On the 26 January 2021 the UK Government International Development Select Committee published a report on the secondary impacts of the COVID-19 pandemic. Kate Hawkins explains what’s in the report and the evidence that ARISE submitted to the process.
The International Development Select Committee has a mandate within the UK government to track and assess international development spending and policy and make recommendations where change is deemed necessary. In April 2020 they opened an inquiry into COVID-19 in low- and middle-income countries and then moved into a second phase later in the year that looked at the secondary impacts and how aid from the UK might mitigate them. It focused on:
Non-coronavirus health care
Economy and food security
Treatment of women and children
Our evidence
We felt it important that we shared evidence from our work in India, Bangladesh, Kenya and Sierra Leone. You can find a shortened version of the points we made in our blog for World Cities Day. We highlighted the effects of violence and mental strain brought about by the pandemic and measures to tackle it. Our evidence explored how daily wage earners were particularly hard hit and that particularly marginalised people in urban informal settlements – such as waste-pickers – were feeling the brunt of the pain. It highlighted the gendered affects of COVID-19 and its impacts on the most vulnerable.
The International Development Select Committee report
The inquiry found that routine healthcare in some countries is grinding to a halt; vulnerable economies risked failure under rising levels of national debt; people across the Global South were more in fear of threats of job losses and starvation than the pandemic; and the virus, and its counter-measures, were increasing levels of gender-based violence, child marriages and other challenges to girls access to education.
The findings of the inquiry echo many of the challenges that we have seen in the course of our work. They cite our work several times and highlight the importance of capturing data on COVID-19 in a manner that adequately reflects the real-world situation for marginalised groups which is disaggregated according to sex, ability, age, status etc. Throughout, they acknowledge that communities that were previously poor are being plunged into further crisis by the pandemic.
The report offers many recommendations for how aid from the UK can better organised. You can find the UK Government’s response to the report here.
We welcome the report and are grateful for the opportunity to provide evidence. Moving forward, we will be following future Select Committee inquiries and supplying data from our work where useful.
As the year draws to a close our Communications Manager, Kate Hawkins, provides a summary of popular content from the website over the course of a challenging year. Did your blog make the top ten? Read on to find out!
To give us an idea of which parts of our work over the year have resonated with our online audience I have put together a top ten of the most popular content on the website. This gives us some insight into you, dear reader, and will guide us in the future.
This blog by myself, Jessica Amegee and Rosie Steege provides a round up of guidance on remote methods – amalgamating knowledge from around the web. It was written when it was clear that ARISE was going to have to drastically shift its ways of working in relation to the pandemic. We’re pleased that it is a piece that has resonated with other researchers in the same boat. It’s also a good reminder that people are interested in the Community Based Participatory Research approach we use, and not just the findings.
This photo essay by Shrutika Murthy was a shining example of the multi-media communications that we are spearheading in ARISE. The photo essay grew out of our work with waste picking communities in Vijayawada, India. Suvartha collects and sell recyclables as an occupation and lives on the fringes of slums. Insights into her life and the feelings of the researcher who is walking alongside her run throughout the photo essay.
The third most popular content was a blog by Joseph Kimani who works at SDI Kenya. He provided a rousing call to action. His aim – to tackle structural violence against poor and marginalized people.
“Violence is a monster that is omnipresent in low-income areas. Slums have become synonymous with violence, crime, criminalization of youth and ‘illicit’ income activities. The feeling of oppression and deprivation makes the entire settlements a no-go-zone. As a result, innocent, poor, marginalized and vulnerable members of communities who cannot escape or leave the settlements are trapped hence affecting their health and wellbeing.”
I’m glad our students are popular. Our students bring new ideas and ways of viewing the world as well as putting in a lot of leg work. They are our foundation and we would not be the project we are without them. Bravo and onwards!
The next five most popular bits of content relate to the Twitter Chat that we held on disability and COVID-19. The event generated a lot of tweets and posters, so I knew it was popular at the time. But it’s great to know that the insights of our experts continue to be useful.
A companion piece to the photo essay by Shrutika Murthy, Shadowing Kishore explores the daily lives of waste pickers through the eyes of Prasanna Subramanya Saligram.
“Until dawn I was in an ambiguous state – oscillating between comfort and discomfort with the shadowing experience. Once daylight broke and we were going through residential areas, I began to feel distinctly uncomfortable.
I worried people might think I was the contractor overseeing Kishore.”
This piece by Jane Wairutu, Eva Muchiri and Jackline Waithaka explored Mukuru Special Planning Area and how changes in policy led to an assessment of health service provision in the settlement. Using innovative methods SDI mapped the availability of Community Health Volunteers and services, providing recommendations for the future.
This blog is unusual for the ARISE site as it is authored by a policy maker, Guillermo Hegel the former Municipal Director of Health (2014-2020) for Villa Nueva in Guatemala. It provides insights for the municipal level – which is key to tackling COVID-19 – and suggests longer term measures that can be the foundation for future pandemic responses.
This section of the site brings together all the research that we have published on COVID-19 this year. The content is an eclectic mix of audio, video, journal articles, blogs, webinars and photo stories. Keep checking back in. We regularly update the page.
“Nearly half of Mumbai lives in slums, some on uninhabitable lands – within an arm’s length of speeding trains or on pavements with their living overflowing on to the adjacent street.”
We end our round up with this blog by Vinodkumar Rao and Smruti Jukur. It explores how we will be studying aspects of relocation – the governance structures, political relationships, organisation of residents, etc. A process already underway in Mumbai and Ahmedabad.
I hope you enjoyed this round up of the top website content of the year. We commit to keeping you informed in 2021 and beyond and are pleased to usher in the New Year with you.
