de hacerse este estudio, lograr detecciones oportunas y hacer conciencia sobre la importancia de este padecimiento y de su detección oportuna.

Un proyecto piloto de FUCAM para la pesquisa mastográfica en el 2005-2006 fue financiado por el Gobierno del Distrito Federal para la adquisición de 6 unidades móviles. Este programa demostró que fue posible diagnosticar casos de cáncer en un 75 por ciento en etapas tempranas; con lo que es posible afirmar que se puede disminuir la tasa de mortalidad por CaMa en México, a través de la continuidad de estos programas. Para la continuidad de la operación de la pesquisa mastográfica, FUCAM recibe donativos de socios y patrocinadores del sector privado.

Por su parte, la Secretaría de Salud del Gobierno del Distrito Federal también implementa programas de tamizaje mastográfico así como estudios de laboratorio, a través de unidades médicas móviles llamadas, “Medibuses” en las zonas conurbadas y con índices de alta marginación. Cuando en los Medibuses se detectan padecimientos crónico-degenerativos, metabólicos o evidencias diagnósticas de cáncer, como lesiones sospechosas o tumoraciones, las personas son canalizadas a los niveles de atención médica de alta especialidad en hospitales dependientes de los gobiernos local o federal.

Estos programas de prevención “a domicilio” contribuyen a que la población en condiciones de pobreza y marginación tenga acceso a servicios de salud preventivos y de detección oportuna; sin embargo debe de ir acompañado de estrategias que garanticen la adherencia de las mujeres en estudios de prevención anuales. En este sentido, es importante destacar la reflexión del Seminario “El ejercicio actual de la medicina, Cáncer de Mama” de la Facultad de Medicina de la UNAM, la cual afirma que desde una perspectiva de salud pública, la disminución de la prevalencia de factores de riesgo implicados en la causalidad del cáncer, puede tener un impacto significativo en la disminución de la morbilidad y la mortalidad. En fin, se deben incluirse campañas de comunicación y educación a la población que favorezcan hábitos de vida saludables para reducir dichos riesgos.

María Fernanda Carvallo, Mexico City Community Manager

Breast cancer is the most common malignant tumor in the world. According to la Fundación del Cáncer de Mama (FUCAM) (the Breast Cancer Foundation), breast cancer is the number two cause of death in Mexico. The Fundación Tómatelo a Pecho (Take It to Heart) attests that the mortality rate has increased in the last fifty years. It is believed that by 2012, 130,000 women had experienced breast cancer.

Breast cancer is closely related to the aging of the population; however, women who live in poor urban areas have a higher risk of getting breast cancer. Poverty has an influence on contracting breast cancer — this is due to the lack of access to health services and prevention programs.

One of the main issues when it comes to breast cancer is early detection. There are a high percentage of women who are diagnosed in advanced stages of the disease, only to be faced with a 35 percent chance of survival. Late detection of breast cancer is caused by a lack of information and cultural development, as well as the lack of technological resources to carry out prevention methods like mammograms to women at risk. In situations like such, the selected method for early detection of breast cancer is through a screening called a pesquisa (inquiry) for healthy women over 40 years old.

The Civil Association FUCAM aims to promote early detection education of breast cancer. There is an emphasis on educating socio-economic groups that have been forgotten and are marginalized in Mexico to assure a diagnosis of the disease, specialized treatment, follow-ups and continued investigation of breast cancer. FUCAM has implemented a program that consists on making mammograms in mobile units stationed near places of work and homes in marginalized and low-income areas. This opportunity given to women aims to detect breast cancer at an early stage, to create awareness about the importance of the disease, and to provide the benefits of detecting it early.

FUCAM launched a pilot project from 2005 to 2006 financed by the Federal District Government in order to expand the mammogram inquiry method by purchasing six mobile units. This project was able to show that it was possible to diagnose breast cancer cases in early stages in 75 percent of cases; additionally, this showed the possibility to diminish the mortality rate for breast cancer in Mexico through the continuation of programs like FUCAM. Funding for this type of program comes from the donations of associates and sponsors from the private sector.

Mexico City’s Ministry of Health also implements mammogram screening programs and laboratory studies through medical mobile units called “Medibuses” in marginalized urban areas. When a chronic-degenerative or metabolic disease, or a diagnostic evidence of cancer (like suspicious lesions or tumors) is detected on the Medibuses, the patients are directed to receive highly specialized medical care in local or federal hospitals.

Mobile health prevention programs help poor and marginalized populations have access to health prevention and early detection services; however, these services must ensure the adherence of women in prevention studies annually. It is important to note the findings from the Seminary, “El ejercicio actual de la medicina, Cáncer de Mama” (“An Exercise in Current Medicine, Breast Cancer”) of the Faculty of Medicine at UNAM, which shows from a public health perspective that the reduction in the prevalence of risk factors involved in cancer can have a significant impact in the reduction of morbidity and mortality. Moreover, communication and education campaigns should be included to teach these populations healthy lifestyle habits to reduce the risk of cancer.

Submitted by Maria Fernanda Carvallo — Mon, 04/08/2013 – 00:00

Catalina Gomez, Rio de Janeiro Community Manager

Brasil está fazendo grandes esforços na consolidação de suas politicas públicas enfocadas na promoção da segurança alimentar e de hábitos saudáveis com foco na população mais pobre e vulnerável. Para atender esta prioridade, o Ministério de Desenvolvimento Social e Combate a Fome (MDS) tem desenvolvido um Plano Nacional de Segurança Alimentar e Nutricional para guiar o trabalho.

Nas cidades brasileiras, como Rio, o MDS e a Prefeitura vêm se focando no apoio as populações de baixa renda para fortacer seus conhecimentos de segurança alimentar e nutricional. Para identificar a população prioritária, o governo federal e municipal tem combinado de focar esforços na atenção nos beneficiários de Bolsa Família. Este é um programa de transferências condicionadas em apoio às famílias mais pobres. A população beneficiaria do Bolsa no Rio é de 235 mil famílias, equivalente a quase um milhão de pessoas.

Os beneficiários do Bolsa Família são apoiados pelo governo não só com as transferências condicionadas mais com serviços de assistência social prestados nos Centros de Referencia de Assistência Social, conhecidos como CRAS. Nestes centros, as famílias podem acessar serviços de assistência psicológica mais também receber informação sobre nutrição e hábitos saudáveis. Para este proposito, o governo tem desenvolvido varias cartilhas, vídeos e documentacao útil para ser utilizados pelo CRAS em sessões de capacitação e eventos comunitários. É importante que a informação providenciada tenha em conta os gostos e cultura locais e a disponibilidade daqueles produtos nos mercados locais. Alguns dos temas discutidos nas sessões dos CRAS têm a ver com a prevenção a obesidade, a promoção do esporte e boas praticas de agricultura urbana.

Os beneficiários do Bolsa Família também rebem apoio no caso tenham crianças menores de 7. Aquelas famílias tem o compromisso dos pães de fazer visitas periódicas no posto de saúde para fazer monitoramento do crescimento dos filhos. Neste sentido os doutores poderão identificar problemas no crescimento e recomendar alimentos e cuidados nutricionais especiais. As mulheres gravidas e nutrizes também recebem apoio dado que elas tem que fazer 5 ou 6 pré-natais para monitorar seu estado de saúde e aquela da criança.

Este abordagem integral na segurança alimentar adotada pelo MDS e implementada no Rio pela Prefeitura tem demostrado ser bastante efetiva com esforços de longo prazo que conseguem melhores resultados que campanhas temporárias e trabalham continuamente com as comunidades informando sobre bons hábitos nutricionais. A estratégia tem sido bem sucedida com apoio dos CRAS que fazem serviços personalizados e promovem a troca de experiências entre famílias e pares.

Catalina Gomez, Rio de Janeiro Community Manager

Brazil is in the process of consolidating its public programs that work toward food security and healthy habits for its poorest communities and most vulnerable populations. The Ministry of Social Development (MDS) has therefore developed various programs and initiatives. One of the most important steps forward has been the creation of the National Food Security and Nutrition Strategy.

In cities, including Rio de Janeiro, the efforts of MDS and the local government have focused on supporting access to food and healthy habits for the urban poor. In order to identify the target population, the local and federal governments have agreed to focus on Bolsa Familia beneficiaries. Bolsa Familia is the national cash transfer program that supports the poorest populations with monthly cash transfers. In Rio, about 235,000 families — almost a million people — benefit from this program.

Bolsa Familia beneficiaries in Rio are supported by the government not only with cash transfers, but also through the provision of social assistance services at Social Assistance Centers, known as CRAS. In these centers, families get social and psychological support, as well as assistance with food security and healthy habits. For this purpose, the government has produced a series of documents and videos, so that the CRAS can use them to organize talks and community events about food security. Most importantly, the information provided takes into account the local taste preferences and availability of food. Some of the most relevant topics discussed at CRAS events are related to the prevention of obesity and malnutrition, the promotion of exercise and healthy cooking, and the dissemination of best practices on urban agriculture.

In addition to information about healthy habits, Bolsa Familia beneficiaries who have children under seven receive extra support. These families must bring their child to periodic health checkups, which include measuring the child’s height and weight. Doctors can therefore identify problems with nutrition and diet. Pregnant women also receive additional support, and are required to undertake five or six pre-natal checkups so that doctors can monitor their diets and the well-being of the baby.

This comprehensive approach to food security and nutrition created by the MDS and implemented in Rio by the local government has proven to be very successful. The program continues to inform populations and generate awareness on the importance of balanced lifestyles, with a focus on the diet and well-being of children and pregnant women. This strategy has also proven successful thanks to the CRAS services, as families get personalized assistance and support, and can also share their experiences with their peers.

Submitted by Catalina Gomez — Mon, 04/08/2013 – 00:00

By Pahima Ahmed, Kalpana Maharajan, and Shalu Sebastian, Dhaka Community Managers

প্রায় ৩.৪ মিলিয়ন নগরবাসী অস্বাস্থ্যকর বস্তিতে বসবাস করে যারা সঠিক স্বাস্থ্য সেবা সম্পর্কে জানে না। বস্তিবাসীরা বিশেষ করে প্রসূতি মা এবং শিশুরা সবচেয়ে জন্ডিস এবং নিউওমনিয়ার স্বীকার। মা ও শিশুর সঠিক ও নিরাপদ স্বাস্থ্যসেবা প্রদান করার লক্ষ্য নিয়ে মোবাইল সার্ভিসের মাধ্যমে “আপনজন” নামের একটি এনজিও কাজ করে যাচ্ছে। “আপনজন” দক্ষিণ এশিয়ার সর্বপ্রথম “এম স্বাস্থ্যসার্ভিস” যা ২০১২ সালের ডিসেম্বরে বাংলাদেশের রাজধানী ঢাকাতে প্রতিষ্ঠিত হয়। মাতৃমৃত্যু হার হ্রাসকরণ এবং শিশুদের স্বাস্থ্যসেবা নিশ্চিত করার জন্য মোবাইলে ক্ষুদেবার্তা এবং কণ্ঠবার্তার মাধ্যমে গর্ভবতী, প্রসূতি, এবং শিশুদের স্বাস্থ্যসেবা প্রদান করেছে এই প্রকল্পটি। “আপনজন” প্রকল্পে মূলত তথ্য ও প্রযুক্তির ব্যবহারের মাধ্যমে নগরবাসীকে স্বাস্থ্যবার্তা পৌছে দিচ্ছে। এছাড়াও “আপনজন” স্বাস্থ্য বিষয়ক পরামর্শের মধ্য দিয়ে তার গ্রাহকদেরকে উন্নত মানের স্বাস্থ্যসেবা প্রদান করছে।

Asha Rani, a 24-year-old mother of two living in the Vashantek slum, says that she used to have no idea about how to raise a healthy child. She did not know about immunization schedules, nutritional recomendations, or common pediatric illnesses that can be handled at home. This was her level of knowledge about health care before she came across the Aponjon service (“the close or dear one” in Bangla), a mobile health service in Bangladesh.

But now she exclaims, “I know that I should keep my daughter on my shoulder for a few minutes after she receives breast milk. She doesn’t vomit anymore and I am so relieved…”

Like Asha Rani, approximately 3.4 million urban poor live in Dhaka’s unhygienic slums, which generally lack proper health care facilities. The slum dwellers, especially expectant and new mothers and their newborn babies, are alarmingly vulnerable to life-threatening diseases like jaundice and pneumonia. However, this vulnerability can be reduced at household level if slum residents get information on safe motherhood and child health care. This is where the Aponjon service comes in.

