Urban Health Updates
Urbanisation, the Peri-urban Growth and Zoonotic Disease. IDS Practice Paper in Brief, Feb 2015.
Author: L. Waldman.
Ebola has had significant, negative effects in the rapidly expanding, unregulated areas of peri-urban and urban West Africa. The residents of these areas maintain vital connections with rural populations while intermingling with and living in close proximity to urban and elite populations. These interconnections fuel the spread of Ebola. The degradation of natural resources, temporary housing, inadequate water supplies, hazardous conditions and dense concentrations of people in peri-urban areas exacerbate the potential for zoonotic disease spread.
Yet the peri-urban remains largely unacknowledged and under addressed in development. In considering the intersections between Ebola, peri-urban settlements and urbanisation, we must recognise that: basic hygiene and isolation of the sick are frequently impossible; disease control through quarantine often ignores poor people’s patterns of movement and immediate
material needs; quarantine can reinforce the political exclusion of peri-urban residents; and there exists the potential for future zoonotic disease emergence in peri-urban contexts.
Development must acknowledge these ever-burgeoning settlements and address the ability of the poor to live safely. This
includes the provision of decent hygiene and sanitation, context-appropriate forms of disease containment, the recognition of the peri-urban poor as legitimate citizens, and improved understandings of human/animal interactions.
Pit Latrine Emptying Behavior and Demand for Sanitation Services in Dar Es Salaam, Tanzania. Int. J. Environ. Res. Public Health, Feb 2015.
Authors: Marion W. Jenkins, Oliver Cumming and Sandy Cairncross
Pit latrines are the main form of sanitation in unplanned areas in many rapidly growing developing cities. Understanding demand for pit latrine fecal sludge management (FSM) services in these communities is important for designing demand-responsive sanitation services and policies to improve public health. We examine latrine emptying knowledge, attitudes, behavior, trends and rates of safe/unsafe emptying, and measure demand for a new hygienic latrine emptying service in unplanned communities in Dar Es Salaam (Dar), Tanzania, using data from a cross-sectional survey at 662 residential properties in 35 unplanned sub-wards across Dar, where 97% had pit latrines.
A picture emerges of expensive and poor FSM service options for latrine owners, resulting in widespread fecal sludge exposure that is likely to increase unless addressed. Households delay emptying as long as possible, use full pits beyond what is safe, face high costs even for unhygienic emptying, and resort to unsafe practices like ‘flooding out’. We measured strong interest in and willingness to pay (WTP) for the new pit emptying service at 96% of residences; 57% were WTP ≥U.S. $17 to remove ≥200 L of sludge. Emerging policy recommendations for safe FSM in unplanned urban communities in Dar and elsewhere are discussed.
Editorial – Urban health post-2015. Lancet, Feb 28, 2015.
An excerpt: There are three opportunities to address urban health post-2015. First, governments committed to improving urban health must prioritise equitable access and adapted delivery of health and related services to the urban poor— including to non-legal residents. Slum dwellers make up the informal employment sector of cities, and are often not present in slums during regular clinic hours. Health services must adapt delivery to reach them.
Correspondence: Urban health in the post-2015 agenda
Authors: Shamim Talukderemail, Anthony Capon, Dhiraj Nath, Anthony Kolb, Selmin Jahan, Jo Boufford
An excerpt: The transformative approach stated in the post-2015 development agenda necessitates innovative and strong partnerships between civil society and private sectors, institutions that can work in an integrated manner, transfer of technology, capacity building, and greater attention than previously given to information access, monitoring, and reporting for accountability. A worldwide shared ambition should be to bring health to the centre of sustainable urban development.
Urban WASH in Emergencies, 2014.
From the 24 – 28 March 2014, RedR held a pilot course for 24 WASH experts on the subject of addressing the social, institutional and technical gaps that currently exist for water, sanitation and hygiene provision in the urban emergency context. This document, produced as a partnership between ALNAP and RedR, captures the key messages, lessons and experiences of both course facilitators and participants on the topic of WASH in urban emergency response.
