Urban Health Updates
Reposted from Sanitation Updates:
This video goes beyond toilets and discusses the sanitation value chain.
Reposted from Sanitation Updates:
This video is of Session 1 of an event which focused on the role of the market within the context of urban sanitation and how to support market actors to achieve sustainable service delivery at scale. We considered both public and private actors, formal and informal, and what types of partnership, institutional models and financing mechanisms are most effective to support pro-poor delivery of urban sanitation services.
We discussed the experience of tools for market mapping and analysis and how these can be utilised as the basis for market strengthening, and will identify effective ways to support governmental authorities to work with private sector actors in market development.
Other sessions are on the ODI YouTube Channel.
As human populations become more and more urban, decision-makers at all levels face new challenges related to both the scale of service provision and the increasing complexity of cities and the networks that connect them. These challenges may take on unique aspects in cities with different cultures, political and institutional frameworks, and at different levels of development, but they frequently have in common an origin in the interaction of human and environmental systems and the feedback relationships that govern their dynamic evolution.
Accordingly, systems approaches are becoming recognized as critical to understanding and addressing such complex problems, including those related to human health and wellbeing. Management of water resources in and for cities is one area where such approaches hold real promise.
Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh
Below is an abstract from a study by Dreibelbis, et al.: Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh.
Behavior change communication for improving handwashing with soap can be labor and resource intensive, yet quality results are difficult to achieve. Nudges are environmental cues engaging unconscious decision-making processes to prompt behavior change. In this proof-of-concept study, we developed an inexpensive set of nudges to encourage handwashing with soap after toilet use in two primary schools in rural Bangladesh. We completed direct observation of behaviors at baseline, after providing traditional handwashing infrastructure, and at multiple time periods following targeted handwashing nudges (1 day, 2 weeks, and 6 weeks). No additional handwashing education or motivational messages were completed. Handwashing with soap among school children was low at baseline (4%), increasing to 68% the day after nudges were completed and 74% at both 2 weeks and 6 weeks post intervention. Results indicate that nudge-based interventions have the potential to improve handwashing with soap among school-aged children in Bangladesh and specific areas of further inquiry are discussed.
Effectiveness of group discussions and commitment in improving cleaning behaviour of shared sanitation users in Kampala, Uganda slums
This study in the December 2015 Issue of Social Science and Medicine evaluated discussions and commitment interventions among shared toilet users in three urban slums in Kampala, Uganda The abstract is reposted below:
Rationale and objective
Access to and use of hygienic shared sanitation facilities is fundamental in reducing the high risk of diseases such as diarrhoea and respiratory infections. We evaluated the effectiveness of group discussions and commitment in improving the cleaning behaviour of shared sanitation users in three urban slums in Kampala, Uganda. The study follows the risk, attitudes, norms, abilities and self-regulation (RANAS) model of behaviour change and some factors of the social dilemma theory.Methods
A pre-versus post-intervention survey was conducted in three slums of Kampala, Uganda, between December 2012 and September 2013. From the pre-intervention findings, users of dirty sanitation facilities were randomly assigned to discussions, discussions + commitment and control interventions. The interventions were implemented for 3 months with the aim of improving cleaning behaviour. This paper provides an analysis of 119 respondents who belonged to the intervention discussion-only (n = 38), discussions + commitment (n = 41) and the control (no intervention, n = 40) groups.Results
Compared to the control, discussions and discussions + commitment significantly improved shared toilet users’ cleaning behaviour. The rate of improvement was observed through behavioural determinants such as cleaning obligation, cleaning ease, cleaning approval and affective beliefs.Conclusion
Our study findings show that group discussions and commitment interventions derived from RANAS model of behaviour change are effective in improving the shared sanitation users’ cleaning behaviour.
A video made by Water and Sanitation for the Urban Poor (WASUP) details a study intended to explore the links between sanitation, population density, and health outcomes in Maputo, Mozambique. The video describes a controlled, before-and-after trial of an urban sanitation intervention to reduce enteric infections in children.
The link to the video is here: https://www.youtube.com/watch?v=Nyk-3jWdzn0
Wasted Health: The Tragic Case of Dumpsites | | Source: by Thomas Dimech | Resource, 8 September 2015 |
A new report by the International Solid Waste Association (ISWA) is highlighting the ‘global health emergency’ affecting tens of millions of people in developing countries who lack good sanitation infrastructure.
