Jacob Omondi reports on housing issues in Mathare slum, Kenya.
Informal settlements can be dysfunctional due to lack of organization as well as neglect by the Government when it comes to channeling funding and resources towards housing development. Allocating resources to support housing should be given more attention in order to eliminate social and structural inequality.
Currently access to decent housing is disparate.
Profiling Mathare
The Mathare slum is the second largest slum in Kenya after Kibera. It is densely populated with a population of around 500,000 residents. As an informal settlement Mathare faces numerous challenges, including problems with access to decent and affordable housing, unemployment, access to electricity and water, disasters such as flooding and fire, and security issues. Access to decent housing is still a major problem, with the majority of homes made from iron sheets and wood. Muungano Wa Wanaviji through Slum Dwellers International undertook a settlement profiling exercise in Mathare valley from 2021 to 2022. This revealed that the cost of renting in Mathare ranges from 1500 to 4000 shillings, with cost depending on location, for example dwellings situated near to the river are cheaper than the ones just adjacent to the roads.
Barbra Derrick was one of the data collectors narrates his experience during settlement profiling, “we first of all did a training on how to carry out settlement profiling which gave me an opportunity to learn on how to carry out mapping and enumeration, it also gave me a chance to easily understand with my community more, when it comes to the population, household income level, cost of housing, services available among others. Informal settlements normally lug behind when it comes to infrastructural development we hope that the settlement profiling will bring positive results that will help improve our living standards.”
Employment
The Mathare settlement is adjacent to Nairobi’s Central Business District. Many Mathare residents work in Nairobi’s Central Business District (CBD) as casual laborers, while others run small scale businesses selling goods and food, and driving taxis and other public service vehicles. However, the rate of unemployment in Mathare is still very high among young people.
Electricity
Electrical connectivity is also a major challenge in Mathare. Most residents are connected illegally, due to the fact these connections are cheaper to install and payment is monthly. However these connections are frequently unsafe and therefore highly dangerous, with risk of fire and electrocution sometimes leading to damage to houses and loss of life.
Disaster management
Houses built in slums are more likely to be affected by major disasters such as floods. During heavy rainfall dwellings are more likely to be affected by flooding especially those near the river. In 2013 in Mathare a landslide destroyed many houses, and killed a number of residents. Due to such dangers, housing costs are lower in more high risk areas leading to vulnerable people being more likely to live near disaster prone areas.
Water and sanitation
Certain areas of Mathare experience regular water rationing, while other areas are serviced by illegal water suppliers meaning they rarely experience the same rationing, due to the illegal supplier’s influence and network in the community. Water is basic commodity that should be provided for free, however people are still forced to buy water at variable prices – ordinarily a 20 litre jerrican costs five shillings, however during a water shortage the cost rises to 20 shillings for the same amount. Due to a scarcity of sanitation facilities, and a lack of proper sewerage systems, large amounts of liquid waste is channeled into the Mathare River, resulting in serious health risks.
Conclusion
In conclusion, it is time the Government gave priority to providing more safe and affordable housing in informal settlements. The Government needs to introduce policies and initiatives to regulate the cost of housing, reduce the risk of disasters such as fire and flood, and regulate the supply of water and electricity.
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Sadaf Khan reports on the disconnect between the UN’s definition of slums, and the diverse realities of these informal settlements.
UN Habitat’s definition of slums is comprised of what are known as the “five deprivations”; lack of i) access to water, ii) access to improved sanitation, iii) sufficient living area, iv) housing durability and v) security of tenure. Raise this definition in a roomful of researchers, activists and professionals who work in slum settings – as we did at the last ARISE Annual General Meeting (AGM) in Mumbai – and you will be met with an indignant uproar about the inaccuracy and injustice of such definitions.
