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.
What’s going wrong?New social, political and economic forces are exacerbating pre-existing inequities, argues The Charter. This is eroding democracy and public systems. This includes unethical and exploitative private sector action. At the same time, multilateral systems – like the UN bodies that exist to protect our rights – are losing their teeth. Unfortunately, the research world is often a part of the problem:
Dominant practices of evidence-based policy making trivialise the lived experiences of ordinary people. Prevailing approaches favour aggregate data over more complex narratives that better represent the lived reality of marginalised people.
COPASAH vision for the futureSignatories to the Charter pledge to ensure that marginalised communities have access to accountability systems and to the promotion of solidarity, empowerment and leadership. Collective action is key to this, and the leadership of women and other disadvantaged people. The Charter outlines a vision where adequately supported public services meet the needs of the marginalised. At the same time it argues that the private sector should be regulated, transparent and accountable. We should build a system where profit does not trump the rights of the people. Both communities and health workers play a key role in providing health care. But they are often overstretched, working under pressure and blamed for weaknesses in the system. The Charter suggests that we must work together – taking our lead from the most marginalised – to monitor weaknesses in accountability systems and collectively press for change.
What next?The Call to action in the Charter provides detailed guidance to researchers on their methods and more general engagement with communities. It urges research bodies to promote community participation and ensure the work is led by community priorities. As a result new knowledge should support communities in their struggles for accountability and the realisation of the right to health. Many thanks to Ravi Ram (Kenya) and Aminu Magashi Garba (Nigeria) for their insightful presentations and for all COPASAH members for their inputs into the Charter and the Call for Action.