Urban Health Updates
An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities
An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Trop Med Intl Health, Mar 2014.
Authors: Julie A. Nicholson, et al.
Objectives – To evaluate how an intervention, which combined hand washing promotion aimed at 5-year-olds with provision of free soap, affected illnesses among the children and their families and children’s school absenteeism.
Methods – We monitored illnesses, including diarrhoea and acute respiratory infections (ARIs), school absences and soap consumption for 41 weeks in 70 low-income communities in Mumbai, India (35 communities per arm).
Results – Outcomes from 847 intervention households (containing 847 5-year-olds and 4863 subjects in total) and 833 control households (containing 833 5-year-olds and 4812 subjects) were modelled using negative binomial regression. Intervention group 5-year-olds had fewer episodes of diarrhoea (−25%, 95% confidence intervals [CI] = −37%, −2%), ARIs (−15%, 95% CI = −30%, −8%), school absences due to illnesses (−27%, 95% CI = −41%, −18%) and eye infections (−46%, 95% CI = −58%, −31%). Further, there were fewer episodes of diarrhoea and ARIs in the intervention group for ‘whole families’ (−31%, 95% CI = −37%, −5%; and −14%, 95% CI = −23%, −6%, respectively), 6- to 15-year-olds (−30%, 95% CI = −39%, −7%; and −15%, 95% CI = −24%, −6%) and under 5 s (−32%, 95% CI = −41%, −4%; and −20%, 95% CI = −29%, −8%).
Conclusions – Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public–private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.
Provision of private, piped water and sewerage connections and directly observed handwashing of mothers in a peri-urban community of Lima, Peru
Provision of private, piped water and sewerage connections and directly observed handwashing of mothers in a peri-urban community of Lima, Peru. Trop Med Intl Health, Jan 2014.
William E. Oswald, et al.
Objectives – To estimate the association between improved water and sanitation access and handwashing of mothers living in a peri-urban community of Lima, Peru.
Methods – We observed 27 mothers directly, before and after installation of private, piped water and sewerage connections in the street just outside their housing plots, and measured changes in the proportion of faecal-hand contamination and hand-to-mouth transmission events with handwashing.
Results – After provision of water and sewerage connections, mothers were approximately two times more likely to be observed washing their hands within a minute of defecation, compared with when they relied on shared, external water sources and non-piped excreta disposal (RR = 2.14, 95% CI = 0.99–4.62). With piped water and sewerage available at housing plots, handwashing with or without soap occurred within a minute after 48% (10/21) of defecation events and within 15 min prior to 8% (11/136) of handling food events.
Conclusions – Handwashing increased following installation of private, piped water and sewerage connections, but its practice remained infrequent, particularly before food-related events. Infrastructural interventions should be coupled with efforts to promote hygiene and ensure access to water and soap at multiple on-plot locations convenient to mothers.
Feb 11, 2014 – Promoting Urban Health and Launch of the Strengthening Ethiopia’s Urban Health Program (SEUHP) – Opening Remarks by Mission Director Dennis Weller
It is an honor to be here today on behalf of the United States Government and the American people to celebrate our partnership with the Government of Ethiopia to improve urban health services in this country.
The Ministry of Health has a strong reputation for its results-driven health program that empowers communities and demonstrates impressive successes. One such example is achieving Millennium Development Goal-4 of reducing child mortality well ahead of schedule.
We are pleased to witness the gains that health service delivery to homes has contributed toward improving health services in rural and urban areas. With an estimated 15.9 million people living in urban areas, Ethiopia is one of the least urbanized African nations. However, the population is growing and by 2050, Ethiopia’s urban population is projected to exceed 77 million.
The health challenges in urban areas are complex. For example:
- HIV prevalence is more than five times greater among women living in urban and peri-urban centers compared to women living in rural communities.
- More than 50 percent of pregnant women in urban centers still deliver at home, and
- Neonatal deaths in urban settings are almost as high as the rate in rural settings.
Adding to the complexity is that with the development of effective anti-retroviral therapies, life-long treatment of HIV is becoming similar to that of chronic illnesses, such as diabetes, cancer, and mental illness. As a result, there have been important changes to the public health response and many governments are now committing to mainstream, integrate, and decentralize HIV care.