Many specific lessons for the WASH sector in the urban context can be drawn from this discussion, including:
• Solid waste management can be of particular importance and there are multiple new technologies that can assist in this sector. • Vector control is more complex but just as essential in the urban environment, especially when considering dengue fever, which is on the rise across the developing world and particularly a threat to urban populations.
• Hygiene promotion remains a critical part of the WASH response but is potentially far more complicated, owing to the diverse target groups in urban settings. Schools are a particular asset for hygiene promotion.
• Diverse target groups may also mean a more responsive and greater range of WASH options may be needed to ensure effective service provision.
A recurring lesson from this discussion has been the emphasis on the interconnected and dynamic nature of the urban setting, and how this challenges ‘silo’-based, sector-structured responses. Recognising this characteristic, many lessons have wider applicability for humanitarian response more generally. Vector control, solid waste management and drainage are key examples of where success or failure in one area could greatly determine results in other sectors. These specialist and technical areas also clearly demonstrate the need for humanitarian agencies to ‘ know their limits and utilise external expertise – including potentially the private sector
Review of Results-Based Financing (RBF) schemes in WASH: A report to the Bill and Melinda Gates Foundation, 2015.
Results-Based Financing (RBF) is an alternative to conventional funding mechanisms for Water, Sanitation, and Hygiene (WASH) projects. As the name suggests, Results Based Financing (RBF) provides funding for an initiative after results have been delivered. This is in contrast to the conventional approach of providing the finance upfront. RBF was developed in an attempt to improve aid effectiveness by increasing accountability, efficiency, and private participation.
Given the massive need to improve WASH services globally, donors have been trying RBF in WASH since at least the mid-1990s. However, until now, there have been no comprehensive evaluations of RBF in WASH. This report summarizes findings from an investigation into whether RBF works in WASH, in what circumstances, how, and why.
The report was prepared by Castalia Advisers, on behalf of a group of WASH donors interested in better understanding RBF in WASH (including DGIS, DfID, USAID, GPOBA, SIDA and others). The study was managed and financed by the Bill & Melinda Gates Foundation.
What is CityLinks
The CityLinks™ model was designed by ICMA as a way to enable municipal officials in developing and decentralizing countries to draw on the resources of their U.S. counterparts to find sustainable solutions tailored to the real needs of their cities. It was formalized in collaboration with the U.S. Agency for International Development (USAID) in 1997 with the launch of a funded program, known at the time as Resource Cities.
Based on the success of Resource Cities, USAID awarded ICMA a new program with the CityLinks name in 2003 and the current five-year City-to-City Partnerships cooperative agreement—now known as CityLinks—in 2011.
This website is for the most recent program: CityLinks 2011-2016. CityLinks leverages the experience and expertise of ICMA’s membership of 9,000 local government chief administrators and their professional staffs. It is based on the premise that well-managed cities are the key to efficient service delivery, economic growth, sound management of resources, and political stability.
U.S. cities offer a great many models for provision of sound water supply and sanitation services, and CityLinks facilitates partnerships between professionals from these cities and their counterparts who are seeking solutions for cities in developing countries.
The CityLinks Knowledge Network is a platform for sharing information on news, events, publications and job postings.
Financing sanitation for cities and towns: learning paper, 2014. Institute for Sustainable Futures; SNV.
The aim of this paper is to provide a starting point for such planning for the service chain and life cycle to occur. It is a synthesis of key literature on financing for the water services sector seeking to achieve the millennium development goals (MDGs) and its post-2015 successor, the sustainable development goals (SDGs). The findings from the literature review are complemented by key insights from an online ‘DGroup’ discussion organised by SNV on the topic of ‘financing for urban sanitation investment’.
The focus of this paper is on access to the upfront finance and other ‘lumpy’ finance needs, for initial investment and for rehabilitation/replacement as physical systems approach their end of life. The upfront investment is the main determinant as to whether there is service at all, and the decisions made upfront have a profound influence on the performance of the entire service chain.
