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Visual Essay: Scaling the physical address system to Mathare 4B settlement

This visual essay by Jacob Omondi and Sarah Ouma explores the impact of introducing a physical addressing system in Mathare 4B settlement in Nairobi, Kenya, highlighting the contributions of young people and women, and how this initiative enhances healthcare delivery. Through participatory settlement profiling and visual storytelling, we illustrate how community-led efforts and the integration of physical addresses can help tackle urban challenges and improve access to essential services.

The 4B physical addressing system

Imagine living in a community where finding your way to someone’s home feels like solving a puzzle, especially during emergencies? For many residents of informal settlements the lack of a physical address isn’t just an inconvenience, it’s a barrier to life-saving services. Recognising this challenge, SDI Kenya and Muungano wa Wanavijiji, with the support of ARISE,  partnered with the community in 4B to implement a physical addressing system that has transformed how services are delivered and accessed.

This system has already brought profound change, especially for community health promoters (CHPs) and waste pickers, whose daily work depends on efficient household access. For CHPs, the system has made it easier to deliver vaccines, conduct door-to-door health visits, and respond swiftly to emergencies. Vulnerable individuals are now identified and attended to without delay, ensuring that children receive timely immunisations, chronic conditions are monitored, and emergencies like childbirth are managed effectively.

For waste pickers, the addressing system has revolutionised waste management in the settlement. Groups like the Mathare River Adoption Group now use the system to organise door-to-door waste collection, achieving near-total coverage of households. This approach has drastically reduced illegal dumping into rivers, roadsides, and drainage systems, promoting cleaner streets, better recycling practices, and a healthier environment for all residents.

The benefits extend far beyond health and waste management. Ambulances now navigate the settlement with precision, cutting down critical response times in medical emergencies. Firefighters can locate and respond to outbreaks swiftly, potentially saving lives and property. Lost children are reunited with their families more quickly, and during natural disasters like floods, rescue teams can prioritise aid for the most vulnerable areas.

By introducing this system, the settlement of 4B has moved from invisibility to inclusion, becoming a model for sustainable urban development. This project highlights how community-driven innovations can restore dignity, improve accountability, and connect informal settlements to essential services

The role of youth in transforming Mathare 4B

Health is not just about surviving, it’s about thriving. Yet for communities in informal settlements like Mathare 4B, thriving often feels like an uphill battle. With uncollected waste, floods, extreme heat, limited healthcare services, and widespread poverty, residents face challenges that directly impact their well-being. Access to quality healthcare remains a distant dream for many.

In the face of these obstacles, a new generation of changemakers is emerging. Through SDI Kenya, Muungano wa Wanavijiji, and the ARISE Hub, the youth of Mathare 4B have become central to transforming their community.

Young people are driving the effort to improve both waste management and health. These young people, full of energy and creativity, bring local knowledge and leadership to the forefront. By working alongside community health promoters and waste picker groups, they address sanitation issues that contribute to poor health.

Beyond sorting and recycling waste, young people played a key role in installing the physical addressing system, which has improved service delivery and emergency response in the area. They’ve also led efforts to raise awareness about the impact of waste management on health, creating a culture of responsibility.

This approach addresses immediate needs and also creates a foundation for long-term health and safety improvements. By reducing pollution and preventing disease, the youth are able to contribute to the  creation of a healthier, safer environment for everyone in Mathare 4B. In this community, the youth aren’t just participants but architects of change.

Slum Going Green and the Mathare River Adoption Group participated in a river cleanup along the Ngong River, as part of the circular economy exchange on transforming waste into a physical address system. Photo courtesy of KYCTV.

Women’s empowerment

At the core of everything SDI and Muungano wa Wanavijiji do is a deep commitment to women’s empowerment. Through ARISE, they set out to support young girls and women in Mathare and other informal settlements, helping them gain the skills and confidence to change their lives. SDI Kenya and Muungano wa Wanavijiji played a crucial role in identifying women from these settlements to undergo training, ensuring that those who needed the opportunity the most were given the chance to succeed. A powerful partnership with Buildher, an organisation that trains women to become artisans in the construction industry, brought this vision to life.

This collaboration wasn’t just about providing skills, it was also about creating real, lasting change. The young women from Mathare who joined Buildher’s programs gained hands-on experience and new opportunities to reshape their futures.

One of the most impactful outcomes was the production of the physical address number plates used in the first phase of the addressing system installation in Mathare, Kiamutisya. These women, who once faced limited opportunities, were now the ones crafting the very system that would help their community access vital services and improve daily life.Blending women’s empowerment with real, community-driven change created a ripple effect, putting women at the forefront of transformation. Working with Buildher has shown that when you invest in women, you’re not just changing their lives, but you’re lifting up the whole community.

Young women from Mathare informal settlement creating a physical address system at the Buildher warehouse. Photo courtesy of KYCTV.

Youth-led research

The journey to establish the physical address system in Mathare 4B wasn’t just about maps and numbers, it was a collective effort, fueled by the energy and passion of the community. It started with a simple yet powerful task: to walk through the settlement, map every home, and gather the stories of the people who live there. It wasn’t easy, but every step was taken with the hope of creating something that would truly serve the community.

At the heart of this process were the community co-researchers, many of them young people from Mathare, who stepped up to play a vital role. They worked hand-in-hand with village elders from Nyumba Kumi, tackling resistance and helping the community embrace this new initiative. The youth brought fresh energy, new ideas, and a deep understanding of what their neighbors needed. Together with guidance and support from SDI Kenya and Muungano wa Wanavijiji, they made sure that the information gathered was accurate, detailed, and, most importantly, meaningful.

But it wasn’t just about collecting data. It was about creating something that felt like it belonged to the community. Residents, especially the youth rolled up their sleeves and got involved in designing unique addresses for each home. This wasn’t just a system on paper; it was a reflection of who they were. Everyone’s voice mattered, and by weaving in their ideas, they built a system that felt truly theirs, one that fit their needs and reflected their identity. It was a process that sparked a sense of pride, ownership, and connection among everyone involved.

Youth conducting a profiling exercise in their settlement, to count the total number of households.

Peer learning

Peer learning is so powerful because when communities come together, they share ideas, learn from each other, and find innovative solutions to their challenges. This approach was brought to life when groups actively involved in waste management from Mathare had the chance to visit nearby settlement Kibera to learn how to tackle one of the most pressing issues in informal settlements: waste and its impact on health.

The exchange between the youth groups in Mathare and Kibera was more than just an opportunity to share knowledge, it was a transformative experience. The Mathare team observed firsthand how effective waste segregation, recycling, and composting practices can change the game when it comes to reducing health risks. One of the standout lessons was learning about the Black Soldier Fly method for managing organic waste, something that had a powerful impact on how they thought about waste as a resource, not just a problem.