We need to be prepared to address the health challenges related to rapid population growth and urbanization before it happens, and I am pleased to say that the Ministry of Health, USAID, and the development community are committed to making sure Ethiopia’s health system is ready to adapt to the ever-changing urban environment. In 2009, the Government of Ethiopia initiated the innovative Urban Health Extension Program.
The program’s aim is to improve access to and equity of public health information and services for urban populations by deploying thousands of nurses to serve as community health workers providing house-to-house health services. In support of the Government’s program, USAID implemented its Urban Health Extension Program from 2009 to 2012. The USAID program supported the training and deployment of more than 2,300 urban health extension professionals and provided HIV services for more than 110,000 most-at-risk persons.
Our partnership with the Ministry of Health is something that we deeply value and is a large part of the success of our joint efforts to address the prevailing health challenges in Ethiopia. Today, we are excited to continue that partnership as we launch USAID’s five-year Strengthening Ethiopia’s Urban Health Program, partially funding by the U.S. President’s Emergency Plan for AIDS Relief. This new program will build on the achievements of its predecessor by expanding access to essential health services.
The program will target vulnerable households in urban communities to reduce HIV- and TB-related illnesses and deaths and the incidence of communicable diseases in mothers, newborns and children. In cooperation with the Ministry of Health, the private sector, regional health bureaus, city administrations, and others, this new program will promote best practices to reach more than 1.6 million urban households with high-quality health services in the coming five years. As we celebrate the gains made over the last few years in combating HIV and TB and improving child health, we are committed to build on Ethiopia’s achievements in the health sector.
Ethiopia’s experience has shown that with commitment, clear policies, and innovative strategies, dramatic success in improving health care is well within our reach. In closing, I would like to thank the Government of Ethiopia for spearheading the Urban Health Extension Strategy that will contribute to strengthening Ethiopia’s health system. With a concerted multi-stakeholder collaboration under the leadership of the Ministry of Health, we will achieve the objectives of the Ethiopian Health Sector Development Plan IV. Today, we take a new step forward in that collaboration and in bringing vital health services to Ethiopia’s urban populations.
Longitudinal Study of the Impact of the Integration of Microfinance and Health Services on Bandhan Clients in India
Longitudinal Study of the Impact of the Integration of Microfinance and Health Services on Bandhan Clients in India, 2014.
Authors: Amanda Johnson, et al.
Between 2006 and 2009, Freedom from Hunger worked with Bandhan, one of the largest microfinance institutions (MFIs) in India, to pilot new health products and services for its clients as part of Freedom from Hunger’s global Microfinance and Health Protection (MAHP) initiative. Funded by the Bill & Melinda Gates Foundation, health innovations such as health education, financing, products, and linkages to health providers were developed and piloted with Bandhan and four other microfinance organizations around the world with the dual goal of improvement of client health and financial protection and the financial performance of the MFIs. Through MAHP, Bandhan identified pressing health needs and concerns of its clients and designed a responsive and cohesive health package: health education forums for clients and community members that deliver behavior change communication on breastfeeding, pre-, post- and neonatal care, infant and child feeding and diarrhea; health loans; health product distributors known as Swastha Sahayikas (SS) who reinforce health messages during home visits, sell health products, and support referrals to local healthcare services.
Evidence of positive changes in important maternal and child health knowledge and behaviors as well as high levels of client satisfaction sustained over a period of five years following the implementation of the program, is very promising. This study is an important contribution to a growing body of evidence for cross-sectoral interventions that address poverty and poor health. Bandhan and other organizations, including microfinance, self-help groups, and savings-led groups that convene women to access financial services, represent a large and mostly untapped resource for creating durable and sustainable channels to reach millions of poor families, and for making important contributions towards the achievement of national and global health improvement targets, especially in the area of maternal and child health and nutrition.
Mortality Trends Observed in Population-Based Surveillance of an Urban Slum Settlement, Kibera, Kenya
Olack B, Feikin DR, Cosmas LO, Odero KO, Okoth GO, et al. (2014) Mortality Trends Observed in Population-Based Surveillance of an Urban Slum Settlement, Kibera, Kenya, 2007–2010. PLoS ONE 9(1): e85913. doi:10.1371/journal.pone.0085913.