This focus is not a denial of the utmost importance of the relatively smaller and ongoingfunding required on a day-to-day and short-term basis, but rather, a recognition that theirfinancing is qualitatively different. Regular sources of revenue might be more readily available forthe smaller ongoing requirements, whereas the ‘lumpy’ investments require finance upfront.
Toilets on Credit, 2015. Trémolet Consulting.
Can microfinance help increase access to sanitation? Today, 2.5 billion people do not use proper sanitation facilities. Essential services for maintaining latrines and treating faecal sludge are also underdeveloped. In many places, toilets can cost up to one year of income for poor households. Private operators of sanitation services do not have enough capital to acquire more equipment and respond to growing demand.
Since 2010, Trémolet Consulting and research partners based in Kenya MicroSave have been exploring the potential of microfinance for helping sanitation markets to develop. The research, funded by SHARE/DFID, culminated with an action-research in Tanzania in which financial institutions were trained to provide financial services for sanitation.
This film explains why microfinance should be explored further, and potentially, included in sanitation programmes. The film also presents what has been done in Tanzania under the action-research and takes the views of households, sanitation entrepreneurs, microfinance institutions and researchers.
WSUP – Stand-Alone Unit or Mainstreamed Responsibility: How Can Water Utilities Serve Low-Income Communities
Stand-Alone Unit or Mainstreamed Responsibility: How Can Water Utilities Serve Low-Income Communities, 2015. Water and Sanitation for the Urban Poor.
Urban utilities throughout the developing world face the challenge of extending services to low-income communities (LICs). This paper draws on current best practice to explore a question that is core to addressing this challenge: how can utilities effectively structure their organisation to extend services to LICs?
Our review of ten utilities reveals three candidate approaches:
- Dedicated, stand-alone LIC unit with operational function;
- Dedicated, stand-alone LIC unit with advisory function;
- ‘Mainstreaming’ approach in which responsibilities for serving LICs are distributed throughout the utility’s operational units.
Urban Opportunities: Perspectives on Climate Change, Resilience, Inclusion, and the Informal Economy
Urban Opportunities: Perspectives on Climate Change, Resilience, Inclusion, and the Informal Economy, 2015. Wilson Center; USAID.
To encourage a new generation of urban scholars, practitioners, and policymakers, and to disseminate their innovative ideas, the Wilson Center’s Urban Sustainability Laboratory, together with Cities Alliance, the International Housing Coalition, USAID, and the World Bank, sponsors an annual paper competition for advanced graduate students working on issues related to urban poverty. The competition is designed to promote the early career development of young urban researchers as well as to strengthen ties between urban policymaking and academia.
This publication marks the fifth year of the “Reducing Urban Poverty” competition and includes a range of perspectives on urban challenges and policy solutions. The 2014 competition called for papers linked to one of the following subtopics: cities and climate change; urban resiliency; inclusive
cities; and the impacts of the informal economy. Each chapter in this volume critically examines existing urban policies and projects, offering original, solutions-oriented research and strategies.
USAID/Ethiopia – Urban Gardens Help Women with HIV, 2015.
USAID supports an Urban Gardens program in Ethiopia to provide vulnerable and HIV-infected women with the tools, land, and knowledge to plant vegetable gardens, feed their families, and sell the produce to increase household income. The program trains women in nutrition, composting, vegetable growing, irrigation, proper hygiene, and HIV/AIDS awareness, and workers with degrees in agriculture assist the women in planting and maintaining their gardens.
The 20-year sanitation partnership of Mumbai and the Indian Alliance. Environment & Urbanization, Feb 2015.
Author: Sheela Patel, The Sparc Team. e-mail: firstname.lastname@example.org
Mumbai is well-known for the scale of the community toilet programme supported by local government, much of it undertaken in partnership with community-based organizations, including the National Slum Dwellers Federation, Mahila Milan (a federation of women’s savings groups) and SPARC (a local NGO), together known as the Alliance.
