All News & Events

14 10 2021

Social mapping in Nairobi

In the second blog in this series, our co-researchers (John Mutinda, Lydia Akwabi, Judith Achieng, Famuel Omwaka, Daniel Obiero, and Joel Mburu) explain the social mapping exercise they embarked on as part of the social and governance terrain study. They were supported by researchers (Caroline Kabaria, Ivy Chumo and Blessing Mberu).

The social mapping exercise was the second part of the mapping social and governance terrain study we embarked on as co-researchers. Following on from the community profiling work we did, it was an equally informative activity involving participants from different social groups representing all the villages in the community. As part of the exercise, a social map/chart is prepared by the community to depict social aspects, and describes what local people believe to be relevant and of importance.

In our social mapping activity, we aimed to understand the social aspects of study communities where the ARISE project has been implemented. The activity entailed mapping/charting six themes: stakeholders, influential groups, marginalised groups, vulnerable groups, social structures, and things one would change if they had power.

In the stakeholders’ section, study participants discussed community stakeholders, and for the influential section, they discussed actors with influence in the community from the lowest influence, to the highest. They also discussed and ranked the marginalised and vulnerable groups in the community from the most marginalised/vulnerable to the least, and finally concluded by listing the things they would change if they had the power starting from the most important to the least.

Next participants took part in a focus group discussion (FGD). We subdivided the participants into two groups during the charting activity before engaging them as one group in a focus group discussion. During the charting, we would guide each of the two groups (one co-researcher in each group) on mapping.

Each group would select a moderator and a secretary and agree on ground rules. Our role was to continuously monitor and guide the groups without influencing their thoughts and ensuring every person was inv

olved in the activity. During the FGDs, one of us would participate as a moderator and another one as a note-taker in the morning and the roles would be reversed in the afternoon. Many community participants said this exercise felt like classwork, as it involved putting thought into what they recorded as a group, but admitted that it was a thought-provoking exercise on things they usually don’t usually think about, particularly the social structures and influential groups.

As with our previous social mapping activity, we ensured that the venue adhered to COVID-19 guidelines. Study participants who arrived late to the venue were quiet and reluctant to contribute to the discussions, our mitigation was to briefly re-consent and explain to them the purpose of the study. Face masks and social distancing affected some participants’ audibility while responding to questions and we asked one to either project their voice or pull down the mask when speaking and pull it up once done talking. A few respondents were dominant in the discussions, and we would guide them politely to allow others to speak.

We scheduled two groups each day; one for female participants and the other for male participants.

This was a community-led activity. Some participants took time debating the ranking for influential, marginalized or vulnerable groups. In many instances, they asked us not to intervene and let them decide on their own. We only gave our guidance where needed and made clarifications where possible. We noticed that some respondents were not participating in the discussion, and we encouraged them to participate and explained the value of their inputs to the final output. Outputs differed based on social group dynamics in the community. For instance, marginalized and vulnerable groups varied from group to group, but people with disability, older persons and child headed households were common. During the focus group discussion we learned that the community had solutions to many of the of the social challenges identified, they just need direction on how to begin.

Every challenge has an opportunity for learning hence we learned a lot from these activities. We learned about social structures, influence, actors, power, marginalized and vulnerable groups in the community during social mapping. Having been raised in the communities, we understood how social structures and influence impacts community profiles mapped in earlier sessions. In addition, we learned how to conduct FGDs and the importance of mastering the content to avoid asking a wrong kind of questions, receiving incorrect responses, thereby compromising the quality of the data collected. Probing was also an important quality of a moderator, allowing them to collect as much information as possible. We learned that patience was a key skill for moderators and note takers, giving participants time to express themselves fully. Being part of this study was a privilege. We are confident that we are well-positioned to understand the community better and be a change to our communities.

14 10 2021

Community profiling in Nairobi

Our co-researchers (John Mutinda, Lydia Akwabi, Judith Achieng, Famuel Omwaka, Daniel Obiero, and Joel Mburu) talk you through their approach to community mapping and charting social and governance terrain. They were supported by researchers (Caroline Kabaria, Ivy Chumo and Blessing Mberu).

This process began with community profiling, which involved community statutory and voluntary organisations identifying community needs, particular issues, and resources. The activity allowed us to gather knowledge of our communities, allowing us to understand the basic information of the settlement, land tenure system, historical background, basic services, and livelihoods in the study sites.

