Garima Greh's Struggle for Transgender Rehabilitation Amid Funding Delays

It was a friend who told Ananya about a make-up course she was pursuing at the government-supported shelter home for transgender persons. “Currently, I am attending computer classes and I plan to pursue graduation,” she said. Her primary focus, she said, is to find a job and become financially independent. But, she aspires to be a dancer--like her friend, 19-year-old Ritika, who joined the Garima Greh six months ago. Their dance group performs Rajasthani folk dance, and Ritika aims to represent India’s transgender community on international platforms.

There were 12 Garima Grehs across nine states which housed 735 transgender persons, as of December 2023. These shelter homes, operated by community-based organisations (CBOs), receive funding through the Support for Marginalised Individuals for Livelihood and Empowerment (SMILE) scheme of the Ministry of Social Justice and Empowerment (MSJE). The Jaipur shelter home where Ananya and Ritika live is run by Nai Bhor Sanstha. The programme offers a one-year stay at the shelter aimed at rehabilitating the residents, steering them away from begging and sex work, and imparting skills to facilitate job placement, enabling them to live with pride and dignity. In cases like Ananya’s where the resident is studying, the shelter homes try to find the money to house them for longer.

The government aims to set up at least one Garima Greh in each state. The CBOs managing these shelters not only offer residents support and a sense of community but also opportunities for upskilling and rehabilitation. However, these shelter homes are struggling to stay operational due to inadequate and delayed funding, IndiaSpend has found. Further, the scheme falls short in addressing many core needs of transgender individuals, including access to specialised medical care, employment opportunities and safety from harassment by police or others, experts told us.

Funding troubles

When the Garima Greh was announced as a pilot project in November 2020, a budget of Rs 36 lakh was allocated for each shelter home for the initial year, including a one-time setup cost of Rs 5 lakh. MSJE had selected 13 CBOs to operate these homes across 10 states during the pilot phase. Initially, 40% of the grant was disbursed, followed by another 40% after six months of operation, with the remaining 20% released at the end of the year. Following the programme's success, it was integrated into the SMILE scheme in 2021.

However, project directors from five Garima Grehs (three in Maharashtra, one in Rajasthan, and one in Delhi) told IndiaSpend that they encountered funding issues after the pilot year. Subsequently, no funds were released for the following two years after the initial year. They have not received payments for the past 13 months, and the situation is expected to persist till June, when the term of the 18th Lok Sabha begins.

Some CBOs have funding and partnerships with corporates, some of them relied on crowdfunding, but smaller grassroots organisations find it very difficult to survive. “We are currently unable to cover expenses such as rent, electricity, water bills, and other daily necessities,” Mansi Jani, project director of the Garima Greh run by Aarju Foundation in Panvel, says. The guidelines require each shelter home to accommodate 25 people, says Jani, but due to financial constraints, they are only able to host 16 people. “We rely entirely on credit for essential supplies, including groceries and vegetables. Additionally, we've had to reduce our staff due to the inability to pay salaries.”

The guidelines require each Garima Greh to have 13 staff members, but the Panvel shelter home is operating without a project coordinator, and until recently, did not have a part-time doctor. “Currently, we have 7-8 dedicated individuals working with us voluntarily, without receiving a salary,” Jani told us.

The guidelines provide for a monthly rent of Rs 40,000 for a 3,000 sq ft space. However, in metropolitan cities, this amount falls short, and CBOs cover more than half the rent from their own funds. Similarly, the salaries offered are considerably lower than market rates. For instance the doctor is paid a salary of Rs 15,000 per month, for a weekly check up of the 25 residents. The budget allocated for food is Rs 100 per person per day for breakfast, lunch, dinner and tea twice a day. This is less than half the average expenditure for a healthy meal in India which is about Rs 220 per day per person. Additionally, the approved recurring cost of Rs 31 lakh a year fails to take into account the increasing costs of rent, groceries, vegetables, and other essential items.

IndiaSpend has reached out to the Ministry of Social Justice and Empowerment for comment on the delay in fund disbursement and the inadequacy of funds. We will update this story when we receive a response.

Guidelines restrict admission, limits duration of stay

The 2011 census estimates India’s transgender population at 490,000, but according to a report by the National Human Rights Commission (NHRC), international findings suggest that this number could be as high as 4.5 million. However, only a portion of the transgender population qualifies to access the benefits offered by Garima Greh shelter homes. To be eligible, residents must be between 18 and 60 years of age. Individuals engaged in sex work or begging are not to be admitted--even if they express a desire to pursue education or skill development, programme directors told us. A 2017 survey of 900 transgender persons conducted by the NHRC revealed that about 15% of respondents were involved in begging or sex work.