The Aponjon program, launched in December 2012 in Dhaka, is the first ever nationwide mobile health service in South Asia. It disseminates maternal and child health care information through pre-programmed mobile texting and voicemail services to expectant and new mothers (primary subscribers) and their guardians (secondary subscribers). The messages use international standard guidelines and are reviewed by national and international experts on a regular basis. Once they register, primary subscribers receive two contextual messages a week (related to the mother’s pregnancy stage and child birth) until the child is one year old; secondary subscribers receive one message a week. The information ranges from the importance of direct eye contact between a child and the mother while interacting, to the importance of exclusive breast feeding in the first six months of the child’s life. Telecommunications operators like Grameenphone, Banglalink, Robi, and Airtel help provide mothers and guardians with this service throughout Bangladesh, and Aponjon has reached more than 40,000 subscribers. The service aims to reach 2 million mothers by 2015. The program is subsidized and therefore affordable, costing only BDT 2 (excluding VAT) per message, and registration is free by SMS or phone call.

The Aponjon project has become successful in utilizing ICT to disseminate health messages to the urban poor. The principal reason behind its success is that it provides useful information that can be implemented at household level. Secondly, it sends health care messages not only to pregnant women and new mothers, but also to husbands and family members, thereby making guardians aware of measures to help raise a healthy child. Thirdly, the Aponjon project disseminates health messages to subscribers via pre-programmed voice messages if they are illiterate or uncomfortable with SMS.

It must be noted, however, that the Aponjon service currently fails to reach the poor who cannot afford mobile phones. The program is indeed trying to expand its services to the poorest by collaborating with a government-run Union Information and Service Center (UISC). The UISC acts as a drop-in center where the poor can receive information about maternal and child health care. In addition, Aponjon plans to add a medical counseling line in order to help subscribers via telephone.

Submitted by Editor — Mon, 04/08/2013 – 00:00

María Fernanda Carvallo, Mexico City Community Manager

La esclavitud del S.XXI es la trata de personas, considerado por la Organización de las Naciones Unidas (ONU) como el tercer delito más lucrativo alrededor del mundo sólo detrás del tráfico de armas y drogas. En su acepción más general, la trata de personas es definida como una actividad por medio de la cual una persona obtiene o mantiene trabajos o servicios realizados por otra a través de la cohersión; y quienes son víctimas que sufren de un ciclo de violencia, desigualdad y desinformación.

Paradójicamente, mientras las fronteras se abren cada vez más a la libre circulación de información, mercancías y capitales, las políticas de control migratorio restringen cada vez más la entrada de migrantes a su territorio propiciando el incremento de desplazamientos ilegales. Así, aumenta la vulnerabilidad de las personas por las condiciones tan precarias en las que se ven obligados a emprender su viaje, condenándolas a la invisibilidad y a ser víctimas de cualquier tipo de atropello a sus derechos más elementales sin la posibilidad de reclamar por ello.

En este sentido, si bien cualquier persona puede ser víctima de trata, ciertamente quienes viven en condiciones de pobreza y marginación tienden a ser más vulnerables a ella. En México, la trata alcanza dimensiones descomunales en comparación con otros países, y si bien las razones son variadas, la condición del país como uno de origen, traslado y destino de migrantes, especialmente centroamericanos, aunada a la porosidad de la frontera sur que permite el ingreso clandestino de miles de personas, hacen de México tierra fértil para el desarrollo de esta actividad.

Con base en lo anterior, y considerando la gravedad del delito, diversos sectores han emprendido acciones para combatir la trata. Desde la sociedad civil, el Centro de Estudios e Investigación en Desarrollo y Asistencia Social, A.C. (CEIDAS), el Centro de Estudios Sociales y Culturales Antonio de Montesinos (CAM), la Fundación Camino a Casa, Reintegra, A.C. y el Colectivo contra la Trata de Personas D.F. han desarrollado observatorios e investigación que sirvan de contrapeso a la información oficial sobre trata de personas y para incidir en políticas públicas como contrapeso a las instituciones gubernamentales.

Diagnóstico sobre la vulnerabilidad de las personas ante la trata de personas

El Centro de Estudios e Investigación en Desarrollo y Asistencia Social, A.C. (CEIDAS) es un centro de investigación específicamente diseñado para el estudio de los derechos humanos desde una perspectiva multidimensional que permita analizar todas sus vertientes. En este sentido, CEIDAS, A.C. señala que es lugar común afirmar que la protección de los derechos humanos es responsabilidad exclusiva del Estado. Y si bien esto es cierto, también lo es que su salvaguarda debe tener matices sociales que permitan a la ciudadanía ser partícipes de sus propios derechos.

Además de la generación de información y conocimiento, CEIDAS, A.C. busca que éstos deriven en acciones concretas que permitan incidir en el marco legal e institucional, por lo que ha desarrollado una red de capacitación e investigación a disposición del público en general a través de internet y redes sociales para así ampliar sus canales de acción.

Así mismo, CEIDAS, A.C. formaliza alianzas estratégicas con instituciones académicas, organizaciones de alcance internacional y gobiernos de los tres niveles para promover una agenda común de riesgos sociales. Según indica, aunque en los últimos años se ha dado una discusión sobre las dimensiones y consecuencias de este delito en México, no se ha construido un sistema nacional de información sobre el tema, y ni las autoridades ni la sociedad civil han logrado consolidar instrumentos de medición que proporcionen información cuantitativa en la materia. Así, desde 2009, CEIDAS asumió la tarea con el apoyo del Departamento de Estado de los Estados Unidos de América de construir el primer Diagnóstico de las Condiciones de Vulnerabilidad que Propician la Trata de Personas en México, el cuál fue realizado en alianza con la Comisión Nacional de los Derechos Humanos.

De acuerdo a la organización, a partir de este diagnóstico fue posible identificar espacios de vulnerabilidad, territorios en los que la migración tanto nacional como internacional es más acentuada; ciudades y destinos turísticos denunciados por los medios de comunicación y organizaciones de la sociedad civil como de alta presencia de explotación sexual comercial infantil y la trata de personas con fines de explotación sexual y laboral; así como la debilidad institucional y del marco jurídico, tanto federal como local para prevenir, perseguir y sancionar a los delincuentes; más aún, para proteger a las víctimas.

Esta investigación constituyó el primer Índice Mexicano sobre la Vulnerabilidad ante la Trata de Personas que, entre otras cosas, ofrece datos cuantitativos sobre los factores más relevantes que aumentan la vulnerabilidad de ser víctima de trata. Asimismo, el índice ofrece un contexto social y económico que permite identificar el perfil de las personas que han caído en el delito así como de las personas que lo cometen. De la misma manera, incluye un indicador numérico que permite desagregar información por entidad federativa sobre el riesgo del delito.

Para distribuir el riesgo del delito en territorio nacional, el índice agrupa a las entidades federativas con base en la probabilidad de que sus habitantes o quienes transiten por ahí lleguen a ser víctimas de trata. Así, los estados se dividen en alta, media o baja vulnerabilidad según el nivel de protección y cumplimiento de los derechos humanos, no en la incidencia del delito.

Siguiendo esta línea de argumentación, el índice también identifica tres fases principales en las que se desarrolla la trata en México: enganche; traslado, encierro y privación de la libertad y explotación para fines diversos. Finalmente, es importante destacar que en la selección de las variables que integran el índice no todos los casos de trata de personas son cometidos por redes organizadas de criminales, señalando con ello que la trata puede ser cometido por personas cercanas a las víctimas.

Con base en lo establecido en el índice, la mayoría de las víctimas provienen de entornos de pobreza, marginación, desigualdad, violencia familiar o comunitaria, adicciones, deserción escolar o analfabetismo, bajos ingresos, trabajos precarios, riesgosos, mal remunerados o la informalidad.

Desarrollo de capacidades a través de la prevención y rehabilitación de la trata de personas

Para pasar de la información a la acción, el proyecto de CEIDAS A.C, no solo tuvo entre sus objetivos generar y sistematizar información, sino también la implementación de talleres de prevención de la trata de personas y promoción de los derechos humanos a profesores y alumnos en escuelas, al tiempo que se incluyeron actividades de continuidad como ciclos de cine y concursos escolares de cartel, ensayo y fotografía. El resultado fue la identificación de poblaciones vulnerables y con base en ello construir un modelo de prevención con seis dimensiones para su mejor atención, que abarca Violencia social, pobreza y carencias sociales, Justicia y seguridad pública deficiente, Precariedad económica y condiciones laborales de explotación, Migración interna e internacional y Violencia y discriminación por género. Una vez identificadas las poblaciones vulnerables, el Modelo busca incidir y aplicarse en las mismas, para lo cual la formación de alianzas resulta fundamental para impactar positivamente las comunidades objetivo.

Por su parte, el Centro de Estudios Sociales y Culturales Antonio de Montesinos, A.C. es una asociación civil que, en el marco de la tercera Conferencia General del Episcopado Latinoamericano, surgió de la necesidad de un grupo de sacerdotes que, en conjunto con académicos laicos, de crear un centro de estudios sociales y culturales sin ningún tipo de afiliación a alguna iglesia para el análisis de la realidad y el entorno más próximo y así contribuir a solucionar los problemas que la aquejan.

Su perfil está enfocado en conocer y analizar la realidad de los procesos sociales en todas sus vertientes en el marco de los derechos humanos a fin de contribuir a la construcción de una sociedad justa y equitativa. Al igual que CEIDAS, A.C., el centro Montesinos busca traspasar la línea de la investigación y desarrolla estrategias de intervención para ayudar a mitigar los problemas que consideran más apremiantes. Para ello, forman redes de acción entre distintos actores sociales en zonas empobrecidas para hacerlas partícipes de sus derechos y sepan exigir su cumplimiento si las circunstancias lo ameritan.

El equipo de trabajo del centro sistematiza sus experiencias en las distintas regiones en las que operan con una metodología participativa con el fin de compartirla con otras organizaciones sociales para finalmente impulsar acciones y proyectos de formación como diplomados y talleres en torno a sus perspectivas centrales. De estas actividades, puedan surgir propuestas sobre Política Social y Participación Ciudadana en organismos gubernamentales, civiles y académicos.

En vista de que el objetivo del centro es contribuir a la organización de los sujetos civiles, sociales y eclesiales para su influencia en asuntos públicos, fortaleciendo sus capacidades de articulación e incidencia, su equipo de trabajo ha desarrollado en conjunto con Indesol, una extensa investigación sobre la trata de personas en el D.F. por considerarlo un delito de suma gravedad que merma la calidad de vida de las víctimas.

Así, fue creado el Observatorio Ciudadano sobre trata de personas con fines de explotación sexual en la Ciudad de México, cuyo fin es analizar, difundir, articular y realizar propuestas con base en una perspectiva de derechos humanos y género sobre el actuar de las instituciones públicas que participan en la prevención, atención e investigación de casos de trata de personas con fines de explotación sexual. Para lograrlo, el Centro e Indesol han formado una red de informantes en albergues, organizaciones de la sociedad civil y redes informales de apoyo que brindan información para un mejor análisis del problema.

En el marco de la actuación de la sociedad civil, la Fundación Camino a Casa, ayuda a las víctimas de explotación sexual comercial infantil, que suman más de 20,000 en México cada año, para la restauración de sus entornos a través de un modelo de atención que les brinda un hogar familiar para una recuperación integral a la sociedad y a una vida con nuevas oportunidades. La Fundación Camino a Casa, A.C. participó en el proyecto bilateral México-Estados Unidos conocido como proyecto Puente, en el cual se trabajó junto con la organización Concerned Women for America (CWFA) en la capacitación de líderes mexicanos para el combate de la explotación infantil. Así mismo, participa de manera activa como organización de la sociedad civil en la Comisión para Prevenir y Sancionar la Trata de Personas de la LVI Legislatura de la Cámara de Diputados, para la aprobación y homologación de la “Ley General para prevenir, combatir y sancionar la Trata de Personas“.

La fundación ha trabajado íntimamente con distintas autoridades a nivel federal y de la Ciudad de México, quienes canalizan a las víctimas que son rescatadas por medio de operativos o llegan a sus instalaciones. Al ser menores de edad, la fundación brinda condiciones de seguridad en un albergue de alta seguridad que procura funcionar como un hogar integral para las víctimas. El modelo de atención implica apoyo a las víctimas en los procesos judiciales, psicológicos y legales en la integración de expedientes, averiguaciones y denuncias, así como apoyo médico, educativo y emocional. El albergue tiene un trato especializado a través de tutoras, trabajadoras sociales y “mamás sustitutas” que brinda un entorno familiar con principios y valores a fin de ayudarle a su recuperación, reconstrucción de autoestima e identidad y proyección de un futuro con nuevas oportunidades.

En el último han atendido a 67 víctimas en el refugio, cuyas edades fluctúan entre los 8 y 18 años y son provenientes de diversos estados del país, así como de Guatemala, Nicaragua, El Salvador y Honduras. Ante el éxito del modelo, Fundación Camino a Casa tiene proyectado abrir doce hogares más con las mismas características en el interior de la República Mexicana.

De igual manera, la Fundación Reintegra, A.C. surgió para brindar atención y rehabilitación para las personas que han sido víctimas de explotación sexual comercial, a través de la restauración de sus derechos humanos, generando oportunidades para llevar una vida productiva, gratificante y digna del sobreviviente. Reintegra realiza proyectos en el área laboral, para que las sobrevivientes sean reintegradas a la sociedad, asesorando sus proyectos personales y de negocios. Al igual que imparte cursos de prevención a instituciones, promueve la denuncia de las sociedad civil y brinda asesoría legal.

