Thailand's Community Organization Developments Institute

Section 2. Health in Slum Communities

Be they public health experts, social workers, journalists, or even the United Nations, one fact agreed across the different actors appears to be that poor health is associated with life in slum communities. What is even more universally accepted and confirmed with time is that the current rate of rapid urbanization will pose a serious global challenge like we have never experienced. More and more urban dwellers are emerging in the least developed countries of the world, and as the UN Population Fund estimates these numbers will continue rising; five of our nearing seven billion world population will be living in urban areas by the year 2030 (UNFPA). Problem is, however, the uncontrollable growth of urban slums also translates to immense health issues. As defined by the UN in 2002, these communities are characterized by “insecure residential status, poor structural quality of housing, overcrowding, and inadequate access to safe water, sanitation, and other infrastructure” (UN-HABITAT). In least developed countries where 78% of its population classifies as slum-dwellers, the people not only face exclusion, insecurity, and rights violations but the consequences are far more detrimental to individual health and overall well-being (UN-HABITAT).

Many challenges faced by slum dwellers can be explained by the very environment that surrounds them from day to day. Because of the poor structural qualities of housing and insecure residential statuses that are characteristic of slum settlements, many residents occupy undesirable land as measures of last resort. For various reasons, those lands are unused because of their typically hazardous geography. Not only does the land come with its inconveniences of forced commuting in dangerous vehicles leading to frequent road and traffic injuries, but the unsafe and heavily polluted environments also directly and indirectly impact the health and safety of slum-dwellers. Realistically speaking, housing in slum communities are built more so for utility rather than livability. Because the main concern is maximizing a limited amount of space for the greatest amount of people, comfort and livable conditions essentially become the trade-offs. As a result, slums are generally densely packed, overcrowded, and constructed with substandard materials and little foundation—anything from cardboard to mud—subjected to fires, landslides, floods, and other natural and man-made disasters (Unger & Riley). In some cases, earthquakes result in immediate deaths due to structural factors that stand obstacle to rescue efforts. In others, the inability to remove excess storm water becomes breeding ground for mosquitoes that go on to spread malaria (Sheuya). Moreover, overcrowding places slum-dwellers at the high risk of respiratory infections, asthma, meningitis, tuberculosis, SARS, and much more. The high occupancy rates coupled with space usage in “all-purpose rooms” perpetuate the spread of respiratory diseases as chances of transmission become significantly higher therein. The close living proximities further enhance opportunities for developing and transmitting more serious diseases like TB, scabies, skin infections, bacterial pharyngitis, rheumatic heart disease, etc. Aside from disease outcomes, there are also positive correlations between overcrowding and negative social behaviors. The rates of domestic violence and child abuse are evidently higher where there is insufficient space (Sheuya).

Besides structural inadequacies, slum communities present an urgent need for sanitation and access as well. When securing land and a shelter overhead is the most immediate of concerns, at times waste disposal takes little priority in slum life. Due to the lack of basic infrastructure like piped water or sanitary drainage, the access to clean water has become a major barrier to the development of these settlements. At the moment, however, the short-term consequences of inadequate water supplies are associated with dysentery, cholera, eye infections, trachoma, worm infections, diarrhea, and pneumonia (Sheuya). More importantly, there is virtually no safe waste disposal system whether it is household, wastewater or industrial wastes. Additionally, the frequent worm infections can develop into more severe conditions involving intestinal hookworms, roundworms, tapeworms, or even anemia, which can lead to birthing complications for girls much later (Sheuya). Driven by the limited choices of slum-dwellers, unsanitary practices, such as open defecation, are habits that carry many long-term impacts on the people’s health and surrounding. Added on with poor hygiene and lack of drinking water, open defecation altogether contributes to about 88% of deaths due to diarrheal diseases in children under the age of five (UN). This alone illustrates the health situation slum-dwellers typically struggle with from a very early age on.