Background – We used population based infectious disease surveillance to characterize mortality rates in residents of an urban slum in Kenya.
Methods – We analyzed biweekly household visit data collected two weeks before death for 749 cases who died during January 1, 2007 to December 31, 2010. We also selected controls matched by age, gender and having a biweekly household visit within two weeks before death of the corresponding case and compared the symptoms reported.
Results – The overall mortality rate was 6.3 per 1,000 person years of observation (PYO) (females: 5.7; males: 6.8). Infant mortality rate was 50.2 per 1000 PYOs, and it was 15.1 per 1,000 PYOs for children <5 years old. Poisson regression indicates a significant decrease over time in overall mortality from (6.0 in 2007 to 4.0 in 2010 per 1000 PYOs; p<0.05) in persons ≥5 years old. This decrease was predominant in females (7.8 to 5.7 per 1000 PYOs; p<0.05). Two weeks before death, significantly higher prevalence for cough (OR = 4.7 [95% CI: 3.7–5.9]), fever (OR = 8.1 [95% CI: 6.1–10.7]), and diarrhea (OR = 9.1 [95% CI: 6.4–13.2]) were reported among participants who died (cases) when compared to participants who did not die (controls). Diarrhea followed by fever were independently associated with deaths (OR = 14.4 [95% CI: 7.1–29.2]), and (OR = 11.4 [95% CI: 6.7–19.4]) respectively.
Conclusions – Despite accessible health care, mortality rates are high among people living in this urban slum; infectious disease syndromes appear to be linked to a substantial proportion of deaths. Rapid urbanization poses an increasing challenge in national efforts to improve health outcomes, including reducing childhood mortality rates. Targeting impoverished people in urban slums with effective interventions such as water and sanitation interventions are needed to achieve national objectives for health.
Singh A, Singh MN. (2014) Diarrhoea and acute respiratory infections among under-five children in slums: Evidence from India. PeerJ PrePrints 2:e208v1 http://dx.doi.org/10.7287/peerj.preprints.208v1
Background: In the wake of burgeoning slum population, a substantial reduction in the prevalence of diarrhea and acute respiratory infections (ARI) is necessary for to achieve necessary reduction in child mortality in urban India. To achieve this, we need evidence based public health interventions and programs. However, a review of previous studies indicate that national level studies focused on slum population are very few. Therefore, the present study aims to study differentials and determinants of diarrhea and ARI in urban slums of India.
Methodology: Using data obtained from the third round of National Family Health Survey conducted in 2005-06, we analyzed information on 2687 under-5 children living in urban slums located in eight selected India cities. Apart from bivariate analysis, logistic regression analysis was performed to identify factor associated with diarrhea and ARI among slum children.
Results: The prevalence diarrhea and ARI is about 8% and 8.5%, respectively. Age, birth weight, access to safe water and improved toilet and region emerge as main factors affecting prevalence of diarrhea among slum children. Safe drinking water reduces the likelihood of getting diarrhea by about 19% compared to unsafe water [CI=0.563-1.151]. Children with normal birth are about 51% less likely to suffer from diarrhea compared to those with unknown birth weight [CI=0.368-0.814]. Older children are about 63% less likely to suffer from diarrhea [CI=0.274-0.502]. Children from Southern cities are about half as likely to have diarrhea as children from slums in Northern cities. ARI is associated with age, birth weight, religion, caste, education, family type, safe water, improved toilet, mass-media exposure, region and separate kitchen. Older children and children with normal birth weight are less likely to suffer from ARI. Children from ‘Other’ religions and OBC are 39% [CI=1.000-1.924] and 49% [CI=1.008-2.190], respectively, more likely to suffer from ARI. Parents’ education is strongly associated with prevalence of ARI. Exposure to mass media reduces the likelihood of ARI to 50% compared to the situation when mother of the child did not have any exposure to mass-media [CI=0.324-0.819]. Non-flush toilet and lack of separate kitchen increase the likelihood of ARI. Children from slums located in Southern region are less likely to suffer from ARI.