But the lessons went beyond waste management. The Mathare group saw how Kibera’s community came together for more than just cleaning up the environment, they observed the power of group savings initiatives and how collective action could spark economic empowerment alongside environmental sustainability. This was more than just about waste; it was about creating a healthier, more resilient community.

With these invaluable lessons in hand, the Mathare team went home equipped with new techniques, and fresh mindset on how collaboration, innovation, and community-driven efforts can tackle the challenges that informal settlements face every day, ready to bring those ideas home and continue the work of transforming their own community.

Peer to peer exchange between Slum Going Green Kibera and youth from Mathare. Picture courtsey of KYCTV.

Launch of the physical addressing system

In November 2022, the residents of Mathare 4B gathered at Upendo Grounds to celebrate a milestone that would forever change their community, the launch of their new physical addressing system. This wasn’t just the unveiling of a project, it was the culmination of hard work, collaboration, and a shared dream to solve long-standing health challenges in the settlement. It was a moment that demonstrated the incredible power of community involvement and collective action.

The event was alive with excitement and energy, with key stakeholders, Muungano wa Wanavijiji, SDI Kenya, the Nairobi County Chief, the area member of the County Assembly, the hospital ward representative, and the area member of Parliament representative, all coming together to witness the success of a project that would bring tangible benefits to the residents of Mathare 4B. 

This launch was more than just a ribbon-cutting ceremony. It was a turning point in Mathare 4B’s journey toward better infrastructure, improved service delivery, and more organised community life. The physical addressing system will now help with navigating healthcare services, from reaching patients during emergencies to facilitating door-to-door health education and vaccination campaigns. It’s a simple yet powerful tool that will make a real difference in the everyday lives of residents.

For the people of Mathare 4B, this launch was a testament to what can be achieved when a community comes together, partners with others, and works toward common goals. It wasn’t just a project, it was a victory for the whole community.

The Environmental Officer from Nairobi County Government recognises the young people who participated in the creation of the physical address system during the launch in Mathare 4B.

The different colors on the address plates—blue for sanitation facilities, yellow for churches, gray for social amenities, red for businesses, and maroon for residential houses—make it easier for people to navigate and access essential services.

Young people organise the physical address system just before the installation exercise.

Youth installing the physical address in a structure in Mathare 4B. Brown is the colour for residential structures.

About SDI Kenya and Muungano wa Wanavijiji

SDI Kenya is a non-profit organisation that aims to address urban poverty. To fulfill their mandate, SDI Kenya provides technical support to Muungano wa Wanavijiji, the largest national movement of slum dwellers  in Kenya.

Founded in 1996, Muungano wa Wanavijiji is a movement that brings together groups from urban slums and other poor communities to advocate for both policy and physical changes to inadequate and challenging living conditions, organised around advocacy and savings, climate change mitigation and adaptation. SDI Kenya and Muungano wa Wanavijiji’s vision is to create inclusive cities where low-income communities have access to adequate housing and services, enabling them to live with dignity. As an affiliate of Slum Dwellers International (SDI), a global network operating in over 20 countries across Africa, Asia, and Latin America, SDI Kenya mobilizes over 28,000  of the most vulnerable women, men, and youth. These communities are brought together through dynamic savings schemes, creating a network at the settlement, city, and national levels. This network aims to drive a collective, bottom-up change agenda for inclusive and resilient cities, influencing global development agendas.

cross-section of management committee

Inclusive sanitation: Working with informal settlement residents in Freetown, Sierra Leone to address sanitation challenges

Read about the inclusive community based approach to addressing sanitation issues in Freetown informal settlements in this blog by Sullaiman Fullah, Ishmail Conteh, Dora Vangahun and Abu Conteh.

In the informal settlements of Freetown sanitation remains a huge challenge, particularly access to decent toilets. This can be due to constraints on digging land (in hilly areas) or limited space available for construction. Limited access to toilet facilities in informal settlements often leads to the unsafe disposal of human waste.  As a result, it is difficult to maintain proper sanitation in these areas. Some residents share the limited toilets available while others defecate openly on the soil or in open drains leading to an increased incidence of water-borne diseases such as cholera, diarrhoea, and typhoid (Macarthy et al., 2018)[1].  Cockle Bay, a coastal informal settlement located on the Aberdeen creek of Freetown is no exception to these poor sanitation challenges. The sanitation problem has been a great concern for residents’ health and the environment. Most households use hanging toilets connected to the sea or large drainages, and poorly maintained pit latrines which are unhygienic and can overflow, particularly during the rainy season. Some residents are still practicing open defecation in the community due to a lack of access to toilet facilities exposing them to an increased risk of infectious disease outbreaks.

A hanging toilet in Cockle Bay.

ARISE and CBPR

The Community-Based Participatory Research (CBPR) approach of ARISE allows researchers to engage communities as active participants during the research, which is crucial for the successful implementation of the project. At the inception of the research project, community members were selected through a competitive, transparent, and inclusive process to act as co-researchers. Their capacity was built through training on participatory and qualitative methods (e.g. social mapping, well-being ranking, Venn diagramming, narrative and key informant interviews, and GIS mapping), and quantitative methods (health and well-being surveys). This allowed them to better understand the community issues and ensured that co-researchers and other community stakeholders were involved in every stage of the ARISE research process. The CBPR approach further led to the co-designing of small-scale interventions across the three study sites, including the construction of the Biofil toilet in Cockle Bay to address the community’s dire sanitation challenges.

Community engagement

Before construction began, the research team conducted several engagement events with co-researchers and community stakeholders. These events reaffirmed the community’s need for a safe toilet facility. During the initial engagement with co-researchers, concerns about a site for construction were raised, prompting two additional meetings to select a suitable site. In a general meeting, two potential sites were selected, but these were later nulled due to technical advice relating to their closeness to the sea, proximity to Aberdeen Bridge, and the risk of demolition by relevant government authorities. The final site was selected at Elet View. It was unanimously agreed upon by community stakeholders in consultation with community residents.

Community engagement for the selection of construction site. Photo credit: Ibrahim Bakarr Bangura.

Construction

The construction lasted for one and a half months, yielding valuable insights at each stage of the work. To ensure that deliverables were met and building standards were adhered to, the ARISE Sierra Leone Urban Research Centre (SLURC) team conducted regular monitoring of the implementation activities and evaluated each phase of the construction to assess progress and address challenges that emerged.

Affixing tiles in the toilet cubicles. Photo credit: Sullaiman Fullah

Biofil toilet in Cockle Bay

The toilet facility was designed with two digesters (5ft × 6ft) and six-compartment units to accommodate many users. Two of the cubicles (one at the front and the other at the back) are specifically designed for individuals with physical disabilities, featuring sloped ramps for wheelchair access. The remaining four rooms are designated for able-bodied users – two for men and two for women. This inclusive design promotes equity by ensuring accessibility for all and fosters a sense of community ownership and shared responsibility in maintaining the facility.

