By Wafa Alam, Tasnuva Wahed and Bachera Aktar
Informal settlements are not a one-dimensional box.
Dr. Hossain Zillur Rahman, BRAC Chairperson
At a recent workshop, stakeholders discussed the health, well being, housing and water and sanitation related challenges faced by the residents and the governance systems in urban informal settlements. They talked about important issues such as migration and urbanization in Dhaka city (Bangladesh) and accountability mechanisms for service providers and community residents. While there are many problems, there is no comprehensive national urban policy which addresses these issues.
- Urban informal settlements in Dhaka are complex.
- Multi-sectoral coordination is required to address these complexities.
- Research on these complexities are needed to inform policy makers.
Thousands of migrants come to Dhaka city every day. This shift from rural to urban areas of Bangladesh is attributable to natural disasters like river or land erosion, lack of job opportunities and a general slow rural economy. However, as identified by Brig. Gen. Dr. Md. Sharif Ahmed, Chief Health Officer, Dhaka North City Corporation, poor income generating opportunities are not the sole reason for this shift. Poor access to quality services also drive people to move out of rural areas. He added that strengthening the quality of education and providing employment opportunities by supporting agriculture and cottage industries in rural areas are vital.
On the issue of rural to urban migration in Dhaka city, Dr. Zillur Rahman said,
We need incentive-based thinking to reduce migration.
He talked about multiple pathways to address migration such as making secondary cities more attractive, improving villages and developing commuter satellite cities around Dhaka.
A holistic approach to health
Ensuring quality health and well being related services in the complex landscape of the urban informal settlements is a major challenge. Multiple actors including government departments, the private sector and NGOs work simultaneously to provide services for the urban poor. Dr. Rahman emphasized the need to identify and map the roles of the stakeholders working in urban Dhaka as a strategy to improve the health outcomes of the vulnerable and marginalized urban communities. The complexities of urban informal settlements need to be looked at with a holistic approach, where humanitarian and development approaches come together, and become part of policy thinking.
Brig. Ahmed talked about the importance of coordinated efforts between stakeholders working in urban areas, and the need for better coordination between the Ministry of Health and Family Welfare, Ministry of Local Government, Rural Development and Cooperatives, private sectors and NGOs.
A lack of coordination between NGOs, donor agencies and government bodies gives rise to problems such as disparity in service concentration, duplication of services and poor referral mechanisms; making it more challenging to improve the well being of the residents of urban informal settlements.
Remodeling existing services
Brig. Ahmed identified poor housing conditions, limited access to safe water, drainage and sanitation facilities and lack of access to quality health services as some of the major challenges faced by the urban poor in Dhaka. While the City Corporation is working to improve the condition of the urban poor, their contribution is not enough to support the growing number of people in need.
Also, as urban informal settlements are not recognized as legal lands, the residents lack access to basic public services. These residents rely on NGOs for basic health and well being related services. NGOs often have to close down their programmes as donors wrap up. That’s when these people are left with no choice but to pay high prices for services and face extortion at the hands of the local mastaans. Often, these mastaans are local leaders who are affiliated and have patronage from political leaders, government and law enforcement agencies.
Dr. Rahman recognized urban centers as being extremely land scarce and said that in such settings giving access to land to solve daily problems like housing may not be feasible. This means we need to come up with innovative solutions or revamp existing services. He gave the example of ‘evening clinics’ as a solution that may be able to meet the need of the urban poor women who are unable to access health centres during the day, when they are busy earning a living by working as domestic aides or in the ready made garments industry.
Two-way accountability is important
Often the residents of informal settlements in Dhaka are paying higher prices for access to basic services like water and electricity. This is the result of poor governance and accountability in those settlements which allow local mastaans in the communities to take control of the facilities and sell to the residents at a higher cost. This issue of accountability needs to be explored from the horizontal and vertical aspects, that is, the accountability of the service provider, as well as that of the user, according to Dr. Rahman.
Generating new knowledge for Bangladesh
Knowledge is an important vehicle through which overall objectives of improving well being can be achieved
Dr. Rahman stressed that new knowledge should be disseminated downwards to communities being researched and upwards to policy makers in Bangladesh. This will help communities understand and improve their current state. When research findings flow into policy thinking, it will also help generate new types of projects.
Research to understand the complexities in informal settlements, such as the ecological and locational diversities that exists between informal settlements, is vital.
The workshop ‘Working Together Towards Health Equity in Urban Informal Settlements’ was held on the 5 September 2019 in Dhaka, Bangladesh. It was jointly hosted by the ARISE Hub Bangladesh and Pathways to Equitable Healthy Cities under the Center of Excellence for Urban Equity and Health, BRAC James P Grant School of Public Health, BRAC University. The workshop was attended by stakeholders from government departments, NGOs and research institutions, who shared information about their work in urban informal settlements and their suggestions for improving urban health.