En México el tutelaje y garantía de la protección de las personas se ha adoptado como evolución de los derechos humanos tanto en el ámbito local como en el nacional, dejando la responsabilidad de la protección y de la seguridad al Estado, sin embargo aún persisten lagunas que orillan a las deficiencias de los marcos normativos del Estado de derecho para hacer frente a fenómenos como el aquí expuesto. El Observatorio Ciudadano indica que los cambios legislativos no son suficientes si no hay claridad mental en los juzgadores, que son quienes tienen al final de cuentas en sus manos la posibilidad de condenar el delito de trata. De aquí la necesidad de que la sociedad civil actúe en un marco de pesos y contrapesos para exigir al Estado proteja los derechos humanos: el fenómeno de la esclavitud del siglo XXI podría abolirse a través de la sinergia de estos actores que orillan al Estado a adoptar medidas de políticas públicas y legislativas frente a este fenómeno.

According to the International Labour Organization, over 70 million young people worldwide are unemployed. This issue is particularly prevalent in the Global South, where youth are twice as likely to be unemployed or trapped in low-quality jobs, limiting development and social mobility. Governments and NGOs have responded with educational initiatives, skills-training projects, confidence-building programs, and a fund to encourage entrepreneurship. Read on to learn about four successful approaches in Cali, Nairobi, Bangalore, and Rio de Janeiro, and then join the conversation below.

Jorge Bela, Gestor Comunitario de Cali

El desempleo juvenil es un problema especialmente grave en Cali. Las tasas de acercan al 33 por ciento, la más alta de las principales ciudades del país (la media nacional en este sector demográfico es del 17 por ciento). Si bien es cierto que la tasa general de desempleo en la capital del Cauca es también superior a la nacional (13 por ciento frente al 9 por ciento), los jóvenes caleños sufren este problema de forma desproporcionada. Aunque las causas del desempleo son complejas, cabe destacar un periodo de recesión económica que duró 10 años, de 1995 a 2005, que coincidió con la llegada de fuertes flujos migratorios. Aunque a partir de 2006 la economía ha crecido, no lo ha hecho en tasas suficientes para absorber la bolsa de desempleo y los nuevos flujos migratorios. La falta de cualificación para los nuevos trabajos que van surgiendo es otra barrera para que los jóvenes obtengan empleo.

Para mitigar este grave problema, existen varias iniciativas tanto públicas como privadas destinadas a mejorar la preparación de los jóvenes. Jóvenes en Acción, un programa de ámbito nacional, prestará asistencia financiera para que puedan completar estudios a unos 4 000 jóvenes caleños. La formación debe ser en carreras técnicas o tecnológicas, aunque también se cubren cursos de capacitación y emprendimiento. El programa está destinado a jóvenes entre 16 y 24 años, que hayan culminado el bachillerato, y que pertenezcan a la Red Unidos, sean víctimas del conflicto armado y/o desplazamiento o beneficiarios de Familias en Acción (Red Unidos y Familias en Acción son programas destinados a ayudar a familias en situación de pobreza). La ayuda económica consiste en un estipendio bimensual de 200.000 COP (unos 100 US$), y se les exige estar bancarizados, algo que también redunda positivamente en su integración en el mercado de trabajo.

Otra iniciativa interesante es el Centro de Desarrollo Productivo, impulsado por la Fundación Carvajal y cofinanciado por algunos aliados tanto internacionales como locales. Esta iniciativa busca formar en oficios tradicionales a jóvenes en los estratos económicos mas bajos y/o en riesgo de exclusión social. En el año 2012 2,727 jóvenes, tanto de Cali como de zonas rurales del Valle del Cauca, recibieron formación como técnicos en el sector alimentario. Es importante que los programas no se circunscriban al término municipal de Cali, pues mejorando la situación de empleo en las zonas rurales próximas se previenen los movimientos migratorios que a su vez fomentan el crecimiento desordenado de la ciudad.

Los programas formativos, buscan mejorar la capacidad de los alumnos de generar ingresos y mejorar la competitividad de sus microempresas. A los microempresarios se les ofrece también formación en técnicas gerenciales y de la normativa a aplicar en el sector alimentario. En 2011 se implementaron ocho nuevos cursos de formación técnica en diferentes oficios (electricidad básica, confecciones, carpintería de aluminio, soldadura, impulsadoras y mercadeo, call center, sistemas básicos, arreglo de computadores y celulares). Cabe destacar que los cursos son impartidos en colaboración con el Servicio Nacional de Aprendizaje, una entidad pública. Sin duda la colaboración público-privada resulta imprescindible a la hora de resolver los problemas del desempleo.

Foto: SENA

Jorge Bela, Cali Community Manager

Youth unemployment (for youths 16-24 years of age) is a particularly severe problem in Cali. The rate is 33 percent, the highest in big Colombian cities (the average national rate hovers around 18 percent). Even though the global unemployment rate in Cali is also higher than the national average (13 percent versus 9 percent), young caleños suffer disproportionately more than older age groups. The causes behind this problem are complex, but it was certainly aggravated by a 10-year recession (from 1995 to 2005), precisely at the time when immigration flows were very strong. Even though the economy resumed growth in 2006, it was not at a sufficient rate to reduce the large number of unemployed, or to absorb the continual arrival of immigrants. The lack of necessary qualifications and skills also poses a barrier for young job seekers, especially for the poorest ones.

Several initiatives, both in the public and private sectors, work to give poor youth the necessary training to improve their chances of finding a job in the emerging sectors. Jóvenes en Acción (Youth in Action) is a national program that provides 4,000 young caleños with financial resources to pursue a technical or technological degree. The program also includes entrepreneurship courses. Jóvenes en Acción is opened to students 16-24 years old who have completed their secondary education. They also have to either belong to the Red Unidos or Familias en Acción programs (which provide assistance to poor families), or be desplazados (forced to leave their hometowns due to threats or violence), or be victims of armed conflict. The students get a bi-monthly stipend of 200,000COP (about US$100). They must also have a bank account in order to collect the stipend.

In the private sector, the Fundación Carvajal’s Centro de Desarrollo Productivo (Production Development Center) trains young caleños in the skills needed for the food sector. The project is co-financed by the Foundation and an alliance of local and international donors. It benefits youths in the three lower economic strata (1, 2 and 3), and those at risk of violence or social exclusion. In 2012, 2,727 students from Cali and nearby rural areas participated in the program. The inclusion of students from rural areas is very important, as improving the employment situation in those areas reduces the immigration flows into Cali, which in turn helps to reduce the uncontrolled growth that plagues not only Cali, but all major cities in Colombia.

The training programs at the Centro de Desarrollo Productivo seek to improve the earning capacity of its students and to make their micro-business more competitive. Micro-entrepreneurs also receive training in management skills and in the fairly complex regulatory framework of the food sector. In 2011 eight new courses were launched, providing technical training in new areas such as basic electricity, call centers, aluminum work, welding, computer and cell-phone repair, etc. The training is done in cooperation with the public Servicio Nacional de Aprendizaje (National Learning Service). Cooperation between the public and private sectors is necessary to improve the conditions for the many young and unemployed in Cali.

Photo credit: SENA

Katy Fentress, Nairobi Community Manager

In September this year the Kenyan government launched the Uwezo Fund, a 6 billion Ksh. cash reserve (approximately $70 million) aimed at channeling financial resources into the hands of youth and women.

Money for the fund was obtained from capital set aside by the Jubilee Coalition during this year’s election campaign, for use in the case of a run-off. The Jubilee Coalition, led by Uhuru Kenyatta and his deputy Samuel Ruto, pledged that any money that was not spent on the campaign would be channeled into a fund of this sort. Six months after winning the election, they stood by their commitment and announced that the application process for accessing interest-free loans was now open to registered youth and women’s groups.

The aim of the Uwezo fund is to address the massive unemployment problem that affects the country, by encouraging entrepreneurship and expanding access to credit. The idea is to generate opportunities for self-employment and to enhance economic growth by investing in community-driven alternative frameworks to development and focusing on youth/women’s groups and savings chamas as drivers of the country’s economy.

In order to be considered, groups must apply from within the constituency they would like to operate from, hold a bank account in their name, and have written recommendations from a District Chief, and they must have been registered with the Department of Social Services for at least six months prior to application.

The government has set up the Uwezo Capacity Building Program, a training course that applicants are required to attend before they even apply for the loan. This is to ensure that the groups have the ability to invest well and eventually pay back the loans. Once the training has been completed, groups can apply for an amount that ranges from 50,000 Ksh. to 500,000 Ksh (approximately $580 to $5,800), which must be begin to be repaid after six months and subsequently over the course of two years.

The Uwezo fund is being overseen by the Ministry of Devolution and Planning. One of the central tenets of the new Constitution that was passed in 2010 was that administrative power would be decentralized to the counties of the country’s provinces. The result of this is that county MPs are in part responsible for the allocation of Uwezo funds, an aspect that has led some people to fear that the wealth may be misused if not subjected to tight scrutiny. In the past, similar programs like the Youth Fund and Kazi kwa Vijana (Work for the Youth) — both flagship projects of the previous government — did not always achieve their intended purposes and, more often than not, ended up lining the pockets of those who were charged with implementing the schemes. In order to minimize this eventuality, the government has announced that it is setting up a committee that will be in charge of overseeing how the money is spent.

So far, it is too early to tell to what extent the fund will effectively create employment for Kenya’s youth. The President has high hopes that it will be successful, and the Deputy’s wife has been touring the country to raise its profile and encourage people to apply. In the meantime the rest of us can only wait, watch — and, if eligible, apply!

Carlin Carr, Bangalore Community Manager

India and China have been saddled side by side in the race for rising economic superpowers. While China has edged ahead on many fronts, India’s large youth population provides a massive potential. “An estimated 1-1.2 million new workers will join the labor market in South Asia every month over the next few decades — an increase of 25-50% over the historical average,” says a World Bank report. Job creation needs to match this upcoming labor force. A new government initiative in India, the National Skills Development Corporation (NSDC), has prioritized providing this generation with the necessary education and training so the country can reap the benefits of its demographic dividend.

While many initiatives have been launched under the NSDC, focusing on building a range of technical and artisanal capacities, an organization in Bangalore focuses on skill-building alongside “potential realization” initiatives. The Promise Foundation‘s research has found that while lack of skills is a major factor that contributes to underemployment or lack of employment with youth, so too does their confidence in their own abilities and job prospects. The organization’s unique method applies behavioral sciences to economic and social development.

The Promise Foundation believes that early intervention is necessary, and has developed three core programs to foster personal and professional growth from a young age:

• Stimulation Intervention Programs focus on early childhood care and education for children deprived of quality experiences for social, emotional and cognitive development.

• Programs for Assisted Learning is an accelerated learning program targeting children who are at risk of failing and dropping out of school.

• Work Awareness and You addresses the career development needs of high schoolers and helps them find answers to questions of planning for fruitful employment in the future.

The three-pronged approach to preparing youth for the job market takes a more holistic and long-term perspective on the need to develop human resources for India. In a recent training in Bangalore, youth in attendance were taught core work attitudes (punctuality, reliability, safety, etc.) and were also part of a program to increase their skills. “Almost all trainees were able to secure better jobs and went on to complete formal education,” says the organization.

The future remains to be seen. Skills training has become a government priority in the country, with a substantial budget allocation and a new uniform curricula for the various skills training initiatives under the NSDC. Yet as the Promise Foundation’s research has shown, there’s much more to developing human resources than just skills, and only when those issues are addressed will this generation’s potential be fully unleashed.

Photo credit: One Laptop per Child

Catalina Gomez, Coordenadora da Rede em Rio de Janeiro

Os “Nem-Nem” são jovens entre 15 e 24 anos que nem estudam, nem trabalham, nem procuram emprego. Segundo dados do último censo, Brasil tem mais de 5 milhões de “Nem- Nem” no seu território, com grande concentração nas áreas urbanas. Rio atualmente tem mais de 150 mil “Nem-Nem”; preocupa que aquela população cresceu em 30 mil entre 2000 e 2010. Quais são as causas deste fenômeno? E quais são as respostas da cidade para enfrentar aquela situação?

Uma causa do fenômeno “Nem-Nem” é a desigualdade e a pobreza. A grande maioria da população carente urbana não tem oportunidade de receber educação de qualidade e porem fica desmotivada e descomprometida dos estudos. Não surpreende que as maiores taxas de abandono escolar sejam entre as populações de baixa renda.

Outro assunto relevante com implicações de gênero e igualdade, são as altas taxas de gravidez adolescente. Muitas das jovens que ficam grávidas interrompem os estudos e a procura de emprego por em quanto cuidam dos filhos. Mais o maior problema, além das implicações da maternidade adolescente, são as consequências negativas da falta de treinamento e experiência na procura de emprego, ficando cada vez mais complicada sua integração no mercado de trabalho.