Establishment of management committee

To ensure sustainable use of the toilet facility, the SLURC research team, and community co-researchers facilitated the establishment of a women-led management committee to oversee the facility’s operations and the formulation of by-laws. The event featured an inclusive and participatory selection process to ensure proper usage, maintenance, and accountability of the toilet operations. The Biofil toilet experts subsequently trained the committee members on best practices for the use of the toilet facility. To sustain the learnings of the training, SLURC designed sanitation stickers relating to the use and maintenance of the facility which were posted outside together with the by-laws.

The management committee with Sullaiman Fullah, a researcher at SLURC. Photo credit: Emmanuel M. Kamara


Handing-over of the facility
The handing-over event gathered together the ARISE Sierra Leone team, media, community members, and community stakeholders. The Executive Director of SLURC, Dr. Joseph Mustapha Macarthy, highlighted in his statement that the installation of Biofil toilet in Cockle Bay was in response to the community’s reliance on inadequate and unhygienic facilities, such as hanging toilets and open sewage. He emphasised that the new environmentally friendly toilet aimed to improve hygiene and sanitation in the community. He proceeded by officially opening and handing over the toilet to community leaders and the management committee and called on them to ensure proper usage and maintenance of the facility. Mr. Francis Reffell, Chairman of the Centre of Dialogue on Human Settlements and Poverty Alleviation (CODOHSAPA), encouraged residents to work together to sustain the new toilet facility. Vincent Sesay, a community stakeholder, expressed his gratitude and commended SLURC, the ARISE team, and the funders for their invaluable effort in providing a decent communal toilet facility in Cockle Bay, emphasising its significance to minimising health risks from the use of unhygienic toilet facilities.

The benefits of the Biofil toilet

The ARISE Responsive Fund support for the Biofil toilet has enabled residents to have access to a hygienic and safe toilet facility in the community, which has greatly helped to mitigate health risks related to poor sanitation. For the first time, residents now use a toilet that is not only hygienic but also eco-friendly. Below are some of the benefits:

  • Minimise health risks: The Biofil toilet discourages residents from practicing open defecation and minimises the risks of water contamination thereby reducing the incidence of waterborne diseases and the likelihood of disease outbreaks.
  • Maintain privacy and dignity of residents: Previously, many residents especially women and children had to depend on poorly maintained pit latrines or unsanitary public toilets. The Biofil toilet provides them with a private and dignified place to use, hence promoting an improved quality of life.
  • Protection of the environment: The toilet’s unique design ensures that waste is properly treated on the site thereby preventing pollution to nearby water bodies. This helps to protect and safeguard the coastal environment of the community.

Challenges

During our initial discussions with co-researchers, they raised concerns about land issues in the community, as much of the land has been reclaimed by private individuals. This caused a huge challenge to secure an appropriate site.

The project was also implemented during the peak of the rainy season. This effected various phases, from community engagement and mobilisation to construction. In some cases, community engagement sessions were cancelled due to torrential rainfall that hindered the mobility of staff and transportation of materials to the site.

Finally, during the project we struggled with managing community expectations. Although some residents actively participated, it became clear that many others expected compensation for any work they were involved in during the implementation of the project.

Conclusion

This sanitation intervention was implemented following the ARISE core values of equity, inclusion, participation, and empowerment. These values emphasised that the voices of residents in informal urban settlements are involved in research from data collection and analysis to implementation and design of interventions. This participatory and inclusive approach addressed the urgent sanitation issues in the community and helps build trust, strengthening local capacity-building, and empowering residents to take action and protect their environment. Through community engagements and collaboration, a hygienic and eco-friendly solution has been provided to improve the quality of life of residents. The inclusive design of the facility ensures accessibility for all, and the management of the toilets promotes equity and communal responsibility. Despite challenges such as land acquisition, heavy rainfall, and community expectations, the project successfully provided a dignified, safe, and sustainable sanitation option, reducing health risks and protecting the environment.  It is essential to replicate such equity-driven and participatory methods in other informal settlements to effectively address sanitation problems, improve public health, and protect the environment.

[1] Macarthy, J., Conteh, A., Sellu, S. A., & Doughty, T. (2018). Water and Sanitation challenges and impact on health in informal settlements.

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ARISE at ICUH 2024 in Marrakesh, Morocco

Some of our ARISE colleagues will be attending the 20th Annual Conference on Urban Health (ICUH 2024) in Marrakesh, Morocco. Find out more below…

ARISE session: Application of community-based participatory research approach with urban marginalised people to develop community-led initiatives for promoting climate resilience and equitable health and well-being: sharing experiences, strategies, resources and tools

Tuesday, 19 November at 3.30 pm GMT

Contributors: Dr Rachel Tolhurst, Ibrahim Gandi, Dr Jiban Karki, Wafa Alam and Smruti Jukur

Community-based participatory research (CBPR) aims to co-produce knowledge with marginalised people in order to challenge and transform material, relational and epistemic inequities. People living in urban informal settlements and other marginalised urban groups face multiple spatial, social and economic vulnerabilities to the health impacts of climate change, including barriers to accessing health promoting services. They often lack opportunities to communicate their needs to and demand rights from health systems planners and providers due to social and political distance, stereotyping and discrimination. Supporting marginalised people to analyse and communicate their own realities, and to promote trusting and respectful communication with governance stakeholders is an important strategy to tackle this exclusion and promote transformative, community-led action for climate resilience and health equity. CBPR encompasses values, processes and tools to facilitate these efforts. We will create a space for sharing, discussion and practice that aims to:

  1. Share principles and practical lessons from applications of CBPR drawing on a 5-year programme working with urban marginalised people in four countries (Bangladesh, India, Kenya and Sierra Leone) and further emergent research on co-producing initiatives to improve health service responsiveness to extreme weather events (Urban SHADE)
  2. Provide a framework for discussion of experiences of CBPR in diverse contexts, including social, economic political and community characteristics
  3. Offer opportunities for participants to practice using tools and approaches

After a 10-minute introduction, participants will have the opportunity to join a 25 minute session at one of the three stations (see below) which will run twice simultaneously. In each station, presenters will share their experience of using a CBPR tool in a specific setting. Participants will be encouraged to share their own experiences. Presenters will then facilitate a session which practices or discusses using the approach.

ARISE session: Access to and uptake of healthy diets in the context of climate crisis: lessons from research in ten African and Asian cities on developing climate-resilient urban food systems

Wednesday, 20 November at 3.30 GMT

Contributors: Dr Rachel Tolhurst, Inviolata Njoroge, Mr Andrew Gerald Omoding, Dr Gloria Seruwagi, Dr Bossissi Nkuba, Dr Sia Tengbe, Dr Surekha Garimella.

