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Building Forward Better Inclusive Livelihood Support in Nairobi’s Informal Settlements

Building Forward Better: Inclusive Livelihood Support in Nairobi’s Informal Settlements

For the large population living in Nairobi’s informal settlements, the long-term effects of COVID-19 pose a threat to livelihood, health, and wellbeing. For those working in the informal sector, who are the lifeblood of the city, livelihoods have been severely supressed by COVID-19 restrictions such as curfews, pushing many into further poverty. This article draws on community data, meetings, and authors’ observations as community organisers, to explore the challenges posed by existing government responses from a community development perspective. We found that poor accountability structures and targeted income support only for the ‘most vulnerable’ exacerbates tensions, mistrust, and insecurity among already vulnerable communities. We draw on a rapid desk review of existing literature to argue that community-led enumeration to validate entitlement claims, improved accountability for distribution, and widening income support is required to build solidarity and improve the future resilience of these communities.

Kimani J., Steege R., Makau J., Nyambuga K., Wairutu J and Tolhurst R (2021) Building Forward Better: Inclusive Livelihood Support in Nairobi’s Informal Settlements, IDS Bulletin, Vol. 52 No. 1 (2021)

Covid-19 Response and Protracted Exclusion of Informal Settlement Residents in Freetown, Sierra Leone

Covid-19 Response and Protracted Exclusion of Informal Settlement Residents in Freetown, Sierra Leone

Freetown has over 1 million residents, many of whom live in about 68 crowded informal settlements. Residents of these settlements struggle daily to access basic services such as water, sanitation, and health-care services. We found that the government’s COVID-19 response measures (curfews, lockdowns, and travel restrictions) excluded informal residents from contributing to its design, and the implementation of these measures prevented these residents from accessing basic services. Like the urban planning processes in Freetown, the COVID-19 response planning was done with the limited inclusion of informal residents, and not considering how these response measures would affect their livelihood priorities. The economic conditions of already vulnerable people such as those living with disabilities, beggars, and women heads of households worsened as a result of these measures. While these challenges were dire, communities were resilient in reversing the spread of COVID-19 through tailor‑made messaging and by supporting the most vulnerable with food and basic needs. In this article we argue that the inclusion of the urban poor in decision-making and urban planning processes can improve service delivery and their ability to cope with health shocks.

Conteh A., Sirah Kamara M., Saidu S. and Macarthy JM. (2021) Covid-19 Response and Protracted Exclusion of Informal Settlement Residents in Freetown, Sierra Leone, IDS Bulletin, Vol. 52 No. 1 (2021)

Strengthening networks and alliances Story of Change

Strengthening networks and building alliances to improve health and accountability in informal urban spaces

One in three urban dwellers now live in precarious, marginalised areas, including informal spaces; this is an estimated 881 million people in low- and middle-income countries. People living and working in informal urban spaces face interconnected challenges, including multiple intersecting health risks and vulnerabilities, and complex, fluid governance arrangements, involving a mix of actors, with often longstanding neglect from state institutions. Social accountability strategies toward improving health and wellbeing of people living and working in informal settlements need to catalyse state responsiveness; create ‘actionable’ and targeted information flows and interfaces between state and citizen actors; and build collective citizen networks and state capacities and incentives for action and mutual learning.

To generate new knowledge, the ARISE approach focuses on harnessing the capacities of urban marginalised people to identify, analyse and communicate their experiences of intersecting inequities, wellbeing, health and governance, and to build alliances for new governance arrangements. ARISE aims to collaboratively develop and pilot social accountability strategies for equity, equality, and wellbeing by working with local stakeholders, with support from researchers in study sites.

One strategy to support change adopted by ARISE is to facilitate meetings and dialogue between marginalised people, policy makers and governance allies. In study sites located in Kenya and India, ARISE research partners have strengthened networks between community-based organisations (CBOs), non-governmental organisations (NGOs) and governance actors in health. The CBOs and NGOs act as intermediaries between urban marginalised communities and formal governance allies. Stronger relationships between the intermediary networks have underpinned a joint understanding of challenges faced by people living and working in informal spaces and enabled pathways for increased representation of the priorities of urban marginalised people in approaches to urban development and health and wellbeing interventions.