Those present vehemently argued that these spaces and communities are not illegal or dirty, and that this narrative is in fact popularised by the dominant classes, the same people who equate slums with the urban poor. They pointed out that calling slums, or informal settlements, illegal is wrong from a human rights perspective. These are thriving spaces with complex governance structures, that, however informal, work most of the time. These structures ensure that, despite the noticeable absence of the state, people have access to water and sanitation, etc., albeit at exorbitant costs.
Our colleagues in Mumbai went on to speak about how people living in informal settlements make important and essential contributions to the local economy. These include waste pickers and sanitation workers, taxi drivers, and small business owners, without whom, the formal part of the city would flounder. They shared how, despite the critical roles these communities and spaces play, people living in informal settlements regularly struggle to access healthcare and social protection and face unnecessary stigmatisation when they engage with the formal structures and services of the city. They highlighted how overlapping vulnerabilities often further marginalise those already at the margins of society, and how poor planning and precarious or unclear tenure status become a catch 22, relieving service providers and the state of any responsibility to the communities living in slum or informal settings.
Shifting the focus: diverse realities in informal settlements
When people who work and live within slums and informal settings are so clear on the necessity of such spaces within cities, why do organisations like UN Habitat, WHO and the World Bank continue to use outdated framings when clearly on-ground realities are so very different? The rationale given is that these physical indicators; access to water, sanitation, appropriate living area, etc., make it possible to measure improvement within the settlement from household to household, providing a means of assessing the impact development programmes have on the spaces and communities living within them.
Unfortunately, what happens simultaneously, as illustrated by the statements above, is that the delicate and complex socio-economic mechanisms that make these settlements work are overlooked and ignored. This is not to say that issues of service provision, tenure security and poor building materials should be disregarded entirely and that they aren’t a genuine concern. We are simply suggesting that the overwhelming value placed on them undermines more pressing challenges experienced by those living and working in slums and informal settlements. Challenges like the threat of evictions (experienced across all ARISE sites), flooding and landslides (Freetown), fire (Dhaka) and gender-based violence, have the power to dismantle communities, disrupt livelihoods and severely impact health and wellbeing of community members.
What we have seen through the process of working with communities across the ARISE landscape is that the needs and challenges of communities vary from site to site and context to context. For example, data from Dhaka and Freetown suggests that age of the settlement may play a role in the level of service provision within a settlement; the more mature settlements seem to be better served. The experiences of ARISE’s Indian partners show that communities find creative ways through which access to services has been gained whilst respecting the prevalent planning and quality standards within the city. These local workarounds provide access, abiding by local bylaws and standards helps evade city authorities looking to shutdown illegal utilities, and the whole process speaks to the intimate knowledge these communities have of the workings of service providers and policymakers. This highlights the ability of communities to be innovative, and to learn and adapt within a system in the hope of achieving formalisation.
Like the sites and contexts they inhabit, communities in slum and informal settings are heterogeneous with internal hierarchies. Marginalised groups dealing with multiple overlapping vulnerabilities – disability, female headed households, ethnic or religious biases – inhabit one end of the socio-spatial spectrum. Whilst those more able, better connected and in positions of power, like local chiefs, elders and community leaders, sit at the other end.
Despite this, or maybe because of it, where the state has failed to provide support and/or services, Community Based Organisations (CBOs), NGOs and Community Advisory Committees (CACs) have been able to organise and mobilise to provide homegrown solutions to service provision challenges related to water, sanitation and hygiene (WASH) and healthcare within the settlements. These informal governance structures often connect outwards to more formal structures, like ward councillors and local politicians, to help facilitate access to basic utilities etc., showing that there are varying degrees of ability to demand accountability from policymakers, service providers and governance actors within these communities.
In essence, what our review of documents from multilateral agencies that speak to definitions for slums and informal settlements shows is a huge disconnect between how these spaces and communities are perceived to be and what they actually are, and, more importantly, are capable of. The uproar and indignation of all those in the room at the ARISE AGM in Mumbai when these definitions were shared was completely justified, as these definitions are flat, broad and focused on deficiencies rather than the heterogeneity and industriousness of the communities and networks within. Additionally, they absolve service providers and policymakers of any responsibility towards the communities within these spaces.