After describing how this community toilet programme developed over the last 20 years and sought city-wide scale, this paper focuses on the Alliance’s co-development with the municipal corporation of a system to monitor conditions in the hundreds of community toilet blocks built. This monitoring system supports government officials in each ward and the communities served by the toilet blocks in identifying and addressing faults. It also helps develop good working relationships between communities and ward and municipal officials, which can allow other key issues to be addressed.
HDSS Profile: The Nairobi Urban Health and Demographic Surveillance System (NUHDSS). Int. J. Epidemiol. (2015)
Authors: Donatien Beguy, Patricia Elung’ata, et al.
The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was the first urban-based longitudinal health and demographic surveillance platform in sub-Saharan Africa (SSA). The NUHDSS was established in 2002 to provide a platform to investigate the long-term social, economic and health consequences of urban residence, and to serve as a primary research tool for intervention and impact evaluation studies focusing on the needs of the urban poor in SSA. Since its inception, the NUHDSS has successfully followed every year a population of about 65 000 individuals in 24 000 households in two slum communities—Korogocho and Viwandani—in Nairobi, Kenya.
Data collected include key demographic and health information (births, deaths including verbal autopsy, in- and out-migration, immunization) and other information that characterizes living conditions in the slums (livelihood opportunities, household amenities and possessions, type of housing etc.). In addition to the routine data, it has provided a robust platform for nesting several studies examining the challenges of rapid urbanization in SSA and associated health and poverty dynamics. NUHDSS data are shared through internal and external collaborations, in accordance with the Centre’s guidelines for publications, data sharing.
Housed under the USAID-funded, ICMA CityLinks program, the App2Action Challenge brings together software developers, designers, and subject-matter experts to develop phone- or web- based tools that help address WASH challenges in a local community.
CityLinks is releasing a Call for Interest for Missions who would be interested in an App2Action Challenge in their communities either to enhance an existing water/sanitation projects or serve as a stand-alone event in support of local development and improved services.
It is fully funded by the CityLinks Leader, and therefore comes at no cost to the field missions. Rather, the Mission’s role can include
a) identifying a sub-national entity (city, province, department, etc.) that would be interested in and benefit from the App2Action Challenge;
b) assistance in defining the WASH challenge;
c) participating on the judge’s panel; and
d) connecting CityLinks with in-country resources and knowledge.
We really envision this model to drive civic engagement and innovation. In the past, there have been international projects similar to this, but on a larger scale. Because we are working with one Mission and a specific sub-national entity , this project structure can be very flexible to their needs and capacity. We ask for an email indicating interest by February 25, 2015.
Water For People – Strengthening public sector enabling environments to support sanitation enterprises, 2014.
Strengthening public sector enabling environments to support sanitation enterprises, 2014. Water For People.
Water For People is piloting sanitation business approaches and seeks to discover under what conditions these approaches are successful. Public sector influence is one condition that has the potential to facilitate or hinder private sector sanitation endeavors.
This study aims to understand: (1) how the public sector enabling environment can facilitate or hinder low-cost sanitation enterprises; and (2) how NGOs can effectively engage the public sector to support sanitation businesses. Data were collected from Water For People staff and partners in nine countries and summary case studies were coded to discover prevailing themes.
Triggering Increased City-Level Public Finance for Pro-Poor Sanitation Improvements The Role of Political Economy and Fiscal Instruments
Triggering Increased City-Level Public Finance for Pro-Poor Sanitation Improvements The Role of Political Economy and Fiscal Instruments, 2014. Urban; WSUP.
Authors: Jamie Boex; Benjamin Edwards.
The goal of this background paper is to provide a general framework for understanding the political economy and fiscal determinants of sanitation service provision by urban local governments. The paper will review existing literature to begin answering several questions: what do we expect to influence spending on local sanitation? Do different fiscal instruments have an impact on expenditure levels? Do increased local revenues lead to increased expenditures over the long term? What role do different stakeholders play in determining expenditure levels?