Lynda Keeru reports back on the third of a series of webinars hosted by the IDEAMAPS network. Speakers explored gaps in our knowledge of how to map deprived areas, how to exchange data and knowledge between stakeholders and what is missing in urban deprivation data.
IDEAMAPS are keen to overcome siloed approaches to slum mapping and ensure that deprived areas are mapped at scale and outputs are used to facilitate change. They have developed a data ecosystem that facilitates fair exchange of information and provides new opportunities for collaboration among diverse stakeholders.
The speakers were from different settings which gave the attendees a rich variety of experiences from different countries and contexts. Vinod Rao, from SPARC India is part of the ARISE consortium on health and accountability which is being implemented in four countries. Their focus is participatory action research which focusses on the health and wellbeing of slum dwellers and people living in slum relocated colonies. In ARISE data is analysed and used as a negotiation tool with state institutions.
SPARC works promoting and supporting area resource centres – which are small centres in slums and slum relocation areas across India. These centres are run by the slum dwellers themselves. The data collected helps to identify the contribution that the slum and pavement dwellers make to the city. The slum dwellers experience many challenges especially the fact that they have no access to basic resources like sanitation.
Selvi Devendra, who is part of the ARISE network and a women’s leader who works with one of the federations relayed her personal story of her life as a slum dweller and data collector and how she acts as a bridge between her community and the local government. She revealed the informal workers’ living and working conditions, as well as the multiple risks that are involved in their day to day lives. Selvi explained that life in the slums on the railway was hard because they were exposed to the sight of accidents very often and were often accused of throwing stones at people traveling on the trains. Selvi now lives in a relocation colony, a few kilometres away from her former residence. Her move was necessitated by events of a random day in which her fellow railway slum dwellers were informed of the looming demolition of their homes and their relocation. This was not only a stressful experience but an unsettling one. Much as the conditions were still dire, they had found some solace in the little security that they now knew in their previous home. Just as they were beginning to experience very basic forms of comfort, such as improved sanitation, they could no longer call this place home. SPARC however stepped in and reassured them that the new location would provide them with better security and they would help them through the transition.
Using the difficult and novel times we are living in because of the COVID-19 pandemic, Selvi explained how pivotal her role has been in building a relationship between the community and the local government. She narrated how they as a team created responsive mechanisms by using the existing community networks. With India going into a very short notice and stringent lockdown in March with absolutely no movement, the country experienced numerous challenges. This was made worse because Mumbai is home to numerous migrants from other cities in India who depend on daily labour wages for a living. The city experienced major problems related to food security. During this time, Selvi and her team were very instrumental in the mobilization and distribution of food and other essentials like medicine to the most vulnerable in the community. She was mobilizing about 1500 packets of food every day for a huge number of about 4500 families in the area in which she lives. This exercise was carried out in partnership with local leaders and government structures which promotes accountability in governance; a major pillar for the ARISE team.
Elsa Rousset and Adesola Adelani Dada, from JEI and SDI Federation (Nigeria) gave participants insights into how they successfully implemented a participatory approach and overcame perennial city-wide challenges with a household energy survey implemented across hundreds of slums and informal settlements in Lagos. They explained that they have managed to do this by embracing the concept of ‘nothing about us without us’. They apply community led approaches in their data collection processes by empowering residents of informal settlements to lead the processes of data collection. They stimulate community empowerment by ensuring that the community understand the purpose of the survey and encouraging them to take up key roles in the data collection processes. Most importantly, the participatory approach requires that the data collected is returned to the community and used to advocate for change.
A key pillar in this approach is ensuring gender inclusion and diversity in the processes by securing a representation of people from varying ethnic groups and also having on board people living with disabilities. They advised that this should also be the case for respondent selection in order to ascertain that the survey captures the true diversity of community realities. To overcome existing challenges, they make an effort to reach out to previously underrepresented local government associations.
The last presenter, Flavia Feitosa gave a presentation on how they had developed a methodology for identifying and characterizing precarious settlements in Sao Paulo. When updating and enhancing the housing plan 2011-2023 for the state of Sao Paulo; they realized that precarious settlements are one of the most relevant housing problems in the city. The MAPPA Project worked closely with a local government and a housing agency to integrate diverse spatial datasets to model the location and type of precarious settlements (favelas and informal settlements). She also described an iterative modelling-fieldwork process that enabled identification of previously unidentified precarious settlements, and multiple rounds of essential field validation data collection. This process included the improvement of information on precarious settlements and assessing housing deficit/ inadequacies both inside and outside precarious settlements. This was achieved by using models of identification and classification of typologies of precarious settlements, quantifying the total number of households in precarious settlements as well as multidimensional assessment of the housing deficit
All the presenters reiterated that research and mapping in urban informal settlements depends on the development and maintenance of trust with the communities involved. It is impossible to achieve any progress without goodwill from the community and one must involve the community every step of the way. The organizations must be willing to get around the challenges together with the community and clarify any misconceptions the community members may have and most importantly, have an understanding of the fact that the data belongs to the community and must therefore be given back to them to act upon once the collection has been completed.
PRESENTERS:
Vinod Rao and Selvi Devendran, ARISE Consortium (India), Elsa Rousset and Adesola Adelani Dada, JEI and SDI Federation (Nigeria) and Flavia Feitosa, Federal University of ABC (Brazil).
If you would like to stay updated about the latest urban deprivation mapping methods, views, and experiences please join the IDEAMAPS network
Abdul Awal and Imran Hossain Mithu explain how Geographic Information System (GIS) was used by the ARISE team in Bangladesh to map Dholpur in Dhaka.
GIS mapping is a commonly used technique for visualizing an area. It can be used in a variety of ways to visualize health service utilization as well as consider the many factors related to location, which may limit people’s ability to access care from acquiring proper heath care.
