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Hayley Stewart

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Sabina Book Post Bangladesh ARISE

Book: Poverty, Gender and Health in the Slums of Bangladesh: Children of Crows

We’re thrilled to announce the publication of our colleague Professor Sabina Faiz Rashid’s book Poverty, Gender and Health in the Slums of Bangladesh: Children of Crows. Sabina is the Mushtaque Chowdhury Chair in Health and Poverty at BRAC’s James P Grant School of Public Health and ARISE PI in Bangladesh, and has written about the experiences of people living in informal settlements.

Poverty, Gender and Health in the Slums of Bangladesh provides compelling and comprehensive ethnographic accounts that depict the daily life experiences and health hardships encountered by young women and their families living in the slums of Dhaka city and the injustices they face.

Through comprehensive accounts spanning two distinct periods (2002-2003 and 2020-2022), Sabina sheds light on the enduring poverty, injustices and health hardships experienced by those living on the margins of society, and shows that despite recent improvements in employment opportunities and greater mobility for young women, their lives reflect ongoing challenges reminiscent of those faced two decades earlier.

This book will appeal to students, academics, and researchers in the fields of Public Health, Medical Anthropology, Gender Studies, Urban Studies, Development Studies, Social Sciences, as well as professionals engaged in urban health and poverty-related work.

Order Sabina’s book Poverty, Gender and Health in the Slums of Bangladesh: Children of Crows  (routledge.com) now.

Screenshot of Slum-Child brief

Brief: Working with Slum-Child Foundation on WASH in Nairobi, Kenya

Supported by the ARISE Responsive Challenge Fund, the African Population and Health Research Centre worked with Slum-Child Foundation (SCF) to address water, sanitation and hygiene (WASH). Clean water often costs more in informal settlements when it is provided by intermediaries, reducing the amount of water people can afford for handwashing. With a lack of space, residents often rely on shared communal toilets, which can increase transmission risk through surfaces and can be hard for pit emptiers to de-sludge when full. Experts on WASH have previously mostly not taken into consideration  the voices of children. This brief presents activities, key outcomes, lessons and recommendations.

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ARISE Slum-Child Foundation Nairobi Kenya Brief April 2024

Journal article WASH Kenya ARISE

Beyond a facility: A cross-sectional survey on WASH service levels and informal social accountability in childcare centres in Nairobi’s informal settlements

Abstract

Access to clean water, sanitation, and hygiene (WASH) services is crucial for a healthy start in life. Social accountability has a potential for enhancing WASH services in childcare centres. However, there are inadequate studies to understand how informal social accountability mechanisms contributes to WASH service provision. To address this gap, we conducted a cross-sectional survey in Korogocho and Viwandani informal settlements in Nairobi, Kenya, to explore the relationship between different levels of WASH services (ranging from basic to limited or nonexistent) and indicators of informal social accountability, including rewards, sanctions, voice, and responsiveness. We employed multinomial regression analysis, utilizing a robust error variance estimator to account for potential biases. Our findings revealed disparities in WASH service provision between the two studied areas, with childcare centres in Korogocho exhibiting higher access to basic WASH services compared to those in Viwandani. Our analysis also highlighted a significant association between informal social accountability mechanisms and the provision of WASH services. Notably, the sanction mechanism exhibited a correlation with all WASH services, suggesting its pivotal role in shaping service delivery outcomes. In light of these findings, it is imperative to prioritize efforts aimed at reinforcing social accountability mechanisms in WASH service delivery frameworks.

