It is not only an epidemiological pandemic but a social one, that has uncovered the perpetual global social, economic, health and political inequalities. Lynda Keeru and Kate Hawkins report back from a recent webinar, ‘Exposing the cracks: COVID-19 and global inequality’. Hosted by The Gender, Justice and Security Hub this event brought together researchers to discuss whether the pandemic can be used as a disruption to the system – exposing cracks that can be exploited to confront power and inequality – or whether it is business-as-usual – exacerbating inequalities and privileging those with power.
Josephine Ahikire painted the clear divide that exists between the rich and poor in Uganda; further worsened by the pandemic. The wealthy in Uganda still move freely facilitated by permits issued to them by resident district commissioners. However, circumstances are completely different for the poor. They are the recipients of the strict lockdowns with minimal livelihood options. They can no longer meet their basic needs like putting a meal on the table as they depend on daily income and live hand to mouth. In an attempt to mitigate these challenges, the government put in place a ‘response for the vulnerable’ – a move in the right direction. However, this was slowed down by the process of identifying the vulnerable. That the government did not know who was vulnerable is alarming as they are the ones most affected by government policies. They are the people beaten on the streets, those who can’t access general healthcare, those that can’t find transport because public transport is prohibited and those who face hurdles when trying to access health services.
The situation in Uganda demonstrates the priorities of the government in investing in control and militarism than in facilitating the population to respond to the pandemic. This is an indication of the close connection between neo liberalism and rising militarism. Militarism is being legitimized as a response to a global health challenge and this is a pattern that is being seen in many other contexts.
Faisal Garba explored how existing inequalities had been exacerbated in South Africa, through the lens of migrant rights. In the context of refugee protection, countries are using COVID-19 to double down on closures to try and further isolate and marginalize refugees and prevent them from accessing what they are entitled to. Countries are using controls on migration to demonstrate their control of the pandemic.
South Africa adopted migrant blind polices in dealing with the pandemic. An example of this is a policy that was executed by the state at the height of COVID-19. A grant was issued to support families and small businesses. However, one of the eligibility requirements was citizenship. This meant that refugees – who were in critical need of food and other necessities – were excluded, deepening the divide between locals and migrants.
The long-standing fallacious belief that began during the HIV/AIDS era in South of Africa that migrants spread diseases has been upheld during COVID-19. The narrative being peddled is that the porous borders provide a gap for migrants to come into the country with COVID-19. State officials unfortunately amplify this message, creating false unity by selling the idea of citizens protecting their country and their country’s health from people who come in with diseases.
Surekha Garimella began by outlining how poor people have struggled for decades and that COVID-19 has brought this to the fore and in doing so made many people uncomfortable. In India the lockdown meant the cessation of livelihoods for many. The extension of women’s care work within the family, community, or for the state has been a considerable burden. Lack of access to health services and health system disruption has led to home deliveries and associated deaths.
During COVID-19 the most marginalized who most need to access protective measures were the ones who got the least. This is happening in a context where people have for decades lived with a huge basic need deficit. The implementation of the Disaster Management Act provided the state with huge power. This was wielded to regulate the lower classes to prevent them from infecting the dominant classes.
Surekha made a powerful intervention about the role of research and researchers in the pandemic response. She argued that the evidence used to formulate public health policies during COVID-19 does not adequately take the poor into account. There is a need to challenge mainstream conceptions of what evidence counts and go beyond the biomedical. This needs to consider that actions have different implications depending on the different societal divisions whether it be class, gender, caste, or geographical location.
“I learnt so much from the webinar and the engaged speakers, who are embedded in a range of different contexts, working to better understand and strategically address the multiple inequities that are amplified by COVID-19. It was excellent to bring learning together across three sister GCRF hubs, on social justice, gender and equity, and I look forward to further joint dialogue and action.“ Sally Theobald, PI, ARISE hub
Kirsten Ainley – Associate Professor of International Relations and the Deputy Principal Investigator of the UKRI GCRF Gender, Justice and Security Hub
Heaven Crawley, MIDEQ Hub
Faisal Garba – Teaches Sociology at the University of Cape Town (UCT) and is the Co-Convenor of University’s Global Studies Programme and works with the Migration for Development and Equality Hub
Dr Surekha Garimella – Senior Research Fellow at the George Institute (@GeorgeInstIN), holds a PhD in Public Health, Gender and Work and works is part of the ARISE Hub
Dr Josephine Ahikire – Principal, College of Humanities and Social Sciences and former Dean, School of Women and Gender Studies and Co-Director on the UKRI GCRF Gender, Justice and Security Hub
This blog was co-produced by researchers and co-researchers in Sierra Leone to share our experiences mapping urban marginalized spaces.