On another front, the environmental sanitation of the slums as a whole poses another health challenge in and of itself. On an individual level, the people’s unsanitary culture drives the spread of cardiovascular and respiratory problems and diseases, but, in turn, on a community level, the community’s surroundings of poor air and water quality are also driving forces that create a perpetuating cycle of developing and transmitting the resulting medical conditions. As mentioned, the majority of slum land is unused and undesirable because of its geological hazards and unsafe environments. The locations of slums are more prone to various natural disasters, and landfills are one of the most common. It has been proven that hazardous areas of landfills are associated with health risks of low birth weight, birth defects, infectious diseases, and cancers (Sheuya). The dark, shabby slum conditions are linked to social conditions like depression because of its little exposure to daylight and noise pollution. There is again the issue of open defecation where we can see that human waste continues to contaminate the environment in this sense. Residents are also at risk of contagious infections like leptospirosis, which develops from living in close proximity to open sewers with high rat densities (Unger/Riley). The characteristics of slum settlements, therefore, are also worsening the already devastating conditions and environment of such communities. The general lack of ventilation, hygiene and exposure to environmental contaminations and indoor pollutions further exacerbate the conditions of lung cancer, pulmonary diseases, and others. Overtime, the exposure to toxic or chemical wastes, industrial and indoor pollution, proximity to dumps, open defecation and sewers, and garbage burning altogether contribute to the poor air quality surrounding slum communities. According to the WHO, from the early to mid-1990s, 100% of urban dwellers lived in cities with air pollution levels higher than the organization’s guidelines. Particularly in developing countries, exposure to air pollution is two to eight times above the maximum WHO guidelines (WRI). What is even more telling is the fact that over 80% of deaths in developing countries resulting from air-pollution-induced lung infections are among children under the age of five (WHO). In the long run, the overall consequences are not only affecting current slum-dwellers and new residents but pose serious human threats to slum newborns and children in the future.

As the World Health Organization emphasized in 1946, health is not merely the absence of diseases and infections; health is constituted by a “state of complete physical, mental and social well being” (WHO). On the surface, medical conditions and concerns must be addressed, but the health challenges that slum-dwellers face cannot be combated by one-dimensional cures and treatments. The health situation of slum communities is a multi-faceted issue beyond that of local or national approaches, and more solutions must come from lasting structural changes. The World Resources Institute predicts from 1998-1999 data that Thailand’s projected loss due to TB sickness and deaths will reach $7 billion by the year 2025 (Tuberculosis and Urban Inequality). At large, Thailand slum settlements dwelling in poverty are suffering the consequences of both losing good health and money.

Section 3. Community Organization Developments Institute (CODI)

In a time where 8.25 million people inhabited 5,500 urban poor communities, the Thai government was struggling to assist the overwhelming populations of squatters and slum communities facing common threats of eviction and overall poor quality housing (Boonyabancha, 2). Instilled with the concept of pushing slum settlements out of their city, the government’s upgrading solutions remained limited in what they achieved on a large scale. The very first slum upgrading initiative began in 1977 pushed forth by the National Housing Authority. The program was a significant stepping stone as the country’s urban poor communities were no longer discounted as livable parts of their cities. Although the reserved attitude of the government initially stood in the way of forwarding slum upgrading, the eventual change in attitude also brought about the newly established Community Organizations Development Institute (CODI) at the turn of the century.

Nevertheless, what CODI has developed into today is largely a result of earlier government attempts in creating pilot housing and slum upgrading solutions in the state. The 1980s saw immense effort from local community movements, urban networks formed by the people, NGOs, and even instances of government-community partnerships throughout the years. Despite the rising momentum, the slum upgrading movement experienced dispersed growth, from “land-sharing schemes” (where squatters received legal ownership if they agreed to sharing the land with its owner) to attempts in securing land tenure (Boonyabancha, 2).