Ivy Chumo; Caroline Kabaria; Penelope A. Phillips-Howard; Hellen Gitau; Helen Elsey; Blessing Mberu (2024). Beyond a facility: A cross-sectional survey on WASH service levels and informal social accountability in childcare centres in Nairobi’s informal settlements. https://doi.org/10.2166/washdev.2024.177

Brief: Working with U-Tena youth organization to address solid waste management

Brief: Working with U-Tena youth organization to address solid waste management

Supported by the ARISE responsive challenge fund, the African Population and Health Research Centre (APHRC) worked with the U-Tena youth organization to address solid waste management (SWM). SWM entails collecting, treating, and disposing of solid material that is discarded because it has served its purpose or is no longer useful. SWM is a challenge in informal settlements because of the following: absentee landlords who flout development control orders; inadequate storage containers; indiscriminate disposal by households; unreliable collection by county government; low household incomes; and limited public education. While working in the SWM space, we realised that water, sanitation and hygiene (WASH) is closely linked with SWM activities. Activities were carried out in Mathare and Viwandani communities in Nairobi, Kenya. This brief presents activities, key outcomes, lessons and recommendations.

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ARISE U-Tena Youth Organisation - Kenya brief April 2024

Malawi Waste Management

Increasing Access to Waste Management Services in Informal Settlements in Lilongwe City, Malawi

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In this blog from Zilire Luka, Bernard Kondowe, Jiban Karki and Hayley Stewart we learn more about the project to increase access to waste management services in informal settlements in Lilongwe, the capital city of Malawi. This work is being undertaken by our partners in Malawi, the Centre for Community Organisation and Development (CCODE) and its alliance partner, the Federation of the Rural and Urban Poor (the Federation), part of SDI. It is funded by the ARISE Responsive Fund.

 

The problem

The local authority, Lilongwe City Council (LCC), faces several constraints, some of which are related to availability of resources, which makes it difficult to collect all solid waste. As a result, the local authorities tend to concentrate their waste collection activities in so-called ‘formal’ areas, neglecting informal settlements.  Currently the council lack sufficient data on how much it costs to collect and properly dispose of a ton of solid waste, though they estimate collection and delivery to the dumpsite costs between MK 3,000 and MK 5,300 per ton.

High urbanisation rates continue to contribute to the growth of informal settlements, with annual growth levels at 5.2% is very high compared to the national growth rate of 2.8% per year. As such, the national urbanisation level of 15.3% is expected to rise to 30% by 2030 and 50% by 2050.  The LCC collects 30% of waste per day, in markets and low-density areas, however there are no waste collection services in informal settlements. The wanton disposal of household solid waste exposes peri-urban dwellers to an unhealthy environment, causing groundwater and air pollution, flooding through clogging water drainage systems and water borne disease, for example, cholera.  The waste for wealth (W4W) concept is also not fully utilised by informal settlements. The W4W approach mobilises and trains community waste entrepreneurs to process waste into various products i.e., compost manure. These community waste entrepreneurs collect garbage from households and markets, sorting it and process it at the established community waste transfer centres.

ARISE outcomes

The work carried out in Malawi addresses a number of ARISE outcomes. Through this project local urban marginalised people will be better able to come together to identify their priorities around health and wellbeing and develop action to achieve their goals. It will lead to increased accountability and responsiveness from local government and other actors to meet the priorities of urban marginalised people, as well as helping urban marginalised people, government departments, other (development/community) organisations and researchers better understand what might improve the health and wellbeing of urban marginalised people.

The project will address the complexities in the waste management value chain (includes all aspects of the waste chain – from before a resource becomes ‘waste’ until the resource is brought back into a new life cycle) in informal settlements, while improving waste management in the targeted informal settlements through the adoption of the three Rs – Reduce, Reuse, Recycle.

Through the interventions we will create a critical mass of organised informal settlements working together to improve their wellbeing through improved waste management, while increasing local accountability and responsiveness to meet the priorities of organised informal settlements in the city. In order to undertake this action, the Malawi team identified study sites in Kaliyeka, Mgona, Mtandire.

Activities to date

So far, the project has collected, organised and disseminated data on waste generation and management for three informal settlements, the highlight of which being the waste audit process. The project has also supported the establishment of waste collection services in two informal settlements – Kaliyeka and Mtandire, which in turn created employment among young people. With the help of local communities, the project has produced different learning and knowledge management materials  (including pamphlets, brochures, and short video clips to disseminate information on proper waste management practices in an informal settlement setting), promoting easy access to information, fostering collaboration between community members and Lilongwe City Council and enhancing decision making efficiency. The team also facilitated the capacity development of 130 community informal waste entrepreneurs in waste handling and processing (collection, sorting, composting and recycling).