Algumas das soluções têm sido propostas pela Secretaria Municipal de Educação, que esta ativamente no processo de melhora da qualidade da educação fundamental e segundaria, tentando priorizar as áreas de maior concentração de pobreza e vulnerabilidade. Algumas das ações de melhora da qualidade educativa têm a ver com a melhora dos quadros de professores e das sessões educativas com foco na aprendizagem e as aulas práticas. As Escolas do Amanhã, que tem sido destacadas no URB.im também contribuem na melhora da qualidade da educação nas áreas carentes e violentas da cidade.

Outra resposta importante, especialmente relacionada com aqueles adolescentes com filhos que ainda estudam o procuram emprego, é o aumento da cobertura de creches públicas para crianças de 0-3 anos, que passou de 7 por cento para 21 por cento entre 2000 e 2011. Este é um aumento significativo, mais ainda é preciso um esforço muito maior.

Nas escolas públicas, também existem esforços na melhora da educação sexual, incluindo mais troca de informação entre os jovens e mais dialogo aberto e guia profissional. Embora estes esforços, ainda é preciso ampliar as campanhas educativas e saúde pública para atender as jovens vulnerais e evitar que as meninas vulneráveis sejam a nova geração de “Nem-Nem”.

Foto: Secretaria Municipal de Educação de Rio de Janeiro

Catalina Gomez, Rio de Janeiro Community Manager

A “NEET” is a youth between ages 15 to 24 who does not study and does not work. According to the latest Brazilian census, there are more than 5 million “NEETs” throughout the country, mainly concentrated in urban areas. In Rio alone, there are more than 150,000, and the number is rising: between 2000 and 2010, there were more than 30,000 new “NEETs.” What are the causes of this phenomenon and what is the city doing to respond to this situation?

Two important causes of the “NEET” phenomenon are inequality and poverty. Many poor urban youth have access only to low-quality education that doesn’t engage or motivate them. It therefore isn’t surprising that the great majority of school dropouts are among the poorest population.

Another relevant issue that has enormous implications for gender inequality is the high pregnancy rates among teenagers, which is one of the leading causes of adolescent girl school dropouts. Many of these girls don’t study or work while they take care of their babies. Beyond the effects of adolescent parenthood, the problem with these adolescent mothers is that after caring for their babies, they become part of the “trapped” population that doesn’t have the skills or work experience required to find a job.

Solutions to these issues have been addressed by the Municipal Secretariat of Education, which is actively engaged in improving the quality of basic and secondary education, targeting the most vulnerable areas. Some of the main initiatives to improve education include the improvement of teaching quality, with greater focus on practical courses where students can learn skills and apply their knowledge. The Secretariat has also implemented the Schools of Tomorrow program (previously covered by URB.IM), which aims to improve education in the poor and violent areas of the city.

Beyond the support provided by public schools, the city promotes courses for youth and adults who have temporarily left the path of education, but want to continue their studies. These courses take place throughout the city, are free of charge, and offer flexible schedules and specialized mentorship, so that students can complete their basic education cycles.

Another important response, especially for the adolescent parents who are still studying or looking for a job, is the increased access to public child care for 0-to-3-year-olds: coverage went from 7 percent of children in 2000 to 21 percent in 2011. This in a significant improvement, but it is still insufficient to meet the great demand. In public schools there are also efforts regarding sexual education, which includes greater peer exchange, open dialogue, and guidance.

However, greater joint public health and educational campaigns are required to prevent vulnerable girls from becoming the next generation of youth that are trapped, not working, and not studying.

Photo credit: Municipal Secretariat of Education, Rio de Janeiro

Carlin Carr, Mumbai Community Manager

Mumbai is a city filled with complexity — economically, socially, religiously, and politically. Nowhere is this more apparent than in Dharavi, the city’s largest and one of the world’s most famous informal settlements. The one-kilometer-squared area houses 600,000 residents who come from all over the country, speaking dozens of different languages and practicing a variety of traditional customs from their home regions. While the diversity of the area is evident, most of the half-million residents have been united on one particular issue: the tenuous future of their community.

Dharavi, once on the outskirts of Mumbai’s central area (which is situated at the southern tip of the peninsula) was originally occupied by fishing tribes pushed out of an industrializing, 19th-century urban center. As migration has increased in Mumbai, many of these new urban dwellers have settled in Dharavi as well. However, what was once the northern hinterlands of the city is now, increasingly, the central hub of the ever-expanding Mumbai, and Dharavi today occupies one of the most central and strategic positions. The city’s two major train lines intersect at Sion, in the heart of Dharavi, and the city’s biggest corporate park, Bandra Kurla Complex, which houses everything from embassies to major international banks, is just across the Mithi River. The slum area’s real estate value has reached a premium. If Dharavi were to be bulldozed tomorrow, it is estimated the government would be able to sell the land for $25 billion.

Redeveloping Dharavi

And so the complications of a city filled with complications manifest themselves in the redevelopment of this small but densely populated plot of land. Dharavi, despite its long history and upgrades by its residents, has been officially labeled a “slum.” In 2004, the government instituted the Dharavi Redevelopment Plan (DRP), a complex multi-stakeholder public-private partnership (PPP) initiative — including international developers, bureaucrats, state agencies, civil society, and social movements — that seeks to give new apartments to the area’s dwellers. The square footage of these new homes, however, has been a subject of controversy: the original government plan was a meager 180 square feet, but in the wake of community resistance the square footage has since been raised to 225 square feet, then to 300, and recent demands are for the flats to reach an area of 400 square feet.

The battle over square footage runs deeper than a simple fight for bigger spaces. Residents, and groups supporting the residents, feel that the government’s approach to slum redevelopment — particularly for the valuable plot of land on which Dharavi stands — favors economic incentives for builders’ gains over fulfilling the community’s needs. Under the plan, the government has raised the Floor Space Index (or FSI), which specifies the permitted buildable area in relation to a plot size. For example, on 100 square feet of land, an FSI of 1 would mean that 100 square feet can be built up, either in one floor of 100 square feet or two floors of 50 square feet each; accordingly, an FSI of 2 would indicate that 200 square feet could be built on this 100-square-foot plot. In Dharavi, the government has raised the FSI to 4 — higher than in the rest of Mumbai — to incentivize developers with the potential to build luxury housing to subsidize the required free slum housing. As Rakhi Mehra of microHome Solutions explains, “Even an extra FSI of 1 is substantial in high-value areas like Dharavi, where another 100 square feet is like gold. In India, giving higher FSI to developers without mandating some minimum density will not really impact the affordable housing supply.”

Furthermore, the DRP has “artificially” sectioned off Dharavi into five areas that were each bid upon by different private developers (see further details of the DRP here on urb.im). Complicating matters, in pursuit of making the area into an “economic hub,” critics say the government and its partners have neglected the existing thriving economy in Dharavi, which The Economist valued at US$500 million in 2005.

Martina Spies, a Vienna-based architect who is researching Dharavi, wrote an article earlier this year on urb.im arguing that the government’s designation is a misnomer. The area is not a “slum” but a “settlement,” she explains. UN-HABITAT defines a slum as a “run-down area of a city characterized by substandard housing and squalor and lacking in tenure security.” This, she says, does not describe the area. Spies says the residents have gone to great lengths to upgrade their situations, and that there is a thriving economic and social fabric there. “One of the most fascinating facts and qualities in Dharavi are the improvements on a very micro-level — all created by the people themselves, transforming Dharavi from a so-called slum into an established settlement. Their incredible strength and discipline has guided Dharavi’s tenants in upgrading their homes by themselves with the help of small bank loans or private savings,” writes Spies.

No one-size-fits-all solutions

One of the major issues with the DRP is that it has created one monolithic plan and goal for an area that is highly diverse, not only in terms of its distinctions mentioned above, but also the various housing and tenure situations. Rahul Srivastava and Matias Echanove, founders of URBZ — an organization in Dharavi dedicated to creating user-generated cities — describe the land titles and occupancy rights in the city as some of the most complicated in the world. In a position paper for the “21st Century Indian City” conference at the University of California at Berkeley held earlier this year, they write, “An array of legislations, policy ordinance, acts and notifications, customary laws, special programs and schemes collide with local practices, populist politics and public opinion to create a mangrove-like pattern of ownerships in the city. At once deeply rooted and floating on murky grounds, occupancy rights seem to be, at the end of the day, determined by politics rather than the rule of law.”

Despite the association of slums as being “illegal” — encroaching on city-owned or privately-owned land — many residents of Dharavi have legal tenure or are legal renters. And while their status brings with them certain rights, the DRP has stripped Dharavi’s dwellers of the essential ability of improving their situation. Srivastava and Echanove provide the example of the Vishal Cooperative Housing Society (CHS) in Dharavi, a chawl that was built by the Bombay Municipal Corporation (BMC) before independence in 1947. In other words, since it was built by the city corporation itself, the chawl’s residents are “legitimate citizens” who pay rent to the city, not “illegal” slum dwellers.

The DRP, however, has complicated the situation of the Vishal CHS residents. In fact, they have taken their case and peculiar situation to the city’s Human Rights Court, arguing — despite the city’s denial — that they have a human right to self-develop as legal tenants. And, in fact, ordinarily this right would be granted to them. However, because the chawl is in Dharavi, where the DRP trumps all, they are denied these basic rights. As Srivastava and Echanove explain, the DRP is “de facto depriving all residents of Dharavi of the rights they would have enjoyed if they were living in any other part of the city.” While the residents of CHS have the means and ability to independently improve their housing situation, they will have no choice but to relocate themselves into government-developed buildings — if, and when, the DRP ever comes to fruition.

Given these complicated and murky circumstances surrounding the DRP, many NGOs and community-led initiatives have stepped in to assist Dharavi’s residents. Society for the Promotion of Area Resource Centres (SPARC) and Kamla Raheja Vidyanidhi Institute for Architecture and Environmental Studies (KRVIA) have worked closely with Dharavi’s residents, listening to their concerns and ideas. Many of their concerns center around the fear of losing space for economic activities, since many residents work out of their small homes or use the outdoor and rooftop spaces for their labor. They are also concerned about the destruction of the social fabric that comes with moving from one-or-two-story residences into large, concrete apartment blocks.

In 2010, SPARC and KRVIA released a publication, “ReDharavi,” that called for more resident participation and community control in the DRP process. Further, they suggested that the mega-master plan be broken down into smaller approaches that recognized the different housing situations in the area — nagars, chawls and co-ops — as well as tenure diversity.

The DRP spreads north

The DRP has been in the works for almost a decade, and, in actuality, very little has been accomplished. Yet, despite the controversy surrounding the plan, the model seems to be taking hold in other areas.

The city of Ahmedabad has a population of nearly six million and is the seventh largest city in India. The city is experiencing many of the same issues as other major urban areas, including its larger neighbor, Mumbai. In spite of the city’s challenges, Ahmedabad is known for its entrepreneurial spirit and inventive nature. After all, it was from Sabarati Ashram in Ahmedabad that Mohandas Gandhi led the people of India on a non-violent freedom struggle to victoriously overcome British rule. Three decades later in 1972, the pioneering Self Employed Women’s Association (SEWA) formed in the city, and today is one of the leading organizations for underserved women in India, and perhaps the world.

In keeping with the forward-looking innovation that runs through the city’s blood, a new project was launched in July 2011 to make Ahmedabad a “slum-free city.” What is surprising, though, is that in a city of such out-of-the-box thinking and entrepreneurship, the Gujarat state government has decided to adopt Mumbai’s DRP model as it embarks on an ambitious plan to upgrade the living quarters of 440,000 slum dwellers in the city. Initially, the PPP project, called “The Regulation for the Rehabilitation and Redevelopment of the Slums 2010,” will focus on 1,200 families who reside in the “crime-prone” slum of Amraiwadi. As in Mumbai, pro-builder policies will provide plenty of opportunity for developers to capitalize off the slum residents’ situation.

The spread of Mumbai’s redevelopment approach to its neighboring state begs the question: Is this the future of development in India? Are there alternatives? B.R. Balachandran, an Ahmedabad-based urban planner and Executive Director of DBS Affordable Home Strategy Ltd, says that new and innovative low-cost housing models are a viable alternative to the governments’ plans in both Mumbai and Ahmedabad. First and foremost, though, these projects need to consider the needs of the residents.

DBS Affordable Housing Initiative

“Housing is a game changer,” says Balachandran, who champions a “holistic” approach to integrating DBS clients into the formal housing system. DBS looks beyond a concrete building or residence into products and services that facilitate its customer base’s transition to formal ownership of their property. The company offers social services that support housing, including facilitating access to home loans, financial literacy, livelihood support, education and health services. Most important, however, is the “active handholding” as families who have mostly lived in slums and informal settings move into housing ownership. This is critical component in making housing a “transformational intervention,” says Balachandran.

