Accountability in Urban Health
“More than half of the world’s people live in cities, with one in three of those living in low- and middle-income countries doing so in informal settlements, sometimes known colloquially as slums, with inadequate access to services and opportunities to shape decisions about their environment. Our research will support the people in our focal communities to claim their right to health.”
Professor Sally Theobald, Liverpool School of Tropical Medicine, Principle Investigator, ARISE
Around the world, the number of people living in cities is growing rapidly. Transforming the lives of vulnerable people in informal urban settlements is vital to accelerate progress towards the Sustainable Development Goals (SDGs). This entails tackling complex, interrelated challenges of poor health, unequal access to services, insecurity and weak accountability. Rigorous research and evidence, combined with community engagement and ownership, must inform these efforts.
The ARISE Hub – Accountability and Responsiveness in Informal Settlements for Equity – is a new research consortium, set up to enhance accountability and improve the health and wellbeing of marginalised populations living in informal urban settlements in low- and middle-income countries.
Living among hazardsFreetown, the capital of Sierra Leone, was planned by the colonial government to accommodate 300,000 residents. Currently, its population is 1,055,964 – three times the original population the city was planned for over 50 years after independence. This situation has been caused by rural-urban drift necessitated by the search for greener pastures. This was further exacerbated by the 10-year civil war that saw a significant movement of the rural population to Freetown seeking security and survival. Most of this population have found themselves occupying ‘hazard’ spots and they cannot afford to rent better housing facilities. Compounding their challenging situation, is their exclusion from social services and employment opportunities, as the available utilities are already overstretched. The FEDURP/CODOHSAPA settlement profile report of 2015 found that approximately 35% of the entire Freetown population lives in hazardous informal settlements.
Supporting local governmentMayor Yvonne Aki-Sawyerr’s request came about at a meeting she convened to discuss ways to mitigate flooding in the middle of the rainy season. It was already becoming clear that the most affected places were neighbourhoods on dumpsites – CrabTong/Kolleh Tong/Gray Bush and Kingtom fell within this category. Her hope was to relocate these settlements to avert a looming catastrophe and to make way for a waste management pipeline. In response to the Mayor’s request, FEDURP/CODOHSAPA leadership engaged with her office to understand the model of relocation. They agreed to assist if internationally accepted best practice on relocation was respected. The Mayor affirmed her commitment to respecting these protocols. A plan was initiated, which included joint community consultations to seek community consensus, community mapping and enumeration by FEDURP/CODOHSAPA, provision of a comprehensive financial package for affected occupants and demolition of structures. FEDURP/CODOHSAPA also committed to broker a consensus with the community since they are a trusted partner.
Community engagementGoing forward, a FEDURP/CODOHSAPA data team was constituted and engaged. Existing mapping and enumeration tools were customised to reflect this specific action. Following that, an initial joint community meeting with Freetown City Council (FCC) authorities was convened where the intended plan to relocate residents was disclosed. We explained that the mapping and enumeration exercise would take place to inform the relocation process. While undertaking the mapping and enumeration exercise, one respondent said this:
We are only cooperating because of FEDURP/CODOHSAPA, so please make sure FCC honours its commitments otherwise you will be held responsible and we will conclude that you have compromised our values and solidarity.For FEDURP/CODOHSAPA, this was a strong message, as this was the first collaboration with FCC to effect relocation procedures and it put our relevance in the communities to the test.
Community entitlementsBased on the data we collected, learning gleaned from an exchange with colleagues in South Africa and consultation with the FCC the following actions were recommended:
- Shack owners have their structures evaluated and paid for in full
- A year’s rent will be offered to tenants which they can use to relocate and rent in a safer settlement of their choice
- Tenants will be offered a minimum grant to kick start their livelihood in their new settlements
What did we learn?Connecting the pieces of this process together, key lessons learned include the following:
- The outcome of this process is a proof that ‘information is power!” FEDURP/CODOHSAPA’s data collection practices provided the leverage for a progressive partnership with, and trust between, the community and FCC, which has now been translated into “knowledge for action.”
- Involving communities in all phases of any development process stimulates sense of ownership. There are no indications of any resistance from the residents. In this case, the role of FEDURP/CODOHSAPA has been very critical in brokering a consensus, which shows how relevant it is as a social movement in fostering community solidarity.
- International exchange learning for slum dwellers and informal settlers is an important tool for capacity and knowledge building. The South African experience shared with and accepted by FCC has proven to be effective.