Lessons learnt

  • Involving the community in the waste management process is crucial – community participation ensures better understanding of local needs, customs, and challenges.
  • There is a real need to take advantage of the informal economy within the settlement. i.e., informal waste pickers often play a significant role in recycling efforts.
  • Lack of information (awareness) about proper waste disposal and its impact on health and the environment is a common challenge in informal settlements.
  • Limited infrastructure is hindering waste collection and disposal efforts.
  • Collaboration of various stakeholders i.e., local authorities, NGOs, and communities, is crucial for the success and sustainability of waste management projects.
  • The promotion of recycling and re-use of waste products (waste-to resource approach) is turning challenges (waste accumulation) into opportunities (source of income) in informal settlements.

We used a number of strategies in addressing crosscutting issues that include;

  • Promoting inclusivity by ensuring that all community members, including vulnerable or marginalised groups (i.e., women and youth groups) were involved in all the project processes.
  • Integrating technology where applicable to streamline data collection, communication, and knowledge dissemination processes.
  • Encouraging a culture of continuous learning and improvement by regularly reviewing and updating M&E processes, coordination mechanisms, and educational materials based on feedback and the evolving needs of communities.

ARISE Kenya CHE screenshot

Urgent Action Needed: Catastrophic Health Expenditure in Kenya’s Rapidly Growing Urban Areas

This brief on catastrophic health expenditure in Kenya’s rapidly growing urban areas look at how the rapid growth of urban populations poses significant challenges to healthcare access in cities in low and middle-income countries (LMICs), such as Kenya. A scoping review on the economic impact of accessing healthcare in urban populations indicates that residents across the city, including those living in informal settlements (colloquially known as slums), incur high costs but the economic burden differs when accessing healthcare. We recommend increased coverage of social protection interventions such as the National Health Insurance Fund (NHIF) and the Linda Mama maternity programme among vulnerable people living in Kenyan urban areas, while considering the complexity of healthcare provision in this context.

This scoping review was conducted as part of ARISE, which aims to enhance accountability and improve the health and wellbeing of marginalised populations living in informal settlements in LMICs. This brief presents results from the review and provides policy options to improve healthcare access in Kenya’s rapidly growing urban areas.

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ARISE Kenya Catastrophic Health Expenditure Brief 2024

 

Community groups in Harare, Zimbabwe

Sharing and learning about public health accountability for informal settlements in Harare, Zimbabwe

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Earlier this month, we heard from ARISE colleagues in Zimbabwe working on the ‘Public Health Accountability for Informal Settlements’ project, funded by the ARISE Responsive Fund.  Here Teurai Anna Nyamangara, Jiban Karki and Hayley Stewart recap on the work being done in Harare.

Project activity

Teurai Anna Nyamangara from the Dialogue on Shelter Trust took us through the activities the team has been up to in Zimbabwe’s capital, Harare; working in two informal settlements. The team mobilised twenty women and youth-led groups in Tafara and Stoneridge, to undertake research on public health issues in the two informal settlements. They undertook a community-led profiling exercise, generating community-led research specifically on public health using focus group discussions as well as community exchanges between Tafara and Stoneridge. Throughout the year, a total of ten exchange and exposure visits were organised, spanning both intra-settlement and inter-settlement contexts, while total of three community public health and accountability dialogues were conducted in Tafar, Stoneridge, and the Harare Federation Region. A solar-powered borehole, equipped with multiple water points, was successfully installed in Tafara, and four stakeholder meetings on SRHR and disaster response were successfully conducted in Tafara and Stoneridge.

Strengthened and more equitable relationships between urban marginalised people and government

There is improved collaboration between communities and government actors, a positive outcome attributed to the ARISE project. This shift is advantageous because government officials are more responsive when communities themselves express their concerns, rather than relying on NGOs to advocate on their behalf. This was achieved through a series of meetings and visits, including a stakeholder disaster response meeting, informal settlements exchange visits, and SRHR stakeholders meeting.