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Improving safeguarding in ARISE Story of Change

Improving safeguarding in the ARISE Hub and beyond

Much of the current discussion on safeguarding comes from the perspective of the humanitarian sector, and direct service provision and implementation. Additionally, researchers working in global health also experience safeguarding challenges, and research funders and donors require assurance that safeguarding processes and policies are developed and implemented to protect participants and researchers, yet governance in the research arena is less developed. Recognising the critical importance of safeguarding in research practice, ARISE Hub partners from five countries have united to collectively learn from each other and co-develop understandings of, and approaches to, safeguarding that will continue to evolve. Institutional systems and processes provided an opportunity for mutual learning among all ARISE Hub partners, in the North and the South. However, the process itself produced multiplier effects, with ARISE Hub experience and knowledge influencing safeguarding guidance and policy beyond the ARISE project in the UK, India, Sierra Leone, Bangladesh, and Kenya.

The ARISE hub learning shows how safeguarding should not be seen merely as a procedural check box process. As such, safeguarding is more than awareness raising and more than
reporting of incidences. Instead safeguarding must be an iterative, ongoing learning journey that is critical, reflective, and inclusive of vulnerable people. It also involves regular points of reflection on what was done in relation to a particular incident, why this response was considered most appropriate, what unintended consequences, if any, arose from particular responses, and what lessons might be learnt from this.

This story of change demonstrates that ARISE has lived up to the promise of safeguarding being an iterative, ongoing learning journey.

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ARISE co-researchers Story of change

ARISE co-researchers: Working collaboratively to build capacity

One of our core strategies to affect change is to support capacity strengthening of urban marginalised co-researchers to generate, collect, and use evidence as new localised knowledge to instigate change.

Strengthening capabilities of urban marginalised people to engage with research processes is central to the principles of CBPR and meaningful participation of marginalised communities. ARISE envisions that strengthening co-researcher capacities built using a CBPR approach to generate new knowledge can contribute to enabling pathways to impact, such as co-production of plans to improve health and wellbeing with both formal and informal governance allies.

Community-based participatory research (CBPR) lies at the heart of the ARISE approach to catalyse a step change in approaches to improving accountability and promoting the wellbeing and health and of urban marginalised people living and working in informal urban spaces. The ARISE approach focuses on harnessing and strengthening the capacities of urban marginalised people to identify, analyse and communicate their experiences of intersecting inequities,
well-being, health and governance, and to build alliances for new governance arrangements.

ARISE anticipated outcomes focus on achieving changes in relationships, action and understanding. In all action sites, ARISE has recruited community members as ‘co-researchers’,
who are partnering with professional researchers and community development organisations across all stages of the research process, including collecting and analysing data from group participatory methods and Geographic Information Systems (GIS) mapping. This Story of Change highlights emerging outcomes of this process in Dhaka, Bangladesh and Freetown, Sierra Leone.

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Exploring gender, health, and intersectionality in informal settlements in Freetown

Exploring gender, health, and intersectionality in informal settlements in Freetown

This paper applies an intersectional lens to health in informal urban settlements in Freetown, Sierra Leone. We explored how intersecting social characteristics including gender, age, wealth, occupation, and tenant status influence health and well-being outcomes. We found that hazardous environmental conditions, poor waste disposal, and waste burning contribute to health problems at a neighbourhood level. Health-care access was also generally poor in informal settlements. However, beyond this, there were differences in people’s experiences of coping with health burdens and accessing care. Against a backdrop of limited state support, coping and access strategies were found to be heavily mediated by people’s social positions and status, especially their ability to draw on support from social networks. There are particular challenges around the management of prolonged health problems. For population groups such as the old and the chronically ill, this creates further vulnerabilities including social isolation, stigma, and cycles of poverty. Although intersecting power dynamics apply to men too, women are particularly disadvantaged by coalescing social inequalities: they are both expected to perform caring roles but are less likely to be cared for. Young and old women were especially vulnerable and reliant on external support or self-sacrifice. This paper contributes to knowledge gaps in intersectional dynamics in urban settings and provides evidence that suggests policy shifts are needed to address the multiple social and health inequalities faced by women in informal settlements in Freetown, Sierra Leone.