Moving forward
Whilst these definitions serve a purpose in terms of assessment and impact analysis for donor organisations, they do a disservice to the communities they describe. These definitions are intrinsically linked to programme funding, capacity building within communities and organisations, and knowledge creation. The omissions and over-simplifications built into them limit the ability of funders to acknowledge and to respond to context specific needs. Moving forward, there is a need to revisit these definitions to ensure they more closely reflect the heterogenous and intersectional nature of the people, places, processes and of course problems within slums and urban informal settlements. These definitions need to be developed in an inclusive manner, bringing on board the opinions of those communities most effected, acknowledging not only the challenges but also the successful workarounds that these communities devise to exist within a system that is reluctant to acknowledge them and the overwhelming contributions they make to urban life.
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Lynda Keeru, Hayley Stewart and Kate Hawkins report back on an ARISE and CHORUS consortia hosted webinar, ‘An intersectional and gendered approach to health and wellbeing in informal settlements.’
Informal settlements are now a widespread reality in cities globally and particularly common in low- and middle-income countries, housing millions of people. The residents of these spaces face multiple issues that impact on their health and wellbeing. This webinar took a specific focus on intersectional and gendered approaches. Both consortia took attendees through the frameworks that underpinned their work. This was followed by a rich panel discussion that dug deeper into the implementation of the frameworks in the different settings across both projects. The webinar was well attended with valuable contributions from participants through the online questions and answers.
ARISE
Laura Dean from LSTM began her presentation by challenging participants to reflect on when they last noticed the existing structural and social inequities that exist around them. She pointed out that they are all around us, with some more visible than others. As cities continue to become even more divided, ARISE is focused on recognising these inequities and working with organisations of slum dwellers and other institutions to change and challenge them. ARISE uses a social determinants approach which aims to unpack dimensions beyond the biological and draw attention to the political, environmental and structural factors that underlie health and illness.
Heightened health challenges experienced by those living in informal settlements include infectious diseases, non-communicable diseases and mental distress. These illnesses are exacerbated by a lack of access to healthcare. The lack of entitlement and denial of the human right to health is fundamentally a problem of unequal power relations. And an absence of formal government institutions creates multiple interlinking systems of informal governance.
To this end, ARISE employs intersectional theory, that is inherently gendered, to help understand these challenges. It uncovers the underlying inequalities within informal spaces that shape the challenges faced by residents. ARISE merges multiple social and anthropological theories to create its equity analysis framework. It uses the theory of structural violence to consider how political, economic and social inequalities can be a cause and consequence of poor mental and physical health, and considers how both symbolic violence (e.g. classism, ethnocentrism) and everyday violence (e.g. physical violence) become mediating processes of structural inequality. Merging these theories of violence with intersectionality theory is essential to allow for academic theory to be operationalized and to promote social change. By taking this approach, ARISE can consider how varying forms of violence interact and are mediated by different characteristics to create nuanced experiences at the individual level.
CHORUS
Sushama Kanan, from ARK Foundation in Bangladesh introduced attendees to the gender and intersectionality framework used by CHORUS researchers in the cities in Nepal, Bangladesh, Ghana and Nigeria. The consortium aims to strengthen health systems in urban areas by developing and testing interventions to strengthen health systems. While the interventions vary according to city context, they focus on linking across the plurality of providers, encouraging multi-sectoral collaboration, responding to the urban burden of non-communicable disease and communicable disease and identifying, reaching and engaging the urban poor. Within all the CHORUS focus cities, researchers have used qualitative and quantitative methods to understand practices around health and have found that individual and community identities determine the health outcomes and behaviours. Inequities are a key feature of all the cities where CHORUS works and identifying and addressing urban inequities fundamental to improving urban health systems.