The report, ‘Wasted Health: The Tragic Case of Dumpsites’, illustrates how the issues surrounding open dumpsites in the developed world 40 years ago are still prevalent in developing countries, but are also being compounded by unprecedented issues such as the unregulated accumulation of discarded electronics, mobile phones, and medical waste.
Some of the main problems identified in the report include:
- open dumpsites receive roughly 40 per cent of the world’s waste and serve about 3.5 to 4 billion people;
- there has been a substantial rise in unregulated dumping of mobile devices, electronic appliances, medical and municipal waste, accelerating the scale of the threat and health risks;
- uncontrolled burning of waste releases gases and toxins into the atmosphere;
- open waste sites in India, Indonesia and the Philippines are more detrimental to life expectancy than malaria;
- 64 million people’s lives (equal to the population of France) are affected by world’s 50 largest dumpsites;
- in addition to the human and environmental impacts, the financial cost of open dumpsites runs into the tens of billions of US dollars.
In preparing the report, researchers analysed 373 toxic waste sites in India, Indonesia and the Philippines, where, the report says, ‘an estimated 8.6 million people are at risk of exposure to lead, asbestos, hexavalent chromium and other hazardous materials’.
It continues: ‘Among those people at risk, the exposure could cause a loss of around 829,000 years of good health as a result of disease, disability or early death. In comparison, malaria in these countries, whose combined population is nearly 1.6 billion, causes the loss of 725,000 healthy years.’
The report also states that over 42 million tonnes of e-waste was generated in 2014 and a lack of trained labour and investment in recycling infrastructure has meant that much of the waste is simply dumped in open landfills, which can lead to further health issues as they can be burnt, exposing locals to dangerous pollutants, heavy metals, volatile compounds and soot.
Call for a ‘global alliance’ to address the issue
Releasing the report, Antonis Mavropoulos, Chairman of the ISWA Scientific and Technical Committee and author of the report, called for immediate action: “Little or no coordinated action is being taken at present and to be effective change can only happen if there is a global alliance to address the issue among governments and key stakeholder organisations.
“We need to start with a plan of how we finance the closure and relocation of the most dangerous sites urgently and provide support through resources of capital and expertise. While the cost will be substantial, it represents an opportunity to invest in the infrastructure and economy of these emerging and poor nations. In addition, the outlay required to close the most risky dumpsites will be just a small fraction of the cost of their health impacts.”
David Newman, ISWA President, said: “The recommendations of this report are clear: the international community has an urgent task ahead in closing waste dumps globally, for the sake of populations affected by them, because they live in or near them, but also because all the world’s people are breathing in the toxins released by burning on open dumps. And the greenhouse gas emissions involved are huge too, and unless we act, the growth of open dumping is inevitable.”
He added: “ISWA and its experts are willing to take part in this global clean up and will, with other interested parties, collaborate on drawing attention to the damage caused to human health through poor waste management practices.”
Can we shift waste to value through 3D printing in Tanzania? World Bank Blog, Sept 2015. Author: C. Paradi-Guilford.
Plastic waste, in particular PET, which is typically found in soda bottles, is becoming abundant in African cities. In Dar es Salaam, one of the most rapidly urbanizing cities in Africa,BORDA found that about 400 tons of plastic waste per day remains uncollected or unrecycled. Although about 98 percent of the solid waste generated per day can be recycled or composted, 90 percent is disposed in dumpsites.
At the same time, the recycling industry has started to grow because of new initiatives, community organizations and private companies. There are a few organizations that repurpose waste into arts and crafts, tools or apply it as a source of energy – such as WasteDar. However, the majority collect or purchase plastic waste from collectors, primarily with a view to export, rather than recycle or reuse locally.
Socially and environmentally, waste management is one of the biggest challenges for an increasingly urbanized world. Waste pickers can earn as little as US$1-2 a day in dangerous conditions with little opportunity for advancement. They make up some of the most disadvantaged communities living in deep poverty.
Through a new market for sorted waste materials, these communities may access higher income generation opportunities in a sustainable manner. This presents an opportunity to explore turning this waste into value more close to home.