Location-allocation models can identify how gaps in health services among specific communities can be reduced. Existing health services are mapped along with road networks which are used to identify and facilitate patient travel pathways and related challenges. Valuable information such as population distribution, income and poverty levels, can also be depicted to determine the best possible placement of new services, as well as to identify specific regions that are underserved.
ARISE is using a community-based participatory research approach to understand community dynamics and health and wellbeing related vulnerabilities, practices, challenges, needs and priorities. Participatory GIS mapping is one of the methods the ARISE Bangladesh team has chosen to map and document the layout of slums, infrastructures (health facilities, religious places, educational institutions, bazars, government offices, water, and electricity supply offices etc.), roads, health facilities etc.
A transect walk is a systematic walk along a defined path (transect) across the community/project area together with the local people to explore the water and sanitation conditions by observing, asking, listening, looking, and producing a transect diagram. Initially, we had a plan to co-create GIS map in April 2020 with the help of co-researchers during transect walks and then synchronize information collected through social mapping into GIS map to complete the mapping.
Suddenly the dark shadow of coronavirus loomed over us and Bangladesh was not shielded from this heinous pandemic. It seized the country from the beginning of March 2020 and is continuing. The country went into lockdown resulting in a suspension of all research field activities to ensure the safety of researchers and co-researchers.
As a result, the ARISE hub decided to apply innovative remote methodologies to research, especially data collection. The ARISE Bangladesh team came up with an innovative idea of testing remote GIS mapping and involving co-researchers remotely in the process. We were a little bit baffled at the beginning about how to complete the remote mapping, but we were able to devise a way forward.
The search for accurate data
We used QGIS 3.10.6 software for drawing the maps. However, the first challenge we faced at the initial stage was to locate our study slums from the QGIS Open Street map. We could only clearly locate Kollayanpur slum among three study slums. One possible reason could be that Kollayanpur is an old and well-known stable slum established in public land. The other two slums – Dholpur and Shaympur are comparatively new settlements and the boundaries of these slums were not identifiable using Google or Open Street maps. Therefore, we decided to search other secondary sources. However, the challenge we faced at this stage was accessing required secondary data about the three selected study sites due to unavailability of the proper data, which is essential for producing GIS maps.
In Bangladesh, slum specific data is limited and unavailable for most of the slums. The available online sources are also not updated. We found some data form the Census of Slum Areas and Floating Population 2014, however, we couldn’t use that 15 years old data as most of the slums in Bangladesh are not stable and the landscape has changed over the period. We also found some other data sources, like some survey reports or published papers from other research. However, again that data were either too old or did not have our study site specific data.
Then we explored Dhaka city maps from both North and South Dhaka City Corporations. We could only manage a digital map from Dhaka North City Corporation, unfortunately that was also not updated. We could not get a digital map from Dhaka South City Corporation as the process of getting map requires physical visit to the City Corporation office which we could not do due to the lockdown. It was also difficult to identify the specific slums from the available sources. Therefore, we applied different strategies for different slums.
In this blog, we will share our experience of conducting remote GIS mapping of Dholpur slum where we were able to involve a co-researcher remotely in the mapping process.
Mapping Dholpur
Dholpur, a slum located in the southern part of Dhaka city under Dhaka South City Corporation, is home to approximately 135,000 people and most of them are City Corporation workers, rickshaw pullers, waste collectors and daily wage earners. People from ethnic minority groups live there, such as the Telegu community. Schools, colleges, mosques, temples, churches and healthcare facilities are some important infrastructures around the slum. Also, there are some informal health facilities for example drug shops.
To create the GIS map of Dholpur slum, we synchronized data from multiple sources, multiple digital maps and mapping software. A co-researcher from Dholpur slum guided us throughout the whole process from the beginning to the end by providing information and validating our maps at different stages.
Step 1 – Drawing the outline
We were unable to identify the area outline of Dholpur slum from the QGIS Open Street map, Google Earth Pro, online sources, and digital maps from Dhaka South City Corporation. Earlier in the research we had met some enthusiastic members of a local youth organization in Dhlopur slum who have been actively involved in many community-based activities. We decided to reach out to them again and request their support in the remote GIS mapping as they know their community better than us.
Figure 1
Anwar Rana expressed an interest in working with us as a co-researcher and helped us with mapping. After explaining to him our purpose over the phone, he shared a hand-drawn community map (Figure 1) through WhatsApp. The members of the local youth organization drew the community map for the purpose of managing their organization’s activities. We were surprised and amazed by the level of detailed information in their map. That map gave us an initial idea regarding Dholpur slum area.
Then we identified Dholpur slum area in the QGIS Open Street map and drew an outline with the help of the hand-drawn community map and shared the screenshot of the map with the co-researcher through Facebook Messenger for validation. After seeing the outline, we made, Anwar marked the Dholpur slum boundary in the Google map and shared his screen with us which helped us to finalize the boundary.
Step 2 – Drawing roads and pathways
After finalizing the area outline, we started the next step of drawing roads and pathways. We identified some broad and major roads and pathways in our GIS map with the assistance of Google map, Google earth pro, Arc GIS satellite map, QGIS open street map, and GeoDASH. We also used the hand-drawn community map to draw some roads and pathways inside the slum which were not identifiable in the online sources. At that stage, we again reached out to Anwar to verify roads and pathways and he made some corrections.
Step 3 – Identifying infrastructure
After finalizing roads and pathways, we started to pin different important infrastructure like health care facilities, educational institutions, clubs, religious places, open spaces, community centres, cinema halls, bazars, government structures, water, and sanitation facilities, etc. with the help of the Urban Health Atlas, Google earth pro, Google map, and QGIS street map. We found many formal (e.g., hospital, clinic, satellite clinic, etc.) and informal (e.g., pharmacy, drug shops, etc.) healthcare facilities from the Urban Health Atlas.