The escalation of global political, economic and ecological crises and associated price surges has contributed to interdependent forms of malnutrition – undernutrition, overweight and obesity –- with enduring societal consequences.  Poor and marginalised urban residents are already vulnerable to food insecurity as well as diet -related communicable and non-communicable diseases in the context of low and precarious incomes, inadequate market, road, water and sanitation and health service infrastructures, and the proliferation of unhealthy processed foods.  Movement restrictions during the Covid pandemic exposed fragilities in urban food systems particularly for the urban poor and those living in informal urban settlements. Changing weather patterns are creating further vulnerabilities by increasing food production uncertainties as well as exacerbating existing infrastructural fragilities. Additional axes of vulnerability that intersect with low incomes are gender, age, disability and migrant/refugee status.  Developing climate resilient urban food and health systems faces further challenges related to political settlements and related governance arrangements, including fragmented accountabilities for food production, food distribution, water and sanitation, roads and health services, between municipal and national governments. 

This session shares findings from research conducted in 5 African cities through the African Cities Research Consortium (ACRC) and from research conducted through the ARISE consortium (Accountability for Urban Health Equity) in 5 cities in India and Bangladesh.  

Urban SHADE and ARISE session: Community-led health initiatives for health equity and climate resilience in informal urban settlements: applications in the context of extreme weather events

Tuesday, 19 November at 5.30 pm GMT

Contributors: Dr Surekha Garimella, Kamilla Karu Gojobe, Milka Kori, Ibrahim Gandi, Inviolata Njoroge, Ms Smruti Jukur, Professor Blessing Mberu, Dr Caroline Kabaria, Dr Ivy Chumo

IPCC reports have identified that impacts of climate change will be concentrated among the most marginalised and poorest urban populations, particularly the one billion people living in informal settlements, where vulnerabilities to extreme weather events such as storms, flooding and heatwaves are already being experienced.  This panel presents and discusses findings from several research consortia engaging with community led initiatives for health equity and climate resilience in informal settlements, through Community-Based Participatory Research in India, Kenya, and Sierra Leone.  Community ‘co-researchers’, professional researchers and development professionals will share experiences from ARISE consortium research, which aimed to strengthen accountability for community health equity in informal urban settlements and will share how community-led initiatives are being adapted to promote climate resilience for health. Presenters will also share initial findings from Urban SHADE, which aims to strengthen health service responsiveness to extreme weather events in informal settlements India, Kenya, and Sierra Leone. 

Presentations will include a consideration of how organised communities can use participatory data collection and analysis as the basis for developing their own processes for responding to extreme weather events as well as for advocating with governance stakeholders to improve responsiveness to their priorities and vulnerabilities. Community vulnerabilities are explored from an intersectional perspective, which considers how intersecting social identities create differential risks within informal settlements.  Presenters will also share experiences of working with a range of governance actors relevant to the impact of extreme weather events on health, including but not limited to health services. They will draw from work including creating physical address systems, co-producing WASH improvements, developing community-based mental health interventions, creating disaster response approaches and co-producing climate resilient housing. In this 60-minute panel, 6 presenters will make an initial presentation lasting seven minutes each, after which the audience will be encouraged to ask questions and reflect on contributions of community and governance stakeholders to promoting inclusive urban development for climate-resilient, equitable health and well-being.  Dr Surekha Garimella (The George Institute, India) will chair the panel as co-I for ARISE and Co-PI for Urban SHADE.

Colleagues will also attend the 8th Global Symposium on Health Systems Research (HSG 2024) in Nagasaki, Japan. Find out more about ARISE activity here.

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ARISE at HSR 2024 in Nagasaki, Japan

Some of our ARISE colleagues will be attending the 8th Global Symposium on Health Systems Research (HSR 2024) in Nagasaki, Japan. Find out more below…

Urban SHADE session: Strengthening the responsiveness of health service provision to extreme weather events for urban marginalised people 

Wednesday, 20 November 2024, 11.40am

Contributors: Inayat Singh Kakar,The George Institute of Global Health India; Nancy Wairimu, Muungano wa Wanavijiji; Jane Wairutu, SDI Kenya; Abu Conteh, Sierra Leone Urban Research Centre (SLURC); Desta Ali, Institute of Gender and Children’s Health Research, Sierra Leone (IGCHR); Lana Whittaker Liverpool School of Tropical Medicine (LSTM)

The greatest gains in health in the context of climate change will be achieved through reducing the risks faced by the urban poor, including by targeting informal settlements (IPCC, 2022). How to reduce health risks in these contexts through strengthened health service delivery which is responsive, equitable and people- centred is, however, currently unclear. The purpose of this session is to stimulate discussion between panellists and attendees about this challenge, focussing specifically on health service delivery in the context of extreme weather events in marginalised urban environments. We will share learning from the Urban SHADE project, which works with a range of community, government and non-government actors through community based participatory action research to strengthen health service preparedness and responsiveness in marginalised urban spaces in the context of extreme weather events in India, Kenya and Sierra Leone. We will present our findings from community consultations, participatory workshops between community members and stakeholders, climate change and health policy analysis, and initial insights from community and health service vulnerability and capacity assessments.

ARISE session: Safeguarding for just and sustainable health systems: Sharing experiences and strategies in health systems research and practice

Thursday, 21 November 2024, 11.40am

Contributors: Linet Okoth, LVCT, Kenya; Bintu Mansaray, College of Medicine and Allied Health Sciences, Sierra Leone; Hannah Berrian, UL-PIRE, Liberia; Sarah Moon, global Safeguarding Manager, Christian Blind Mission

Engagement of marginalised populations in the co-production of knowledge that challenges epistemic injustice demands rigorous and transparent safeguarding mechanisms. This session explores shares safeguarding lessons from health policy and system research projects to strengthen reflexive ‘learning health systems’ that consider ever-changing positions of power and privilege from an intersectional standpoint.

Oral presentation: Hybrid Governance of Health Service Delivery in Informal Urban Settlements in Dhaka City, Bangladesh: Systems, Actors and Challenges

Thursday, 21 November, 8am in Room 103

Presented by Bachera Aktar as part of the ‘Enhancing emergency and primary care networks: Governance and reform insights’ session.

Oral presentation: Adapting to climate change vulnerability: Insight from lived experiences and system challenges 

Friday, 22 November, 9.40am in Room 109

Presented by Sabina Rashid as part of the ‘Enhancing emergency and primary care networks: Governance and reform insights’ session.

Poster:  WASH-related violence in urban informal settlements in Bangladesh, Kenya, India and Sierra Leone: Co-producing knowledge for just health systems

Authors: Bintu Mansaray, Rosie Steege, Samira Sesay, Inviolata Njeri Njoroge, Ivy Chumo, Caroline Kabaria, Blessing Mberu, Partho Mukherjee, Surekha Garimella, Riaz Hossain, Sabina Rashid, Rachel Tolhurst, Neele Wiltgen Georgi, Kate Hawkins, Sally Theobald and Laura Dean

Poster:  Empowering community researchers voices: Lessons from ARISE community-based participatory research in Bangladesh for translating health knowledge

Author: Muhammad Riaz Hossain, BRAC

Colleagues will also attend the 20th Annual Conference on Urban Health (ICUH 2024) in Marrakesh, Morocco. Find out more about ARISE activity here.

