Session report: Accountability from below? Learning from Participatory Research processes on water and sanitation in informal settlements
As part of the Seventh Global Symposium on Health Systems Research the ARISE consortium hosted an online session, ‘Accountability from below? Learning from participatory research processes on water and sanitation in informal settlements’. Hosted by Vinodkumar Rao, the session included the voices of our co-researchers and partners in our focus countries Bangladesh, Kenya and Sierra Leone.
Accountability from below
The session opened with an informative video which brought together community members speaking about accountability, how leaders should be accountable for particular roles, and how to hold them accountable. A community member said, “We hold the honourable member of parliament and councillor accountable because we are aware that we are the ones that voted them into power and if they do not meet people’s expectations, we simply vote them out.” According to another, accountability is the responsibility given to somebody to enhance development in the community. A man in the community said that in his understanding, accountability is a process that for whatever someone is doing, they should be held accountable especially when they fall short of not performing their assigned roles and responsibilities.
In terms of health seeking behavior and challenges, community members expressed that a number of people within the community seek illegal health services from practitioners who are not certified. Most do so because they can’t afford the quality health services offered at the health centers. Most people in the community are poor and have no means to afford good health care services. In most cases, it is only when the health condition gets very bad that they seek funds and rush to the health center and in some cases, it is often quite late. Health centers have become too expensive and too money-minded. In the Cockle Bay community in particular, there are too many obstacles to attaining good health because of issues such as the lack of access to pure drinking water and proper toilet facilities.
Learning from participatory research processes on water and sanitation in urban informal settlements
This video gave a picture of life in the informal settlements through the eyes of the residents. Elizabeth Ngoru, a resident in Nairobi, explained that if there are toilets, there should be water. It is difficult to live without water and use the toilet. Jane Mwiklali explained that they have to pay to use the toilet beforehand. Philip Muasya explained the challenges by painting a picture of his family using the toilet at a cost, saying, “I have four children and then there is my wife and I. A visit to the toilet is thirty Kenya shillings. If each were to visit the toilet once, it would cost me 150 shillings. So will I buy food, or pay for the toilet?”
Dr. Caroline Kabaria of APHRC explained that in the informal settlements, people use pit latrines that need to be emptied often because of the high population density. The pit latrines’ casual laborers provide a very vital service which the government has proved incapable of doing as relayed by Eva from SIDAREC, a community based organization. Owing to the fact that they are so essential, they should be catered for particularly in terms of safety equipment to ensure that they do not contract diseases while at work.
The approach of ARISE in these informal settlements is interdisciplinary and multisectoral so as to work with the different players: community organizations, service providers, government departments, non-governmental organizations and private actors to stimulate mutual learning in urban informal settlements. The study recommendations will empower the slum communities and service providers to demand for services affecting equity. Some community members in the video said that the project had empowered them to rely on themselves for solutions and reduce their reliance on the governments.
Sweety Akter from Bangladesh explained the challenges that come with using communal toilets in informal settlements. In the past, there was no provision of public water supply, but different stakeholders have worked to ensure that there is now water supply. This is however not the case in the entire area of the informal settlements. The quality of water is not good for drinking as it smells. This poses a risk of cholera, diarrhea and jaundice. Much as it is not good quality water, people stay awake up until 2a.m. to get water for cooking and drinking and sometimes still don’t make it. Sweety explained that they do not know of any place to complain about these issues or any ideas on how to solve any of these problems they face.
The bathing areas are spaces with no roofs which makes it particularly hard for women to shower. The men pass by and stare at the women bathing; and many women are reluctant to share the challenges they face when bathing in these spaces. The communal toilets and bathrooms that they use have been financed with the help of NGOs, city corporations and the contributions of community members. Sweety reiterated that if the community members relied on the NGOs to finance the toilets entirely, they would not have taken up the active responsibility to maintain and clean the toilets. The community believes that if all stakeholders work together, they can jointly put an end to the issues related to water, toilets and bathing spaces.
The Indian Alliance of SPARC, National slum dwellers federation and women’s collective are working on negotiating with state agencies against forced evictions. While the quest to safe housing and no-eviction guarantee remained the top struggle, the women’s network felt that working on sanitation in the immediate term was equally important since it was very low in the political priority list. Only dialogues and negotiations would yield a solution. In order to get the government accountable and provide these services, the organized federations made up of women drew up a design of both of the physical sanitation facilities and the processes. The design needed to be sensitive to the needs of women and young children. They studied the person to toilet ratio and made recommendations. In the implementation framework, there was a negotiation for involvement of local residents and the involvement of community contractors. This enabled the allotment of a central role for community members. This ensured that the state contributed capital resources and the residents would take up the management of its maintenance. Together, the alliance members have taken up a long and arduous journey to develop such accountability systems.
The governance systems of most countries in the global South, are not designed to cater to informality. Urban planning and development continue to be a body of knowledge about formal habitats. The challenges presented by informal living and working are far from being incorporated into it. This necessitates for innovative ways of seeking political accountability from the duty bearers., The above demonstrates that a solution-based approach may be one of the best ways to seek accountability. Once the state could see the possibilities and the impact it created, the sustainability of the approach in seeking universal sanitation was clearly visible.
Christine Amondi, a co-researcher at APHRC shed light on the experiences of sanitation workers, communities and governments by drawing attention to their unique challenges as well as the opportunities she identified. Challenges to sanitation workers include a lack of personal protective gear like overcoats, gloves and boots and a lack of proper equipment to use in the transportation of faecal waste. Christine also identified opportunities that have been beneficial to workers such as organised groups that aid in the access to protective gear, and capacity building and training opportunities. In the wider community some of the challenges they face include poor WASH facilities due to population density and commodification of WASH facilities. Co-creation of solutions provides an opportunity to work together in identifying areas for the construction of WASH facilities such as toilets. The Government faces a major challenge in its inability to provide services to everyone due to high population density. Christine did highlight an opportunity in the fact that there are well-laid regulations to ensure equitable distribution of resources to all citizens. The government also partners with the community on WASH innovations.
Our panellists then shared reflections on what they had learned by working together through ARISE. Co-researcher Zakaitu Sesay from Sierra Leone said, “Living in an informal settlement, people think we can’t do anything, we can’t be be among educated people. But we can, and we can learn.” During her work with ARISE she has worked with colleagues to write a blog, collect data, undertake analysis, and do field mapping. Christine Amondi, a co- researcher from Kenya, said her work with ARISE has allowed her to meet partners in Sierra Leone which has taught her a lot. She said she found it rewarding to learn CBPR approaches, social mapping, power dynamics and data analysis.
Session chair Vinod Rao summarised the discussion saying that it was clear that urban informality and the problems that rise from crowding and growth is a matter of a larger policy issue. To solve these issues we need a higher level of buy in at national level, and this can be facilitated by collective community action putting pressure on governments.