To precisely pinpoint location of the landmarks, we searched for the coordinates (latitude and longitude) and placed it on our desired map. We tried to identify infrastructures inside the slum from the hand-drawn community map Anwar shared. However, we could not find specific geospatial data of those infrastructure from online sources and it was also not possible for Anwar to collect GIS points for us as he does not have access to required technology. As a result, in this remote method, we could not identify important infrastructure including healthcare facilities located inside the slum. Anwar marked and identified some informal health care facilities within the slum which we could not identify through the online sources.
The final map
After validating and adding different landmarks, we created the final GIS map of Dholpur slum (Figure 2). We also shared the final map with our Anwar. He was so excited to see the output. This digital GIS map is an additional support to visualize the different facilities within and outside the slum.
Figure 2
Although, the remote method of GIS mapping was very new for us, but we went through a memorable and exciting journey. The challenges we encountered at different stages of mapping process gave us the opportunity to think creatively and identify innovative alternate options and solutions to overcome the challenges. The involvement of Anwar from the beginning made our journey a lot easier. It was really challenging to connect with him remotely because of his engagements in other work and slow internet connections. However, we are very much grateful to him for his time, support, and guidance throughout the mapping process.
Once Indira Gandhi said, “every new experience brings its own maturity and greater clarity of vision,” which we realized throughout the journey of the remote GIS mapping.
Lynda Keeru summarizes what was learned at a recent webinar on building equitable partnerships in international research programmes.
International research has increasingly been taking on an equitable partnerships approach – an intentional tactic that clearly articulates the distribution of resources, responsibilities, effort and benefits within consortia. This approach also includes ethical sharing and use of data which responds to the needs of communities where the research takes place. Equitable partnerships are based on mutual respect guided by values like trust, accountability, transparency, active communication, constructive engagement and mutual learning. At the core of this approach is the importance of acknowledging the different inputs, interests and desired outcomes of all involved
The UKRI GRCF Action Against Stunting Hub hosted a webinar ‘Equitable Partnerships in international research’. The meeting sought to explore how different Hubs and institutions build, maintain, and evaluate equitable partnerships and help ensure that research outcomes are beneficial.
So, what makes for a good partnership? Some of the reflection made during the webinar included that good partnerships include:
Joint agenda setting
Clarity of roles and responsibilities
Fair recognition of incentives and interests of all partners
Building trust which requires transparency and accountability
Regular communication to avoid assumptions
Structured time investments in the partnership because building and maintaining relationships is a long term process
Regular reviews of the health of the partnership
Dispute resolution systems
Fairness and equity were identified by the UKCDR community as key factors that help to mitigate the risks of exploitation, abuse and harm. They not only reduce power imbalances but also ensure that all key stakeholders are consulted and engaged in the research process.
Chris Desmond, a Co-director of the Accelerate Hub spilled a number of gems including that even the most well-intentioned interventions have their own challenges such as systematic racism, how to make the process meaningful and not a tick box exercise and being realistic about what can be achieved during the five year horizon of most research partnerships.
Sally Theobald, the Principal Investigator of the ARISE consortium and Linet Okoth of LVCT Health shared their experience of the ongoing journey of promoting equity in partnerships guided by their theory of change. To be most effective, they agreed on shared values right from the start at the proposal writing stage and ensured that there was ongoing review of these values throughout their partnership review process and made adaptations to systems and structures as appropriate.
Equity in voice, power and resource mobilization, commitment to ethical interactions at all levels of the programme and transparency and accountability in all processes are some of these guiding values. In addition, they have put in place management structures that ensure that all partners can propose and lead sessions during monthly webinar series and partnership meetings. Their executive committee also comprises of a representation from all partners with a rotating chairing position and membership from the early career researchers’ network. Additionally, they have created thematic working groups to ensure shared responsibility and they are co-convened and led by partners from both the North and South.
Linet discussed how the ARISE safeguarding process has been developed with a focus on equity and partnership, learning and sharing, and an iterative, ongoing learning journey that is critical, reflective and inclusive of vulnerable people.
In conclusion, strong partnerships require strong foundations with clear management structures and joint responsibilities that ensure ownership. Flexibility, focus and openness are vital for strengthening partnerships.
Webinar Presenters/Contributors:
Chair: Professor Claire Heffernan, Principal Investigator, Action Against Stunting. Speakers: Sian Zarkow, UKRI, Chris Desmond, Accelerate Hub, Sally Theobald, ARISE and Linet Okoth, ARISE.
In this blog by Jackline Waithaka and Jane Wairutu the issue of women’s leadership is explored through the identification of women making change in the informal settlements of of Nairobi, Kenya.
The world has witnessed the emergence of women leaders most of whom have rose to break the traditional glass ceilings that barred them from taking up leadership positions despite possessing the necessary skills. Over time, women have constantly evolved realizing new roles. Their progress within the society has proven substantial yet uneven as women all around continue to be vastly underrepresented in decision making as well as community set-ups. These are the facts, and they tell a story. A story of resilience and enthusiasm to lead despite the setbacks encountered.
When supported and empowered to take up leadership positions, women have exhibited the ability to lead. They have successfully demonstrated the ability to lead through organizing around issues that are fundamental to them and in the long run advance their interests for overall well-being of a community.
The Kenya movement of Slum Dwellers demonstrates that facilitating women’s leadership builds a culture of self-confidence and empowerment thereby inspiring continuous wave of female grass root leaders interested in carving out a different narrative for their communities. Paving way for emergence women to become leaders is no mean feat, however, for over 20 years, the federation has sought to support women leaders who make a large number of leaders even with the alliance, and are always seeking ways to uphold this practice in a bid to build on its vision of sustainable and inclusive communities.
Gender barriers in leadership and solutions
Being a woman, they saw as though we had no power. But because there were many of us, we combined our forces together. We did not shy, nor did we back down.