Bangladesh women cooking in the road

A book review of Sabina Rashid’s ‘Poverty, gender and health in the slums of Bangladesh: Children of Crows’

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Hilary Standing and Sally Theobald have reviewed Sabina Rashid’s book ‘Poverty, gender and health in the slums of Bangladesh: Children of Crows’ for the PLOS journal’s Speaking of Medicine and Health blog.

“This is an unusual book. It inverts the usual academic conventions. It doesn’t foreground theory or give us a lot of statistics. Instead, it gives us an utterly absorbing set of narratives of women and their families living in slum settlements over two time periods, each marked by crisis and uncertainty. Here, it’s the details that count – the worn and patched clothing, the missed meals, the constant resort to loans, the stories told to hide the fact that the family has been reduced to begging. The small but telling details that give us the warp and weft of urban poverty.” Read more on the PLOS Speaking of Medicine and Health blog.

IMPACT STORY: Responding to water, sanitation, hygiene and solid waste management challenges in Nairobi’s informal settlements

IMPACT STORY: Responding to water, sanitation, hygiene and solid waste management challenges in Nairobi’s informal settlements

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Authors: African Population and Health Research Council (APHRC), Kenya with the ARISE Consortium

Improving Water Sanitation and Hygiene (WASH) and Solid Waste Management (SWM) practices and access was a key focus of ARISE work by the African Population and Health Center (APHRC) in Nairobi.

Background

Providing WASH services in informal settlements is a challenge. Clean water often costs more in informal settlements when it is provided by intermediaries, reducing the amount of water people can afford for handwashing. With a lack of space, residents often rely on shared communal toilets, which can increase transmission risk through surfaces and can be hard for pit emptiers to de-sludge when full. SWM is the collecting, treating and disposing of solid material once it has been discarded. SWM is a challenge in informal settlements because: absentee landlords flout development control orders; inadequate storage containers; indiscriminate disposal by households; unreliable collection by county government; low household incomes; and limited public education. Furthermore, access to WASH and SWM has an equity component. The elderly often have problems accessing water in informal settlements where water points are distant. People have to queue to get water, so they may have to pay someone to go to fetch water for them. People With Disabilities (PWDs) can find it difficult to access toilets. Women and youth are largely responsible for household WASH management and bear a disproportionate burden when these basic services are lacking.

Community outreach event in Nairobi

What happened?

Catalysed by the ARISE Responsive Fund, in Viwandani APHRC partnered with U-Tena, an NGO that works to promote health and wellbeing through the exploration of performing arts and dance. There were a series of high-level consultation meetings with partners that resulted in collaborations with Child Fund and the Winnie Atieno Foundation in addressing challenges related to SWM and WASH services. The project engaged the community, government officials, nongovernment officials, performing artists, youth, women, land owners, local partners, and elected leaders in advocating for SWM and WASH services. Consultative meetings set a clear path for community outreach, stakeholder meetings, dialogues, artistic outreach, and committee consultative forums. From the consultative meeting process, we collaboratively identified the need to construct a solid waste collection and separation transfer station at the community level. This decision was validated by the community and solid waste workers, building consensus.

Community outreach was conducted with performing artists from June to September, 2023. The artists did a series of crowd moving performances with key messages on WASH and SWM. Together stakeholders collaboratively identified a SWM separation point. ARISE established an oversight committee including the senior chief, assistant chief, WASH and Health sub-county representatives, a ward administrator, village chairperson, youth representative, community health promoters, community-based organisation (CBO) representative, landowners, and representatives of persons with disabilities. Through dialogues, a marathon event and activities on Global Handwashing Day, people were informed of and educated about WASH and the SWM separation point.

Community activity on global handwashing and toilet day

Impacts

As a result of this intervention a common solid waste separation site was co-identified, co-validated and operationalized within Viwandani informal settlement and governance structures have been put in place to champion, advocate and support its use.

Through ARISE, the governance actors were made aware of the importance of responding to community needs. Community-Based Participatory Research (CBPR) processes improved accountability by bridging gaps between communities, researchers and policymakers. It also built and strengthened relationships between urban marginalized people and governance actors by creating new fora for connections and strengthening existing spaces for engagement between governance and community stakeholders.

Community dialogues

Lessons learned

  • Partnership is key in SWM and WASH: Key outcomes and activities would not have been achieved without collaboration and networking.
  • Magnet Theatre: The arts, particularly the use of theatre and visual arts, are a strong tool for awareness creation and engaging the community. Feedback is solicited and amplified hence the community is not only a consumer of information but also a generator of the same. It also gives community an opportunity to participate in addressing the challenges they are facing.
  • Key community focal persons: Identification and involvement of key focal persons is key in the success of any community initiative. Their understanding and willingness to support determines the success or the failure of the project.
  • Multi-disciplinarity at the local level: When community leaders in different fields/areas work closely together, it becomes possible and easier to identify a key challenge and seek solutions. Working closely, the leaders can begin to address the issues in the community at their level before they escalate to higher levels.
  • Community empowerment and accountability: When a community is empowered, they demand their rights. For example, the community was demanding quality living conditions and a clean environment from landowners, elected leaders, and local partners through U-Tena and other CBOs.
  • Responsiveness: The local stakeholders led by local political leaders and partners took the initiative to allocate space for waste collection points, expand the road network with proper drainage, and promised to bring affordable water to Viwandani.
  • Inclusion is key: All stakeholders from the community, national government, and county governments were engaged in discussions on SWM and WASH. This enhanced the uptake of implementation.

Formation of community committees

What’s next?

  • There is a need to continue supporting the community in reaching out to their leaders, where they can raise issues of concern.
  • SWM actors should collaboratively develop a long-term waste management plans that account for population growth, urbanization trends, and environmental sustainability.
  • There is a need to consider integrating informal waste pickers into formal waste management systems to improve livelihoods and resource efficiency.
  • There is a need for actors in SWM to invest in infrastructure such as waste collection points, transfer stations, and recycling facilities tailored to the specific needs and constraints of informal settlements.
  • Actors in the WASH sector should be involved in addressing SWM, as poor SWM affects WASH service delivery.

References

ARISE consortium (2024) Brief: Working with U-Tena youth organization to address solid waste management

Acknowledgements

Thank you to Anthony Mwaniki, Louise Clark, Sweta Dash, Kate Hawkins, Nazia Islam, Jiban Karki, Nicholas Kyalo, Peter Mokaya, Leah Murphy, Anthony Mutuku Nthenge, Emilly Otieno, Hayley Stewart, Jackline Syonguvi, Joe Taylor and Sia Tengbe for developing and editing this output.