At the same time, 3D Printing is expanding
3D printing is an additive manufacturing process that applies layers of materials (typically plastic) to develop an object that is made up of thinly sliced horizontal layers. The design of the object is made in a Computer-Aided Design program using a 3D modeling, then is inputted into the 3D printer. Gaining popularity, 3D scanners are also used to make a digital copy of ab object. 3D printers take an input of filament consisting of varying types of plastic to create the object.
3D printers can be found in schools and other training institutions, digital fabrication and maker spaces, small research and development (R&D) labs…or even one’s home. Maker spaces or digital fabrication laboratories make these openly available. They are small-scale workshops that offer digital fabrication services to the tinkerers, creative problem solvers, entrepreneurs or anyone who wishes to apply and build on their technical skills. They were originally designed as prototyping platforms for local entrepreneurs, but they have now expanded to universities and higher education facilities.
Check out the Fab Foundation to learn more about the international network that supports digital fabrication spaces called “Fab labs.” These spaces are rarely built in isolation and often are integrated into existing innovation, startup, academic, and entrepreneurial ecosystems.
Wait, how does plastic waste connect to 3D printing?
A nascent opportunity to rethink the way we use, or rather reuse, plastic is the growing market for 3D printer filament. Predictions suggest that 3D printing filament market will reach $1.052 million by 2019. Currently, the cost of one kilogram (kg) of filament anywhere between $25 and $40. However, in new markets, such as Tanzania, this cost can go up to as much as $60 or even $80, including fees for shipping from China. This creates a barrier for the burgeoning local communities interested in 3D printing to access the necessary supplies.
Filament can be sourced directly from waste picker groups in developing countries. Filament with the Ethical Filament (“EF”) mark is produced ethically on a ‘fair trade’ basis, enabling waste pickers to receive more income from the recyclable materials they collect.
Companies like Protoprint are already taking advantage of this opportunity by conducting a pilot study in cooperation with Waste Pickers in India to develop ethical 3D printer filament made out of HDPE plastic. This filament can also be used for 3D printing prototypes or products themselves depending on their complexity and design.
Below are three current initiatives that are working in the recycled plastic space in varying capacities.
- Refil is a company based out of the Netherlands that is creating high quality affordable 3D printer filament out of recycled plastic. Through a specially developed process they are recycling car dashboards, into ABS plastic filament.
- The Plastic Bank is working on developing an open source extruder that creates filament from industrial waste/ocean plastic. To look at the open source hardware schematics.
- Appropedia is a wiki page for collaborative solutions to address sustainability and poverty reduction, including plastics for 3D printing.
- Tech for Trade is a UK charity that works with local entrepreneurs to test innovative approaches for building sustainable technology businesses. They founded the Ethical Filament Foundation, which aims to ensure income sustainability of waste pickers, reduce the environmental impact of 3D printing and onboarding recycled filament producers to use their Ethical Filament Standard.
- FabLab Bohol: The plastic upcycling project in Bohol, Philippines is an initiative that recycles used plastic materials to generate income for the community. One of the main products is plastic piping for septic tank use to protect the local marine life.
- Agbogbloshie Makerspace Platform (AMP): It is a transnational youth-driven project in Ghana to promote maker ecosystems in Africa, starting at Agbogbloshie. The agenda is collective action to prototype tools and co-create a hybrid digital-physical platform for recycling of ewaste material, making, sharing and trading.
Caption: The Plastic Bank’s Open Sourced Extruder
Examples of 3D printed products
- Infant Vein Finder Students from the University of Nairobi created an infant vein finder to address the infant mortality rate in Kenya. (Kenya)
- Weather Stations USAID developed a 3D printed weather station that integrates with a raspberry pi to provide instant access to weather data. (Zambia)
- Umbilical Cord Clip Field Ready developed the design and provided communities with access to printers to print the clips. (Haiti)
- Prosthetics 3D printed prosthetics for amputees specifically in developing economies. (Kenya)
- Solar Panel Bases Village Energy piloted using 3D printers to make their solar panel bases to decrease production time. (Uganda)
Green Digital Fabrication in Tanzania
Through the Green Digital Fabrication initiative in Tanzania, the World Bank will test the opportunity to shift PET plastic waste to value through collaboration across the recycling industry, local innovators and entrepreneurs, makers and tinkerers, leveraging 3D printers and new, low-cost PET extruder technology. The initiative will assess the feasibility and the market opportunity to turn PET plastic waste into 3D printer filament that can be sold locally or globally, and to then print unique, locally appropriate and marketable products, which could be then traded and sold by waste collectors back to their communities.