This activity involved participants representing different groups from all the villages in Korogocho and Viwandani informal settlements. We gave the study participants a printed map and asked them to identify and map basic amenities in their villages. Amenities to be mapped included; open spaces, health facilities, education facilities, water points, waste disposal sites, floodlights and other important basic services. The participants marked each of these amenities with a unique number or letter on the map and created a legend, for easier identification during analysis. After exhausting the amenities in their villages, we guided the study participants to sit in a circle while we recorded a focus group discussion (FGD). The discussions revolved around the status and governance of mapped amenities.

Our field day began with the arrangement of the hall/meeting room to ensure adherence to COVID-19 containment measures. This included adding in a sanitation station and ensuring social distance in the seating arrangement. We also displayed printed maps on spaced tables to allow for social distancing. Respondent consent was garnered upon arrival. We scheduled two groups for each day: one in the morning with female participants and another one in the afternoon with male participants.

As community members, we found this interesting because we got to learn more about our communities. We learned a lot about basic amenities, accountability, and equity of the amenities. During the focus group discussions many things emerged about the accountability of resources. Every group had different dynamics and the discussions had diverse and informative content. As co researchers we are also community members, and familiar to many respondents, which really allowed the study participants to open up and they were really receptive throughout the study.

These activities had their challenges. For example, some participants took time to understand the map and align themselves with it. In such cases, we used our understanding of the community to explain to the map to them using known landmarks to enable them to map the amenities as accurately as possible. Some participants did not understand certain questions during FGDs, evident by their responses. In such cases, we had to rephrase the question as many times as possible until the respondents understood. Some participants also spoke in a low tone which made it hard when taking notes and we had to ask respondents to project their voice.

Some participants complained about the length of the FGD sessions, but we reminded them of the importance of this activity.

We had routine debrief sessions for co-learning and co-sharing. Researchers and the community also had trust in us as co researchers, and we were motivated and confident to give our best. We felt that the activity was of benefit to us, the community, and the researchers. Respondents had a common blanket of recommendations including improvement in public toilets, public primary and secondary schools, electricity, dumping sites, water, upgraded housing, public hospitals, security with street lighting, and improved police services.

12 10 2021

Uncovering the voices of the most vulnerable in health systems is important

The President’s Lecture 2021 webinar hosted by RSTMH brought about some thought provoking conversation and presentations from Professor Sally Theobald and her colleagues, Abriti Arjyal, Bachera Aktar and Zeela Zaizay.

The webinar was a great opportunity to share learning on analysing and addressing intersecting inequities in global health across different contexts, projects and health issues. The presentations demonstrated the power and the potential of social science, participatory process and co-production processes for change.

The event highlighted three different projects that focus on three different types of neglected areas. These are neglected countries: particularly fragile and shock prone contexts, neglected communities in urban informal settlements and neglected health issues or conditions like neglected tropical diseases and stigmatising skin conditions.

Metaphors exert a powerful influence on our daily lives and Sally used a very significant one as she launched her speech. We are all in the same storm, but we are not all in the same boat. COVID-19 has demonstrated that we live in an interconnected but unequal world. We are differentially positioned in terms of our vulnerabilities to the pandemic. COVID-19 has been seen as a spotlight that amplifies the existing inequalities; exposing and often exacerbating these inequities.

In the UK, black and minority ethnic groups and people living in cramped conditions have been particularly adversely affected. The pandemic has also impacted and exacerbated how inequalities play out on a global stage.

Engagement with a community health volunteer (CHV) in the photovoice process in Foyah District, Liberia. Photo: REDRESS

Neglected Countries

ReBUILD for resilience research consortium works in partnerships in Sierra Leone, Lebanon, Nepal and Myanmar. They focus on fragility in health systems because 2 billion people around the world live in fragile and conflict affected settings (FCAS). The number of poor people living in FCAS is expected to rise 60% from the current 17% according to projections from the World Bank and other organisations. These settings experience multiple health challenges that emanate from severe resource constrains, multiple shocks and stressors to the health systems like the COVID-19 pandemic, weak and contested institutions, as well as the absence of reliable routine data.

The ReBUILD consortium has a resilience framework which focuses and grounds health systems; and views them as complex adaptive systems with gender, equity and human rights also being central. Sally explained the intricacies of how all this works together to underpin ReBUILD’s work and focus on health systems strengthening and access to better health.