Health and wellbeing survey respondents

IMPACT STORY: Collaborative generation of data on the health and wellbeing of waster workers in India

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Authors: The George Institute for Global Health, India (TGI), with the ARISE Consortium

As part of ARISE, researchers from The George Institute (TGI), India worked with local partners and waste worker communities in Delhi and Andhra Pradesh to develop a survey to gather quantitative data on the health and wellbeing (H&WB) of waste workers. This census-style survey with 10,000 adult waste workers resulted in an increased understanding of the dynamics of waste worker communities, and a new source of data that community members can draw upon to influence policy and advocate for targeted interventions that address their unique challenges and aspirations. 

Background

An estimated 1.5 million people are engaged in waste work in India, and yet, there has been no large-scale data driven study or evidence around the H&WB of waste workers on a national or state scale. However, many governance actors tend to demand quantifiable data for decision-making when waste workers approach them for interventions and/or grievance redressal.

Through ARISE, the research team at TGI identified the global and local gaps in the data pertaining to waste workers, and this was confirmed by local partner organisations and waste workers living in Delhi and Andhra Pradesh.

Waste workers in these informal settlements highlighted the importance of having data on their own health and wellbeing, and they wanted to have the numbers and statistics ready so that they could, “Speak the language of the governance actors in their conversations and negotiations with the governance actors.”

To help address this lack of data, between 2021 and 2022 the ARISE team began work with partner organisations and community members to create a simple survey questionnaire and develop the appropriate data collection methods to collect quantitative data around the H&WB of respondents in Delhi and Andhra Pradesh.

Starting in February 2023, researchers held regular training and reflection sessions with enumerators. Using a participatory action research (PAR) approach, these sessions aimed to ensure that enumerators understood how to conduct surveys with marginalised communities and to be respectful and sensitive to waste workers when conducting the surveys.

Between March and July 2023, preliminary data collection took place across eleven districts of Delhi and Andhra Pradesh. During the regular reflection sessions, the survey tool was continually refined to incorporate feedback from enumerators during the first phase of the survey.

 For improved survey results, Enumerators were trained on social determinants of health using participatory research methods and regular presentations. The figure above depicts one such training sessions with enumerators using the “Power Walk” method.

Impact

The H&WB survey resulted in a set of comprehensive data from a diverse sample of 10,000 waste workers (4,200 women and 5,800 men), which has improved understanding of the dynamics of these waste worker communities who were otherwise not reflected in any national-level or state-level data.

The process of developing the survey and training enumerators from the waste worker community, as well as having access to precise evidence from the quantified data, has helped to empower community members and partner organisations and has strengthened their capabilities to influence policies and advocate for targeted interventions that address their unique challenges and aspirations.

On-going community action and advocacy with governance providers is taking place using the evidence gathered in the H&WB surveys. In Delhi, one of the enumerators told us about how the initial results from the survey have been used for action in their area:

 “There are two primary concerns we have identified through the survey process: first is the need for Anganwadis (early childhood learning centres). For this we have also met the local Anganwadi Officer who will be visiting Bhalaswa Village (in Delhi). Through this, women and children will be able to avail health check-ups and nutritious meals, vaccinations and maternity scheme cards.

Second, is that we have demanded identity cards for waste picker friends in Yamuna Vihar in Delhi. Through this, waste pickers will be able to secure a space for waste segregation and pull-carts.”

The H&WBS was designed to illuminate the living and working conditions of informal waste workers. In the figure, a surveyor administers the survey outside the household premises of a waste working family

Lessons learned

For the H&WB survey process, we adopted a census-style approach, that included a broad range of data on, for example, demographics, education, occupational details, household assets, conditions and social participation, health status, menstrual health, water, sanitation, and hygiene (WASH), utilisation of health services, mental health, substance use, recreation, and perceptions of the social environment. This helped to ensure that diverse voices within communities were heard and represented.

The research team factored in contingencies such as periods of rain, extreme heat and/or heat waves, regional and religious in gauging access to communities. Timelines were adjusted according to these delays, and enumerators were given considerable flexibility to work without undue pressure.

For the research team, the H&WB survey has been an entry point into learning and working with quantitative data. The team has been working towards better data monitoring, cleaning and analysis in the process.

What next

Seeing the results of the H&WB surveys in these areas, other organisations and waste worker communities have expressed interest in replicating the survey in their own communities. For example, waste workers living in Shimla (one of our ARISE action sites) have reached out to TGI researchers to request a similar survey in their area.

The research team is finalising the H&WB survey report and planning ways to disseminate the findings with the community members and other stakeholders.

Acknowledgements

Thank you to Sweta Dash, Louise Clark, Kate Hawkins, Nazia Islam, Jiban Karki, Leah Murphy, Anthony Mwaniki, Hayley Stewart, Joe Taylor and Sia Tengbe for developing and editing this output.

Relevant resources:

Lakshmi J.K. et al. (2020) Planning the India health and well-being survey, ARISE Consortium,

Planning the India health and well-being survey
Prioritisation exercise in VIjaywada

IMPACT STORY – Building hope: Waste pickers unite for secure housing in Andhra Pradesh

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Authors: The George Institute, India with the ARISE Consortium

Since 2019, ARISE researchers from The George Institute (TGI), India have worked with partner organisations and waste pickers in the informal settlements in Vijayawada-Guntur of Andhra Pradesh to identify and address priority areas to improve their health and wellbeing. During priority-setting activities in 2021, community members highlighted an urgent need for secure housing and set about identifying actions to address this. The process resulted in allocation of secure housing or land ownership to some community members and has helped establish better relationships between the community and governance actors.

Background

For waste workers in informal urban settlements of Vijayawada-Guntur, Andhra Pradesh, India, secure housing is not just a roof over one’s head but embodies dignity and security. While waste workers have historically faced threats of repeated displacement, this threat became much worse during and after the Covid-19 pandemic.

“Somehow get us housing, we can manage everything else” – Female waste picker, Vijayawada

“When I die, I do not want to be considered an unidentified body. I want to be taken to my own place and get my last rites done.” – Female waste picker, Dump yard in Guntur, Andhra Pradesh

As part of ARISE, TGI worked with waste pickers from Krishna Lanka and Vaddeswaram informal settlements, using the community-based participatory research (CBPR) approach, to understand and address the priorities of the waster worker communities. Between 2019 and 2021, ARISE TGI researchers held community meetings, interviews and focus group discussions with community members.

In September 2021, after Covid-19 restrictions had eased to a certain extent, researchers from TGI and our local partner organisation Dalit Bahujan Resource Centre (DBRC) undertook prioritisation exercises with the community members. The aim was to seek and centre the community members’ inputs for decision-making and accountability-seeking. From a range of identified priorities, housing emerged as the highly ranked issue for the community members.