Anastacia Wairimu, Kahawa Soweto
To date, women face limited access to leadership positions despite the strides undertaken in creating positions of power for women. Anastacia Wairimu, a national federation leader who has served as a leader within the federation for fifteen years admits to having faced opposition from male counterparts. As a means to navigate through opposition from the men, Anastacia explains on importance of leveraging on their numbers in order to claim their spaces as equally competent leaders in their community.
Anastacia Wairimu leading community discussions in Mukuru
Women leaders all around the globe are still a minority as men continue to outpace women in leadership roles in most sectors. Inclusivity in leadership remains a significant gap to address as a means to ensure achievement of gender balance within positions of power.
Nancy Njoki, also a national federation leader within the slum dweller grass root movement in Kenya, also explains, women leaders are often held to higher standards than men and many occasions, they require to do more than their male counterparts including sharing testimonials in a bid to prove one’s leadership ability.
Such preferences act as biased gate keeping factors hence the growing need for women to proactively communicate their desires to serve in leadership positions. Drawing from federation experiences, providing a supportive space for women to take up minor leadership responsibilities then advance to major responsibilities enables understanding on the importance of promoting gender inclusivity in leadership.
Family and leadership, balancing it all
It comes with its fair share of challenges. This is because even as a woman serving in a leadership position, one still needs to perform their duties as a wife and a mother. This therefore calls for one to work extra hard.
Nancy Njoki, Mathare
Family is the foundation of communities and in many settings women who double up as mothers and wives within the family setup, play a vital role in the wellbeing of a family. Women who have overtime actively claimed leadership positions within the society while taking on their family duties have demonstrated what women can do. Determining how best to align family and leadership requires consideration of both sides.
Nancy Njoki who doubles up as a mother of four, and has served as a national federation leader for ten years, explains it requires double effort to successfully juggle between the roles.
Over time women leaders have had to confidently grow into their leadership positions in order to address issues that in the past, they were unable to. In some cases, this has resulted to conflict at home or with society as Nancy Njoki further notes. It is therefore critical for women leaders to communicate with their families to ensure they understand their participation in federation activities which are geared to create positive change within the community.
In order to strike a balance, it requires carefully structuring and planning one’s activities in a bid to achieve the balance.
Navigating through the roles and leading change
It requires commitment and may take up most of your time. Commitment to other social issues can easily be overridden by leadership duties.
Emily Wangare, Mathare
Emily (pictured second from the left) participating in peaceful demonstrations in Nairobi, calling an end to forceful evictions
Women have steadily emerged in leadership roles bringing to the exercise of leadership an arsenal of strengths.
Through volunteerism, and helping to amplify issues of the most marginalized, leaders such as Emily have taken up exceptional roles thereby contributing substantively to the development of their communities. Through her leadership role in Mathare, Emily has capitalized on her position to participate in matters community organizing through mobilizing community self-help groups in Mathare among other organized groups, and has mentored them through the essentials appertaining loan application for livelihood. Over time, the federation’s savings model mainly has given rise to the emergence of more female leaders within grass root communities as has evolved as a tool that has largely increased women’s participation in the federation.
Additionally, when community has faced eviction threats, Emily emerged at the forefront to carry out advocacy around the issued threats, a move that enabled the formation of cooperatives and as a means to lobby for community land. As a result of frequent confrontations with authorities and leading collective advocacy efforts, evictions were avoided. Despite the challenges that existed, leaders like Emily have been at the fore front of land eviction struggles in Mathare through activism further highlighting impact of women’s leadership presence on the frontline of resistance to evictions.
Further reflections from Christine Mwelu, also a national federation leader from Mukuru Viwandani, explains how her leadership role also positioned her at the forefront of major community processes. Earlier in March 2017, Mukuru was declared a Special Planning Area effectively freezing development in order to pave way for development of an integrated development plan. For over five years, Christine along with other community leaders took up central role in supporting to mobilize community to participate at every stage of the planning process. Her participation in the process seeks to depict at scale the contribution of women in matters community development if provided a platform.
To sustain the present and future tire of impactful women leaders from low income communities, it is critical to invest in women and set the agenda for continuously nurturing a wave of upcoming female grass root leaders to deliver the envisioned change.
Epidemics are a window into society. They reveal our social relationships and circumstances. The global pandemic has brought to the fore the inequalities that persist within our towns and cities. The spread and the impacts of the disease have not been even. As the world continues to grapple with the fallout from the pandemic, this year’s World Habitat Day is an important, if not urgent moment to reflect on the interaction between pandemics, health and cities.
At the beginning of the pandemic, in my neighbourhood in London, there was a sense that we were all in it together. Yet, underlying this good spirit, the inequalities across cities and within cities have been undeniable. Across cities, there are differing health system capacities, economies, and infrastructure. While London had less acute care bed space than Berlin or Rome, it had more than many cities in the Global South; and the UK government was able to provide more economic support to the residents of London than was possible in Kampala or Dhaka.
There have been important inequalities between residents within cities. Facing lockdown in London was very different depending on whether you had a garden, could work from home and have your food delivered, compared to if you lived in a tower block, with limited space and perhaps had insecure work delivering food. Likewise, in cities like Mumbai, some people were able to protect themselves in private gated homes while others living in informal settlements could not socially distance or wash hands and found their livelihoods suddenly curtailed. Studies have found that 57 per cent of people living in ‘slum’ neighbourhoods in Mumbai had antibodies to COVID-19 compared to 16 per cent in ‘non-slum’ areas.
Cities on the frontline – but overlooked and misunderstood
With COVID19, most of the spread has been in urban settings – reflecting issues around space, connections, and density. Yet, COVID is not the only major epidemic the world has faced in recent years, and it continues a long list of outbreaks which have had urban dimensions for example Ebola in West Africa, Zika, Yellow Fever in Angola, or Cholera in Zimbabwe.