Through the practical application of 3D printing in the context of plastic waste, the initiative also aims contribute to the broader movement on turning waste to value as well as the development of local maker and digital fabrication communities.
The initiative is funded by the ICT4D Trust Fund at the World Bank, and is a partnership between the World Bank,COSTECH, Tena Recycling, Tech for Trade and the Ethical Filament Foundation, the Buni Hub, and STIClab.
Bringing Back the Water: USAID’s Indonesia Urban Water, Sanitation and Hygiene (IUWASH) program, Frontlines, Sept/Oct 2015.
Changes in weather patterns are already affecting everyday life in Indonesia. On the islands of Sumatra and Java, places naturally lush with vegetation, rivers and streams are beginning to dry up, exacerbated by heavy deforestation and expanding urban areas.
When it does rain, it is often more intense now and causes flooding in downstream populated areas. USAID’s Indonesia Urban Water, Sanitation and Hygiene (IUWASH) program has promoted a simple way to collect this rain and return it to groundwater aquifers: infiltration ponds.
Read the complete article.
A Corridor of Contrasts: On the road from Abidjan to Lagos, urbanization offers risk and opportunity, hardship and hope
A Corridor of Contrasts: On the road from Abidjan to Lagos, urbanization offers risk and opportunity, hardship and hope, 2015. African Strategies for Health.
To document issues affecting the health of people living in urban areas along the corridor, the US Agency for International Development’s (USAID) Africa Bureau and Global Health Bureau commissioned African Strategies for Health (ASH) to capture the stories of people who live and work along the road.
In January 2015, a journalist and photographer traveled the route and interviewed USAID staff, private and public health service providers, USAID implementing partners, and urban residents. This report is a compilation of those stories and the recommendations made by people living along the corridor for improving services for those who need it most.
MIT/CITE – USAID: Evaluation of water filters in Ahmedabad, Oct 2015.
Background – CITE’s household water filter evaluation allowed us to study innovations with the potential to better the lives of India’s “water poor”—the 76 million people in the country who lack improved drinking water.
CITE teams studied over 100 models of householder water filters from nine major brands available on the market in Ahmedabad, India. These models fell into three main categories: conventional particle filtration (cloth/jali mesh), gravity non-electric filters, and reverse osmosis filters.
In Ahmedabad, MIT students and researchers worked closely with students from local Indian universities to conduct the evaluation. Another student team spent the summer in the Consumer Reports labs in Yonkers, New York conducting lab tests of the same models being tested in the field.
CITE used multi-criteria analysis and Consumer Reports-style rating charts to guide its water filter evaluation report, which was released in October 2015.
- Cloth and jali filters are cheap and common among low-income users, but are not effective in reducing E.coli, or turbidity.
- Gravity non-electric filters are moderately priced and far more effective than cloth filters at reducing E.coli and turbidity.
- Reverse osmosis is a popular type of water filter system perceived as the best, but most of these systems are not an affordable option for the poor. Moreover, these filters generate wastewater at rates triples that of the clean water they produce—a negative environmental impact in a water scarce region.
- Postponed assembly at the retail level for certain water filter products can be very effective in scaling the supply chain. The locally branded “Dolphin” reverse osmosis water filters assembled by the distributors and retailers are promising from a scalability perspective.
- Water filters offer a good retail entrepreneurial opportunity since the assembly process is straightforward and requires few technical skills.
- A low-priced water filter is not sufficient for reaching rural populations. The more affordable gravity non-electric models are not readily available in rural areas, where they may be needed most.
- Water filter use seems to be dependent on use of water filters in the past and peer effects. This suggests that sustainable water use may be better suited to community- and neighborhood- scale interventions, rather than market interventions, at least in the short-run.
- A majority of water filter purchasing decisions were influenced by the buyer’s close network, most often a family member.
- Knowledge about household water filters designed for the bottom of the pyramid is low among that market segment. Technology adoption proves difficult when one’s peers do not have knowledge about a particular product.