Conclusion: The findings call for dedicated programs and policies, in line with those already existing ones such as RAY, IHSDP, NUHM, ICDS and JNNURM, for the development of urban slums through provision of affordable housing, improved sanitation, safe water and clean fuel. Adequate nutrition to mothers and their children should be ensured and vulnerable groups identified in the analysis should be the focus of future public health intervention and strategies. The use of mass-media to change health behavior should also be considered.
Jan 2014 – 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.
Measuring slum severity in Mumbai and Kolkata: A household-based approach. Habitat International 41 (2014) 300e306.
Authors: Amit Patel, Naoru Koizumi, Andrew Crooks.
E-mail addresses: firstname.lastname@example.org, email@example.com (A. Patel), firstname.lastname@example.org (N. Koizumi), email@example.com (A. Crooks)
Slums pose a signiﬁcant challenge for urban planning and policy as they provide shelter to a third of urban residents. UN-Habitat reports that, in 2001, approximately 924 million people lived in slums or informal settlements across the world (UN-Habitat, 2003). However, varying deﬁnitions of what constitutes a slum result in different slum population estimates. Most deﬁnitions treat a slum as a community of several households, rarely recognizing that housing conditions differ for each individual household within the area. Moreover, deﬁnitions of slums usually take a dichotomous approach whereby a place is either a slum or not. Little attempt is made to go beyond this slum/non-slum dichotomy.
This paper moves beyond the traditional ways of deﬁning a slum by proposing a new household level enumeration of slums and developing Slum Severity Index (SSI), which measures the level of deprivation on a continuous scale based on the UN-Habitat’s slum deﬁnition. We apply this new approach of analyzing slums to a household survey dataset to estimate the total number of slum households in Mumbai and Kolkata, two megacities in India. To contrast our approach, we compare these estimates with the Census of India’s. The comparison highlights stark differences in the two estimates and the slum/non-slum household classiﬁcations. The main objective of this study is to demonstrate the usefulness of the household level analysis of slums in drawing implications for designing and implementing slum policies.
State of Women in Cities 2012-2013, 2013. UN HABITAT.
Women need more equitable access to infrastructure, especially sanitation. Although over half (53 per cent) of the survey respondents thought that their cities were ‘committed’ in some form to promoting infrastructural development to fully engage women in urban development and productive work, only 22 per cent stated that they were ‘fully committed’ or ‘committed’, with a high of 39 per cent in Johannesburg. In turn, only 29.5 per cent of respondents felt that infrastructure was adequate, with lows of 15 per cent in Rio de Janeiro and 18.5 per cent in Kingston. The most problematic area was access to sanitation, especially in Bangalore and Rio de Janeiro. 50 per cent stated that sanitation and the burden of disease acted as barriers to the prosperity of women in cities.
Women residing in slums require special attention. Although women in slum and non-slum areas of cities experience a similar range of challenges in relation to gender inequalities, the greater concentration of poverty in slum settlements aggravated by overcrowding, insecurity, lack of access to security of tenure, water and sanitation, as well as lack of access to transport, and sexual and reproductive health services, often creates more difficult conditions for women in trying to achieve prosperity.
More attention to women in the informal economy needed. Only a little over one-third (35 per cent) of city dwellers thought that their cities had programmes that addressed the needs of women working in the informal economy. In cases where programmes existed, almost half (48 per cent) thought that these sought to legalise informal activities, while 44 percent aimed to move informal workers into the formal economy,with a further 42 per cent feeling that these programmes aimed to improve the quality of informal employment.
National Urban Health Mission (NUHM) for urban poor launched by Health Ministry – Source: The Health Site, Jan 21, 2014
Indian Health Minister Gulam Nabi Azad Monday launched the National Urban Health Mission (NUHM) here to provide health security to the urban poor, amounting to about 200 crore people.
‘The mission envisages setting up health check-up infrastructure and create manpower for the welfare of the poor dwelling in cities and towns on the lines of the National Rural Health Mission (NRHM),’ he said on the occasion.
The central government will bear 80 percent of the cost of implementing the programme in 779 urban areas with over 50,000 population across the country by 2015.