Community members also highlighted the linkages between housing rights and health and well-being. The threat of repeated displacement greatly increased after the Covid-19 pandemic. In 2022, the waste workers in these informal settlements faced aggressive threats to their housing rights. Residents of Krishna Lanka were unfairly blamed as being carriers of the Coronavirus and were subsequently evicted from the area. Community members also repeatedly expressed how women, particularly young girls, were very vulnerable to sexual harassment due to lack of proper housing and sanitation.

The team realised that securing housing for the community members was the most crucial task at that moment. Researchers and DBRC worked towards better understanding processes for housing allocation, be it through engagements with the local secretariat office or through various housing entitlement schemes. DBRC also played a crucial role in facilitating dialogue between the community and governance actors throughout 2022 and 2023.They engaged in consistent follow-up, supporting the community to advocate for their and needs.

To further address this identified need, actions were identified and allocated to community members, researchers, and DBRC. Community members took steps to get their identification documentation completed, DBRC worked with the local secretariat office to get housing allocated, and the research team looked at the various schemes under which housing could be made available for the communities.

After numerous petitions and persistent efforts, the government responded by launching a mass drive to issue identity cards to community members. This was a significant step towards addressing their immediate housing needs, marking a pivotal moment in their struggle for stability and recognition.

Communities in Vaddeswaram showing their land ownership documents. Communities were allotted plots and government will be building houses for them.

Impact

In October – November 2022, 12 families from Krishna Lanka were allotted housing in Rajarajeswari peta, a neighbourhood in the city of Vijayawada, and 35 families are in the process of being allotted housing. And in 2023, 11 families living in Vaddeswaram were allotted plots in Amaravati, the capital city of Andhra Pradesh. However, 25 families are still waiting for housing due to bureaucratic delays and the requirement for mandatory identity cards. Whilst this has caused a great deal of distress for the community, TGI researchers and DBRC are supporting community members to obtain identity cards. However, the 2024 change in government has unfortunately halted the process as the new administration has yet to revisit and address this pressing issue.

The team and community members have encountered situations that required collective problem-solving. After allotment of houses in Krishna Lanka, the community was unexpectedly asked to pay INR 60,000 to the municipal corporation. While this was the subsidised rate decided by the authorities, it was a major setback for community members considering the myriad forms of deprivation and insecurities they were already regularly facing. The most viable solution was to rely on the Scheduled caste and Scheduled Tribe Sub-Plan (SCSP/TCP) for a ‘Direct Benefit Transfer’ (DBT) to community members. After several meetings with Tribal Welfare Department officials, multiple visits, and petitions by the community members, a one-time DBT was provided to all the people who were allotted housing, and they were finally able to move to their houses.

This process – from the identification of housing as a priority to working together to get governance actors to allocate housing – has helped ARISE TGI researchers to solidify relationships with the community, establish our commitment to the embeddedness of research and action, and strengthen trust with the community.

The process also improved access to information, enabling waste workers to navigate the bureaucratic processes involved in obtaining housing or any other benefits from governments in future.

Importantly, it has established pathways for relationships between the community and governance actors. Community members have realised that there are ways to voice their grievances, demand their rights, and get action from the governance actors.

Observing the community’s persistence, government officials started paying more attention to their issues and have even sought their involvement in various government activities, including introducing new initiatives, awareness campaigns, and community meetings.

Communities from Krishna Lanka receiving the one-time amount disbursed from the tribal department for housing allotment.

Lessons

Through this process, ARISE researchers, community members and governance actors learned the following lessons:

  • Recognising housing as a priority, and improved understanding of linking housing rights to health and well-being.
  • Improved access to information, enabling waste pickers to navigate the bureaucratic processes involved in obtaining housing or any other benefits from governments in future.
  • Secure housing can provide women with a sense of ownership and control over their living space. It also gives them a sense of permanency and gives them the confidence that they are leaving some asset behind for the next generation.

What next

The connections established with governance actors during this process have been maintained by community members, who regularly visit government offices to address their ongoing concerns, including:

  • Addressing unintended consequences: In certain cases, the allotted housing was suboptimal and lacked thorough consideration. Community members had little choice about the location and type of housing they received. Some homes had water issues and security risks; others were in locations further away from people’s livelihoods, affecting their ability to get to work. The team is working towards ameliorating these issues and understanding scope for further developments in this area.
  • Securing utilities: The community has come together to take collective action in securing reliable access to clean water and electricity, resources that were not assured by the local authorities or utility providers when their housing was allocated.
  • Enhancing advocacy: Building on their past successes, the community is refining its strategies to tackle other systemic issues and assert their rights. Community-led meetings are proving to be invaluable for sharing information and planning future actions.
  • Sustaining support: DBRC and the ARIISE TGI research team continue to support the community to navigate emerging challenges and to facilitate deeper engagement with governance actors.

Acknowledgements

Thank you to Sweta Dash, Louise Clark, Kate Hawkins, Nazia Islam, Jiban Karki, Leah Murphy, Anthony Mwaniki, Hayley Stewart, Joe Taylor and Sia Tengbe for developing and editing this output.

Power of Light parade in Freetown, Sierra Leone

IMPACT STORY: How ARISE art projects facilitated community priority setting and communication in Freetown informal settlements

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Authors:  Sia Tengbe, Kate Hawkins, Ibrahim Juldeh Sesay, Samira Sesay, Ibrahim Gandi, Sulliman Conteh, Abu Conteh, Samuel Saidu, Francis Reffell, Briama Koroma, Joseph Macarthy, Bintu Mansaray

ARISE research has taken an interdisciplinary approach to data collection within the broad remit of Community-Based Participatory Research (CBPR). One area of collaboration that has been particularly fruitful is partnership and engagement with artists and the arts. This has constituted a fascinating innovation in the way data is collected and communicated on health and wellbeing in informal settlements. An opportunity to receive Liverpool City Council financial support to partner with internationally recognised artist Luke Jerram was taken up by partners in Sierra Leone. Dubbed the ‘Power of Light’ project, this partnership was an opportunity to make an impact on the communities that we work with in Freetown.

Background

Since 2020, the Sierra Leone team – from the Centre of Dialogue on Human Settlement and Poverty Alleviation (CODOHSAPA), the College of Medicine and Allied Health Sciences (COMAHS), the Institute of Gender and Children’s Health Research (IGCHR) and the Sierra Leone Urban Research Centre​ (SLURC) – have been collecting data relating to health, wellbeing, health systems accountability, spatial inequalities and other forms of marginality using a range of participatory methods in informal settlements in Freetown. These findings have been documented in blogs, articles, briefs and dissemination workshops. However, effectively communicating these findings at the community level has been a challenge.

A range of concerns have been highlighted through this work and even though there are other factors at play a lack of safety and security, especially at night, and particularly  for women and girls was one of these concerns. The risk of harm reported by women and girls  is related to inadequate water, sanitation and hygiene facilities, since responsibilities for cleaning and the collection of water are often gendered, with women and girls assumed to be responsible. Study communities also were concerned about the impact of inadequate and unreliable electricity supply on their daily activities such as their livelihoods and their children’s education.