Following a period of community upgrading projects and the rise of organizations and networks, in 1992 the Thai government launched the Urban Community Development Office (UCDO) aimed to further support communities through small loans. An important characteristic of the UCDO is its unique take on income generation within slum communities. While Thailand enjoyed economic successes between the 1980s and 1990s, the poorest remained living in poverty as those successes did little to benefit them or their desperate living situations, for that matter. As land prices continued soaring, housing conditions worsened and urban settlements and their squatters faced greater risks of eviction. As UCDO improvements began to take hold, a “more participatory [model] of support” was put into place through community-based savings and credit groups (Boonyabancha, 3). With a total of 30 million U.S. dollars, UCDO was entitled to then redistribute the funds as loans to communities to use for different housing improvements (Boonyabancha, 3). Together, a governing board, consisting of interest groups, senior government staff, academics, and senior community leaders, was also provided to the community for purposes of technical support. What was crucial was that the community would only be eligible for financial assistance if it demonstrated the ability to manage their finances as a group—with the clear incentive that interest rates for the loans were significantly lower than those of other money lenders. Along with the grants and loans, communities were well-equipped to development their respective housing plans without any restrictions, and the various savings groups that formed further fostered growth of community networks overtime. As a whole, these community networks play a vital role in making available the UCDO (and later CODI) funds for low-income groups of Thailand as they are founded on bases of communal problems, occupations, savings groups, and more.

After much success, UCDO received increasing support from foreign governments as well. Some implementations include another grant program targeting environmental improvements, which received 1.3 million U.S. dollars from the Danish government. Following the financial crash of the Asian market in 1997, the Japanese government assisted Thai savings groups manage their loan repayments. For a period, UCDO also received financial support from the World Bank’s Social Investment Fund for students, HIV patients, and the sick and elderly (Boonyabancha, 4). Moreover, UCDO has created many lasting changes visible through the 950 community savings groups that have been established, the 47 funded housing projects for 6,400 households, and the smaller grants issued to 796 communities consisting of 68,208 families in the country. As far as finance, the program has shown promising rates of return, as well; rough estimates show that 2 million Baht had been acquired in terms of assets from all the different projects (Boonyabancha, 4).

By 2000, UCDO had grown larger and more established, and it was time for even greater expansion: CODI. At a glance, CODI shows no real differences from its UCDO foundations—except for its legal standing. Whereas UCDO remained housed under the NHA, CODI was its own independent public organization under the Ministry of Social Development and Human Security (Boonyabancha, 4). This gave it the leverage of both applying and securing funding from the annual government budget directly and even wider opportunities in partnering with outside urban and rural groups. Evidently, CODI collaborated with over 30,000 rural organizations throughout Thailand (Boonyabancha, 4). CODI shares many of the same qualities as the former UCDO from holding a board of representatives to its strong vision of maintaining communities’ self-managed savings and loans groups.

Since the upgrading initiative launched in the year 2000, the Baan Mankong pilot has implemented their programs in over 415 communities extending their reach to 30,000 households in 140 cities all around Thailand (Boonyabancha, 10). Besides land upgrading, CODI promotes social upgrading on multiple fronts from building cooperative land ownership to distributing small loans within the communities—giving the people themselves full control over upgrading their own lives. The distinguishing factor from conventional slum upgrading approaches is that it places the focus on the slum-dwellers rather than what external actors like governments and organizations can do and provide for the settlements. Instead of bringing financial and structural support from the outside, the community manages its own finances, building processes and projects from the ground up. Essentially, the money stays within the community and how the people choose to utilize those resources is entirely up to their discretion. This demand-driven model contrasts that of supply-driven approaches of the past, as only communities determined to implement improvement projects receive loans from the Thai government.

Because the program itself is so flexible, there are no real specifications on any projects, guidelines, or outcomes, even. Each community group defines its own plans and goals tailored to their own population—everything from the type of land to purchase to the housing plans for all the different families. Furthermore, the direction and flow that each project takes is precisely how the slum communities imagine their upgrading process, whether they are surface-level infrastructural improvements or greater structural changes. In Uttaradit, upgrading began with a comprehensive survey mapping all slums and their squatters in the surrounding area in an effort to distinguish which would remain and which would relocate in the process. The method of first gathering relevant information gives a community the opportunity to build and expand upon a network of members aware of the population’s interests, needs, and problems. With the collected information, the community is then able to form an improvement plan based on those needs assessments.