We conducted GIS mapping of three informal settlements to identify key landmarks, physical features, environmental hazards, health risk areas and social groups. The purpose of this work is to use the map to aid participatory data analysis that will identify key health and wellbeing challenges within communities and make maps accessible to community members so they can use them as they wish.
Building our capacity
Our Field team in Sierra Leone is comprised of eight researchers (three women and five men) and 15 co-researchers from across three project communities (seven women and eight men). Before taking up the GIS mapping of project communities (Cockle Bay,
Dwarzark and Moyiba), we held series of workshops to build our capacity as researchers and co-researchers on how to use GPS for boundary mapping and Open Data Kit (ODK) to map services. Workshops were facilitated by CODOHSAPA’s mapping expert (Richard Bockarie) and the team’s capacity and confidence were improved for the intended task.
“We also learned about the GPS and surveying; it was the first experience for some of us. We acquired technical knowledge. We listened to each other; we held meetings. If we made mistakes, we would find ways to correct them and go back on the field. The mapping exercise also allowed us to know our communities better and what the real boundaries are of our communities.” (Co-Researcher)
Organizing the team and completing the mapping
Eight days was allocated for boundary and service mapping across three communities (five days for boundary mapping and three days for service mapping). Three researchers and five co-researchers were assigned to the Dwarzark community, three researchers and five co-researchers were assigned to the Moyiba community and two researchers and five co-researchers were assigned to the Cockle Bay community. One community pointer was assigned to each community. Dwarzark and Moyiba had more researchers due to larger land size and rugged terrain which makes it difficult to navigate. With limited equipment two GPS and three phones were allocated to each community.
Informal settlements have unique power dynamics. There are local chiefs found across these settlements who were installed by the local government either as tribal or community chiefs. They are charged with the responsibility of regulating customary or bye-laws in their communities. Before our activities began, community leaders (councilors, community chiefs, chairmen and chairladies) and other relevant stakeholders were informed about our objective. This was intended to enhance community buy-in.
In the field, the bigger group assigned to each community was divided into sub-groups in order to cover more ground and efficiently manage time. We also agreed that groups should have a briefing before and after every exercise per day. This was to help us build confidence and address unforeseen challenges.
Reflection from Co-researchers on mapping community boundaries and services
A reflexive session was held after the mapping exercise with co-researchers and community pointers on the importance of the features mapped and the usefulness of the maps to their communities, successes, challenges and lesson learnt from the mapping exercise. The following reflections were share by co-researchers:
Identifying health and wellbeing issues and environmental hazards
“It is important to map the health centre. If the mapping shows that there are no health centres, we can show the government that help is needed. It gives us information on what should be improved.” (Co-researcher; Fatmata B Sesay Moyiba community)
“The health center is a key feature in the community because they help the community people. The environmental hazards are important to map also. In Dwarzark community, we do not have dumping site, so people use the drainage to dump the waste. But this is not good because if rain comes, it will overflow.
It is important to map these features to know what the issues are and to have improvement, for example constructing a dump site.” (Co-researcher; Zakiatu Sesay Dwarzark community)
“It was useful to map out important features within our communities. All of these features are important. In the Dwarzark community, those who are living in the upper part are very prone to disaster and deprived of certain facilities. Those who live down are a little better-off. These physical features are important to identify to gain in-depth understanding of the community.” (Co-researcher; Mohamed Sesay, Dwarzark community).
“All the features mentioned are important. The environmental features (flooding area and dumping area) are important to map. During this project, we categorized the communities as hillside or sea-side. The hillside communities have health hazards. Through the mapping and observation, we know where they are located, in which CDMC (Community-based Disaster management Committee, these are groups formed in every informal settlement to champion disaster mitigation activity within their communities.) were later notified, so that they would clean the areas.”