To reside in a Garima Greh, individuals are required to obtain an Aadhaar card and a ‘transgender certificate’ if they do not already possess these documents. However, getting these ID cards made can be challenging, as IndiaSpend reported in June 2021.

“Many transgender people are ostracised by their family or face abuse at home, thereby being left with no choice but to flee. More often than one would suspect, they don’t have access to their official documents, not even with their dead name (the identity or name assigned to them at birth),” Sakshi Mamgain, a doctor who runs Dehradun-based organisation United for Transgender Health (UTH), explains. They have been volunteering with the Garima Greh in Delhi for the past three years.

According to a study by NHRC, an estimated 98% of transgender individuals leave their homes. A survey conducted in 2022 across three Garima Grehs revealed that only 37% of respondents had a certificate.

Another concern is that the guideline mandates that residents must vacate the shelter home after one year. “The existing framework is such that it banks on the residents to possibly relocate to a new city, attend to their nuanced personal physical, mental and emotional challenges, build a social support system from scratch, and essentially turn their lives around within a year. Additionally, they also need to equip themselves with skills so they are able to make a living and sustain themselves outside the shelter home,” said Mamgain.

For certain residents, the absence of a secure home can pose significant dangers. Rudrani Chhetri, the project director of the Garima Greh in Delhi run by Mitr Trust, said after the shelter home released a disabled resident, she had to seek shelter at a religious place. “She was compelled to grow facial hair and present as male to remain there. We intervened and brought her back here within our capabilities, as it was traumatic and unsafe for her,” Chhetri recounts.

Medical care is expensive, transgender-specific medical care is not accessible

The shelter homes are required to have a doctor for routine check-ups, although medical expenses are not covered under the scheme.

"Transitioning is the core need of a transgender person, and we support them in this process, even though it’s not a part of the Garima Greh scheme," Maya Awasthy, the project director of Garima Greh in Mumbai run by TWEET Foundation. Transitioning involves several steps that need medical intervention, such as counselling for gender dysphoria, laser treatment, hormone replacement therapy (HRT), and gender affirmation surgery among others. To undergo these procedures, individuals require a Gender Identity Disorder certificate from a doctor.

“We assist our residents in obtaining the certificate from the state-run hospital and our counsellor,” Awasthy says. “We also help them select an endocrinologist to commence HRT, although we cannot cover the expenses as it is not included in the government scheme."

“Transitioning itself is a multi-level process, and gaining access to specialised medical support is a challenge for a majority of the transgender population," Mamgain explained. The NHRC survey revealed that three in five transgender respondents expressed a strong desire to undergo gender affirmation surgery. “An individual may opt for surgery or hormone therapy to align their physical appearance with their gender identity. Without access to proper medical support, many individuals unfortunately resort to over-the-counter medications or unmonitored procedures,” Mamgain added. “For instance, HRT is tailored specifically for each individual and requires serial monitoring by an endocrinologist.”

Another concern is that some traditional communities still practise unofficial procedures due to a lack of healthcare access, which can be dangerous.

Transitioning is a deeply personal journey and is subjective, with some individuals opting not to undergo surgery while others may choose to undergo various procedures, each tailored to their specific needs. In 2022, the National Health Authority announced that gender affirmation surgery would be available free of cost to transgender individuals in selected hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). However, Mamgain told IndiaSpend that this is not true in practice. “Most government hospitals perform more emergency than elective procedures; procedures that are deemed ‘medically necessary’. In a private setting, gender affirmation surgery can cost anywhere between Rs 3-6 lakh or more depending on the procedure. Taking into consideration consultations and blood work-ups, hormone replacement therapy typically costs a few thousand rupees each month.” These procedures are more affordable in government hospitals, which are more accessible to residents of Garima Greh.

Mamgain also highlighted the inadequacy of the medical curriculum in preparing doctors in government hospitals to provide transgender-specific care. “While the medical team is equipped to perform the same or similar procedures for pathological cases, the current training lacks focus on trans-specific care. The doctors and patients would both benefit greatly if LGBTQIA+ health was included in the curriculum. Most doctors assume patients to be cis-gendered and heterosexual, thereby limiting the clinical assessment and potentially missing out on key diagnostic findings.”

They give an example of how certain “regular” practices in government hospitals lack sensitivity and end up being traumatic for the patients. “Due to the lack of gender inclusive infrastructure, sometimes patients are not assigned wards based on their identified gender. Even in rare instances when they are, they face discrimination from other patients and their attendants. One must understand that the individual experiencing gender dysphoria and undergoing surgery is already in a mentally and emotionally vulnerable state. Such incidents can be extremely detrimental to their healthcare experience and lead to a disinclination to crucial follow-up or even routine visits.”