Human resources is a key area of focus and particularly, community health workers (CHWs). CHWs are critical bridges between often neglected marginalised rural communities and health systems. They have proved to be essential, trusted and first-line responders providing health services in settings affected by conflict; often juggling many different programmes. It is the cadre every vertical programme wants to link and work with; resulting in a host of responsibilities. COVID-19 has brought new challenged and layered additional responsibilities for them.

Abriti Arjyal presented findings from the consortium’s study; the gendered experiences of community (CTC) providers in Fragile and Shock Prone Settings: Implications for Policy and Practice during and Post COVID-19. The most vital information she shared is the fact that these cadres play an important role in the COVID-19 response. Their experiences and challenges are shaped by existing gender norms and challenges. Thus, understanding these and incorporating these in design and implementation of community health programmes would not only ensure effective roles of female CHW but also broadly serve to amend existing gender inequities among community providers.

Female Community Health Volunteers (FCHVs) gathered to plan for a community health campaign. Photo: HERD International

Neglected communities

Countries are urbanising fast and in cities one in three people live in urban settlements. Speaking about the ARISE consortium work, Sally mentioned that cities face innumerable challenges. Some of these include housing, food insecurity, water and sanitation, pollution, access to healthcare among others. Most of these are caused by long-standing neglect from states as well as residents’ limited voice and power.

Cities illustrate some of the world’s darkest disparities in income, health and wellbeing. The presentation spelt out the consortium’s vision and how they carry out their work; referencing Bangladesh.

Bachera Aktar, who presented on the Bangladesh ARISE work, indicated that new vulnerabilities and vulnerable groups emerged during the pandemic with anticipated impacts into the post-pandemic era.

COVID-19 has generated new challenges impacting the broader social determinants of health and wellbeing. Bachera summarised the diversity of methods and approaches they have used to support the co-production of research with peer researchers and communities living and working in informal settlements. She highlighted the importance of ongoing community engagement to support translating research into action.

Neglected conditions and diseases

The aim of the REDRESS project is to use a person-centered approach to evaluate existing health system interventions for the management of severe stigmatising skin diseases in Liberia. People centered approaches are at the heart of REDRESS; meaning consciously adopting the perspectives of individuals, families and communities; seeing them as participants as well as beneficiaries and responding to their needs and preferences in humane and holistic ways.

Zeela Zaizay spoke about the community engagement, involvement and participation that they have been using in REDRESS in Liberia. Community engagement in this setting facilitates problem identification, design, planning and implementation of programmes.

He outlined key priority areas in REDRESS including establishing community advisory boards and a Ministry of Health technical advisory board; involving people affected by severe stigmatising skin diseases and other community actors as peer researchers, using participatory methods to elevate and listen to community voices and ongoing sharing of learning.

Lessons learned

The pandemic has indeed illustrated that no one is safe until we are all safe. There is a need to understand disparate voices, perceptions and knowledge hierarchies in making decisions. Combined efforts are called for to promote key issues such as vaccine inequity and reviewing existing structures and systems around key issues like funding and vaccination politics.

Teamwork and partnership are essential for strengthening and supporting health systems that are inclusive, people centred and built on the diverse views, perspectives and experiences illustrated in the presentations.

There is a need for continuous discussions on challenging knowledge hierarchies and applying the use of innovative research methods including social science and participatory knowledge to build partnerships and action and equity.

16 09 2021

“We choose food” — two young people’s stories about how the pandemic has affected their lives

Nicera Wanjiru (Muungano Kibera) conducts a double interview with two young people of the same age who live in Kibera informal settlement in Nairobi. How have their lives have been affected by the Covid-19 pandemic?

The announcement of the first case of Covid-19 brought Kenya to a standstill. Cessation of movement, curfews, lockdowns were never anticipated. The majority of young people lost their jobs. Young people saw their mothers and fathers break up and others were forced to change careers. To find out more I conduct a double interview with Vivian Vushele who hails from Kakamega County and resides in Kibra, and Charles Gicura. Vivian witnessed her parents separate during Covid-19 Pandemic: living with her siblings, they saw another side of their Dad that they had never seen. For Charles, he had to change careers, having trained in hospitality there was no hope for hotel industries. He says it hasn’t been easy.

Looking down at the last year, how were you affected by COVID-19 pandemic?