“The edge of the banking area is a particularly important feature to map. We need to identify this boundary. There are massive banking activities currently going on there which has changed the landscape of the community. Cockle Bay is situated on wet land and very prone to flooding.
We are very scared that one day high tide and heavy rain will happen simultaneously, which has never happened before, but if it does happen the community would be seriously damaged. We need to work as a community to prepare ourselves for this day. We wouldn’t be able to save our properties, but we need to be ready to save our lives.” (Co-researcher; Frank Bubu Kamara Cockle Bay community)
“The boundary mapping is also important; it helps the community to know what the boundaries are. For the seaside communities, it is important to map the boundaries because people are banking. So, in 5 years, we will be able use the map to asses and indicate the extent of the banking activity and the threat it poses to the community” (Co-researcher; Esther B. Sesay Cockle Bay community)
Supporting to strengthen accountability mechanisms to address identified challenges
“My position influences my access to services in the community. In hilltop areas, it is hard to have water access especially for young girls. So, we sensitized the water manager on this issue and allocated a certain time for young girls to fetch water to protect them. This allows us to reduce issues related to teenage pregnancies and early marriage.” (Co-researcher; Zakiatu Sesay Dwarzark community)
“I am also a community animator for NGOs working in my community. So, people know me because of this community work. It makes me feel good. I am also the community chairlady and I control 32 taps in the community. This taps really helps the community by protecting young girls from early marriage and teenage pregnancies. It also prevents school dropout by enhancing water access.” (Co-researcher; Jamestina Sia Bayo Moyiba community)
“I am a CDMC chairlady, so it is important for me to map out the dumping site to organize the CDMC team to clean these areas and reduce health hazards. All of the features are really important for me to map since they allow me to better understand and coordinate programme more efficiently.”(Co-researcher; Zakiatu Sesay Dwarzark community)
“We had to explain to the dwellers that we were not surveyors but mapping the community boundaries as part of the ARISE research project so that they would let us pass. We learnt a lot about the GPS mapping techniques. Now we are able to map anything. It also allowed me to know more about my community.” (Co-researcher; Saud Kamara Moyiba community)
Building capabilities and capacities
“There was a good working relationship between the researchers and co-researchers in the field as always. We divided the team in two sub-groups, but the information circulated well between the groups allowing the work to be successful. We would meet every morning and do a briefing on how to tackle challenges in the field. We were happy to do the work, so we got the best out of everyone. For most of the co-researchers, it was the first time we were doing this work, and we were very enthusiastic.” (Co-researcher; Mohamed Bangura Dwarzark community)
“The researchers were very caring and respectful to us which helped a lot to get the work done. There was a good working spirit, we ate together etc.… This good interaction really helped realize the work.”
“It is important to have good pointers that know the community well for the work to go faster and easier.” (Co-researcher; Jamestina Sia Bayo Moyiba community)
“We are happy because we learnt a lot. As co-researchers we did our work on our own. (Co-researcher; Issa Tuary Moyiba community)
Challenges in mapping informal settlements
Mapping informal settlements comes with lots of unforeseen challenges that might be encountered. These can range from challenges of equipment, personnel, personnel, time management, geographical terrains of communities or the community residents themselves.
We underestimated the size of Dwarzark and Moyiba community, so it took more days to complete. To complete the mapping than we had anticipated.
The GPS had a technical fault which also delayed the pace of work. There were also doubts about whether to map certain areas as informal settlements or not. This is because some community zones had massive properties. In the end, the contested areas were mapped since the technical team and community pointers (who were selected because they lived in these communities) gave directions on how to draw appropriate boundaries.
Community members in Cockle Bay were fearful when they first saw the team mapping the boundaries. Community members repeatedly asked about whether it was part of the eviction process. The intervention of co-researchers and the community chief, allayed their fears. The community Chief assigned one community stakeholder to us so we could explain our objectives to residents. With support from the co-researchers and community pointers we were able to gain their trust.
It was difficult to take photos and map out boundaries on the coastline in Cockle Bay due to high tides. As a result, researchers had to wait for low tides to continue, causing delays.
There were few incidents of accidental falls and minor injuries sustained by some co-researchers and researchers during the mapping exercise. They were taken to the community center for treatment and we tried to find better ways of navigating rugged terrain using ropes and support to each other to cross rivers and climb hills.