To ensure that gender and equity is addressed, CHORUS is using a framework based on work by Rosemary Morgan and colleagues, as well as an action learning group. CHORUS has also developed a gender and intersectionality guide to assist researchers in understanding and applying these concepts to their work. The gender framework has been useful in all stages of the research process, including in conceptualizing and designing projects, sampling and disaggregating data and in analysis. The framework has also been used to reflect on the internal dynamics of country teams and the workings of CHORUS as a whole.
It uncovers how gender and other social stratifiers, such as socioeconomic status, ethnicity, and education levels work as a power relation and driver of inequity in health systems. This focus has allowed the team to ask important questions about the division of labour, access to resources, social norms, ideologies, beliefs and perceptions, and formal and informal rules and decision making. Through these reflections, teams have been able to better identify how power relations are constituted and negotiated in urban settings as well as how they could be shifted positively in the contexts where CHORUS works.
How gender shapes health in different contexts
Speaking about Nepal, Abriti Arjyal from HERD International explained that the gender influenced the experiences, opportunities, constraints and power to seek health care among the urban poor. There is a clear intersection between gender and occupation within the context of the urban poor. Most of the urban poor are daily wage workers and they have limited time to visit any healthcare facility and access services. This means the availability and accessibility of the health services is one of the important factors that determines the health seeking behavior of the urban poor. Participants noted while most government health facilities services are available for free or at a minimum cost, they are often at odds with their working schedules. Additionally, women face the dual responsibility of taking care of household chores while also having to earn. Owing to this, they prefer seeking medical attention in facilities closer to them in order to make their lives easier.
Abu Conteh from SLURC, Sierra Leone discussed how the ARISE framework has contributed to understanding intersectionality and gender differences within the context of the slums in Freetown. In Sierra Leone the framework revealed how structural violence shapes health outcomes and the choices that people make. It has guided questions around health outcomes by revealing why certain groups of people are continuously excluded from healthcare services or why some people are much more susceptible to certain health issues than others. Living in informal settlements continues to be deeply stigmatised. Women carry an additional burden of stigmitisation, as they are considered inferior members of society. Many women living with chronic diseases, are denied access to education while their male counterparts are allowed to go to school. Consequently, this denies them opportunities in life and affects their economic opportunities heightening difficulties in accessing healthcare, reinforcing a pattern of exclusion for certain groups of people.
Speaking about experiences in Dhaka, Adrita Rahman from the BRAC University, JPG School of Public Health in Bangladesh described how female headed households in informal settlements are impacted by poverty, power relations and gender dynamics that result in women experiencing high levels of vulnerability. They are solely responsible for making money and taking care of the households and as a result, they often prioritise their family’s needs, and ignore their own healthcare requirements. The long waiting periods in health facilities mean that to seek health care women must take time off work, without sick leave, and are under the constant threat of losing their jobs.
Chineyere Mbachu from the University of Nigeria presented a preliminary analysis, from qualitative interviews carried out among informal providers in urban slums. Through the interaction with the providers, they teased out a pattern influenced by gender and intersectionality. The patent medicine vendors in the settlements are mostly men while the traditional birth attendants are female. Men tended to have higher levels of education and had access to more networks in comparison to the traditional birth attendants. The project aims to avoid propagating any gender differences and imbalances in access to resources, particularly for the providers.
Ivy Chumo from APHRC in Kenya discussed child headed households. She described poor, uneducated children expected to head households. Emergencies such as COVID-19 further exacerbate their vulnerabilities and marginality. They face many challenges including access to health care services. Many of their biological and physical needs are unmet. These children lack a voice and are institutionally invisible. The lack of representation leads to a lack policy inclusion. There is a need to treat these children as the children they are and not adults. The majority of child headed households in informal settlements are female and are more likely to experience sexual violence compared to boys, and may have to trade sex for basic needs like food, water and education. Notably, girls were highly susceptible to structural violence due to community social structures that favored boys while seeking to meet their basic needs. Consequently, female child-headed households went through a lot of physical abuse as a result of a lack of adults to support them and inability to escape from a scene of physical violence.