Abu Conteh, Annie Wilkinson & Joseph Macarthy (2021) Exploring gender, health, and intersectionality in informal settlements in Freetown, Gender & Development, 29:1, 111-129, DOI: 10.1080/13552074.2021.1885215

Kenya team working

A second letter from Kenya to UKRI

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The UKRI research budget is facing cuts that may affect our ability to continue with work within ARISE. Our team in Nairobi, Kenya from LVCT Health reflect on what potential reductions in the budget for this work means on the ground.

Before COVID-19 many people did not understand why we have to address the health and social needs of slum dwellers and how their poor health affects all of us. With the pandemic, it became a worry when it was thought that COVID-19 would spread rapidly due to poor ventilation and lack of water and sanitation in slums resulting in widespread deaths.

A COVID-19 response that included lockdowns and curfews highlighted the vulnerability and desperation of the situation in slums which have chronically lacked water, sanitation, ventilation and other amenities. Gender-based violence emerged as a real and present danger as reports of women and girls being raped on their way to the outside toilet at night or being abused in their houses by their newly unemployed partners. The government prioritized identification of the vulnerable but discovered that data on these groups was lacking.

ARISE – a UKRI funded research project – identified vulnerability and marginalization as a key challenge that would limit attainment of the Sustainable development goals (SDGs) even prior to COVID-19. Through ARISE in Kenya, partners had begun to identify the most vulnerable and marginalized within slums (even though most slum dwellers are disadvantaged, some are worse off than others). This information proved to be critical to the county government when the identification and registration of the vulnerable in slums by the government begun.

LVCT work in ARISE has involved identifying, following and working with the poor elderly, people with disabilities and child headed homes who emerged as extremely vulnerable to document their lives in visual form using photos (photovoice). The stories are aimed at showing the county government, NGOs and other community members their day to day lives, the struggles they go through ensuring that interventions involve them and are evidence based.

Story One

Alice working at the dumpAlice is a 17 year old girl. Her mum is bedridden so she is the breadwinner for her mother and younger siblings. She is forced to work in the dumpsite and wash clothes in people’s homes to buy food which affects her ability to go to school. As a young girl she is easily verbally abused or not paid when she goes to wash clothes in people’s homes.

 

 

 

 

 

 

 

Story Two

Beatrice and the trench“I took a photo of that trench because of the blind and old people like myself because an old person cannot be able to jump across it. It is a danger to the old and it is problematic to me because I use this route often as I go to the shop. The sewerage that passes through there is also hazardous,” Beatrice a 78 year old woman.

 

 

 

 

 

Making an impact

Our work in ARISE Kenya has been of great utility to the Kenyan Government (Nairobi Metropolitan Services) by providing empirical and systematic approaches for identifying marginalized and vulnerable people to benefit from government funded social assistance programmes.

In March 2021, the Nairobi Metropolitan Services (NMS) initiated a mapping of vulnerable households for purposes of enrolling these households into the Universal Health Coverage (UHC) programme. At the same time, the NMS needed to know and map people that are most vulnerable to economic shocks due to the COVID-19 pandemic. NMS urgently required concrete and empirical evidence/approaches for identifying people that would benefit from publicly funded social assistance interventions. Lessons from the community based participatory research approaches by ARISE Kenya were taken up by NMS decision-makers to tailor the kind of assistance provided to these vulnerable groups in the slums.

All this has only been possible due to funding from UKRI and our partnership with LSTM to carry out research that is relevant, high quality and timely. Cuts to development research mean that work that looks beyond the surface and ensures investments by low- and middle-income countries are evidence based and relevant suffer. Gains made towards achieving the Sustainable Development Goals will be lost and even reversed.

We urge the UK government to reverse the decision to cut funding to international development research.

 

 

Lilian of LVCT Health and Blessing of APHRC with a member of the community during a group assignment in Kenya

A letter from Kenya on the impact of the potential UKRI funding cuts

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The UKRI research budget is facing cuts that may affect our ability to continue with work within ARISE. Our team in Nairobi, Kenya from APHRC – Blessing Mberu and Caroline Kabaria – reflect on what potential reductions in the budget for this work means on the ground.