Resident in Moyiba community reported to us about incident of violence and robbery in a section of the community. That section of the community was inaccessible by the team for several days.
Although faced with many challenges we were able to complete the mapping exercise. It was a great experience for us all, as we learnt new things about our communities, exhibited great teamwork and had fun.
Upon completion of the boundaries and service mapping, a draft map was produced and a validation workshop convened. The validation workshop comprised of all those who participated in the mapping exercise such as researchers, co-researchers and community pointers. During the validation session, co-researchers were asked what they wanted to do with these maps within their communities and for ARISE data analysis. They stated that they want to use the map to advocate for development in their communities and also to change the behavior of people doing banking, building in hazardous locations and for proper waste management. We are continuing to support communities to take forward their priorities.
Produced by (Researchers) Samira Sesay, Abu Conteh, John Smith, Dr. Bintu Mansaray, Mary Sarah Kamara, Daphnée GOVERS, Samuel Saidu, Ibrahim Gandi and (Co-researchers) Mohamed Bangura, Mohamed Sesay, Zakiatu Sesay, Sinneh Turay, Hafsatu Kamara, Jamestina Sia Bayo, Fatmata B Sesay Suad Kamara, Issa Turay, Abdul Karim Kamara, Alieu Bah, Frank Bubu Kamara, Esther A Kamara, Abu Sesay.
This blog was produced by Daniella Kennedy and Ibrahim Gandi, Research Assistant, CODOHSAPA. Daniella wanted to share her story as part of ARISE’s exploratory research phase in Dwarzark community, Sierra Leone. Daniella is a wonderful, friendly and peaceful person. She is strong and passionate about education. She wants to raise awareness about some of the challenges she faces trying to have a career and about the way people think about her within her community. She believes that her dreams can be achieved because she believes in the potential within herself.
My name is Daniella Kennedy. I am living with my parents and two brothers in Dwarzark community one of the informal settlements in Freetown, Sierra Leone. My father is a commercial bike rider ‘‘okada rider’’ and my mother looks after me and my two brothers. I was born with a physical form of disability called Locomotor disability. I can neither walk nor pick or hold an object, so I rely on my family for physical support. I am treated like anyone else in my family. I don’t feel like a person with disability in my family. I am loved by everyone including our neighbours.
My mother (Isata Kennedy) is a hardworking woman. She is strong and passionate about taking care of me and my brothers. She has really been supportive to everyone in this family, although she faces lots of challenges and ridicule from people.
‘‘People have been saying different things about my child’s disability and also asking several questions about my patience in taking care of Daniella from childhood to now. Some even say that if they were the ones that gave birth to such child, they would have dumped or killed her rather than wasting time to raise her. Despite all their comments, I am keeping and caring for my daughter. She is the only daughter I have now. I believe my child is a gift from God and she was born this way for a reason. I will not consider any option other than taking care of Daniella. My greatest challenge at this moment is carrying Daniella in and out of the house, through which I have sustained back pain.’’
At an early age, I was admitted in a Home for Children with Disability. However, due to distance and financial challenges, my parents decided to find me a school within our community. But ever since, I have been attempting to gain admission into schools within my community – I have not been successful in this effort.
I have been marginalized by denying me admission into the community schools. But maybe it is because of my disability, because I can’t make proper use of neither my hands nor my feet, I can’t walk or hold an object. I am not happy being born this way, especially when seeing girls of my age doing things that I may want to do but I can’t because of my disability. I feel so bad. At times, I am frustrated by not having the opportunity to go to school. I’m a friendly person and I always want to go out with my friends to play but I can’t. Instead, they always come to me. I have lots of friends and I learn a lot from them. We play, laugh, watch TV and eat together. They always come to me after school and I ask them lots of questions about what they learnt at school.
