Engineering as a tool for improving human habitat

The conventional approaches to poverty alleviation in the slums entail a cocktail of interventions in health, education, governance and physical improvements, often stretching the scarce resources far and thin. Driven by the 'poverty' mindset, physical measures such as minimal paving, public water posts and community latrines actually brand the slums apart instead of assimilating them into the urban infrastructure fabric. The concept of Slum Networking proposes comprehensive water and environmental sanitation infrastructure as the central and catalytic leverage for holistic development. At costs less than the conventional 'slum' solutions, it tries to penetrate a high quality urban infrastructure net deeply into the slums to assimilate them into the city rather than lock them in as disadvantaged islands. Further, it transcends resource barriers and 'aid' through innovative partnerships and the latent resource mobilisation potential of the so-called 'poor'. This paper examines Slum Networking as implemented in Sanjaynagar in Ahmedabad, India and compares it with a similar settlement with no interventions in Ahmedabad. It assesses the knock-on impact of physical infrastructure on health, education and poverty. Finally, it evaluates the multiplier effect of physical infrastructure and the partnerships on the subsequent investments by the community in its own shelter and habitat. Copyright © 2009 Inderscience Enterprises Ltd.

Emergency department crowding: prioritising quantified crowding measures using a Delphi study.

AimsEmergency department (ED) crowding has been associated with a number of negative health outcomes, including unnecessary deaths, increased waiting times and a decrease in care quality. Despite the seriousness of this issue, there is little agreement on appropriate crowding measures to assess crowding effects on ED operations. The objective of this study was to prioritise a list of quantified crowding measures that would assess the current state of a department.MethodsA three round Delphi study was conducted via email and an Internet based survey tool. The panel consisted of 40 professionals who had exposure to and expertise in crowding. Participants submitted quantified crowding measures which, through three rounds, were evaluated and ranked to assess participant agreement for inclusion.ResultsThe panel identified 27 measures of which eight (29.6%) reached consensus at the end of the study. These measures comprised: (1) ability of ambulances to offload; (2) patients who leave without being seen or treated; (3) time until triage; (4) ED occupancy rate; (5) patients' total length of stay in the ED; (6) time to see a physician; (7) ED boarding time; and (8) number of patients boarding in the ED.ConclusionsThis study resulted in the identification of eight quantified crowding measures, which present a comprehensive view of how crowding is affecting ED operations, and highlighted areas of concern. These quantified measures have the potential to make a considerable contribution to decision making by ED management and to provide a basis for learning across different departments.