VIVIAN: For me, I was very much affected together with my family that is when my dad and mum separated. Their marriage became violent and my mother chose to leave. Where my Dad was working they were forced to quit their job, staying at home with no job was not easy. It wasn’t a good environment for them. It actually made my parents separate it really affected me and my younger siblings it something we never thought it would happen to our family, ever since we were young we used to see on how our family was going on and how our family was and future plan for the family was. But now when the corona thing came in. We were able to see the other side of our dad we never knew it was terrible.

GICURA: Well, last year was quite difficult, to say the least. Because with the emergence of Covid-19. A lot of our dreams were shattered, maybe because you were working and lost the job or you had a job opportunity or maybe you had something going on that is maybe school perhaps all of that was shattered because of the regulations that government put in place. You didn’t know what next, you were put in a place where you were living a day at a time.

What has resilience meant to you?

GICURA: The urge to being adaptive. You had to adapt at each day challenge that was put before you, you had to conquer it. Because there was not any other option, so you had to be adaptive of the circumstances that you were facing at that particular time. Also just encouraging my peers and family because it was a difficult time for all of them. So you had to fight not for own self but for others as well

VIVIAN: We had to pick up the pieces. This a family where we used to stay together united. We still have hope and none of us is ready to lose their dreams. We had to cope up with everything we had to pick up the broken pieces and move forward. For me that was resilience, despite all that was happening, we never lost hope.

Has your hope for the future been affected?

VIVIAN: At first they were, so it was that time I was to join a film school but due to that, everything collapsed and so we had now to start another new chapter of life. So everything was shattered.

CHARLES: Well, yes! I guess at my age having to switch careers it can be very challenging. Because you don’t know what next, you don’t have the bearing of life anymore at times you feel like giving up. But you have that spirit telling you to push on. I can say my dreams were shattered at first but by each passing time you realize then you pursue a place for yourself and then for your family too.

As a young person, have you had access to things like water, medicine, sanitizers and information in your community?

VIVIAN: I would say at first when the pandemic arrived I saw some organization which actually tried on bringing this things, water sanitizers but now due to much population they couldn’t sustain it. So we got it like for two months and everything was shattered. We had to strive to get this thing. As a family we chose food over water and sanitizers. In fact, we were struggling to get that food leave alone sanitizers.

GICURA: Well at first there was this Government directive of providing sanitizers also free water from and also other NGOs around this place. It helped the community a lot a lot. I mean people were depending on the water they were given to wash their hands, the sanitizers to protect themselves from the virus. But as time went by this initiative came to an end, and at the process people started buying these sanitizers from their own pocket money. To an extent it became a source of families fighting because you could see the argument coming up because of one is suggesting they buy the sanitizer and water to wash their hands to protect themselves and the other party is saying we need food on the table. So they were disagreeing a lot based on the fact that these amenities were not provided to us later on.

Were these services affordable?

GICURA: Services such like water were expensive, especially in this part because the population is high we have scarcity and also a lot of people are depending on this water for a lot of things, for their businesses for their daily routine, so water became a very rare commodity. So yes we lack such items in our community for those who could not get free water they had to buy it and it was expensive.

VIVIAN: At first sanitizers were at high price and we couldn’t afford it because of the situation back at home we couldn’t afford that kind of money to go buy sanitizer and leave food so we had to choose food over sanitizer. It wasn’t fair.

Have you been involved in any projects to support your friends or community?

GICURA: Yes I did! We opened a group as young people in my community, this was after safe and inclusive cities training. From this we were able to benefit from certain projects from the chief’s office because we were doing an initiative of cleaning up our community and Kibera at large. From this we were able to benefit from things like water for the community because the chief provided some amenities to us so as we can clean our cities. So in short what am trying to say by opening the group the project just came to us.

VIVIAN: Actually there is a group that am in we went through some training from SAIC which was decent work and safety. We were able to start up a poultry farm and we kept some chickens and actually it has really impacted our lives positively.

Do you think as a country, we are able to cope with pandemics like Covid-19?

VIVIAN: For now am very sure as a country and even individuals we are. This is because the Covid-19 pandemic has taught us a lot in terms of saving the little money you have. Actually when it came it was very sudden so at least now as much as we are spending we need to know we need to save some extra amount of shillings just in case of emergency.