Due to my love for education, I have learnt over the years to read and write using my mouth by reading text books and notes brought home by my brothers and from my interaction with friends. They teach me a lot at home. I can also plait my doll using my mouth. I can do different styles on my doll. I want to fulfil my dream of being educated and having a career, but ever since I left the home for children with disability at age seven, I have not been able to gain admission into any school in my community. My parents decided to take me back to the home with support from FEDURP/CODOHSAPA after five years of trying but unfortunately, I am faced with a new challenge. I have developed too much weight for mother and other people to carry me on their backs. I have no assistive device to carry me around and I need constant attention and assistance from people at this stage. With all these challenges, the chairman of the Home clearly stated that the home has been operating on its policies since its establishment. They only admit children with limited form of disability. According to the chairman, he asserted that my condition does not fall under any of their categories and the home does not have the necessary provision to take care of me.
“We just do not have the financial and human capacity to look after Daniella. We have tried all we can as an institution to help her but our capacities are just too limited to support her. No provision exists at the home for people with such form of disability.”
Often emphasized by the chairman, this has sealed my fate that I cannot be readmitted into the Home for Children with Disability because there is no one to take care of me.
As mentioned earlier with no assistive device, I find it difficult to move around especially when there is no one around to help me. As such, I want people to support me to have access to an assistive device to aid my movement around. On top of that, I have also undergone series of operations in order to improve my condition, for which I need support to have access to proper medical service. Lastly, I want to go to school and have a career – but with so much financial challenges and marginalization, achieving my dream has been really the most challenging for me.
Daniella is one of many children with disability out there, who go through similar challenges. She does not have access to an assistive device to help her move around. At age seven she managed to get supplied with a locally made wheel chair during her time at the Home for Children with Disability. And now, after several years the chair is not in good condition and leaves Daniella in much pain whenever she uses it. As ARISE we will continue working with Daniella to understand and share her needs and priorities with the public and further advocate for change and integration in federation activities.
Digging into urban health: uncovering concepts and action for health and social justice in informal settlements
What’s it all about?
Rapid urbanization is re-shaping social and economic life and, with it, human health and health systems. Most of the world’s population is now urbanized, yet one-third of urban residents live in precarious ‘slums’ and ‘informal settlements’. These city-dwellers typically lack access to healthcare and vital health-supporting services. Slums are widespread in the Global South but often hidden in plain sight, reflecting residents’ lack of voice as well as sectoral and disciplinary silos. This session asks how health systems can better engage with the social, economic and environmental realities of informal settlements, in hopes of improving residents’ health and promoting social justice.
Urban areas often experience deeply entrenched health and social inequalities, but also concentrate knowledge, economic dynamism, and vibrant local organisations that can foster innovations in health-promoting practices. However, practical and conceptual approaches to deliver health systems for low-income urban residents often fail to address intersectoral challenges and the ubiquity of informality in the Global South. Vast amounts are spent on health services, while the social, economic and environmental determinants of health in informal settlements remain overwhelmingly neglected. Informal settlements are also poorly represented in official statistics, rendering them invisible to health officials and policymakers.
To reveal new insights into slums and urban health dynamics, the session will be organised like an archaeological dig: it will go beyond superficial observations to analyse the underlying structural determinants of health, and participating urban researchers, policymakers, and practitioners will foster interdisciplinary dialogue that can promote health equity and the broader 2030 Agenda.
Mr Robert Hakiza, a Congolese refugee in Uganda and director of Young African Refugees for Integral Development, will highlight urban displacement and associated risks to well-being. In particular, how urban refugees living alongside other low-income residents in Kampala struggle to access housing and healthcare, and face additional challenges of discrimination, lack of documentation, or language barriers.
Mr Abu Conteh, an urban health researcher at the Sierra Leone Urban Research Centre (SLURC), will highlight the complex, undercounted health burdens in Freetown’s informal settlements, drawing on research into residents’ life histories and the roles of formal and informal governance structures.
Dr Alice Sverdlik, an urban researcher at the International Institute for Environment and Development (IIED, UK) will highlight how health in informal settlements is influenced by multi-level factors including household poverty; inadequate shelter, services and infrastructure; unresponsive local governance and exclusionary planning.
Dr Surekha Garimella is a researcher at the George Institute for Global Health (India) working on participatory approaches with waste-picking communities in Bangalore’s ‘informal spaces’. She will highlight collective community processes to improve health services entitlements for urban poor and marginalized residents.
Professor Sabina Faiz Rashid is an anthropologist and the Dean of the BRAC James P Grant School of Public Health. She will highlight the social and structural inequalities which contribute to health vulnerability in informal settlements in Bangladesh
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
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.