This transformational intervention is what the Dharavi Redevelopment Model is lacking and why its potential is questionable. The top-down approach and leap from slum to high-rise misses the need for incremental steps towards integrating the urban poor into the formal housing market. The house is an investment in their future, and, says Balachandran, “there need to be incremental investments in this that the community needs to be a part of.” In other words, simply “replacing a bad house with a better house” lacks the holistic approach and involvement that DBS believes is essential to moving people up the value chain and into the formal housing market. For this to happen, government investment in housing must simultaneously involve investment in moving the poor up the socio-economic ladder by including health, education and “equipping them to deal with life.”

DBS’ affordable housing model acknowledges an important point in housing upgrading for the poor: the process that is needed to successfully improve their circumstances. In a redevelopment project as complicated as that in Dharavi, it is essential to make this community-centered process a part of every step in the project. Without involving the voices of the people, the DRP — or any of India’s urban renewal projects — runs the risk of missing the mark completely, undoing the livelihoods, social structures and intricately interwoven environments in Dharavi that have been so carefully developed over so many years.

Warga Jakarta haknya diinjak-injak. Hak warga untuk meruang kota, jauh dari impian masyarakat madani. Lagipula, masyarakat ideal itu tidak ada. Kota-kota di Eropa yang tingkat welfare-nya sudah baik saja masih sering dievaluasi dan di complain. Tapi harusnya ada yang dinamakan bahan-bahan dasar sebuah kota. Kriteria dasar ini meliputi: hak anak untuk memiliki taman bermain, hak pejalan kaki untuk berjalan di pedestrian tanpa resiko ditabrak mobil, hak air minum, hak memiliki perpustakaan yang bagus dan gratis, hak untuk bisa menghirup udara segar di taman kota, hak punya transportasi umum yang cukup dan terjangkau dan masih banyak lagi hak-hak warga Jakarta yang tidak tercapai. Ironisnya, kebanyakan penduduk tidak mengetahui hak meruang kotanya. Kota-kota di Eropa dan Amerika Serikat dianggap mewah; padahal mereka tidak mewah, hanya memenuhi kategori kebutuhan ruang publik saja. Jangan sampai ruang publik dijadikan barang mewah.

Submitted by Daliana Suryawinata — Mon, 06/25/2012 – 01:00

The coupling of community savings groups and housing provision in the ACHR/IIED-ACCA process is a strategic step in a global transition toward sustainability, toward an ecological age. Why? First, it’s about what that coupling means, entailing as it does the formation and consolidation of finance (through savings) and space (through housing and settlement) as common resources at a very real scale: the community. Second, it’s about a fundamental problem of ecology. Learn more.

Submitted by Marco Kusumawijaya — Mon, 06/11/2012 – 01:00

The lives of hundreds of thousands of people in Asian cities have been transformed thanks to an innovative project that enables the urban poor to improve their living conditions in partnership with city governments. Across Asia, ACCA’s investment of US$2.3 million has unlocked US$35.6 million worth of government land for poor people’s housing. ACCA has allowed people to take charge of their own development and make changes as quickly as possible and on a city-wide scale. This contrasts with the islands of development that governments and donors tend to create, and which rarely engage poor people as active participants.

Submitted by Jakarta — Mon, 06/11/2012 – 01:00

Permasalahan kota Jakarta yang kompleks tidak mungkin ditangani sendirian oleh pemerintah. Kabar baiknya, selepas dari cengkraman Order Baru, gerakan masyarakat sipil, khususnya yang terfokus pada problema urban, bersemai dengan subur di Jakarta. Mulai dari kelompok akar rumput yang menyuarakan hak warga miskin, sampai advokasi di media online yang digerakkan warga kelas menengah dan terbukti efektif.

Submitted by Julisa Tambunan — Sat, 06/09/2012 – 01:00

Dengan segala kompleksitas kota Jakarta, sulit untuk memaksimalkan partisipasi publik dalam membuat perencanaan kota yang lebih baik. Padahal, masyarakat lokal seharusnya berpartisipasi dalam melakukan perencanaan kota untuk memastikan pembangunan yang dilakukan pemerintah sesuai dengan kebutuhan. Pemerintah DKI Jakarta memiliki metode Musrenbang (Musyarawah Perencanaan Pembangunan), sebuah sistem perencanaan botom-up yang dilakukan mulai dari tingkat RW. Namun, dalam pelaksanaannya, pelibatan warga miskin atau kelompok yang terpinggirkan dinilai belum optimal. Berita baiknya, banyak pihak yang telah menyadari hal ini. Salah satunya adalah Forum Pengembangan Partisipasi Masyarakat (FPPM), didukung oleh The Asia Foundation, yang menerbitkan buku Panduan Perencanaan Musyawarah Perencanaan Kota.

Submitted by Julisa Tambunan — Wed, 05/23/2012 – 01:00

Beragam alternatif solusi ditempuh pemerintah untuk mengatasi dan mengurangi risiko banjir di Jakarta, mulai dari pembangunan kanal banjir sampai pembersihan sungai. Yang terbaru dan cukup inovatif adalah perencanaan kontingensi dan pemodelan dampak bencana melalui pemetaan partisipatif.

Submitted by Julisa Tambunan — Sat, 05/19/2012 – 01:00

Sulit untuk mengatakan dengan persis berapa jumlah penduduk Jakarta saat ini. 20 juta? 12 juta? 20 juta di siang hari dan 12 juta di malam hari? Sensus penduduk tidak pernah dapat sepenuhnya diandalkan karena sebagian besar warga Jakarta yang berdiam di perkampungan kumuh, contohnya, tidak memiliki Kartu Tanda Penduduk (KTP). Padahal, KTP adalah “karcis masuk” untuk mendapatkan berbagai akses terhadap fasilitas perkotaan mendasar seperti tanah, air, maupun sanitasi. Mercy Corps mencoba untuk melakukan pemetaan masyarakat di perkampungan kumuh terbesar di Jakarta, Penjaringan, khususnya yang tinggal di sekitar jalan tol layang menuju Tanjung Priok, dan mengadakan perencanaan spasial partisipatif bekerja sama dengan Kelompok Masyarakat Pecinta Kolong Tol dan Universitas Indonusa Esa Unggul.

Submitted by Julisa Tambunan — Wed, 05/09/2012 – 01:00

Masalah tanah masih menjadi masalah utama bagi warga miskin di ibukota Jakarta. Meski intensitas pemberitaannya kian berkurang, penggusuran tetap merupakan momok yang menghantui masyarakat miskin Jakarta, khususnya pendatang. Sejumlah organisasi non pemerintah dan lembaga swadaya masyarakat telah lama menyuarakan keberatannya dalam praktek-praktek penggusuran yang kerap kali tidak mengindahkan hak asasi manusia (HAM). Human Rights Watch (HRW) adalah salah satu organisasi yang menyoroti hal ini dan mengusulkan solusi.

Submitted by Julisa Tambunan — Wed, 05/02/2012 – 01:00

Mercy Corps reports that it is monitoring the situation in Indonesia after a powerful 8.6-magnitude earthquake struck off the coast of Sumatra island on Wednesday. Major aftershocks have followed. Tsunami warnings were issued for several countries, including Indonesia, India, Sri Lanka and Thailand. There were reports of power outages in Aceh Province, the region closest to the first quake’s epicenter, but no immediate reports of casualties or damage. All Mercy Corps staff of nearly 150 in Indonesia have been accounted for. Staff in Jakarta and in Banda Aceh reported feeling major shaking that lasted more than a minute and a series of major aftershocks. The organization says it will continue to monitor humanitarian needs arising from the quake and potential tsunami. Read more.

Submitted by Jakarta — Wed, 04/11/2012 – 01:00

One of the biggest problems in Jakarta’s many slums is child malnutrition. Most residents of these neighborhoods don’t have kitchens or cooking supplies to prepare their own meals, so they purchase cheap street food that is usually high in fat and sugar, but low in protein and nutrients. As a result of this poor diet, at least 17 percent of children throughout the city suffer from acute malnutrition, as well as anemia and stunted growth — and that percentage is much higher in the slum neighborhoods where poor families are concentrated. Another problem that plagues Jakarta’s poorest areas is unemployment, with some estimates putting unemployment rates in poor neighborhoods at more than 30 percent. Both of these problems — malnutrition and unemployment — are being directly addressed by a Mercy Corps program that helps food cart vendors dish out healthy food to children. Read more.

Submitted by Jakarta — Thu, 01/12/2012 – 00:00

Land titles have a big impact on the lives of the poor: without them, residents of informal or marginalized communities are in constant fear of relocation or demolition, and are prevented from benefiting from the land’s productive uses. Housing tenure gives slum residents a guaranteed right to the land and their properties, and enables them to make investments that improve their living conditions. The following articles describe four initiatives in Bogotá, Rio de Janeiro, Johannesburg, and Bangalore that are working to resolve the tricky issue of land titling. Read on to learn more, and then join the discussion below.

Jorge Bela, Gestor Comunitario de Bogotá

Uno de los principales frenos al desarrollo de los asentamientos irregulares es la falta de títulos de propiedad por parte de sus ocupantes. En Colombia, donde los conflictos armados que se prolongan desde hace décadas han sumado un número significativo de desplazados por la violencia a los flujos migratorios observados en toda Latinoamérica, este problema tiene una especial gravedad. Para atajar este problema en el año 2005 se aprobó una ley que permitía la transferencia gratuita de predios fiscales, o de titularidad pública, que hubieran sido ocupados antes de 2001. El alcance de esta ley deja fuera del proyecto de titulación a los asentamientos edificados sobre predios de propiedad privada.

Uno de los proyectos mas exitosos dentro de este programa se está realizando en Bogotá. Se trata de un asentamiento informal extendido sobre 70 hectáreas en las localidades Álvaro Uribe Uribe y Suba, y en el que vivían más de 5.000 familias. El proyecto fue lanzado en 2008 y en la actualidad se han entregado ya 4.200 títulos. El proyecto es singular por su tamaño, es el mayor de Colombia, y por el alto porcentaje de éxito conseguido con el mismo. Alejandro Quintero, coordinador del Grupo de Titulación y Saneamiento Predial del Ministerio de Vivienda considera que el proyecto constituye un modelo a seguir en otras ciudades, y ya tienen previsto aplicarlo en a Cúcuta y Melgar.

Los terrenos eran propiedad del Estado colombiano, lo que requirió una serie de actos legales para facilitar su cesión: incluso el Presidente tuvo que emitir un acto administrativo para ceder en primera instancia la propiedad al ministerio de vivienda, quien con posterioridad lo transfirió a la Alcaldía de Bogotá. Fue la Alcaldía, a través de a Secretaría Distrital del Habitat quien se encargó del complejo proceso de entrega de títulos. A pesar de la dificultad jurídica de la operación y de la diferente orientación política de las administraciones local y nacional, la relación entre ambas ha sido fluida en este proyecto, según afirmó Alejandro Quintero.

Aunque la asignación de títulos es relativamente costosa, pues se requiere un certificado de plano predial, el avalúo del inmueble y otros gastos, gran parte de estos se cubrieron gracias a un préstamo del Banco Interamericano de Desarrollo, que acompañó al Ministerio de la Vivienda en este proyecto. Aunque los habitantes de los asentamientos en un principio recibieron las visitas de los funcionarios, que se acercaban a sus viviendas para recabar datos, con recelo, pronto se solventaron estos problemas de confianza. Las viviendas ubicadas en zonas de alto riesgo, como quebradas, o en el ámbito de seguridad de la cárcel de la Picota, fueron excluidas, y sus habitantes incluidos en un proceso de reubicación. Tampoco se entregaron títulos a las personas que hubieron obtenido la vivienda mediante fraude o extorsión, ni a las que excedían de un valor de 79.000.000 COP (unos 40.000US).

Al tiempo que se entregaban los títulos, se realizó un proyecto de regulación urbanística y otro de mejoramiento de viviendas. Para Alejandro Quintero los efectos de todas estas intervenciones han sido rotundos: los habitantes de los 14 barrios que resultaron tienen una mayor calidad de vida, gozan de una mayor seguridad jurídica, quedan más lejos de la pobreza al tener un patrimonio que les permite respaldar actividades económicas, y generan ingresos fiscales nuevos para Bogotá. Para el 15 de noviembre han organizado un Foro Internacional de Titulación en el que esperan intercambiar experiencias con otros países de la región.

Jorge Bela, Bogotá Community Manager

Lack of property titles is one of the most significant barriers to development and poverty reduction in informal settlements. This problem is particularly serious in Colombia, where people displaced by several decades of armed conflict have joined the large number of immigrants for economic reasons in creating the largest number of informal settlements in Latin America. A law enacted in 2005 sought to tackle, at least partially, this problem by allowing for free transfer of property to informal residents. The scope of the law was limited to settlements established on public land before 2001, thus excluding all settlements on private land.

One of the most successful programs undertaken under this law is in its final stages of implementation in Bogotá. It covered a huge informal settlement, 70 hectares in total, over the Usme and Álvaro Uribe wards, with over 5,000 families living there. The project was launched in 2008, and 4,200 property titles have been issued so far. The project is unique because of its size and the high rate of success. Alejandro Quintero, coordinator of the group in charge of the project in the Ministerio de la Vivienda, believes it can serve as a model for other cities, and Ministerio is in the process of launching similar ones in Cúcuta and Melgar.