The paper first briefly looks at the role of political factors in constraining local expenditure decisions. Having established the political context fors anitation finance, the paper then turns to a more in-depth review of the fiscal determinants of service delivery expenditures.
USAID and the Bill & Melinda Gates Foundation partner with Ministry of Urban Development to help India achieve sanitation for all
Jan 14 – USAID and the Bill & Melinda Gates Foundation partner with Ministry of Urban Development to help India achieve sanitation for all | Source: NRI News
New Delhi (Jan. 14, 2015): The Ministry of Urban Development (MoUD) has partnered with the United States Agency for International Development (USAID) and the Bill & Melinda Gates Foundation to advance the Swachh Bharat Clean India Mission, launched by the Government of India on October 2, 2014.
The MoUD has signed a Memorandum of Understanding (MoU) with USAID and a Memorandum of Cooperation (MoC) with the Bill & Melinda Gates Foundation. These agreements formalize a shared commitment to providing sustainable sanitation solutions in urban areas, eliminating open defecation, and safely containing, treating, and disposing of human waste.
The Bill & Melinda Gates Foundation will provide technical and management support for successful implementation of the urban sanitation program, including the set-up of a national Program Management Unit (PMU) within the MoUD.
USAID will establish a knowledge partnership with the MoUD to identify and scale best practices, build technical capacity, and advance public-private partnership focused on sanitation. USAID will also link to the Government of India’s “Smart Cities” initiative, promoting water and sanitation as an essential element of sustainable and inclusive urban development.
Commenting on the partnership, the Honorable Minister of Urban Development, Shri Venkaiah Naidu said, “The Swachh Bharat Mission seeks to realize the Government’s vision of a clean and developed India by 2019. We will work together with the Bill & Melinda Gates Foundation and USAID to ensure every city and town in India has a world class, affordable, waste management system. The provision of safe sanitation is critical in bolstering public health and environmental outcomes for all of India’s urban population – particularly women and the poor.”
“At the Bill & Melinda Gates Foundation we believe that overcoming India’s sanitation challenge is critical to enable every child, no matter where they live, to survive and thrive. We salute the ambition of the Government of India’s Swachh Bharat Mission and are excited to cement our partnership with the MoUD and USAID, to help make that ambition a reality,” said Girindre Beeharry, India Country Director, Bill & Melinda Gates Foundation.
USAID Mission Director John Beed remarked that “USAID is honored to be supporting the Swachh Bharat Clean India Campaign and to join in this new knowledge partnership with India’s Ministry of Urban Development. We are committed to working with the Government of India, states, cities, the private sector, and other partners such as the Gates Foundation to bring to bear the immense talents, expertise, networks, and resources of the public and private sectors to strengthen water and sanitation services across urban India. This partnership is one of many concrete steps being taken toward fulfilling agreements made at Prime Minister Modi and President Obama’s first summit on September 30.”
Estimates by the World Bank show that diarrheal diseases linked to poor sanitation and hygiene are responsible for over 200,000 deaths per year in India. The Swachh Bharat Mission aims for a cleaner and healthier India by 2019 and these partnerships are a significant step towards achieving this target.
A new screening instrument for disability in low-income and middle-income settings: application at the Iganga-Mayuge Demographic Surveillance System (IM-DSS), Uganda. BMJ Open. 2014 Dec 19;4(12):e005795. doi: 10.1136/bmjopen-2014-005795.
Authors: Bachani AM, Galiwango E, Kadobera D, Bentley JA, Bishai D, Wegener S, Hyder AA.
OBJECTIVE: The measurement of disability in low-income countries is recognised as a major deficiency in health information systems, especially in Africa. The Iganga and Mayuge Demographic Surveillance System (IM-DSS) in Uganda provides a special opportunity to develop population-based data to inform national health policies and evaluate innovations in assessing the burden of disability in Uganda. In this study, we apply a new instrument to screen for physical disabilities at the IM-DSS. The study utilised a modified version of the short set of questions proposed by the Washington Group on Disability Statistics. The instrument was applied at the household level and information was collected on all individuals over the age of 5, who were residents of the IM-DSS.