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.
Chair: Professor Claire Heffernan, Principal Investigator, Action Against Stunting. Speakers: Sian Zarkow, UKRI, Chris Desmond, Accelerate Hub, Sally Theobald, ARISE and Linet Okoth, ARISE.
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.
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.
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.
Dr Zubin Shroff, Alliance for Health Policy and Systems Research, WHO, Switzerland
Dr Geetanjali Lamba, Alliance for Health Policy and Systems Research, WHO, Switzerland
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
Freetown is home to over one million people, with over 68 informal settlements spread across precarious land spaces. These settlements are often built on marginal lands around sea fronts, dumpsites and on dangerous mountain peaks, which always constitute high risks, but are made worse during health emergencies.
Informal residents experience greater spatial inequalities than their formal counterparts. Inadequate provision of services including health, water and sanitation services highlight some of these spatial inequalities, which expose residents to different health circumstances.
Narratives about exclusion have pervaded city planning for a long time, causing a vertical relationship between informal dwellers and policy makers. There is a top-down relationship between city authorities and informal dwellers, which excludes informal residents from decision making. Often, there is confusion around response to emergencies in these marginalised spaces due to dearth of data on varying levels of marginality.
With COVID-19 spreading across communities, informal residents are not only at risk of contracting COVID-19 and other infectious diseases due to environmental conditions (including overcrowding) but are also experiencing loss of livelihoods as well as challenges in access to health, water and sanitation services. These conditions require quick response from city authorities to enhance an inclusive city planning and service delivery.
How has the city responded to COVID-19?
Response measures to reduce the spread of COVID-19 in Freetown have been fairly impressive. These measures include active case search and isolation, physical distancing and use of face masks. Social distancing has been enhanced mainly through nationwide lockdowns, curfews and inter-district travel restrictions. However, these response measures have been put in place with limited consultation with the vulnerable groups mostly living in informal spaces.
There have been gaps in providing a guided response that meets the needs and wellbeing of informal settlement dwellers. During the lockdowns in April and May 2020, we conducted phone interviews with co-researchers and other informal residents living in Dwarzark, Moyiba and Cockle Bay. The interviews focused on the state of the COVID-19 response and impact on health and wellbeing of residents across our research communities. We would like to highlight the exclusion of informal residents in current response planning. We observed during our discussions with residents that they were deeply concerned about not being able to meet their most basic needs due to restrictions on movement.
There has been a drastic reduction in the number of visits to the health centres during the COVID 19 restrictions, especially amongst non-beneficiaries of free health care (FHC) provision. For many non-beneficiaries of FHC, access to healthcare was limited due to restrictions on vehicle movement and okadas (motor bikes providing easy access to non-motorable and high traffic areas) during the lockdowns. Fear of being sick or showing any visible symptoms related to COVID-19 has also affected access to healthcare for many community members.
Due to fear of being infected with COVID-19 and associated costs of seeking healthcare, people outside the FHC (adult males and females without disability and not non-Ebola survivors), self-medicated with medicines obtained from pharmacies and patent drug stores. Generally, people were afraid that their neighbours might call the emergency response number if they were found to be sick. Stigma around quarantine was one of the issues driving fear. There were general misconceptions about COVID-19 and its spread, which can only be addressed through sustained engagement with communities.
While residents were engaged in sensitizing their peers about seeking formal healthcare and maintaining confidence in the health system, their efforts were not synergised with health workers and responders. Sensitisation was done in parallel by informal residents and responders with minimal collaboration, and a lack of support for resident processes.
Community Health Workers bridged this gap and volunteered to provide much needed sensitization to residents to follow health regulations and to avoid being infected. Messages disseminated included hand washing, maintaining social distancing and visiting the health facility when they thought they were sick. Residents requested for training by health workers to prevent spread of COVID-19.