‘Primary health centres, sub-centres, referral units will be strengthened in urban areas and manned by auxiliary nurse midwifes (ANMs). Mobile health check-up vans will visit these centres with two doctors, two nurses and a pharmacist,’ Azad said. (Read: Bangalore’s urban poor to get healthcare facilities)
About 200 million people in urban areas will have access to free healthcare.
Lauding the central government’s initiative to provide healthcare to the needy, Karnataka Chief Minister Siddaramaiah said focus should be on creating awareness towards prevention than cure.
‘Urban rich have access to healthcare facilities but for the urban poor, medical expense is beyond their means, as 17 percent of them live in slums and majority of them are migrant labourers, rag pickers and marginalised sections of society,’ he noted.
State Health Minister U.T. Khader rolled out the ambulance service ‘Nagu Magu’ dedicated to shift pregnant women to the nearest hospital and take them back to home after delivery safely. About 10 ambulances will be operational across Bangalore from Tuesday for the service.
‘We have submitted to the central health ministry a project plan to implement the mission in Bangalore, Bagalkot, Mangalore, Mysore and Ullal in the coastal area at a cost of Rs.132 crore. About 50 health kiosks will be up across Bangalore under the mission,’ Khader said.
Urban health in India: who is responsible? The International Journal of Health Planning and Management, Jan 2014.
Indrani Gupta, Swadhin Mondal. Correspondence to: S. Mondal, Quarter # B2, Institute of Economic Growth (IEG), University of Delhi North Campus, Delhi-110007, India. E-mail: firstname.lastname@example.org
Urban health has received relatively less focus compared with rural health in India, especially the health of the urban poor. Rapid urbanization in India has been accompanied by an increase in population in urban slums and shanty towns, which are also very inadequately covered by basic amenities, including health services. The paper presents existing and new evidence that shows that health inequities exist between the poor and the non-poor in urban areas, even in better-off states in India. The lack of evidence-based policies that cut across sectors continues to be a main feature of the urban health scenario. Although the problems of urban health are more complex than those of rural health, the paper argues that it is possible to make a beginning fairly quickly by (i) collecting more evidence of health status and inequities in urban areas and (ii) correcting major inadequacies in infrastructure–both health and non-health–without waiting for major policy overhauls.
Coping Strategies among Urban Poor: Evidence from Nairobi, Kenya. PLoS One, Jan 2014.
Authors – Djesika D, et al.
Abstract – Aims: In Kenya, it is estimated that 60 to 80% of urban residents live in slum or slum-like conditions. This study investigates expenditures patterns of slum dwellers in Nairobi, their coping strategies and the determinants of those coping strategies.
Method: We use a dataset from the Indicator Development for Surveillance of Urban Emergencies (IDSUE) research study conducted in four Nairobi slums from April 2012 to September 2012. The dataset includes information related to household livelihoods, earned incomes of household members, expenditures, shocks, and coping strategies.
Results: Food spending is the single most important component, accounting for 52% of total households’ income and 42% of total expenditures. Households report a variety of coping strategies over the last four weeks preceding the interview. The most frequently used strategy is related to reduction in food consumption, followed by the use of credit, with 69% and 52% of households reporting using these strategies respectively. A substantial proportion of households also report removing children from school to manage spending shortfalls. Formal employment, owning a business, rent-free housing, belonging to the two top tiers of income brackets, and being a member of social safety net reduced the likelihood of using any coping strategy. Exposure to shocks and larger number of children under 15 years increased the probability of using a coping strategy.
Policy Implications: Policies that contain food price inflation, improve decent-paying job opportunities for the urban poor are likely to reduce the use of negative coping strategies by providing urban slum dwellers with steady and reliable sources of income. In addition, enhancing access to free primary schooling in the slums would help limit the need to use detrimental strategies like “removing” children from school.
Determinants of households’ cleaning intention for shared toilets: Case of 50 slums in Kampala, Uganda
Determinants of households’ cleaning intention for shared toilets: Case of 50 slums in Kampala, Uganda. Habitat International 41 (2014) 108e113.
Innocent K. Tumwebazea, et al.
Cleaning shared toilets is important if users are to receive the signiﬁcant health, social and economic beneﬁts associated with having access to these facilities. However, achieving and maintaining hygienic toilets shared by several user households in urban slums is usually a challenge. This study assesses determinants of households’ cleaning intention for shared toilets in Kampala, Uganda. Using a structured questionnaire for the household interviews and an observation checklist, data from 1019 users of shared toilets was collected in 50 randomly selected urban slums.