Sanitation Service Delivery – Making Kumasi a Cleaner City, Sept 2015. Source: PSI Impact |
Sanitation Service Delivery (SSD) is a USAID/West Africa regional urban sanitation project that is implemented by PSI in collaboration with PATH and Water and Sanitation for the Urban Poor (WSUP). The project aims to improve sanitation outcomes by developing and testing scalable business models that engage private sector service providers and by contributing to the creation of a strong enabling environment for sanitation in West Africa. WSUP plays a vital role in supporting government partnership efforts to strengthen public support for improved sanitation and fecal sludge management (FSM) services in Ghana — an important aspect of the SSD.
Highlighting the important role governments will play in this endeavor, Dana Ward, PSI country representative in Ghana and chief of party for Sanitation Service Delivery (SSD) Project in Ghana, Benin, and Cote d’Ivore caught up with Anthony Mensah, director, Waste Management Department Kumasi Metropolitan Authority (KMA), about the city’s strategy to make Kumasi among the five cleanest cities in Africa.
In this Q&A, Anthony Mensah responds to questions on successes and challenges of the Kumasi program. Read the complete article.
Launch of “Strengthening Water and Sanitation in Urban Settings” project in Kolkata.
Kolkata, 12 August 2015: TERI University and the U.S. Agency for International Development (USAID) in association with Coca Cola and The Energy and Resources Institute (TERI) today launched the ‘Strengthening Water and Sanitation in Urban Settings” initiative in Kolkata. The WASH programmes (Water, Sanitation and Hygiene) aim to reach 50,000 beneficiaries in low-income settlements and over 300 professionals through WASH governance studies. It will also reach out to 2,500 students through 20 municipal schools across India.
The goal is to help achieve the Government of India’s sanitation targets by conducting a WASH risk analysis in slums of Kolkata and Chennai. As first steps, two urban neighbourhoods – Kannagi Nagar and Nedunchelliyan Nagar in Chennai, and areas in KMC wards 57 and 58 (Khayari basti, Arupota and Dhapa) in Kolkata – have been chosen for household surveys.
The project will assist in developing participatory intervention strategies in urban areas, and in building the capacity of faculty and students through a model sanitation curriculum.\
Read the complete article.
Urban Malaria: Understanding its Epidemiology, Ecology, and Transmission Across Seven Diverse ICEMR Network Sites
Urban Malaria: Understanding its Epidemiology, Ecology, and TransmissionAcross Seven Diverse ICEMR Network Sites. Am Jnl Trop Med Hyg, Aug 2015.
Authors: Mark L. Wilson, Donald J. Krogstad, et al.
A major public health question is whether urbanization will transform malaria from a rural to an urban disease. However, differences about definitions of urban settings, urban malaria, and whether malaria control should differ between rural and urban areas complicate both the analysis of available data and the development of intervention strategies. This report examines the approach of the International Centers of Excellence for Malaria Research (ICEMR) to urban malaria in Brazil, Colombia, India (Chennai and Goa), Malawi, Senegal, and Uganda. Its major theme is the need to determine whether cases diagnosed in urban areas were imported from surrounding rural areas or resulted from transmission within the urban area.
If infections are being acquired within urban areas, malaria control measures must be targeted within those urban areas to be effective. Conversely, if malaria cases are being imported from rural areas, control measures must be directed at vectors, breeding sites, and infected humans in those rural areas. Similar interventions must be directed differently if infections were acquired within urban areas. The hypothesis underlying the ICEMR approach to urban malaria is that optimal control of urban malaria depends on accurate epidemiologic and entomologic information about transmission
Entering the city: emerging evidence and practices with safety nets in urban areas, 2015.
Author: Ugo Gentilini, World Bank.
Most safety net programs in low and middle-income countries have hitherto been conceived for rural areas. Yet as the global urban population increases and poverty urbanizes, it becomes of utmost importance to understand how to make safety nets work in urban settings. This paper discusses the process of urbanization, the peculiar features of urban poverty, and emerging experiences with urban safety net programs in dozens of countries. It does so by reviewing multidisciplinary literature, examining household survey data, and presenting a compilation of case studies from a first generation of programs.
The paper finds that urban areas pose fundamentally different sets of opportunities and challenges for social protection, and that safety net programs are at the very beginning of a process of urban adaptation. The mixed-performance and preliminary nature of the experiences suggest to put a premium on learning and evidence-generation. This may include revisiting some key design choices and better connecting safety nets to spatial, economic, and social services agendas compelling to urban areas.