Food and livelihood challenges
Many informal residents in Freetown do not have sustained means of livelihood, and their income sources are linked to the informal economy. They survive mostly on hand to mouth and cannot afford food beyond a day. This makes stocking up on food very challenging. The relatively spontaneous lockdowns complicated the existing food access vulnerability of informal residents. Food prices increased rapidly in the periods before the lockdowns, and informal dwellers who rely on daily income suffered hunger. For example, the lockdown in May coincided with the Muslim fasting which contributed to the increase in food prices. In many of those circumstances, low income earners depended on their neighbours or relatives for help. A community resident remarked as follows in one of our interviews:
The food situation is bad for residents; I saw a young girl with a plastic bag looking for cooked food to buy for her family. I realized from that point that the girl’s family did not have raw food or rice at home to prepare for that day. I was worried that they might not have something to eat on the first day of the lockdown. At that time, we saw soldiers coming, so we ran away without being able to help to the young girl…As a widow and a single mother myself, it was not easy putting together some food for my children that will last us for three days. People are not happy, and the prices of food items are going up rapidly, so how can you manage to stock up food for a three-day lockdown. And moreover, this is a month of fasting when prices are generally high. (A widow at Moyiba)
Owing to the vulnerability of many informal residents, many experienced severe hunger. In Dwarzark for example, many residents including homeless children and people with disability were concerned that their needs are not often considered in planning, so it becomes even more difficult for them during crisis periods. Many of these groups depended on NGO and community support during crisis, but these streams of support were not forthcoming during the lockdown restrictions. During the second lockdown, homeless children had no shelter to live and many were begging in the neighbourhoods for food. Community elders however recognised these challenges and arranged for shelter at the community centre. Community elders also pleaded with residents who had enough food to provide for the homeless children.
Water and sanitation
Persistent lack of access to water and sanitation services are among the most frequent concerns of informal residents. Most settlements are not connected to the national water grid, so they access water from different sources, some of which are of poor quality. Water tanks supplied by government to communities through the Sierra Leone Water Company (SALWACO) were considered useless by community residents because they have not been refilled since the Ebola period, some five years ago. These access concerns became more challenging during the lockdowns. In their desperate search for water, many people ignored social distancing regulations. Many of them clustered around the few water access points.
In Dwarzark (one of the hillside informal communities), most of the wells dried up completely at the peak of the dry season in April, so most residents relied mainly on a solar powered tank to regenerate water. In Moyiba (another hillside community), youths in charge of public taps or ‘‘tap collectors’’ developed a strategy of closing the taps from time to time to control the huge crowds and to enhance even distribution. They devised a way of preventing multiple access by identifying people who had already collected. Those who could not withstand the huge crowds travelled to nearby communities to access water.
Children and women were mostly at the centre of water collection since schools had been closed by government to prevent spread of the virus. Children were therefore coming into contact with huge crowds during these interactions. Access to sanitation was also a challenge, since private indoor facilities are less common. Use of shared toilets or open defecation are widespread, which required people to risk leaving their homes or go to the streams or shared spaces. Moreover, outdoor toilets often exposed women and girls to sexual exploitation in informal settlements.
In addition to health, water and sanitation challenges, communities were also concerned about their security during lockdowns. Police and soldiers were deployed in communities to enhance adherence to response measures. Checkpoints were mounted with frequent patrols. There were incidents of beatings or arrests of people who ventured out to look for food and other basic needs by security personnel.
For many residents, the food situation was so dire that they had to plead with their neighbours for food or money to buy basic food items. Women and girls are likely to be particularly vulnerable to public and private violence. This is an area that needs further exploration as recent crime statistics from the Sierra Leone Police reveal high rates of sexual violence and penetration of women and girls in Freetown. Such incidents could be higher in informal settlements where safeguarding awareness is low, coupled with increased risk of gender based violence.
Lessons for future health responses
Communities, especially informal settlements experience immense pressure to meet their daily needs, including food, water and sanitation services. Yet, they are not well considered in urban policy planning and emergency response by city authorities.
In times of crisis, informal residents have shown much intuition to respond appropriately. With little resources, they provide relief support for their counterparts mostly in need of help. They organise fair distribution of scarce resources like water in accordance with social distancing regulations.
The current COVID-19 response has shown that limited involvement of informal residents in planning and the response has caused severe hardships. An inclusive process of city planning is imperative for a socially just response that meets the needs of all. Yet, communities feel disempowered because they have not been provided with much support to enhance their local actions in the fight against COVID-19. This account of community agency shows the strong capacity of communities in organizing themselves during emergencies or crisis to promote safe health behaviours and reduce spread of infections. Such actions could be leveraged upon by health professionals and policy makers to improve community surveillance and health promotion.