The Power of light project presented an opportunity to help address these issues. The Power of Light project was funded by the Liverpool City Council and Luke Jerram (a UK-based artist of international renown) as part of the 125th anniversary celebration of Liverpool School of Tropical Medicine.

Luke and a videographer, Jackson Kingsley, travelled to Freetown and worked with ten local artists who had been identified by the research team. They all collaborated on the ‘Power of Light’ Project. The Project was a combination of the creation of paper-based light sculptures, the installation of solar powered street lighting and a street carnival.

The artists were introduced to the key messages from the ARISE research related to safety, education, access to water and sanitation services and climate change. Twenty one solar-powered streetlights were installed in public areas across three communities. A parade at Dwarzark which brought together school children, community chiefs, youth, researchers and co-researchers marked the end of the project in Freetown where the installed solar lights were officially switched on and handed  over to the community. Participants danced to melodious tunes played by a local brass band through the main street from Dwarzark Junction to the community centre near the main football field, showcasing designed sculptures to the community. The evening ended with refreshments and the distribution of 60 small LED lights to participating children to help with homework and navigating more safely at night. Furthermore, the team also rehabilitated the Moyiba community primary school, and the main water point in Cockle Bay. The project was documented in a short film. The impact of this work has reverberated outwards. In 2023 a presentation on this work won best innovative poster award at the International Conference on Urban Health.

Impact

The inclusion of locally based artists and a film maker in the co-production process was an opportunity for capacity building, cross learning and fostering stronger relationships in the community.The paper sculptures reflected the identified health and wellbeing priorities of residents within our communities and reflected these messages back to the broader community in a fun, inclusive and simple manner.

The distribution of LED lights to children and the rehabilitation of the primary school helped to provide a supportive learning environment and highlighted the importance of education for children. The rehabilitation of Moyiba primary school can help create a more conducive learning environment and may potentially improve their academic performance and educational outcomes. The rehabilitation of the main water point at Cockle Bay and toilet facilities at the Moyiba primary school will improve access to water, sanitation and hygiene facilities.

The installation of solar powered streetlights has helped to address some of the safety concerns that disproportionally affect women and children at night within these communities. They have also had the knock-on effect of supporting local businesses who can now stay open later.

Lessons learned

The installation of the streetlights was widely accepted and appreciated by residents of the three communities as they saw the increased economic, educational, and security potential of the project. However, due to the limited number of lights that were installed, not all areas in the communities were sufficiently covered. Issues of equity are a core concern for ARISE and this learning was fed back into subsequent art projects. The Power of Light project acted as a catalyst for other ARISE countries to conceive of and implement their own art projects, including photography in India and Kenya, the recording of the songs of waste workers in India and other artistic collaborations with Luke in Nepal and Bangladesh.

Art as part of storytelling in community workshops in Nepal, with Luke Jerram

Art as part of storytelling in community workshops in Nepal, with Luke Jerram

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In August we had the privilege of once again working with internationally renowned artist Luke Jerram on another community project, this time in Nepal. Working alongside our partners at PHASE Nepal, Luke devised and delivered a workshop with a women’s community group in Khudikola informal settlement, Pokhara, Nepal. As part of the project Luke and our ARISE team visited three informal settlements in and around Pokhara. Here Luke shares his reflection from his time spent in these communities.

The first community we visited, Mathillo Ghotse, was a small village at the base of a valley which had a fast-flowing milky white river running through it. Single story houses had been built at random, made predominantly with breezeblock concrete walls and corrugated roofs.  As we arrived down the hill, we passed a scene of children playing football on a waterlogged pitch, with cows on the field helping to create an extra wall of defence for the goalkeeper. 

On our tour we spotted a few distilleries, where large saucepans of liquid boiled, creating a strong alcohol made from maize. Many villagers drink this alcohol, which is the root of numerous social problems within the community. One of the main forms of employment in the village at this time of year was pulling sand and gravel from the fast-flowing river. Young men and women scrape the mud from the riverbed by hand and filter it using nets and woven baskets.  It is then carried on their backs to the edge of the river, ready for collection by lorries for use in the construction industry. Backbreaking work, villagers are paid £4 a day. Occasionally, we were told, the area would flood washing all their hard work away.

Presumably left unaccompanied by their parents as they worked, and with poor safety infrastructure around the river, some children had drowned in the river previous years. With funding and support from ARISE and Phase Nepal, a nursery and primary school with accompanying toilet block had been built for the village, providing care for the children during the day. Having only just been completed, with the walls and ceiling of the building still drying out, we were welcomed by the community and helped to launch this new building. While this is a huge development, there is still room for further improvements. The leaders suggested they would appreciate children’s playground in the garden area connected to the new building. Luke Jerram plans to support all three settlements he visited, through The Jerram Foundation, and has asked the community for a costed list of improvements they’d like to see. 

The second settlement was Barahi Tole. As we arrived, we could see parts of the road had washed away. The foundations of an entire house had disappeared (presumably by a flood), leaving the corner of the property above dangling precariously, and starting to collapse. Some 50 chickens were sheltering from the heat of the day, beneath the foundations of the house in this newfound space. Subsidence in the village is a major problem, caused by the loose sand, gravel and small rocks that make up the landscape. ARISE and Phase Nepal has funded the completion of a community space. They provided funding for materials, and the community then built a community space, installing walls, windows, electrics and flooring. This new village hall will become a real asset and focal point for the village in the years to come.

The final informal settlement the team visited was Khudi Khola, an hour’s drive from Pokhara. Despite not being officially recognised by government authorities, the informal settlement did have a school at the top of the hill.

As in Malto Gosti many people make money by collecting and carrying baskets of boulders, gravel and sand up the steep river banks to sell to the construction industry (earning approximately 10p per basket). Some women in the village have suffered from pelvic organ prolapse, caused by the tension and damage to their bodies by this backbreaking work. 

Everyone wanted the opportunity to work, to help their families and their community improve their situation. The words and ideas they shared were turned into imagery which then formed stencils used to decorate umbrellas. The workshop (using umbrellas), was designed specifically for the monsoon season! The umbrellas were then paraded by the group through the streets, accompanied by Nepali music.

All the tools, torches, art materials and umbrellas were donated to the community after the event. The children were delighted to be given pens and pencils to help with their schoolwork. There was a great cheer at the end, when we let the women’s group know we were also gifting them the sound system we used for the parade as well!

The women’s group have been asked to draw up a list of projects which could be deliverable by their community, if they were given investment to do so.  Based on the findings of the research workshop The Jerram Foundation is now allocating funds, to deliver practical improvements in these communities.

Find out about other work undertaken with Luke Jerram through the ARISE project.

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