The major challenge is that our understanding of urban health has not kept up with patterns of urban development. The world is urbanising dramatically. The global population is now majority urban and the proportion of urban residents is increasing. Urban populations are growing fastest in the Global South. We know that inequality and poverty have a range of negative impacts on health but we do not clearly understand the social determinants of health in many of these rapidly growing urban settings. Urban-health interactions are overlooked and misunderstood; we know least about the most vulnerable settings and people, in particular, the one billion people living in informal settlements.
However, despite these very evident trends, spending on and attention to urban development is limited. Often there is a lack of urban policy, both at the national level and within key sectors e.g. in health or pandemic preparedness policies. While health receives significant aid funding, the urban development receives comparatively little. Another problem is that health experts are often disconnected from urban experts and planners. We are left with siloed health and urban activities. In addition, local expertise is too often ignored.
Most importantly, there is a politics of neglect when it comes to informal urban settlements. There is a severe lack of data and evidence on informal settlements in part because governments do not collect it out of the fear that it would validate the existence of settlements they deem to be illegal. Exclusionary policy and practice are evident in the way poorer and marginal residents are not routinely included in planning processes. All of this follows a long history of blaming the poor for their problems and treating them as vectors of disease, not as victims.
Clearly, there is an urgent need to better consider the characteristics of this urban growth and implications for health. Highest up on the ‘urban/health’ priorities should be informal settlements.
Improving our understandings of health in informal settlements
The first thing to note is that we cannot generalise about urban settings in the global south. Cities, settlements, and people are all very different, whether you are in Salvador in Brazil, Wuhan in China, or if you are a male migrant worker in India or a female low caste waste picker.
Informal settlements also look very different from one another. A case in point is in Freetown, Sierra Leone, where there is a dense settlement in downtown area on the coast built out of rubbish, and another is a hillside settlement on the outskirts of the city and much more spacious. They both have infrastructural challenges, but they are different.
A starting point is that heterogeneous social, political and economic relations shape urban spaces. Drivers of health and well-being comprise intersections between environmental deprivations and hazards as well as social marginalisation, stigma, violence. Ambiguous governance also shapes health. Cities have complex governance arrangements across sectoral, administrative and spatial scales, much of which is invisible and informal; as a result, accountability is unclear. It is a challenge to identify drivers of multiple, intersecting inequities in health and wellbeing and routes for redress.
So how do we address these challenges? Certainly, we need increased investment and attention to urban settings, and improved data. But perspective is also vital.
We need to do four things:
Learn to ‘see like a city’ – we need to understand systems and interactions, and especially informal dynamics
Learn to ‘see like a citizen’ – understand how people are expressing and understanding rights and entitlements, how they are claiming accountability and from who
Consider invisibility – who and what is not seen, or not easily counted? For example displaced or migrant populations who cannot claim rights
Focus on social infrastructures as much as the technical and medical, recognising that learning, dialogue, and collaboration are the key to progressive change.
It may feel hard to look to the future when we are still navigating our way through this global crisis. But what happens next depends on how we can diagnose and influence the power relations which have shaped urban development trends towards inequality and exclusion.
A key long-term response must be to marshal interdisciplinary, intersectoral and intersectional approaches, which pay attention to power dynamics, and most importantly, are inclusive of the most marginalised.
— This blog by Annie Wilkinson and based on the author’s presentation for UN-Habitat Norway ‘World Habitat Day’ Webinar on Pandemics and Future Cities. It was first published on the IDS website and is repeated here with permission.
This blog was written for World Cities Day, 31 October 2020. The theme this year is Valuing Our Communities and Cities. People in informal urban settlements deserve our support and solidarity. In the blog we explore how they are experiencing some of the secondary effects of COVID-19 and mechanisms that could strengthen the ways that they are involved in the pandemic response.
Current upheavals highlight longstanding socioeconomic inequities that continue to raise difficult policy and accountability questions. Some forms of vulnerability are more discernible than others. Nearly one billion people live and work in informal, under-serviced, and precarious urban conditions. Before COVID-19, these communities occupied a peripheral and precarious space, both physically and in the imaginations of those in power. Such spaces are often rendered invisible and excluded from city-wide processes of development, at other times hyper-visible as sites of chaos or calamity.
Non-COVID-19 related health care
Our colleagues in Sierra Leone have argued that people living in informal urban settlements are more pre-disposed the chronic conditions which affect COVID-19 but that this is under-explored.
“The ‘slow violence’ of informal settlements includes everyday exposure to poorly managed waste, dust, smoke, fires, floods, disease vectors, long journeys across cities on overcrowded shared transport which can spread infections, occupational hazards, crime, but also insecurity, stress, lack of accountability, discrimination, abuse, invisibility, exclusion from economic and political power, and an inability to claim and maintain basic rights or services.”
In all contexts we work in lockdown has led to mental health strains and greater stress and anxiety are reported as precarious existences deepen with continued containment. Lockdown itself is troubling but also the loss of income that comes with it. In Sierra Leone we have documented detrimental psychosocial effects on health care workers as well as interventions from the Ebola epidemic that may help alleviate some of this burden. In Kenya as in other settings, access to healthcare has been disrupted. This has impacted particularly on mothers and children, residents with chronic conditions and the elderly.
“Individuals with chronic illness suffer a lot as they need specific medical attention, yet …we lack timely and adequate information on treatment of chronic illness…. Sometimes when they access the information, we lack money to buy drugs during this outbreak as many people have lost jobs…”
In India the heightened cost of transport to facilities and of services is having a troubling effect. Fear of infection is leading some to rely more on private pharmacies.