Employment challenges, despite upskilling

The primary objective of Garima Greh is to empower transgender persons by providing them with skills to support their rehabilitation. However, the scheme lacks funding for education and training.

“We offer support with funding, but it is not part of the Garima Greh scheme,” Maya explains. “Technical courses such as MS-CIT [Maharashtra State Certificate in Information Technology], fashion designing, and make-up artistry are provided. We aim to enrol them in reputable institutions, like National Institute of Fashion Technology, to ensure that the certification holds value. But this funding is managed independently and is separate from Garima Greh. So we partner with corporates. Our success rate in job placement is 60%, with a retention rate of 90%.”

Providing training alone is not sufficient, according to Vinod Chavan, project coordinator of the Garima Greh in Thane run by Kinnar Asmita. "We have sent individuals to work in malls, call centres, and private companies, but they faced bullying and stigma, being labelled as sex workers. This demoralised them greatly and affected their ability to become self-reliant, despite us doing our best to educate and train them."

This presents a significant challenge, as highlighted by the NHRC survey where 89% of respondents said that there are no employment opportunities even for trained and skilled people. To address this issue, the organisation Kinnar Asmita has initiated projects such as the TransFormation Salon, a hair salon staffed entirely by transgender individuals from the Garima Greh. “We have managed to place 22 out of 79 residents because we managed to create opportunities and safe workplaces for our community. We hope that these initiatives will serve as examples to society, showcasing the capabilities and aspirations of transgender individuals.”

However, such opportunities are not accessible to everyone. Corporate partnerships aren't easily obtained, nor are funds for independent business initiatives. "Corporates generally prefer employing individuals who are educated or have completed at least grade XII education,” Pushpa Maai, project director of Jaipur’s Garima Greh, says. According to Census 2011, 44% of the transgender population is not literate.

Further, not all CBOs have access to the same resources or corporate networks. Grassroots organisations often lack the same levels of social media presence, educational opportunities, and exposure. “We encounter substantial barriers in accessing education and employment opportunities, making us one of the most marginalised segments of society,” said Jani. “Reservations are needed to bridge this gap and guarantee equal access for transgender individuals, not only in employment but also in education. We have the right to lead safe and dignified lives.”

Garima Grehs struggle to create a safe space amidst apathy from authorities

Since establishment, many of the Garima Grehs have witnessed several instances of conflict. Most often, it is the parents of residents who come to confront and force their children to return home. Despite the protocol to involve the police when admitting a new resident, such conflicts persist.

Chhetri recounts an incident that occurred at Delhi’s Garima Greh. “This happened in July 2022. Late one night, the police entered the shelter and took one of our transgender men with them, at the request of his family. When other residents went to the police station to enquire, they were assaulted by the police.” Chhetri explained that transgender men are particularly vulnerable to such harassment. “They are often treated as daughters by their families and bear the burden of patriarchal expectations. When they leave their homes, family members, police, and influential individuals often intervene, we are also subjected to blackmail and threats.”

While the Transgender Protection Act of 2019 includes provisions for the safety and protection of the community, the law alone is insufficient. “There are significant gaps in the implementation of these laws, and authorities themselves are often unaware of our rights,” said Chhetri. “Although there are chapters addressing discrimination, denial of education, and healthcare, there is no recourse for individuals when these rights are violated. Most states, including Delhi, lack a transgender welfare board. When we faced trouble, there was no transgender protection cell to help us.”

“The police came to our home late at night; that would never have happened in a women’s or children’s shelter home," she adds. "This is a ministry-supported shelter home, and we ourselves are unsafe." In 2022, IndiaSpend reported on the vulnerability of the transgender community to police harassment.

IndiaSpend has reached out to the Ministry of Social Justice and Empowerment regarding the set up of Transgender Protection Cells across states, inquiring about their functionality and activities.

Despite these challenges, the CBOs are keeping these shelter homes running because of a profound sense of community. “It is not easy, but we are determined that whatever happens, we have to do this for the collective aspirations of our community," said Pushpa.

“These shelter homes are a testament to the determination and tenacity of the community," said Jani. "The beneficiaries are our community, and we strive to empower ourselves for the welfare of our people. Even though we are struggling to keep our shelter homes running, it is a deeply personal project, and we take great pride in how we have managed to face these adversities. Through these homes, we aim to showcase our resilience to society, hoping that our capabilities and aspirations will be recognised.”

We welcome feedback. Please write to respond@indiaspend.org. We reserve the right to edit responses for language and grammar.