Now and into the foreseeable future, Sub-Saharan Africa is expected to have the highest rates of urban growth of any major region, and with its cities already having the highest proportion of slum-dwellers and urban poverty, the policy challenge for solutions remain enormous.

As cities continue to attract excess rural populations and people looking for economic opportunities, slums’ share of the urban population will continue to grow, particularly in fast developing and low-income countries where the rate of urbanization exceeds urban systems’ ability to scale services. One key feature of African urbanization is the associated degradation in human dignity engendered by intra-urban inequities.

Significant investments in evidence generation and policy and programmatic interventions will be needed in the coming years if sustainable urban living is to be achieved.

In seeking answers to these challenges, the ARISE Hub funded by UKRI provided a unique opportunity to begin the measurement and documentation of these issues through a spectrum of research methodologies and equitable collaboration among various global Northern and Southern experts.

Data gaps in urban informal settlements

Several key questions arising from past and future research investments relate to how to achieve improved health and economic outcomes for the urban poor. What particular interventions work and which did not? Answering these questions and taking adequate stock, require appropriate data at the local levels. The importance of local-specific data systems is reinforced by the limitations of global and national level data sets, which generally produce national indicators that blur inter and intra sub-group inequities and often lack aggregation at local levels, where the needs are located

To address this gap, the ARISE Hub in collaboration with African Population and Health Research Center  collected and documented evidence to inform policy and action in Kenya. This is informed by the perspective that sustained significant investments in data systems at local levels will be an important component of the push to address urban challenges, especially in monitoring and evaluation of interventions and in determining what works for specific sub-groups of the urban population, including migrants, refugees, asylum seekers, non-migrant and several vulnerable sub-groups. This work which has taken place in the last two years may be jeopardised if the UKRI funding cuts did not exempt and protect such efforts.

The importance of participation

As part of the search for pathways to address urban inequities, promote inclusive urban development and build resilient and healthy cities in Africa, our Hub has set up research infrastructure that have employed public participation methodologies, including community recruited co-researchers in the co-identification and definition of community problems.

Our approach supports communities to be active drivers of the charge towards the promotion of equity, security, health and well-being in informal urban settlements. This is the process of working with marginalized people living in poverty in informal settlements to create strategic alliances for collective action to demand rights, and improved accountability and responsiveness of services to promote health and wellbeing. It involves the convening of fora that enable dialogue and build coalitions of residents of informal urban settlements, formal and informal actors and service providers to set priorities, co-develop, and test actions for change in accountability, promote service provision and system responsiveness.

This model research engagement is being shaken and may be aborted if the funding cut announced by the UKRI are not reversed or in the worst-case scenario, affirmatory and protective initiatives of such unique outreaches and engagements on behalf of the British people and Government are not undertaken.

Supporting students

Linked to this agenda is capacity building at Masters and Doctoral degree levels together with exchanges and collaborations to develop a critical mass of African and Africanist and young Global South researchers that will continue to champion evidence generation, knowledge management and evidence-based advocacy for cities, citizens and governance through the 21st Century and beyond. This program, has kicked off to a great start and enthusiasm with up seven Doctoral and two Masters Students from India, Bangladesh, Kenya and Sierra Leone, all whom are registered at Liverpool School of Tropical Medicine.

For ARISE this typifies the evidence of collaboration and equitable global partnership, which was a set goal under the grant. The danger to this initiative is looming under the UKRI proposed funding cuts and the opportunity cost to global health and UKRI and LSTM’s contribution in capacity building for public health will be significant and will be a very great lost opportunity.

To conclude, as we strive to make cities and human settlements inclusive, safe, resilient, and sustainable we will require sustained investments informed by credible local scientific evidence. It is important to develop and implement tested, context relevant service delivery models that engender inclusiveness and address intra-urban inequities. Identifying and promoting empowerment of communities as active drivers in the vision of co-creation of development, sustaining past and future investments in data collection, evidence generation at local levels and capacity building at graduate levels will need to be prioritised, protected and sustained.