Since then, much has been learned from the pilot projects that have served as models from the beginning. In 2007, CODI reports itself that 226 cities in the Bangkok district are undergoing the upgrading process now in 68 different provinces, approving 495 projects in a total of 957 communities (CODI). Over the years, Thailand has also seen increasing collaboration between the organization and government negotiating with public land owners in the country. Simply put, their interest in converting public land for housing for the poor is a win-win proposition for both sides. While the people are given the chance to transform their land and lives, public land departments are generating a profit with rental arrangements for the communities too. Some landowners, however, remain unconvinced and entirely trusting but there are often alternative means to ease those agents into the situation. For instance, the State Railway of Thailand (SRT) remained hesitant about directly leasing their property to squatter communities since their agreement with CODI in 2006 granting 14 communities the permission to “upgrade on-site” (CODI). The next year, CODI signed another MOU with the SRT allowing another 100 communities to join their site, the only condition being that CODI acts as intermediary between both ends. Now, all land is leased to CODI, which in turn sub-leases to the communities to keep upgrading projects progressing.

In perspective, from 2003 to 2007 the Baan Mankong program has made incredible progress. 78 percent of households have been successfully upgraded in original or nearby locations; 97 percent of those have secured their tenure and resolved their eviction issues; 82 percent of households have now obtained long-term land security (CODI Report). Although there remains much to be accomplished in the slum upgrading movement as a whole, these are powerful results produced singlehandedly by a community organization.

Section 4. Bang Bua Canal Community

Before any upgrading took place, hundreds of canal communities have resided in Klong Bang Bua for over 100 years. Shortly after settlement, the communities faced eviction as the Thai government made way for plans to construct roads and army headquarters. The people became scattered as family after family was forced to leave the land. In December of 2003, CODI’s Baan Mankong program adopted the Samaki Ruam Jai community as part of its upgrading process throughout northern Bangkok. Since 2004, the canal communities have secured a long-term lease agreement with the Treasury and Irrigation Departments, made both environmental and infrastructural land improvements, and created a prosperous, growing community where thousands of squatter families find home to.

Prior to this formal rebuilding program, however, the squatter communities of Bang Bua had an existing number of localized upgrading movements underway. Because of the canal’s proximity to Sripathum University, for several years the communities have organized canal cleaning projects with the university. In one example, the people have begun producing their own natural cleanser composed of Effective Microorganism (E.M.) in order to combat the growing pollution caused by numerous factories alongside the canal. Additionally, large-scale cleaning takes place annually within the community where nets are set up to rid any solid waste (CODI). Overtime, the localized cleaning initiative that began with a handful of concerned members quickly transformed into a community-wide goal of the pilot project in Samaki Ruam Jai as the upgrading process took hold.

As upgrading plans developed, many filtering and sanitation methods were implemented in the people’s homes. More recently, one system designed by the people themselves is a kitchen waste water filtration that essentially purifies water after it drains in the sink. This method is not only low-cost (about 90 U.S. dollars) to install but also offers an extra layer of filtration to maintain a clean canal (CODI). Moreover, the accumulated oil is typically collected and sold for candle-making and therefore another means of generating profit for households. Furthermore, another measure to ensure minimal pollution is the effective usage of a communal septic tank that treats the entire community’s sewage before it enters the Bang Bua (CODI). Another sustainable way that has helped support families is growing greens to beautify the areas surrounding canal. It has even been reported that some are earning enough from selling morning glory greens to send their children to universities (CODI). Purification of the canal then addresses the problem of pollution with low-cost solutions and encourages the community to contribute environmentally to create a source of income for their families at the same time. More importantly, long-term plans have also been established simultaneously, such as goals of building a flourishing floating market or a community health center (ACHR, 2). In the future, the hope is that community will see greater opportunities to expand in areas of tourism.