The settlement’s land was owned by the central Colombian Government, which presented unique legal challenges. A Presidential decree was necessary first to transfer the property to the Ministerio de la Vivienda, which in turn transferred it to the City of Bogotá. The City, through its Secretaría Distrital del Habitat was then in charge of the complex process of issuing individual titles to settlers. Despite the legal difficulties and the fact that the city and national governments were controlled by opposing political parties, the cooperation between them has been mostly smooth, according to Mr. Quintero.

Even if the land is transferred for free, there are significant expenses associated with the process, which can be prohibitive for settlers. It is necessary, for example, to issue certificates of land registry, and to make price appraisals for each house. The Inter American Development Bank gave a loan to the Ministerio de la Vivienda to cover these costs, thus further facilitating the process. Although the residents were initially reluctant to provide the exhaustive information necessary to obtain the titles, soon a trusting relationship was established between then and the authorities. Houses located in high-risk areas, such as riverbanks, or too close to the Picota jail — the largest in Bogotá — were demolished, and the affected families where included in a relocation program. People who had obtained their houses through violence or fraud, as well as houses worth over 79,000,000 COP (about $40,000), were also excluded from the process.

At the same time that the titles were being issued, urban planning and housing improvement projects were implemented. Alejandro Quintero believes that the result of all these initiatives has been clear: the inhabitants of the 14 neighborhoods resulting from the mass regularization of the informal settlements enjoy higher living standards, have stronger legal protection, are further away from poverty as they now have assets they can use to back economic activities, and generate new fiscal income for the city. On November 15th, the Ministerio de Vivienda will hold a seminar in order to share this experience with other countries in the region.

Catalina Gomez, Coordenadora da Rede em Rio de Janeiro

Rio de Janeiro está avançando na expansão efetiva da titulação de terras e beneficiando a sua população mais vulnerável. Esta direção positiva é o resultado da implementação do programa habitacional Minha Casa Minha Vida e do programa de melhoramento de bairros Morar Carioca.

Minha Casa Minha Vida está focado em apoiar famílias de baixa renda na aquisição de moradia nova e na provisão do seu título de posse. O programa foi criado em 2009 e conta com a liderança e financiamento do Ministério das Cidades. Este ministério tem construído mais de um milhão de unidades habitacionais no Brasil e tem previsão de entregar mais dois milhões até 2014. Especificamente no Rio, Minha Casa Minha Vida é liderado em parceria pelas secretarias de habitação dos governos estadual e municipal; até hoje já fizeram entrega de mais de 60 mil moradias novas construídas em espaços regularizados, garantindo condições legais, habitacionais e ambientais adequadas.

Morar Carioca complementa estes esforços focando-se no apoio da população que mora em assentamentos irregulares por médio de intervenções de melhoramento de bairros, expansão de serviços sociais e a promoção da regularização fundiária e a entrega de títulos de posse. O programa que foi lançado a partir de 2010 é liderado pela Secretaria Municipal de Habitação em coordenação com outras instituições.

Especificamente sobre os processos de regularização e titulação realizados pelo Morar Carioca, vale ressaltar a complexidade daqueles processos; eles envolvem vários procedimentos burocráticos que levam meses em concluir, tais como: (i) registro das terras e seu uso; (ii) pesquisa e registro socioeconômico dos beneficiários; (iii) preparação da documentação legal e delimitação; e (iv) autorização dos títulos de posse. Todos estes trâmites são feitos com um número limitado de pessoal especializado, o que ressalta a necessidade de fortalecer os recursos humanos nesta área.

Embora a regularização fundiária e a titulação sejam processos complexos e longos, Morar Carioca tem conseguido avançar na entrega de resultados com mais de 50 mil famílias beneficiadas com títulos de posse. Parte do sucesso do processo é a criação de varias unidades de informação nas comunidades beneficiarias que providenciam assistência e apoio para as famílias durante o ciclo de regularização e titulação.

Ainda com os resultados bem sucedidos destes programas, existem dois desafios principais. O primeiro destaca a necessidade de reduzir os tempos de regularização e titulação para que sejam mais efetivos e menos burocráticos. O segundo, ainda mais complexo é a necessidade de fortalecer os direitos dos cidadãos que não tem documentação legal de propriedade suas terras e estão sendo expulsas para dar espaço às obras relacionadas com a Copa e as Olimpíadas.

Foto: Secretaria de Estado de Habitação de Rio de Janeiro

Catalina Gomez, Rio de Janeiro Community Manager

Rio de Janeiro is actively moving forward with the expansion of effective land titling for its most vulnerable citizens. This positive trend is the result of the implementation of programs such as Minha Casa Minha Vida, the national housing program, and Morar Carioca, the city’s urban upgrading program.

Minha Casa Minha Vida (My House My Life) supports low-income, first-time home buyers with the provision of affordable and flexible home-buying schemes, as well as though the provision of land titles upon the receipt of their new homes. The program, which was launched in 2009, is funded by the Ministry of the Cities; since then it has delivered more than one million houses throughout Brazil, and is expected to deliver two million more by 2014. In Rio, Minha Casa Minha Vida is implemented in partnership between the state and municipal housing secretariats. To date, these institutions have delivered more than 60,000 new units (and have announced 40,000 more for next year), all which have been constructed in formal spaces, with adequate legal, urban, and environmental conditions.

Morar Carioca complements these efforts by supporting residents of informal settlements. The program works to upgrade neighborhood conditions, expand social services, and conduct regularization and titling services. Morar Carioca has been in place since 2010 and is led by the city’s Secretariat of Housing, in coordination with other local government bodies.

With regard to the land regularization procedures and title provisions provided by Morar Carioca, it is worth noting that these processes aren’t as straightforward as many would think; they involve various bureaucratic procedures that sometimes take months to complete. These steps include (i) registering land extension and use; (ii) carrying out socio-economic profiles and registry of beneficiaries; (iii) preparing legal paperwork for land delimitation; and (iv) authorizing and issuing proper land titles. All of these tasks are carried out by a limited number of officers, demonstrating the need to strengthen related human and technical capacities in this field.

Although land regularization and titling are complex and time-consuming processes, Morar Carioca is moving forward with the delivery of land titles and legal tenure services. As of June 2013, there have been around 50,000 families who have benefited from land regularization and legal tenure services. Pivotal to the program’s successful land regularization process has been the establishment of information desks in each beneficiary neighborhood, so that residents can receive guidance on the regularization procedures and further completion of the titling process.

Although these two programs are well established and have been effective in delivering successful results, there are two main challenges ahead. The first is the need to make land regularization procedures more effective and less bureaucratic. The second is the need to properly address the rights of residents, including those without legal documentation. This is particularly relevant in a context of reported displacements of low-income families without proper land tenure in order to make room for World Cup and Olympic Games facilities.

Photo credit: Secretaria de Estado de Habitação de Rio de Janeiro

Tariq Toffa, Johannesburg Community Manager

In South Africa, the government’s response to the characteristically peri-urban poverty of informal settlement (between 1.7 million and 2.5 million households) has occurred within the paradigm of individual title (subsidised housing), the conventional route for informal settlement upgrading in the country. Despite well-intentioned policies, however, this ownership model is far removed from lived realities; where many households are condemned to either waiting patiently for state-subsidised housing or to land occupation, while others cannot access the state subsidy, such as foreign nationals and the poor-but-not-poor-enough-to-qualify. In the longer term, the model could even be said to lock poor people into marginal locations.

Reflecting global trends over the last decade, however, a more flexible approach is also emerging, as represented by the Urban LandMark (Urban Land Markets Programme Southern Africa) programme, which advocates for opening up more officially recognised channels of land supply as a primary means for improving the pro-poor access to and functioning of urban land markets, and the benefits that flow from it. Based in Pretoria, the programme was set up in 2006 with funding from the UK’s Department for International Development (UKaid), and is now hosted at the Council for Scientific and Industrial Research in South Africa.

While an emphasis on individual ownership rights represents one approach to tenure; a second approach emphasises the administrative and legal mechanisms to tenure security as a first step towards official recognition. The Urban LandMark model, in seeking to realistically provide increasing levels of security during the period between informal settlement of an area and the delivery of ownership (through the housing subsidy), incorporates elements of both views. This incremental approach is probably the most distinctive feature of the model.

A second and integral aspect of this approach is context specificity. By recognising existing local practices in land management (how land is accessed, held, traded, etc.), more appropriate responses that enhance community agency are built. Co-funded by the Cities Alliance Catalytic Fund with UKaid, Urban LandMark researched little-understood, local practices in six poorer urban areas in Southern Africa in order to provide guidance on incrementally securing different routes to tenure in informal settlement upgrading (or “regularisation”). In Johannesburg, from 2009 the City worked closely with Urban LandMark in the City’s Regularisation programme. Tenure security was provided to informal settlements through legalising the land use, allowing them to be upgraded in situ in an incremental way until they can be formally developed. This legal innovation entailed an amendment to the zoning scheme, and resulted in some 23 settlements being declared as transitional areas in 2009.

A third important — though not emphasised — aspect of the incremental approach is the potential role accorded to space; for recognising local practices also means engaging the socio-spatial relationships that underpin them. Since municipal registers of informal settlement occupants have already been found to play a role in the land market, by linking it to the actual spaces through which practice occurs (e.g. layout plans), they may become an important hybrid resource for tenure security, and economic and social functions.

Although the delivery of ownership will likely remain a national objective for some time, given the magnitude of informal settlements, alternative approaches remain crucial. However, land use and allocation in Southern Africa remains a highly political issue. It remains to be seen how perceptions of interim-focused models will fare in the long term, against the evidence of past provisions and current expectations of formal housing.

Fig. 1: Different routes to greater tenure security. Fig. 2: Street and shack numbering: one mechanism for incrementally securing tenure. Both photos by Urban LandMark.

Carlin Carr, Bangalore Community Manager

Housing tenure can have a transformative impact on the lives of the poor. The security of ownership rights opens pathways for slum dwellers themselves to upgrade their living environments without fear of relocation or demolition. Beyond improved structural environments, tenure security also leads to improved health conditions, education levels and income levels. In this sense, housing tenure’s ripple effects make it one of the single most important aspects of improving the lives of slum dwellers.

Yet housing tenure is a complicated issue. India’s most recent policy to tackle urban poverty and create “slum-free cities,” Rajiv Awas Yojana (RAY), recognizes the importance of tenure in creating inclusive cities, but has run into obstacles. RAY’s main tenet is “the security of tenure through entitlement.” In order to enforce this, the policy states that no Central Government support will be given to states which do not give legal entitlement to slum dwellers. The progressive mandate, however, has been less than well received from local governments, leaving RAY in a state of stagnation. “Rajiv Awas Yojana (RAY) has failed to take off, with states expressing reluctance to comply with mandatory provisions for availing central funds under the scheme such as according property rights to slum dwellers and earmarking 25% of the municipal budget for spending in colonies and slums where the urban poor live,” says a 2012 article in the Hindustan Times. Policymakers have had to revisit the strict mandates to encourage movement with the scheme.

At meeting of over 100 policymakers, academics and practitioners at the Center for Environmental Planning and Technology in Ahmedabad, the participants broke down into working groups and devised strategies and recommendations for providing land tenure in RAY’s policy on slum-free cities. Here are a few key recommendations:

• Review land ownership patterns: It’s essential to start from a point of identification in the land tenure process. Many tenure issues arise from slums being on private lands or on public lands designated for other uses. It’s important to advocate for bringing all parties — owners and residents — together to negotiate the process and devise mechanisms and strategies for residents to gain rights to tenure.

• Provide tenure at the slum level: Giving land tenure at the slum level rather than the individual level reduces the likelihood that the tenure will be misused.

• Ensure basic services are available: Whether the slum has tenure rights or not, basic services should be extended to all the slums. There was a consensus by the group that there should be universal coverage of basic services in all the slums.

• Involve the community in the process: While “community participation” has become a great buzzword around urban poverty policies and interventions, there are few, if any, institutional mechanisms in place to ensure the participatory process. The CEPT working group suggests that the community must be involved from data collection to the design of the scheme — be it tenure rights or otherwise — to monitoring of the intervention once it’s in place.

RAY is set to launch now and will be in the implementation phase from 2013-2022. The coming decade will be one to watch in India. RAY’s success, in the end, can only be measured by whether India’s cities have become more inclusive and equitable — not simply if they are slum-free.

Photo credit: University of Salford Press Office

Durante el último siglo, la esperanza de vida en el país ha presentado un crecimiento importante, el cual ha sido constante, pasando de 59.4 años en 1965 a 76.8 años en 2011, es decir, ha presentado una tasa de crecimiento media anual de 0.57%, de igual forma, el cambio epidemiológico se ha comenzado a observar.