Lauren Wallace from the School of Public Health at the University of Ghana spoke about the gendered perceptions of the Community-based Health Planning and Services (CHPS) program in urban communities in Accra. CHPS is a national programme that places nurses in communities where they provide basic primary healthcare. Nurses are supported by volunteers who liaise between the health workers and community members and support activities such as community outreach and home visits. CHPS was initially piloted in rural areas with particular emphasis on improving maternal, reproductive and child health indicators. Initial findings show that in urban areas, there are challenges in implementing the program including the limited number of nurses, logistics, limited understanding of the program and difficulties motivating volunteers. Owing to these challenges, the CHPS programme as it is implemented in these urban settings mostly caters to MCH and SRH activities. The community’s perception is that it is a program meant for women and their children hence there is need to find ways to engage other populations including men.
Partho Mukherjee from The George Institute in India works with waste workers. They are often denied health services despite the fact that their occupation is hazardous due to frequent exposure to toxic materials. In attempting to shift gender norms and promote gender inclusion, researchers realised that the system is often not ready to work with these very marginalized groups of people because migrants rarely have local political power and it is difficult for them to hold local governance structures accountable. Discrimination faced by migrants, cutting across gender, limits access to public health care. Policy makers should address strengthening the primary health care system in both rural and urban areas. Partho highlighted the need for a longstanding funding commitment to implement this.
Sushama Kanan, from the ARK Foundation who conducted their research with the transgender community in Dhaka, said that there was a clear difference in male, female and third gender experiences in terms of accessing and providing care. Research findings reveal that the trans population faces discrimination in health centres when accessing services. Trans people reported being told by healthcare providers not to go to the health centres because it will offend other patients. She recommended that service providers need to be trained to show more empathy to trans people and the creation of formal policies to address stigma and bias.
Moving forward
The webinar concluded with chair Helen Elsey from the University of York thanked participants and attendees for their time, and commenting that the session had made it clear just how valuable this kind of analysis can be in unearthing and understanding the inequities that are being seen in urban contexts, particularly informal settlements. She highlighted how as gender and social norms continue to transform in these settings, there is room for optimism and progress on these issues and insights like the ones shared at the webinar can really help us move towards great urban equity.
Community exchanges are crucial, as they enable communities to observe how others in similar situations have resolved their issues. By identifying similarities, they can learn from each other and test new solutions. Community exchanges also foster a sense of solidarity among communities by highlighting that many others also face similar challenges. This shared understanding helps strengthen relationships and promote collective action to address common problems.
Over the past four years, we have engaged in discussions with residents from relocation colonies in Ahmedabad, who were displaced due to the Sabarmati Riverfront redevelopment project, and with the members of the National Slum Dwellers Federation and Mahila Millan in Mumbai.
Local accountability and governance structures
Initially, our exchanges focused on understanding the context of their relocation in Ahmedabad. We examined their living conditions, housing provided by the state, and how they managed operations and maintenance. However, we soon realized that many communities lacked organization due to the absence of cooperative societies or proper procedures for maintaining a transparent system.
Slum relocation sites in Ahmedabad are characterized by a spate of vulnerabilities, and people suffer due to poor institutional support post-relocation, poor access to basic services, and caste conflicts among the residents. These issues largely emerge because of poor local accountability and weak governance structures, such as Co-operative Societies that are responsible for operations and maintenance and keeping the colonies in order.
This is in contrast to Mumbai, where relocation sites of a similar nature, through the continued support of NGOs, have successfully operationalized well-functioning societies and have robust community-based organizations in the form of the Mahila Milan and federations.
Having them learn from each other then becomes imperative in devising strategies that can be emulated within local contexts.
How can community exchanges be transformational?
We invited prominent resident leaders to visit Mumbai’s slum relocation colonies to learn about organizing societies and managing operations. As a result of these visits, several informative exchanges took place, with some transformational results.