GICURA: Yes! I guess we have a lot of information now as a community about Covid-19 and people are really aware of what we are dealing with compared to the last few months where we didn’t know what this thing was. We also saw people face stigma when you are diagnosed with Covid-19. In fact we saw people being beaten up because they coughed in public. Nowadays people are in a better position of how they judge, of how they behave themselves and everything so I guess yeah, we are at a better place.

Any final messages?

VIVIAN: I would really love for our government to consider our youth because in slums we have so many talents, we have so many gifts. So if the government would really consider it. I think that would be the best thing. Some of us we actually need that small push up maybe us going to school and pursue our education and am very sure we would change the entire city.

CHARLES: YEAH! The whole issue of mental health, I guess it’s the main issue facing young people in this community a lot of people are said to be depressed and also they don’t have the avenues or facilities to go when they face this circumstances. So I feel if the Government can provide facilities where people can go and get counselling so as they can improve themselves and the families they live in.

23 08 2021

COVID-19, the epidemiological and social pandemic

It is not only an epidemiological pandemic but a social one, that has uncovered the perpetual global social, economic, health and political inequalities. Lynda Keeru and Kate Hawkins report back from a recent webinar, ‘Exposing the cracks: COVID-19 and global inequality’. Hosted by The Gender, Justice and Security Hub this event brought together researchers to discuss whether the pandemic can be used as a disruption to the system – exposing cracks that can be exploited to confront power and inequality – or whether it is business-as-usual – exacerbating inequalities and privileging those with power.

Uganda

Josephine Ahikire painted the clear divide that exists between the rich and poor in Uganda; further worsened by the pandemic. The wealthy in Uganda still move freely facilitated by permits issued to them by resident district commissioners. However, circumstances are completely different for the poor. They are the recipients of the strict lockdowns with minimal livelihood options. They can no longer meet their basic needs like putting a meal on the table as they depend on daily income and live hand to mouth. In an attempt to mitigate these challenges, the government put in place a ‘response for the vulnerable’ – a move in the right direction. However, this was slowed down by the process of identifying the vulnerable. That the government did not know who was vulnerable is alarming as they are the ones most affected by government policies. They are the people beaten on the streets, those who can’t access general healthcare, those that can’t find transport because public transport is prohibited and those who face hurdles when trying to access health services.

The situation in Uganda demonstrates the priorities of the government in investing in control and militarism than in facilitating the population to respond to the pandemic. This is an indication of the close connection between neo liberalism and rising militarism. Militarism is being legitimized as a response to a global health challenge and this is a pattern that is being seen in many other contexts.

South Africa

Faisal Garba explored how existing inequalities had been exacerbated in South Africa, through the lens of migrant rights. In the context of refugee protection, countries are using COVID-19 to double down on closures to try and further isolate and marginalize refugees and prevent them from accessing what they are entitled to. Countries are using controls on migration to demonstrate their control of the pandemic.

South Africa adopted migrant blind polices in dealing with the pandemic. An example of this is a policy that was executed by the state at the height of COVID-19. A grant was issued to support families and small businesses. However, one of the eligibility requirements was citizenship. This meant that refugees – who were in critical need of food and other necessities – were excluded, deepening the divide between locals and migrants.

The long-standing fallacious belief that began during the HIV/AIDS era in South of Africa that migrants spread diseases has been upheld during COVID-19. The narrative being peddled is that the porous borders provide a gap for migrants to come into the country with COVID-19. State officials unfortunately amplify this message, creating false unity by selling the idea of citizens protecting their country and their country’s health from people who come in with diseases.

India

Surekha Garimella began by outlining how poor people have struggled for decades and that COVID-19 has brought this to the fore and in doing so made many people uncomfortable. In India the lockdown meant the cessation of livelihoods for many. The extension of women’s care work within the family, community, or for the state has been a considerable burden. Lack of access to health services and health system disruption has led to home deliveries and associated deaths.

During COVID-19 the most marginalized who most need to access protective measures were the ones who got the least. This is happening in a context where people have for decades lived with a huge basic need deficit. The implementation of the Disaster Management Act provided the state with huge power. This was wielded to regulate the lower classes to prevent them from infecting the dominant classes.

Surekha made a powerful intervention about the role of research and researchers in the pandemic response. She argued that the evidence used to formulate public health policies during COVID-19 does not adequately take the poor into account. There is a need to challenge mainstream conceptions of what evidence counts and go beyond the biomedical. This needs to consider that actions have different implications depending on the different societal divisions whether it be class, gender, caste, or geographical location.