Submitted by Saúl Guarneros — Wed, 02/27/2013 – 12:05

“Pobre es aquel que no tiene ni pa comer…” — Esther

Según el CONEVAL, una persona que vive en una zona urbana es pobre cuando su ingreso es menor a $2,114 pesos al mes y carece de un derecho social o más.

Submitted by Jesús Gastelum — Sat, 02/23/2013 – 09:36

En la Ciudad de México, el impuesto conocido como predial es cobrado por la Secretaría de Finanzas, tal como lo establece el Código del Distrito Federal (Art. 126-133) Dicho impuesto, es establecido de acuerdo al valor determinado por el gobierno local o por ciertas instituciones o personas que deberán cumplir con diversos requisitos (Artículo 22 de dicho código), tomando en cuenta el valor de mercado, el tipo de construcción y otras características (valor catastral).

Submitted by Saúl Guarneros — Sun, 02/17/2013 – 19:41

Hoy en día el proceso de concentración de la población en las áreas externas de la Ciudad, como respuesta a la concentración humana, industrial, comercial y financiera, ha provocado cambios importantes en los patrones de viajes de la movilidad del D.F.. Mientras que en la década de los ochentas los viajes tenían origen y destino en las mismas Delegaciones, actualmente las distancias por recorrer son más largas e interdegacionales, inclusive hasta los municipios del Estado de México pertenecientes a la Zona Metropolitana. En este contexto, la administración del Gobierno del Distrito Federal desde el 2006 ha implementado diversas estrategias para transformar la movilidad y sentar las bases de una política pública de transporte integral. Leer más o discutir.

Submitted by Maria Fernanda Carvallo — Mon, 02/04/2013 – 23:00

Las ideas mueven al mundo, al igual que los números lo modifican. De acuerdo a Miguel Székely, un número puede despertar conciencias, puede movilizar voluntades, puede llevar a la acción, puede generar debate, y en casos afortunados, puede llevar a la solución de un problema. Los números que han sido protagonistas en México son los datos que surgieron de la medición del nivel y la intensidad de la pobreza en el país. En este contexto, funcionarios de la Secretaría de Desarrollo Social (SEDESOL) y académicos conformaron un Comité Técnico para la Medición de la Pobreza a nivel federal a fin de encontrar un indicador que estableciera la magnitud del problema, caracterizara el fenómeno para el diseño de políticas públicas, programas y acciones y evaluara los cambios en las condiciones de vida de las personas al igual que la incidencia de las acciones gubernamentales en la pobreza. Leer más o discutir.

Submitted by Maria Fernanda Carvallo — Mon, 01/28/2013 – 00:00

In Mexico City, the land levy known as ‘predial’ is collected by the city’s Ministry of Finance, as established by the Código Fiscal del Distrito Federal (Art. 126-133). The tax is set based on the value determined by a government official or institution (Art. 22 of the same code) by considering its market value, the type of building, and other characteristics (known as valor catastral).

Submitted by Saúl Guarneros — Sun, 01/27/2013 – 18:52

“La ciudad (polis) es una de las cosas que existen por naturaleza; y el hombre es, por naturaleza, un animal político.” — Aristóteles

Según la Organización Mundial de la Salud (OMS) el hombre y la mujer son seres biopsicosociales. Este término engloba al ser humano como un ente físico, mental y social.

En otras palabras, este término quiere decir que el ser humano es un ente con un organismo complejo y con una mentalidad enredada que construye su vida con base en valores, conciencia, ética, motivaciones, deseos, personalidad, entre varios ingredientes. Estas variables se forjan en sociedad a través de la familia, amistades, comunidad, municipio, nación, grupos sociales, entre otros.

Si estas aseveraciones son ciertas, sin duda vale la pena analizar, debatir, describir y entender lo que ocurre en las ciudades tomando en cuenta que dentro de ellas habitan millones de personas que por diversos que sean sus intereses, todos buscan construir un mínimo de bienestar.

En este contexto, agradezco a Dallant Networks, URB.IM y en especial a Víctor Dallant por invitarme a deliberar sobre historias de personas en ciudades que buscan incrementar su bienestar y disfrutar su dharma, a través de diferentes estrategias e interacción con diversos actores de la sociedad civil, gobierno, organismos internacionales y sector privado.

Es así que les comparto que a partir de hoy damos el banderazo a este Blog en donde vamos a reflexionar sobre historias de personas que buscan incrementar su bienestar en la Ciudad de México. Algunas serán historias exitosas, otras serán historias de fracaso y otras serán ideales para abrir el debate y opinar en esta arena ciudadana que es el world wide web.

Por último, te invito a que formes parte de este debate activo en twitter a través de las cuentas de @urb_im, @dallant, @fer_carvallo y @jesusgastelum.

Submitted by Jesús Gastelum — Sat, 01/19/2013 – 21:20

Les doy la bienvenida a este blog, el cual estará enfocado a la Prospectiva Estratégica, la cual es una disciplina que abarca una visión global y dinámica del futuro, reduciendo así la incertidumbre del futuro, es decir, en palabras de Maurice Blondel: “El futuro no se predice, sino que se construye”.

Bajo este tenor, en este espacio se abordarán temas socioeconómicos, es decir, desde temas variados como la obesidad, hasta temas de recaudación fiscal.

Submitted by Saúl Guarneros — Mon, 01/14/2013 – 21:50

Al interior de México las mujeres, indígenas y adultos mayores no gozan de igualdad de oportunidades en temas de acceso educativo, salud y laboral entre otros. Dentro de estas poblaciones, los adultos mayores analfabetas que viven en las ciudades enfrentan una constante vulnerabilidad al no contar con las habilidades suficientes para poder satisfacer sus necesidades básicas y difícilmente pueden ingresar al mercado laboral por falta de capacidades. La generación de adultos mayores de 65 años o más, son los que presentan mayor rezago educativo. De acuerdo al Consejo Nacional de Población (CONAPO), en México en el año 2011 el 24 por ciento de las personas de 65 años o mayores eran analfabetas, mientras que el 94 por ciento de la población entre los 15 años de edad y los 64 saben leer y escribir y son capaces de utilizar dicho conocimiento. Leer más.

Submitted by Maria Fernanda Carvallo — Wed, 11/07/2012 – 00:00

Investigadores pertenecientes a la Asociación Latinoamericana de Investigadores de la Comunicación (ALAIC), afirman que las TIC constituyen hoy en día un factor nuevo que se suma a la brecha de la desigualdad social, ya que el acceso a ellas ocasiona un distanciamiento cultural entre quienes la usan y aquellos sectores de la población que no tienen la posibilidad. Además del distanciamiento social, dicho factor provoca un fenómeno educativo de analfabetismo digital, que consiste en la incapacidad para el uso de estas nuevas tecnologías. Leer más.

Submitted by Maria Fernanda Carvallo — Wed, 10/24/2012 – 01:00

According to the WHO, more than 450 million people worldwide suffer from mental disorders. These illnesses are particularly common, and are especially destructive among the poor, those with chronic health conditions, minority groups, and communities exposed to conflict and disasters. Moreover, almost 75 percent of the Global South’s mentally ill remain untreated. In honor of World Mental Health Day (October 10th), read on to find out what is being done to resolve this issue in Bangalore, Cape Town, Accra, Bogotá, and São Paulo, and then join the discussion below.

Carlin Carr, Bangalore Community Manager

This year marks an important turning point in mental healthcare in India. The landmark Mental Healthcare Bill 2013 has been introduced and is under review to be passed as law. The new bill decriminalizes suicide and protects the rights of the mentally ill from inhumane treatment. It also “aims to ensure that proper medical treatment is provided to mentally ill patients” and “seeks to regulate the public and private mental health sectors and establish a mental health system integrated into all levels of general health care,” says an article in the Indian Express. Gaps in care have been filled by NGOs that not only work to provide treatment but to increase public awareness around issues of mental illness that have added to stigmatization of these patients.

In Bangalore, the Richmond Fellowship Society has been operating services since 1986, though it is part of the world’s largest global charity network focusing on mental illness. The organization says that over 10 million people in India suffer from schizophrenia, “while the figure for those suffering bipolar affective disorder, depression and anxiety disorders stands at a colossal 150 million.” While the numbers cut across socio-economic status, the poor, especially the homeless, are inordinately affected. Experts estimate that by 2020, mental health disorders will be the second leading cause of disability and death. The World Health Organization (WHO) has created a comprehensive Mental Health Action Plan 2013-2020 to increase awareness and services.

The Fellowship focuses on a Therapeutic Community approach which emphasizes using skill and compassion to enable the mentally ill to rebuild their lives with dignity. Outreach services include halfway homes, long-term stays, and public awareness campaigns as well as development, research and advocacy on related issues. Importantly, the Richmond Fellowship has also launched a training program for care providers to improve services on the ground. The Fellowship runs Asia’s only M.S. degree in psychosocial rehabilitation and counseling “to address the paucity of trained manpower” in the field. The degree is affiliated with the Rajiv Gandhi University of Health Sciences in Bangalore.

While organizations such as the Richmond Fellowship are working to fill the gap in services to the mentally ill, the 2013 bill marks an important step in integrating effective steps for mental illness care into community health centers. The biggest challenge will be training care providers to be aware of symptoms and to create a chain of intervention points so that more serious cases can be referred outside. After all, NGOs such as the Richmond Fellowship are few and far between across the country, and a tiered approach — as the Fellowship uses, depending on the length and seriousness of care needed — is essential in providing long-term rehabilitation for healthier and happier people.

Photo credit: Huw Thomas

Tariq Toffa, Cape Town Community Manager

In South Africa, many factors including disease, poverty, abuse, violence, and changing social structures contribute to the high occurrence of mental health issues (over 16.5 percent of adults). Another contributing factor is substance abuse, as South Africa is one of the top ten narcotics and alcohol abusers in the world (15 percent of the population has a drug problem). In many ways a legacy of apartheid’s disenfranchisement and dislocation, substance abuse in the Western Cape is higher than any other South African province, particularly in Cape Town’s non-white urban hinterlands known as the Cape Flats; and has been linked to cognitive deficits, mental health problems, aggression, depression, anxiety, sexual risk behavior, crime and violence.

Within such harsh conditions, one notable project on the Cape Flats is the Sultan Bahu Drug Rehab Centre in Mitchell’s Plain, which has achieved the highest drug addiction recovery rate (87 percent) and retention rate (83 percent) in the entire province (its three drug rehab centres in the Western Cape also form some of the only internationally accredited facilities of their kind on the continent). This is all the more remarkable given that most rehab centers have a success rate of less than 3 percent.

The success of the facility, in part, lies in attending to both the complex needs of the individual (based on ‘cognitive behavioral’ therapy constructs) as well as to the affected families at all stages of the rehab process, and in appropriateness to context, culture, and religion. Thus, within a generally poor community, the services are made physically and financially accessible; and both the two primary religious affiliations of Mitchell’s Plain (Christian and Muslim) are accommodated, by providing for an imam and a priest to serve the interests of both Christian and Muslim patients — a pluralism that startled parliamentarians in a recent visit to the facility. Practitioners at the Centre are also enrolled for post-graduate studies in addictions care — a first in South Africa.

The Rehab Centre is a social outreach project of the Sultan Bahu Centre (SBC), a faith-based NPO which provides a wide range of social projects throughout the country, and its achievements have not gone unnoticed by Provincial Government. To improve service delivery to the poor, the government has increasingly recognized the need for partnerships with other stakeholders, such as faith-based organisations (FBOs) or NGOs. Thus, the Department of Social Development in the Western Cape recently announced that the Rehab Centre would be awarded the first pilot outpatient opiate replacement program in the country, which allows patients “a fine line of functioning” not based on intoxication and withdrawal. With this the SBC will form one of the beneficiaries of the R87 million (US$ 8.7 million) pledged to fight the province’s drug scourge. Moreover, National Government has requested that it provide rehab programs throughout the country.

While in some respects the SBC example may be a hard one to emulate (its open door policy, free treatment to the unemployed, etc.); yet in providing a complex synthesis of services appropriate and sensitized to multiple contexts (physical, psychological, social, economic, religious), the SBC appears to be charting a new and multifaceted model for social service provision in a ‘new’ democratic South Africa. As an FBO that now extends the most current modern rehab treatment in South Africa, it also positions a middle path to the taboo issue of mental disorder in South Africa, often viewed solely as a spiritual problem to be solved by traditional healers or church alone. In bisecting such modern-traditional binaries, and in bridging governmental and non-governmental resources, new openings for treatment of drug abuse and related mental disorder in the Western Cape are emerging.

Photo Credits: eNCA

Felix Nyamedor, Accra City Community Manager

The issue of mental health stigmatization in Accra is of great concern to individuals, families, civil society groups, and many religious bodies. There is stigmatization about the condition, stigmatization concerning the persons with the condition, and stigma is also attached to the people who work in the area of mental illness. These concerns affect the resources and quality of life of the mentally challenged. In addition, its economic and social impact on the person, the family, and the workers are enormous.