SPARC

A second letter to UKRI from India

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WE HEARD WITH DISMAY THAT THE UKRI RESEARCH BUDGET IS FACING MASSIVE CUTS. OUR TEAM IN INDIA WANTED TO DEMONSTRATE SOME OF THE WAYS THAT UKRI FINANCING HAS MADE A DIFFERENCE AND WHAT WILL BE LOST SHOULD IT BE TAKEN AWAY.

By Vinod Rao

Legacy health problems related to poverty, such as tuberculosis, are a focus area of ARISE. SPARC and TGI, the India teams of the hub, are working together on the systemic issues associated with the magnitude of the burden and the threat posed by this disease that seems inseparable from poverty. SPARC and TGI are working with local organisations that are embedded in disadvantaged communities, and engaging in participatory action research, to facilitate, support, and demonstrate a community health approach to tackling a longstanding public health problem by addressing some systemic issues.

Health in the colonies

Relocation colony in AhmedabadFrom May to July 2020, supported by ARISE, SPARC undertook a series of phone interviews with residents in living in relocation colonies and informal settlements across Mumbai (including ARISE study sites). The interviews aimed to understand the perception of residents about the COVID-19 health crisis, Government and local response to the crisis, and experiences of lockdown.

 

 

The interview findings helped the federations understand the prevalence of co-morbidities and, consequently, ARISE-supported federations working with SPARC offered direct nutritional support to 150 families with members who have serious health conditions, including tuberculosis (TB). These families had been severely affected by COVID-19 movement restrictions, which limited both livelihoods and access to clinical treatment.

In August to November 2020, inspired by ARISE and its work on the health of informal settlement residents, SPARC and its federations conducted a survey of over 4,000 families living in 13 locations in Mumbai informal settlements and relocation colonies. Mahila Milan approached SPARC for support to develop the questionnaire, collect data, and conduct analysis. The survey locations included ARISE action sites as well as other relocation colonies and slums, predominantly in M-East ward.

Relocation Colony at Natwar Parikh Compound MumbaiThe survey inquired about co-morbidities in the wake of COVID-19, as well as food security and access to food. Both activities led to an increased awareness among the federations that TB, which reduces the access to basic needs of affected households, is a pressing issue for informal settlement residents. Health problems are often seen as a private rather than a collective issue, resulting in hesitancy to share information. A resident from Indian Oil Colony said:

“When we surveyed, very few people reported having TB, but as soon as we announced that we wish to assist with food during the lockdown to families having someone with severe disease, there was a flurry of requests. So, we have to change the way we involve people for their health problems.”

 

 

These reflections led federations to engage with District Tuberculosis Officers, municipal actors, and elected representatives to understand how they might support efforts to reduce the spread of TB and address the challenges faced by residents living with TB.

The importance of funding from UKRI

This coming together to the improve the living conditions of disadvantaged populations in urban informal settlements, was possible only because of the constitution of the ARISE Hub supported by UKRI. The proposal to slash funds for such work in low- and middle-income countries will adversely impact the scale and the impact of the project, leaving the participating marginalised communities in the lurch, and engendering a loss of faith and confidence with the partner civil society organisations that will negatively influence the work they may take up in the future.

The India team hopes that resources will still be made available to fulfil the commitments to improving health systems for the marginalised communities.

Garbage collection in Shimla

A letter to UKRI from India

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WE HEARD WITH DISMAY THAT THE UKRI RESEARCH BUDGET IS FACING MASSIVE CUTS. OUR TEAM IN INDIA WANTED TO DEMONSTRATE SOME OF THE WAYS THAT UKRI FINANCING HAS MADE A DIFFERENCE AND WHAT WILL BE LOST SHOULD IT BE TAKEN AWAY.

By researchers at the George Institute for Global Health, India

Addressing gender in waste picking communities

Door to door garbage collector in Shimla

May 2019 marked the beginning of our association with waste workers (sanitation workers, and door-to-door garbage collectors) in Shimla, Himachal Pradesh, India. Initially, most of our interactions were restricted to men waste workers, who often occupied positions of leadership within their unions, and/or administrative positions within the municipal corporation. Women waste workers were rarely ever visible and continued to remain at the margins. Often, their absence from these discussions was explained away on the basis of their household responsibilities, low credibility, and lack of literacy, education, and awareness.