Strengthened and more inclusive relationships within and between networks of community organisations

There was capacity strengthening through learning visits within and across the targeted slum settlements, as well as visits with decision makers. These exchanges helped in peer-to-peer learning, exploring experiences around access to basic services. When community members from different slums visited each other and learned together, alongside local officials and policymakers, there was a real visible transformation in their relationships.

In an exchange visit, the development technical team from Tafara visited the technical team from Dzivaresekwa, a settlement that had recently been upgraded. The exchange helped the Tafara team learn skills to spearhead their own development projects. and they have since started visiting the local authority on their own.

Enhanced understanding of wellbeing and health drivers for urban marginalised people

As described above, two community profiling exercises were conducted, with ten focus groups carried out in Tafara and Stoneridge informal settlements, specifically addressing public health issues. To ensure accuracy and reliability, feedback and verification meetings were conducted as part of the data validation process.

Data was compiled which the community then presented to decision-makers, highlighting gaps in service delivery. The findings served as a valuable learning resource to inform inclusive actions and policies. These findings were presented to stakeholders. The profile reports included data indicating challenges related to poor access to Water, Sanitation, and Hygiene (WASH) facilities.

Challenges

The pre–election, election, and post- election periods in 2023 were politically febrile, making working in the informal settlements more challenging and sensitive than usual. The research team had to rely on community leaders to run activities and hold meetings and gatherings on our behalf.

Lessons learnt

  • Communities are first responders to the challenges they face – disaster and health related – so there is a need to invest resources directly into communities, so that they can scale up their interventions. It is crucial to prioritise locally led adaptation principles, and invest in community resilience.
  • Savings groups form the basis of collective action in urban poor communities, especially informal settlements. The savings groups in informal settlements save for different purposes such as buying land and building houses.
  • Community-led data collection enhances capacity by filling knowledge gaps and helping shape policies and policy responses. There is a need to co-produce data through participatory data collection, which can then be used by both state and non- state organisations to address highlighted gaps in health issues.

Pic credit: Dialogue on Shelter Trust

ChildSpace Responsive Fund Kenya

Brief: Working with Child Space Organization to Reach Children Heading Households in Nairobi

Supported by the ARISE Responsive Challenge Fund, the African Population and Health Research Centre (APHRC) worked with Child Space Organization to reach out to children heading up households in the attempt to address the vulnerabilities and marginalities they face. Child headed households (CHHs) refer to families that have a minor as the head of the households. CHHs are vulnerable to health and wellbeing challenges. These challenges can broadly be divided into three categories: Biological and physical challenges; strategic challenges (i.e. children’s limited levels of autonomy and dependence on adults); and institutional invisibility due to a lack of voice in policy agendas. This brief presents key activities, outcomes, lessons and recommendations.

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ARISE Kenya - ChildSpace Responsive Fund brief 2024

 

An illustration showing life in an informal settlement

Improving Accountability for Equitable Health and Well-being in Urban Informal Spaces: Moving from Dominant to Transformative Approaches

An illustration showing life in an informal settlement

Abstract

This article critically reviews the literature on urban informality, inequity, health, well-being and accountability to identify key conceptual, methodological and empirical gaps in academic and policy discourses. We argue that critical attention to power dynamics is often a key missing element in these discourses and make the case for explicit attention to the operation of power throughout conceptualization, design and conduct of research in this space. We argue that: (a) urban informality reflects the exercise of power to confer and withhold advantage; (b) the dominant biomedical model of health poorly links embodied experiences and structural contexts; (c) existing models of accountability are inadequate in unequal, pluralistic governance and provision environments. We trace four conceptual and empirical directions for transformative approaches to power relations in urban health equity research.
ARISE Consortium (2024). Improving Accountability for Equitable Health and Well-being in Urban Informal Spaces: Moving from Dominant to Transformative Approaches. Progress in Development Studies, 0(0). https://doi.org/10.1177/14649934231225530

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