Data analysis showed that most of the shared toilets are unhygienic. Less than a quarter of the shared toilets, for instance, were hygienically clean to users’ satisfaction. The main cleaning intention determinants included: importance of using a clean toilet, the effort involved in cleaning the toilet, the disgust felt from using a dirty toilet, and cleaning habits. Although it is important to have access to sanitation facilities, emphasis should be placed on how to engage users to ensure that the facilities used are appropriately cleaned and maintained.
MCHIP Launches Collaborative Document for Community Health Worker Programs at Scale, December 2013.
MCHIP is pleased to post for public comment its collaborative document for community health worker (CHW) programs at scale. This document, “Developing and Strengthening Community Health Worker Programs at Scale: A Reference Guide for Program Managers and Policy Makers,” is an in-depth review of issues and questions that should be considered when addressing key issues relevant for large-scale CHW program.
Rather than being an instructional manual, the Reference Guide is meant to provide a framework for those in leadership positions in-country as they consider how to develop, expand, and strengthen their CHW program. It is our intention to make this a “living document” that will be revised periodically as the experience and evidence grows in this rapidly expanding activity. The Reference Guide has been developed in parallel with the URC/Project ASSIST CHW Decision-Making Support Tool, which is also in the process of being released.
Nutritional Disparities among Women in Urban India. Jnl Health Pop Nutr, Dec 2013.
Siddharth Agarwal, Vani Sethi
The paper presents a wealth quartile analysis of the urban subset of the third round of Demographic Health Survey of India to unmask intra-urban nutrition disparities in women. Maternal thinness and moderate/severe anaemia among women of the poorest urban quartile was 38.5% and 20% respectively and 1.5-1.8times higher than the rest of urban population. Receipt of pre- and postnatal nutrition and health education and compliance to iron folic acid tablets during pregnancy was low across all quartiles. One-fourth (24.5%) of households in the lowest urban quartile consumed salt with no iodine content, which was 2.8 times higher than rest of the urban population (8.7%).
The study highlights the need to use poor-specific urban data for planning and suggests (i) routine field assessment of maternal nutritional status in outreach programmes; (ii) improving access to food subsidies, subsidized adequately-iodized salt and food supplementation programmes, (iii) identifying alternative iron supplementation methods, and (iv) institutionalizing counselling days.
Geographic Tools for Global Public Health: An Assessment of Available Software, 2013. MEASURE Evaluation.
There is a growing list of software options for those wishing to map data. Users in global public health often have little time or money to invest in developing the technical expertise and data required for mapping, and are therefore confronted with capacity and data constraints that can make mapping difficult to implement. This makes the process for selecting the most appropriate software especially challenging.
In this guide, the MEASURE GIS Working Group evaluates the features and ease of use of five commonly used mapping applications: ArcGIS, Quantum GIS (QGIS), Epi Info, Google mapping tools (including Google Maps, Google Earth, and the related MEASURE E2G tool), and DevInfo.
Multi-actor Approaches to Total Sanitation in Africa, Policy Brief No. 8, 2013. United Nations University.
Since the 2000s, African cities have witnessed a series of interventions to improve water and sanitation. This policy brief outlines key lessons learned from the intervention experience, drawing on the UNU research project Multi-level Urban Governance for Total Sanitation (2011–2013) under the Education for Sustainable Development in Africa (ESDA) Project. It highlights the importance of multi-actor approaches for promoting: (1) an institutional framework to coordinate civil society organizations, community-based organizations, and the state agencies across levels; (2) policy recognition of water and sanitation as socially embedded infrastructure with gendered dimensions; and (3) the relevance of scientific research and university education to ongoing policy interventions.
Improved Sanitation and Its Impact on Children: An Exploration of Sanergy. Impact Case Study No. 2, 2013.
Esper, H., London, T., and Kanchwala, Y. The William Davidson Institute.