Special thanks to the following co-researchers who provided information and photos for this blog: Abu M. Sesay, Mohamed Bangura, Zakiatu Sesay Suad Kamara.
On 1 July 2020, UKCDR hosted a webinar titled, “Preventing harm in research – safeguarding in international development research.” The webinar came a few months after UKCDR’s launch of the guidance on safeguarding in international development research in a bid to ensure the highest safeguarding standards in this context.
UK funders of international development research worked with UKCDR to develop a set of principles and best practice guidance on safeguarding to anticipate, mitigate and address potential and actual harms in the funding, design, delivery and dissemination of research.
This webinar, targeted at the international development research community, aimed to:
Raise awareness of the new guidance, increase understanding of the definition of safeguarding in the context of international development research
In the link provided, you see an agreed definition of ‘safeguarding’ as:
Any sexual exploitation, abuse and harassment of research participants, communities and research staff, plus any broader forms of violence, exploitation and abuse relevant to research such as bullying, psychological abuse and physical violence.
There was however a caveat on the fact that this definition was agreed on by UK funders and expert advisory groups and specific to the research context.
What does the guidance do?
The guidance supports all who are involved in the research processes to anticipate, mitigate and address potential and actual harms in the funding, design, delivery and dissemination of research. Safeguarding processes face various challenges in the international development research realm; some of which were outlined as safeguarding falling between the cracks and the idea that safeguarding was something for NGOs rather than academia.
At the breach of safeguarding guidelines, several things come to play that inhibit the reporting of these issues including:
Attitudes of colleagues and supervisors, concerns about being a ‘good’ fieldworker
Concerns about career prospects and fear of jeopardizing research
Rights of victims/survivors and whistle-blowers
Equity and fairness, transparency and accountability and good governance were the key principles of safeguarding that were outlined in the webinar.
Among the key speakers were Sally Theobald and Bintu Mansaray both of whom are part of the ARISE consortium which also contributed to the UKCDR guidelines. Sally highlighted that ARISE has written their experiences of preventing and addressing safeguarding concerns and practices, process and positionality in marginalized spaces as a practice paper in the BMJ Global Health. It is a jointly authored paper that draws on the experiences of everyone across ARISE. She ran the participants through what was in the paper and said that it featured safeguarding and global health and vulnerability as relational concepts. The paper delves into the realities of informal urban contexts, where we see the intersections of inequity play out and how they are shaped by gender, class, sexuality, disability as well as unequal power relations.
The paper also outlines the different steps undertaken in ARISE to develop a shared approach to safeguarding as well as the key learnings which includes how safeguarding, ethics and health and safety concerns overlap, the challenges of referral and support for safeguarding concerns within frequently underserved informal urban spaces and Importance of reflective practices and critical thinking about power, judgement and positionality and decolonization.
Bintu pointed out that ARISE started by asking all the countries in the consortium to outline the existing policies of safeguarding which fed into the safeguarding policy that was developed. They also set up a training to give researchers a feel of what safeguarding was, followed by country teams brainstorming on the meaning of safeguarding in their contexts and developing equivalents of the term in their local languages. This provided a unique opportunity to see the similarities and differences on safeguarding issues in the different contexts (between Kenya, Sierra Leone, India and Bangladesh). She concluded by saying:
The UKCDR guidelines act as a guide and then as ARISE, we contextualize them to fit our different contexts.
Sally wrapped up the session with saying that safeguarding just like ethics is not a tick box exercise. It is an ongoing, critical and reflective journey that includes partnerships, participatory processes and building of trust. The process needs to speak to the key values that come through in the guidance of equity transparency, accountability and having the different vulnerable groups at the heart of the process. It is vital for everyone to understand that everybody has a role to play when it comes to safeguarding.
Safeguarding in International Development Research – Presentation by Sheila Mburu, Research & Policy Officer, UKCDR
Developing and applying the UKCDR safeguarding principles and guidance – Presentation by Linnea Renton, Research Fellow on Safeguarding, Antislavery Knowledge Network, University of Liverpool
Reflections on safeguarding – Presentation by Sally Theobald and Bintu Mansaray on behalf of ARISE hub