Aside from implementing environmental ideas, different types of redevelopment plans have also been rapidly put into place as part of the larger community rebuilding process. The proposal for a six-meter walkway has been in the works since 2004 (CODI). Later, building plans were revamped due to spatial concerns as the community preferred allocating their limited land to more housing rather than greater access for automobiles. The plan of a canal walkway, however, sprung from the people’s sense of insecurity about fires in the community. They wanted fire trucks to be able to enter and leave with ease, but in the end the idea of “land sharing” was proposed. The communal agreement of land sharing, therefore, serves dual purposes of satisfying the needs of both the communities and the greater public. Because this is the first ever case of public land being leased directly to the people, this construction was their way of “giving back” to the city of Bangkok (ACHR, 7). Further negotiations were then made with the District Authority to share the costs of constructing the canal itself—the community members would be responsible for two meters and the city the remaining third meter. With the financial support of Baan Mankong and voluntary cooperation of the people, the community saw the building process from initial construction to its final stages when an agreement was formed about the primary purpose behind erecting a canal walkway in their home. Ultimately, they reached the conclusion that the walkway was not built to accommodate larger cars but people and small automobiles like motorcycles, bicycles, carts and vendors (ACHR, 7). Above all, the canal walkway has greater social implications beyond transportation and aesthetic purposes, as the walkway has become a lively public space—filled with scenery, vendors, children playing—and a truly thriving part of the community.

In addressing housing insecurity, the majority of funding from CODI is allocated to building and rebuilding affordable housing for existing and incoming squatter families. Essentially, the core of this upgrading project focused on financing a poor urban community and improving their living situations regardless of their economic standing. The upgrading process, therefore, is inclusive of all families and individuals from start to finish. While most generally take out monthly CODI housing loans of 1,000 Baht (approximately 30 U.S. dollars per month to be repaid in 15 years), many households do not have any earning members to help repay those loans (ACHR, 8). A number of families have also successfully built their houses without the support of loans, relying mostly on their own funds and resourcefulness. In any case, building plans accommodated those who could afford it with “welfare houses” and encouraging the use of recycled and cost-reducing construction materials. Funded by the community itself with the aid of CODI subsidies, welfare houses support the poor, elderly, and disabled members of their area. Because the concept of welfare houses was so well-received in Bang Bua projects, it has been incorporated in many upgrading plans in other Baan Mankong communities throughout Bangkok. In conjunction with housing reconstruction, a community savings group has been established to provide further long-term support for struggling families. This type of welfare system is made possible by community member contributions where every individual donates one Baht per day (ACHR, 8). In part, the savings program also accumulates interest from lending housing loans to the community at a slightly higher rate than CODI (ACHR, 8). Together, the savings group finances various community activities, pays for welfare services, and provides reserves in cases where members have any issues with repayment.

More specifically, most of Samaki Ruam Jai follows three basic housing models developed in collaboration with architecture faculty from local universities. First, there are “detached”, or single, houses that have the two-story fundamental layout of a kitchen, bathroom, living room downstairs and two bedrooms upstairs (ACHR, 9). The twin houses are generally double detached houses reserved for larger families that requires a 300,000 Baht housing loan offered by CODI, compared to a 200,000 Baht loan for the singles. Finally, there are townhouses (also called row houses) that require a smaller housing loan of 150,000 Baht (CODI). Townhouses are meant for closer living with a 45x45m2 dimension both upstairs and downstairs consisting of two bedrooms like the other two models (CODI). This shows that each of the three models is customized to different family sizes and living styles. Families of up to eight are comfortably housed in twin houses whereas average-sized families can select either detached or town houses.

Most of all, the most unique feature of the Bang Bua upgrading project is that this is not a sole construction plan or rebuilding process. In many ways, it is a social process where upgrading a community means upgrading beyond where they dwell, what facilities they utilize on a daily basis, and what new infrastructure and technology are introduced. More than just infrastructural improvements and visible outcomes, it is about upgrading a way of life where the people’s sense of community and network become self-sustainable and where families can achieve self-sufficiency through means that benefit both the community and individuals therein. The upgrading of the Bang Bua Canal has met great receptivity and achieved huge successes. Not only is the land now livable and thriving with community members, but a strong network bond of 12 communities has forged over common walkways, communal savings groups, and countless welfare programs assisting the most vulnerable members across communities. In the community of Samaki Ruam Jai alone, 25 families have entirely rebuilt their homes while the rest are progressing just as quickly. The people of the community have not only secured their land rights and overcome threats of eviction, but have established long-term leases, families supported by a stable source of income, and a sustainable way of life with a promising future on land that belongs to them.