Improving water issues in the relocation colonies
In the relocation colonies in Ahmedabad, women were generally underrepresented in conversations and decision-making processes. However, we knew, from the historical work of Mahila Milan, that including women could greatly improve problem-solving efforts for issues that residents at relocation colonies in Ahmedabad faced.
In May 2022, during medical camps, a group of Mahila Milan members from Mumbai visited the relocation colonies. During this community exchange visit, the Mahila Milan encouraged women in the colonies to participate. Despite being told by men that women wouldn’t participate, things changed when Mahila Milan members visited individual homes and invited women to the meetings.
These meetings empowered the women to form groups, address local issues, and voice their opinions. As a result, more women began participating in the process. After one such meeting, the newly motivated women successfully protested a water issue with their political representative and got their concerns addressed.
Overcoming caste differences and gender divides
Before COVID hit, male community members from Ahmedabad visited Mumbai for a community exchange. They were surprised to see, firstly, people from all religious communities living and working together, and, secondly, women in positions of leadership and being very articulate about challenges and the work they do around it. In contrast, in their own communities religious segregation and constant caste clashes were large barriers to unifying the residents. The visit changed their thinking, and they realized that bringing people together is crucial for addressing common issues effectively.
After returning to Ahmedabad and reflecting on their experience in Mumbai, there was a significant increase in women’s participation and an improved understanding among community members about the importance of collaboration and overcoming caste differences. This experience changed their perspective on how associations work and why participation from all is essential.
These examples demonstrate how community exchanges can expose people to other ways in which people with similar backgrounds live and function. Community exchanges can help to broaden perspectives and show that there are other successful ways of living! Women get inspired and motivated when they see other women like them articulate and be vocal about issues they seek solutions to. This effect encouraged us to intensify the exchange efforts.
Strengthening emerging cooperative societies in Ahmedabad
In March 2023, we organized a community exchange to understand how to strengthen the emerging cooperative societies in Ahmedabad. This time, we were clear that more women from Ahmedabad needed to participate in the exchange, and thankfully, there indeed were more women from Ahmedabad than last time.
Participants in the community exchange in March 2023. Image credit: SPARC
During the three-day exchange visit, members from the Ahmedabad slum relocation colonies visited the Mahila Milan in Mumbai. They revised their understanding on the role of community savings as a mode of organizing people and the myriad other ways in which the slum communities in Mumbai federated themselves. They also spent time speaking to members of a cooperative society of a slum relocation colony, seeing for themselves how their society was formed and how it maintains records of its roles, responsibilities, and activities. The main learning was that it was essential to maintain good documentation to be able to seek legitimate negotiations with the Government actors.
What exchanges of this nature do for a community in fostering a sense of collective action can be surmised by the words of Shrafat Hussain (name changed), one of the attendees from Ahmedabad:
“What we saw in Mumbai, and from what I heard from the others… I want our site to set a similar example for the societies and relocation sites in Ahmedabad. The next exchange should use us as an example of what is possible”.
The poster presented findings from a community-based participatory research method “Governance Network Mapping” that explored the local-level governance of COVID-19 pandemic response in two informal urban settlements in Dhaka city. It was part of a multi-method PhD research. The findings revealed that in informal urban settlements, the pandemic was managed through a hybrid arrangement between multiple types of actors at the local level – formal and informal, health and non-health and state and non-state actors.
The COVID-19 pandemic unveiled the importance of recognizing the influence of informal governance actors and community engagement in pandemic and disaster management, especially in informal urban settlements. Hybrid arrangement has the potential to provide support to poor and marginalized communities, that might not be otherwise forthcoming, but also brings challenges to effective targeting and delivery of support to those most in need. The pandemic has also highlighted the need for strengthening the capacity of local government to play the coordination role effectively in future pandemic and public health emergency management.
Winning the Lancet-CUGH Student Poster Competition and receiving the award in front of global public health experts was a great accomplishment for me as a PhD student and also as a health systems researcher.