SETTING: The study was based at the IM-DSS, which covers the parts of Iganga and Mayuge districts in Eastern Uganda.
PARTICIPANTS: 57 247 individuals were included in the survey, with 51% of the study population being women.
PRIMARY OUTCOMES: Activity limitations
RESULTS: The overall prevalence of physical disability at the IM-DSS was 9.4%, with vision being the most common type of difficulty reported in this population, and communication being least prevalent. Disability was less likely to be observed among males than their female counterparts (OR 0.75; 95% CI 0.71 to 0.81; p<0.001). Statistically significant associations were found between disability and increasing age, as well as disability and decreasing household wealth status.
CONCLUSIONS: This study shows that the modified short set of questions can be readily applied in a DSS setting to obtain estimates on the prevalence and types of disability at the population level. This instrument could be adapted for use to screen for disability in other LMIC settings, providing estimates that are comparable across different global regions and populations.
Realizing the Right to Sanitation in Deprived Urban Communities: Meeting the Challenges of Collective Action, Coproduction, Affordability, and Housing Tenure. World Development, Vol. 68, Jan 2015 pp. 242–253, 2015.
Author: Gordon McGranahan, International Institute for Environment and Development (IIED), London, UK.
There are serious institutional challenges associated with low-cost sanitation in deprived urban communities. These include a collective action challenge, a coproduction challenge, a challenge of affordability versus acceptability, and a challenge related to housing tenure.
This paper examines these challenges, revealing both the importance of community-driven sanitation improvement and its difficulties. The nature of the challenges, and the means by which two successful community-driven initiatives have overcome them, suggest that while recognizing the human right to sanitation is important this should not be taken to imply that typical rights-based approaches are the appropriate means of realizing this right.
- Jan 9, 2015 – Abstract submission deadline for International Conference on Urban Health
Theme One: Addressing socioeconomic and environmental determinants of urban health and health inequities
Understanding how the urban context shapes population health and where interventions are best focused to improve and sustain health and health equity requires attention to a range of social, economic and environmental determinants and their impacts. Conference organizers are particularly interested in learning of successful (and failed) interventions that address these broader determinants which are key to sustaining health improvement in urban areas.
Theme Two: Urban health care and public health service provision across the life course
Dramatic changes in disease trends in the urban environment and their implications over the life course demand innovative prevention and treatment strategies. Current evidence on challenges associated with the dual burden of communicable and non-communicable disease, the impact of urban lifestyles, gender inequity, and changing demographics such as aging, need to be addressed in both urban planning and the implementation of public and privately funded direct services.
Theme Three: Measuring, mapping and monitoring urban health
Rapid unplanned urbanization can quickly overwhelm the provision of basic public services such as transport, water and sanitation, food security, health and social care and housing, the health consequences of which disproportionately impact the urban poor. It is important that cities and organizations working in partnerships for governance of cities have the capability to identify and monitor the health status of their populations, especially health disparities; rates of urban in and out-migration; the availability of health, social and educational services and methods to locate gaps in coverage; factors known to impact the health of urban citizens such as air quality, energy demands, and availability of adequate water and sanitation, is critical. New methodologies and approaches are needed to measure, map and monitor urban health to ensure accountability and provide critical evidence to plan for the future.
Theme Four: Strengthening governance for urban health
In many countries, rapid urbanization and the rise of megacities has overwhelmed the capacity of local government to provide for urban citizens. Effective urban governance is needed to ensure access to basic health and social services, and to create and sustain a healthy urban environment. Urban policies that guide planning and decision making around health, and urban governance structures and processes that ensure service coverage and quality, emergency preparedness, and social protection, are critical. New approaches to working with the private sector and information communications technologies offer promise, but regulatory issues and standard setting need to be addressed.