Economy and food security
COVID-19 has pushed previously financially stable people across informal settlements into poverty. For example in Dhaka, Bangladesh, the pandemic led multinational companies to cancel orders to garment factories plunging this workforce, who mainly live in informal settlements, into precarity. There is risk of malnutrition and starvation as day labourers are prevented from earning an income. COVID-19 has disrupted traditional networks of support. People are resorting to loan sharks as rent and food are hard to buy on credit. They are relying on community/family members, collecting cash from friends. Local crime rates have also risen. How long can this go on for?
When people are in ‘obhab’ (scarcity), people tend to fight more, they tend to resort to stealing. There is a chance of increasing crime in this community. I am worried that theft and crime will increase in our community.
In India, as elsewhere the work of ‘waste pickers’ and other sanitation workers is vital to the cities they work in, particularly now when the need for a sanitary environment is at its greatest and there has been an increase in biomedical waste. Yet, they remain ‘invisible’. Despite their key role, the provisions put in place to ensure their safety in the pandemic are inadequate. For example, aid meant for vulnerable populations, is often based on certificates of citizenship which denies these communities eligibility for many forms of relief, leaving them no resort but philanthropy and luck.
“We are Indians! I have all the documents like you have, to prove that I am an Indian: voter ID, ration card, Aadhar card…But we do not get rations since the ration cards are based at our homes, which we moved from six years ago. I transferred my Aadhar card because we cannot get jobs here without an Aadhar card and PAN card.”
This has been exacerbated by brutality in policing of lockdowns, targeted as informal communities, a troubling pattern that has been seen in many countries including Kenya. A community member in India said:
When we tried to resume work after the lockdown, we were troubled by the police. They said we give rations and all that, then why do you need to get out? But rations are not much. If the NGO had not supported us then, we don’t know what we would have done. We would have died of starvation before corona hit us.
The health system alone cannot solve these issues which require multi-sectoral approaches to address the structural, economic, patriarchal and social inequalities poor people face.
In Bangladesh, as elsewhere, we have seen stigma and discrimination against households affected by COVID-19. The coronavirus is seen as contagious and fatal disease. As a result, there are fears of quarantine and isolation or being locked up and never seeing one’s family again. Red flags are placed in homes of infected people and the media pictures of death, and bodies being thrown in separate burial grounds stokes fears that people will be buried without the appropriate religious ceremony. Fears of getting the virus have resulted in surveillance of others, under-reporting, harassment of family members with spouses returning from abroad, harassment of people with flu-like symptoms and suspicions about outsiders.
Treatment of women and children
In Kenya and elsewhere there have been increases in reports of Gender Based Violence (GBV) in informal settlements since COVID-19 began, and lockdowns and curfews were put in place.
Women are the hardest hit by COVID-19, they are primary caregivers of individuals who are ill during COVID-19 pandemic… Women are not the decision makers in most families and as such, the money they make in a day to day activity ends up in the hands of men in the family.
In Kenya, people with disabilities make up 10 percent of the population, an average of 4.4 million people. 66 percent of these people live in rural areas while 44 percent are in urban settlements, mostly for work purposes. Due to the rise of sexual harassment and domestic violence, disabled people have been majorly affected and abused by a spouses, parents or caregivers. The frustrations of lack and mental stress makes them among the more vulnerable victims. This causes unwanted pregnancies and contracting sexually transmitted diseases.
Conclusion
We need to address the situation of the urban poor through context-specific policies and action in the COVID-19 response. We should not think of the urban poor as a homogenous group, so data must be disaggregated (by gender, age, occupation, ethnicity and other axes of inequity). Longitudinal qualitative research is critical to capture impact now and post-pandemic. We must also reframe health beyond a biomedical (disease model) approach and put in place socially just models with the well-being of communities and people at the centre. Health decisions and policies must be balanced with social and economic interventions.
Communities have the potential to mobilise and take action to address life-threatening experiences. For example in Sierra Leone, FEDURP members’ action in Thompson Bay supported quarantined homes with drinking water while government support was delayed. In Funkia FEDURP members used the fund generated from the public toilet they manage to give out revolving loans to their members to revitalise their livelihood sources.
There is an urgent need to bridge the gap between formality and informality through recognition and inclusive participation so that the needs and aspirations of informal settlements can be addressed. There is a growing need to recognise and draw on community knowledge, creativity and capacities, which is the basis of first responses during pandemic. Governments should place communities at the centre of development aspirations and actions and work with them to develop appropriate support.
This blog draws on the work of Kate Hawkins, Sabina Rashid, Joseph Etyang, Janice Cooper, Bintu Mansaray, Rosie Steege, Caroline Kabaria, Sally Theobald, Blessing Mberu, Laura Dean, Haja Wurie, JK Lakshmi, Joseph Macarthy, Hayley Macgregor, Karsor Kollie, Joanna Raven, Lilian Otiso, Rachel Tolhurst, Annie Wilkinson, Abu Conteh, Beate Ringwald and Francis Anthony Reffell.
A webinar on 5 November 2020, 10:00-11:30am CET (Geneva) organised by the Alliance for Health Policy and Systems Research, bringing together findings from six countries featuring our colleague Francis Reffell.
COVID-19 has a disproportionately large impact on vulnerable populations globally, including but not limited to slum dwellers and migrant workers. These populations often have limited access to basic water, sanitation and hygiene (WASH) facilities, live in cramped conditions where it is difficult to socially distance and are more likely to be dependent on a daily wage. Vulnerability to loss of income also makes it difficult to meet basic nutritional needs. Therefore, implementation of potential government recommendations such as social distancing and WASH to slow the transmission of COVID-19 becomes extremely difficult.
Both the effects of COVID-19 and the strategies to mitigate these effects must be context-specific, taking into account the needs of these populations. While considering individual contexts, bringing together learning from a wide range of socio-economically, culturally and geographically vulnerable populations will help us learn from experiences that may be more widely applicable.