In Accra, mental health patients are confined to specific institutions such as Pantang Hospital and Accra Psychiatric Hospital, among others. It is common to see mental health patients with tattered clothes, looking poor, dirty, hungry, neglected, isolated, and some are sometimes even lynched.

The stigma associated with mental health issues stresses some family members, who then fail to associate with such patients even after treatment, making their integration into their families very problematic. Some relatives ultimately abandon their family member in state institutions in order to limit the negative perceptions others will have towards them.

Ghana’s Mental Health Bill, which seeks to increase the rights of the mentally challenged, was passed in 2012. Unfortunately, the provisions made in the Bill have not been fully implemented. Plans are in place at the Ministry of Health to form a permanent board to address issues concerning mental illness stigmatization in the country. In the absence of government action, the mental health advocacy group For All Africa Foundation (FAAF) is pushing to change societal perceptions of persons with mental disorders through education. FAAF’s work includes a variety of different approaches aimed at changing the major structural and attitudinal barriers to achieving positive mental health outcomes in Accra. In addition, it critiques actions of Ghana’s government and encourages policy makers to improve services and treatment of the mentally ill. The Accra Psychiatric Hospital, spearheaded by Dr. Akwasi Osei, has embarked on an integration process of the inmates back to their families. Working together with the Kintampo Health Research Institute, they have also introduced helpers into the communities to educate residents about mental health stigmatization. This process has helped to lessen the level of stigmatization in Accra, and families have been increasingly encouraged to accept and care for patients.

The Mental Health Society of Ghana is an organization that works to educate and advocate for the needs of people with mental health concerns in Ghana. It aims to represent the mentally ill in a unified organization, to protect their rights and wellbeing, and to reduce society’s stigmatization through advocacy projects.

Support for the eradication of mental illness stigmatization through proper education and institutional capacity-building for mental health institutions can go a long way to change the lives of the mentally ill.

Jorge Bela, Gestor Comunitario de Bogotá

La situación de los habitantes de la calle se considera como uno de los problemas más complicados de resolver en las grandes ciudades latinoamericanas. Según un censo elaborado en 2011 por la Secretaría de Integración Social (SIS), en Bogotá se identificaron 8.385 habitantes de calle, un 86.9 por ciento de los cuales son hombres, y el 8.4 por ciento son menores de 18 años. El 17.9 por ciento son jóvenes entre 19 y 25 años, y el 38.9 por ciento son adultos entre 26 y 40 , quedando un 32 por ciento, de adultos mayores. Otro dato interesante de este sondeo es que el 58 por ciento se dedica a la recolección de objetos de reciclaje, el 34 por ciento a mendigar, el 28 por ciento a servicios no cualificados y el 10.7 por ciento a delinquir. Aunque es posible que estas cifras no recojan el número total de habitantes de la calle, quizá en una proporción considerable, sí que son reveladores en su estructura demográfica y en sus ocupaciones.

Existe una vinculación estrecha entre trastornos mentales, consumo de estupefacientes y los habitantes de la calle. Según el estudio de la SIS, en Bogotá el 68.1 por ciento consumen bazuco y el 80.5 por ciento de ellos lo hace todos los días. Además, el 64.6 por ciento consumen marihuana, el 63 por ciento de estos de forma diaria. Aunque la Secretaría de Salud de Bogotá reduce la incidencia de este tipo de problemas al 30 por ciento, y es muy difícil establecer una cifra exacta, es sin duda demasiado elevada. La falta de acceso a los sistemas de prevención y tratamiento agrava aún más los problemas de los habitantes de la calle, que se ven forzados a acudir a las salas de emergencia en momentos de crisis, poniendo una fuerte sobrecarga en estas salas, que en todo caso no están preparadas para solventar los problemas de fondo de este colectivo.

Por todo ello cabe destacar un programa lanzado por la Secretaría de Salud de Bogotá, que busca crear 130 camas adicionales, repartidas en cuatro centros en distintos puntos de la ciudad, y destinadas a atender a personas con problemas de salud mental y derivados del consumo de estupefacientes, en especial a los habitantes de la calle. El plan prevé también la creación de un nuevo centro de salud dedicado específicamente a los jóvenes con estos problemas, entre los que se ha detectado un alarmante aumento del nivel de suicidios. La Alcaldía busca con este reforzamiento especializado combatir y prevenir problemas de salud mental, al tiempo que se contribuye a liberar la presión a la que, por diferentes motivos, están sujetas las salas de emergencia de Bogotá.

Hasta ahora se han abierto 30 camas, de las 50 previstas para este centro, en la clínica Fray Bartolomé de las Casas; 12 camas en el Hospital San Blas; y una unidad móvil destinada a jóvenes y adolescentes. Otras iniciativas están en marcha. Con las primeras camas abiertas en 2013, es aún muy temprano para evaluar el resultado de este proyecto, y si en efecto se consigue llegar a los habitantes de la calle. En todo caso, es una orientación adecuada el dedicar recursos para la prevención y el tratamiento de los problemas de salud mental de los habitantes de la calle, en vez de dejar que estos se acaben por resolver en las salas de emergencia, con un coste superior y una efectividad mucho menor.

Jorge Bela, Bogotá Community Manager

Homelessness is one of the most complex and difficult to address problems in all large Latin American cities. A census led in 2011 by the Secretaría de Integración Social (SIS), found 8,385 homeless people in Bogotá. Of those, 86 percent were male. 8.4 percent were under 18 years old, 17.9 percent between 19 and 25, 38 percent between 26 and 40, and 32 percent were older than 40. As for their occupation, 58 percent were garbage recyclers, 34 percent begged, and 10.7 percent stole and robbed as a form of living. Although it is almost certain that this survey did not register much of the homeless population, it is still quite revealing regarding the population’s demographics and occupation.

There is a close link between mental disease, drug abuse, chronic illness. and homelessness. The SIS study found that 68.1 percent of homeless in Bogotá use bazuco (similar to crack). Of those, 80.5 percent use it on a daily basis. Furthermore, 64.6 percent smoke marijuana, 63 percent of those on a daily basis. It is very difficult to establish a precise rate of drug abuse (the Secretaría de la Salud de Bogotá estimate sets it at 30 percent), but it is dramatically higher than in the general population, and constitutes a major problem for the homeless population. Lack of access to treatment and prevention aggravates the situation, as the homeless often get treated only in emergency rooms during acute crises. This is far from desirable, as emergency rooms in Bogotá are operating beyond full capacity, and are not prepared to treat the underlying problems, only to mitigate the effects of the crisis.

In order to tackle these problems the Secretaría de Salud de Bogotá has launched a program to create 130 new hospital beds, distributed in four health centers around the city. These beds are specifically targeted to treat mental health and drug abuse patients, specifically the homeless. The program also includes the creation of a new health center reserved for treatment of young patients, as suicide rates within this population have risen abruptly in the past few years. This program, launched by the City Government in 2012, seeks to better treat and prevent mental health problems, while at the same time improving the overcrowding in the emergency rooms.

To date, 42 hospital beds (30 at the Fray Bartolomé de las Casas clinic, and 12 at the Hospital de San Blas) have been put into place, as well as a mobile unit to treat young patients. It is still too soon to evaluate this program (the first beds were only put into service in 2013). Also, the homeless are often difficult to convince to seek treatment, so it will be necessary to monitor whether they use the new facilities. Nevertheless, it is good policy to use resources to treat and prevent mental health problems in the homeless population, instead of letting these problems end up in emergency rooms, where the costs are much higher and the treatment less apt.

Catalina Gomez, Coordenadora da Rede em São Paulo

Segundo a Coordenação Nacional de Saúde Mental, Álcool e Outras Drogas, três por cento da população brasileira sofre de transtornos mentais severos que precisam cuidados contínuos e nove por cento da população apresenta transtornos leves que precisam de tratamentos eventuais.

Para atender o grande desafio da atenção à saúde mental, o governo brasileiro vem apresentando avanços importantes liderados pelo Ministério da Saúde. No tema regulatório, o ministério aprovou no ano 2001 a Politica Nacional de Saúde Mental que estabelece importantes orientações de política afastando-se das hospitalizações e dando prioridade aos serviços de terapia e reintegração social. Adicionalmente, a legislação orienta que os municípios são as unidades encarregadas de providenciar os serviços de saúde mental no seu território.

Demos uma olhada sobre como funciona a resposta municipal no cuidado da saúde mental numa cidade. São Paulo, por exemplo, é uma das cidades que tem sido líder neste tema; sua resposta à saúde mental é coordenada pela Secretaria Municipal de Saúde. Aquela Secretaria tem adotado uma abordagem integral, compreendendo que a saúde mental faz parte fundamental da saúde em geral; seu diagnostico e tratamento deve estar acompanhado pelos diferentes serviços de saúde. Por exemplo, aqueles pacientes que tenham doenças mentais leves são referidos aos serviços de saúde básica para controle e monitoramento.

Para o tratamento de doenças mais severas, a Secretaria vem implantando os Centros de Atenção Psicossocial, conhecidos como CAPS, os quais são instituições que visam à substituição dos hospitais psiquiátricos focados no isolamento dos pacientes. Os CAPS oferecem serviços gratuitos mais humanos focados no cuidado, no tratamento e na interação social dos pacientes. Cada centro tem equipes conformados por psiquiatras, enfermeiros, psicólogos, terapeutas ocupacionais, auxiliares de enfermagem e monitores.

Atualmente operam vários CAPS distribuídos pela cidade, incluindo 20 CAPS para adultos e mais outros 20 CAPS com foco na atenção de drogas e álcool, uma das doenças que estão preocupando mais às autoridades públicas. Também a cidade tem 13 CAPS para crianças e adolescentes com doenças mentais que precisam de tratamento terapêutico. Estes centros fomentam um trabalho junto com as famílias e tentam evitar ao máximo a internação dos pacientes para evitar seu isolamento.

Embora exista uma necessidade de ampliar estes serviços, a cidade tem avançado com o estabelecimento de serviços adequados. Para complementar estes esforços, a Secretaria Municipal de Saúde organiza atividades para indivíduos com doenças menores com objetivo de promover sua integração social. A Secretaria, conjuntamente com outros órgãos públicos e em parceria com organizações da sociedade civil, organizam caminhadas pela cidade, visitas a museus e atividades comunitárias para que os pacientes consigam interatuar, compartilhar experiências e ainda mais importante, consigam se sentir cidadãos ativos e valorados.

Foto: Secretaria Municipal de Saúde

Catalina Gomez, São Paulo Community Manager

According to Brazil’s National Coordination of Mental Health, Alcohol, and Other Drugs, three percent of the country’s population suffers from severe mental disorders that require continuous treatment, care, and support, and around nine percent of the population has mild mental disorders that require sporadic treatment.

To address mental health issues, the Brazilian government, through its Ministry of Health, has moved forward with key steps. On the regulatory side, the country approved the 2001 Mental Health Policy, which marked a strategic change of policy from a focus on hospitalization towards a greater emphasis on therapeutic care and social reintegration. Additionally, the legislation emphasizes that although mental health care is a shared responsibility within the various levels of government, municipalities should be the main implementors of care services.

Given that mental health care provision is considered a municipal responsibility, let’s take a look at what this implies at the city level — São Paulo has been one of the leading cities in this respect. Its response to mental health care is coordinated by the Municipal Secretariat of Health, which has adopted a comprehensive approach. This means that the city understands mental health as a fundamental part of overall health, and it therefore promotes its diagnosis and treatment in coordination with other health services, and never in isolation. This also means that individuals who present mild and temporary mental illness are referred to the basic health care system.

To address more severe mental illnesses, the Secretariat has put into place Psycho-Social Attention Centers, known as CAPS (Centros de Atenção Psicossocial). These aim to replace the traditional psychiatric hospitals that used to isolate patients with more human interventions focused on care, support, and social interaction. The CAPS conduct proper diagnosis and offer free care and support services to people with different levels of mental illness. Each center has a specialized team assigned composed of psychiatrists, nurses, psychologists, occupational therapists, and social monitors.

Currently, São Paulo has several CAPS operating throughout the city, including 20 CAPS for adults and 20 additional CAPS that focus specifically on treating alcohol and drug abuse, which are some of the most pressing concerns from public authorities nowadays. In addition, there are 13 CAPS for children and adolescents with mental illnesses that require therapeutic treatment. The centers targeted to youth tend to avoid committing children to institutions in order to prevent their isolation from their families and communities. Their work focuses on promoting social integration and family involvement in their treatment.

Although there is an urgent need to expand these services, the Secretariat of Health has certainly moved forward in implementing an adequate service model. To complement these efforts, it organizes free activities targeted to individuals with mild mental illness in order to promote their integration within society and to avoid their exclusion and stigmatization. The Secretariat, along with other government institutions and in partnership with non-governmental organizations working in this field, organizes walks around the city, museum visits, and other social activities to help patients interact with other peers, share experiences, and crucially, feel like active and valuable citizens.

Photo credit: Secretaria Municipal de Saúde