We explore the impacts that Sanergy, a venture providing sanitation facilities and franchising opportunities to the BoP, has on children age eight and under and on pregnant women from the BoP. Sanergy designs and builds 250 USD modular sanitation facilities, called Fresh Life Toilets (FLTs), and sells them to local entrepreneurs for 50,000 Kenyan shillings (KES) or about 588 USD in the Mukuru slum of Nairobi, Kenya. Franchisees receive business management and operations training from Sanergy and earn revenues by charging customers 3-5 KES (0.04-0.06 USD) per use.
We found that Sanergy has the greatest impact on its customers’ children. Sanergy also has substantial impacts on children of franchisees and children in the broader community. The majority of impacts that occur on franchisees’ children are the same as those that occur on customers’ children. In addition, franchisees’ children benefit from the income their parents receive from owning the toilets. However, if parents take out loans to purchase the franchise, their ability to provide for their children may be reduced during the loan repayment period. Franchisees’ children are likely to have greater health benefits from using the toilets, since they are able to use them for free and as often as required, as these are located right outside their homes. Although franchisees’ children will have greater health benefits at an individual level, at an aggregate level, customers’ children will have larger health benefits since the number of franchisees’ children will always be less than the number of customers’ children.
Children living in the community surrounding the FLTs (non-customer children), experience many of the same health benefits as customer’s children as a result of improved cleanliness of the nearby environment. As more people use FLTs, a reduced amount of human waste is found on the ground, resulting in better health outcomes for children. People also begin to have an increased sense of respect for their environment. It is important to note that despite these health benefits, children are still at risk of contracting sanitation-related diseases from exposure to polluted water and other contaminated sources. The impacts we observed on the children of Sanergy’s stakeholders varied within and between the age categories of 0-5 and 6-8 years. We expect that children ages 0-5 receive greater health benefits, as they are more likely to be exposed to contaminants from crawling and playing on the ground and have more vulnerable immune-systems.
Based on the likely outcomes Sanergy has on children across its value chain, we identify opportunities that Sanergy can explore to enhance, deepen, and expand its impacts on children age eight and under and on pregnant women.
Switching Managua on! Connecting informal settlements to the formal city through household waste collection. Environment and Urbanization April 2013.
María José Zapata Campos and Patrik Zapata.
- Gothenburg Research Institute, University of Gothenburg, Göteborg, Sweden; e-mail: email@example.com
- School of Public Administration, University of Gothenburg, Göteborg, Sweden; e-mail: firstname.lastname@example.org
This paper explores the organizing of household solid waste management collection and disposal practices in informal settlements. It is based on a case study of an NGO project that supports Manos Unidas (Joined Hands), an informal waste picker cooperative in Managua, Nicaragua. Using horse carts, these waste pickers collect household solid waste from informal settlements where there was no previous regular, official waste collection.
Unlike many development projects, which try to control people’s agency, the support examined here focused on the residents of illegal neighbourhoods and the waste pickers, who themselves became city constructors and co-producers of basic services such as household waste collection rather than service recipients of aid programmes or municipal governments. By slightly changing the actions of the actors already involved in informal waste handling in the informal settlements, the project succeeded in transforming an agent of pollution into the solution to several interconnected problems, namely illegal dumping by the cart-men and residents, the cart-men’s low and irregular incomes and the lack of household waste collection services.
Health of the Urban Poor Program (HUP)
The Population Foundation of India (PFI) is assisting the central government and eight state governments in India, by leading a consortium of technical and implementation partners, in designing and implementing urban health programs, under the USAID-funded Health of the Urban Poor (HUP) program. The PFI-lead consortium works towards strengthening the planning and monitoring systems to deliver innovative models of healthcare, especially maternal, neonatal and child health services (including choices of family planning), while integrating the other determinants of health (nutrition, water, sanitation and hygiene), for the urban poor. These interventions are designed within a larger governance and convergence framework, in partnership with the available private and non-government sector, and supported by effective community engagement at the slum level.
The Health of Urban Poor (HUP) project strives to support, strengthen, and improve Government of India’s comprehensive package of maternal and child health services, and nutrition interventions, including promotion of water supply, sanitation and hygiene services in urban slums. HUP provides technical and capacity -building support to government of India, state governments, local self-governance institutions, line departments, and local civil society organizations to design and implement comprehensive health programs for urban poor in eight states.