This webinar will bring together country teams from Ghana, Vietnam, India, Sierra Leone, Guinea-Bissau and Kenya, all of whom have been engaging in responding to COVID-19 in the context of vulnerable populations in their settings. The webinar seeks to draw lessons learned from these teams. The Alliance hopes that such lessons will be useful for those working on similar issues in other settings, including policymakers tasked with responding to COVID-19 and health systems researchers keen to better understand the added value of HPSR in such a response.
Moderators
Dr Zubin Shroff, Alliance for Health Policy and Systems Research, WHO, Switzerland
Dr Geetanjali Lamba, Alliance for Health Policy and Systems Research, WHO, Switzerland
Panellists
Dr Matilda Aberese-Ako, University of Health and Allied Sciences, Ghana
Prof. Bui Thi Thu Ha, Hanoi University of Public Health, Vietnam
Mr Francis Reffell, Centre of Dialogue on Human Settlement and Poverty Alleviation (CODOHSAPA), Sierra Leone
Ms Niloufer Memon, Bridgespan Group, India
Mr Yussuf Sane, Tostan, Guinea-Bissau
Mr Kennedy Odede, Shining Hope For Communities, Kenya
Faith Munyao, Veronicah Mwania and Beate Ringwald conduct a community based participatory research (CBPR) study on prevention of intimate partner violence and HIV in Gitathuru, Korogocho, Nairobi, Kenya. In this blog they share their experience of conducting this ARISE-affiliated project together.
Beate: After working from home for five months, I was excited about the restart of the study (my PhD research project) in August. It has already been a great learning journey for me, and I am grateful that you have joined me. I have been exposed to participatory group work since my time as a youth leader in my local parish. Since then, I have used it a lot in my work. But this is the first time that you have used a participatory approach to research. How do you like it?
Faith: It is a unique kind of research, because the community is fully engaged.
Veronicah: I love it. To me, this is the best approach that I have experienced so far. The participatory research approach puts value on the people. The community is involved in the research and drives the process. It gives people the time to digest information. It does not impose foreign ideas on the community, is very inclusive, and empowers the community.
Faith: This is an opportunity to learn how research with communities can be done differently. I like about the participatory approach to see how eager community co-researchers are to learn and come up with ideas on how to do things. For example, they came up with a name for themselves. The community co-researchers are involved in all steps of the study, unlike in other studies where they are mainly engaged as informants during data collection or involved as data collectors. I like the formation of the local research team and the capacity building of the community co-researchers. When discussing their tasks with them, they were free to say what they want and what they do not want to do.
Veronicah: The participatory approach creates partnerships between community members, national and international researchers. For this long-term engagement, ethical considerations become an ongoing process throughout the study and are not a one-off exercise.
Beate: It sounds like you see great potential in participatory research. What are its benefits?
Veronicah: Participatory research, especially the visual methods that we use, offers unique learning about the study topic. It also gives us as researchers time to learn as we go and adjust. Regular debriefing has proven to be very useful.
Faith: Researchers are likely to get more information, because visual methods offer new ways of seeing. They do not restrict participants on what to say and not to say. I also see that the community co-researchers feel appreciated. They are given the opportunity to share the problems at the community. The weekly meetings and reflections give them also the time to digest information.
Veronicah: I agree. The community is fully engaged in identifying the problem and seeking solutions. In the process, capacity of community co-researchers is built. I hope by the end of the study we will be leaving the community impacted.
Beate: As you mentioned, participatory research involves long-term engagement with the community. This is different from many other studies whereby community members are met once for a short period of time. What challenges do you foresee, and how could we mitigate them?
Faith: So far, time has been a challenge. Everything takes longer than anticipated, including time for tea breaks, an important time for bonding and socialising.
Beate: True, we often have ambitious time plans. Time indicated in guidelines for methods is usually underestimated. I am learning how to make more feasible plans for our meetings and give room for in-depth discussions.
Veronicah: The study requires commitment of community co-researchers over a long period of time, with regular meetings on Saturday mornings. It is challenging if co-researchers are missing meetings due to other commitments. Being flexible and adjusting meeting times to dates when many are available has been useful.
Beate: We are still at the beginning of the study. I am looking forward to the joined data collection and analysis with co-researchers. What are you looking forward to?
Veronicah: I look forward to finalizing the definition of intimate partner violence and to discussions on power dynamics in the community that influence HIV and intimate partner violence risk. I also want to see us achieving the study objectives. I can’t wait to see the impact of the study on the community.
Faith: I am curious to explore with the community how intimate partner violence and HIV intersect and the solutions that they will come up with. Also, I am looking forward to seeing sustainability and ownership of the project by the community.
Beate: This is awesome. Thank you very much, Faith and Vero for sharing your experiences and reflections on community based participatory research with me and the ARISE family.
About us
Faith Munyao is a Kenyan researcher with four years of experience in HIV and Gender Based Violence-related qualitative research.
Veronicah Mwania is a Kenyan researcher with 17 years of experience in market research and health research.
Beate Ringwald has five years of experience in desk-based global health research and over ten years of experience in participatory work with youth, women and communities.
Within the ARISE Hub, this research project is a partnership between LSTM, LVCT Health and Gitathuru village. The study seeks to strengthen community capacity to prevent intimate partner violence and HIV in Gitathuru, Korogocho, Nairobi, Kenya. It is guided by the ALIV[H]E framework, which stands for Action Linking Initiatives on Violence against women and HIV Everywhere. Locally the study is known as the Korogocho ALIV[H]E study.
The next five most popular bits of content relate to the Twitter Chat that we held on disability and COVID-19. The event generated a lot of tweets and posters, so I knew it was popular at the time. But it’s great to know that the insights of our experts continue to be useful.