ARISE has enabled us to address gender deficits and create equitable spaces within the communities, in order to amplify the voices of women waste workers. We are also in the midst of planning training on gender, leadership, and health for the community members.

The ARISE Hub, through sustained funding from UKRI made it possible for us to form enduring relationships with women waste workers, start an open dialogue with them, and better understand their lived realities, paving the way to collaboration for improvements in their living and working conditions. Funding cuts will jeopardise this progress, and worse, may reverse the gains made.

Skill-building on education for waste picking communities

DBRC training

Dalit Bahujan Resource Centre (DBRC) is a civil society organisation working for the socioeconomic and cultural transformation of marginalised communities, including waste pickers. The ARISE TGI team has partnered with DBRC to work for the health and well-being of these communities.

Waste pickers view the education of their children as the principal means of breaking the cycle of poverty and drudgery, and as a pathway for better health and well-being.

The pedagogy and curriculum have not accomplished the goals of education. Nearly 60% of children in grade 5 in government schools, and 40% in private schools cannot read a text of grade 2. Further, they are not conducive to learning by first generation learners: A large proportion drop out of schools.

The ARISE TGI team conducted skill-building sessions for DBRC staff engaged in education activities, on how to create an open and fun learning environment to enhance aptitude for learning in children.

The UKRI funding cuts will adversely affect the capacity-building of DBRC staff to facilitate better learning by children, and thereby the development of the waste picking communities.

Nutrition, health, and well-being of waste picking communities

Children eating

ARISE Hub has partnered with Hasiru Dala (HD), a civil society organisation that works towards the socioeconomic development of waste pickers by advocating for their integration in the municipal solid waste management system.

When the COVID-19 lockdown was eased to facilitate some movement, HD found that the majority of the children, in a settlement of waste pickers, were moderately or severely malnourished. HD, and allied civil society organisations, and ARISE, took the matter up with local authorities and other stakeholders to seek action. The alliance facilitated access to the public distribution system, for subsidised food grains, for families that lacked this access. Further, children, who hitherto had had no access to the pre-school nutrition and child immunisation programme of the government, received assured supplies of food grains and nutritional supplements through the centres delivering this programme. Regular interactions with community members are ongoing to explore the food practices of the communities, and facilitate the availability of culturally appropriate food for the communities, particularly children.

After-school education programmes and therapeutic play sessions for children have been instituted to address the effects of systemic oppression and discrimination on children, and prevent school dropouts. Other determinants of health and well-being that need to be addressed are the provision of safe drinking water and toilets in the settlement. Recovery from undernutrition is a long and intensive process requiring frequent follow-up, community level facilitation for feeding, improving health through participation, and funding to sustain the programme.

UKRI funding cuts will seriously undermine the efforts made so far, and set the community back in its path to better health and well-being.

Building exciting linkages beyond ARISE

Delhi Roundtable Leadership Training for wastepickers

The ARISE India Team participated at the Delhi Roundtable Leadership Training for waste workers in New Delhi, organised in collaboration with the People’s Health Movement, India, and Women in Informal Employment: Globalizing and Organizing (WIEGO) on 6 February 2021. Reflections from the three ARISE hub project sites in India were presented.

The leadership training session included insights into the health and well-being of the waste workers, the marginalisation of waste workers despite their centrality to the waste economy, the apathy of the state, and ways in which workers can be community leaders.

The session also included some specific concerns regarding women waste workers and the urgency of gender-sensitisation training in the community.

The ARISE team built a conversation around the livelihood of the waste workers and their immediate health and well-being concerns. Participants articulated certain demands that they would later put forward to government authorities, e.g. regular health check-ups to safeguard them from occupational health issues.

The session drew attention to the differences among waste workers from different cities. E.g. in Bengaluru, workers were able to access affordable, hygienic food from government canteens. These discussions also gave the participants ideas to take back to their community.

The ARISE TGI team, funded by UKRI, has been able to go beyond the project boundaries and engage with communities with shared concerns, maximising the social impact  of the work. UKRI funding cuts will limit experiences and best practices to share, and negatively affect the outreach capacity of the team.

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