“I learnt so much from the webinar and the engaged speakers, who are embedded in a range of different contexts, working to better understand and strategically address the multiple inequities that are amplified by COVID-19. It was excellent to bring learning together across three sister GCRF hubs, on social justice, gender and equity, and I look forward to further joint dialogue and action.“ Sally Theobald, PI, ARISE hub

Speakers:

Kirsten Ainley – Associate Professor of International Relations and the Deputy Principal Investigator of the UKRI GCRF Gender, Justice and Security Hub

Heaven Crawley, MIDEQ Hub

Faisal Garba – Teaches Sociology at the University of Cape Town (UCT) and is the Co-Convenor of University’s Global Studies Programme and works with the Migration for Development and Equality Hub

Dr Surekha Garimella – Senior Research Fellow at the George Institute (@GeorgeInstIN), holds a PhD in Public Health, Gender and Work and works is part of the ARISE Hub

Dr Josephine Ahikire – Principal, College of Humanities and Social Sciences and former Dean, School of Women and Gender Studies and Co-Director on the UKRI GCRF Gender, Justice and Security Hub

19 08 2021

Challenging the status of women and youth in the WASH sector in Kenya

Kenya’s progress towards achieving Sustainable Development Goal 6 has been slow, with only 59% and 29% water and sanitation coverage, respectively (JMP, 2019). Sewered sanitation is currently available to only about 3.9 million people in 26 counties with 61% of these being within Nairobi County. 21 counties lack any systems for waste management (WASREB, 2020), while funding for sanitation remains low. With less than ten years to go, Kenya must act fast if it is to achieve water and sanitation for all by 2030.

Women and youth are largely responsible for household water, sanitation and hygiene (WASH) management and bear a disproportionate burden when these basic services are lacking. However, they are often left out of critical discussions and decisions relating to water and sanitation. There is evidence that women and youth participation in water and sanitation decision-making and governance can lead to their social-economic and political empowerment and can enhance performance outcomes for the household and community (UN, 2019).

The ARISE team at African Population and Health Research Center (APHRC) supported the Water Services Providers Association (WASPA), Ministry of Water, Sanitation and Irrigation (MWSI), Women in Water & Sanitation Association (WIWAS) and the County Government of Nakuru to hold the inaugural Youth & Women in WASH conference (Conference website) in Naivasha, Kenya from 30June – 3 July, 2021. The theme was ‘Unlocking potentials of Youth and Women for Sustainable Water and Sanitation Services.’

The Conference was officiated by Hon. Sicily Kariuki, EGH, the Cabinet Secretary, Ministry of Water, Sanitation & Irrigation (MWSI). It brought together stakeholders from the water and sanitation sectors to share good practices, deliberate on prevailing challenges, and formulate strategies to leverage youth and women’s potential to accelerate the realization of universal access to potable water and safely managed sanitation services.

In her opening address, the Cabinet Secretary, Hon. Kariuki outlined the efforts her ministry was implementing within the Water Sector in promoting and championing women’s inclusion in decision making in order to empower them and improve services in the sector.

“When women and youth are incorporated in these sectors and in all sectors for that matter, the individual, the organization and the community is enriched,” she said.

Chief Administrative Secretary, Gender from the Ministry of Public Service, Youth and Gender Affairs, Hon. Dr. Linah Kilimo noted that access to clean water and adequate sanitation contributes to the achievement of gender equality and women’s empowerment. She noted that the violation of these requirements was a violation of women and youths’ rights.

“Inadequate access to safe hygienic and private sanitation facilities is a source of shame, physical discomfort and insecurity for millions of women across the world”, she said. “In informal urban settlements like Mathare valley in Nairobi, women have to wait until it is dark to empty their bowels. As a result, they tend to drink less during the day resulting in all kinds of health problems,” she added.

The CAS reiterated government commitment to affirmative action funding for women and youth through the Ministry of Public Service, Youth and Gender Affairs. She urged women and youth groups at the conference to take advantage of interest-free loans such as the Women Enterprise Fund, the Youth Enterprise Development Fund and UWEZO Fund to develop and earn profits from water and sanitation projects.

The ARISE team at APHRC supported the conference preparation with Caroline Kabaria chairing the Scientific and Technical Committee. Blessing Mberu gave a keynote address on capacity development and research to optimise the untapped potential of youth and women in the WASH sector. In his address, Blessing highlighted the need for continuing demand for equity in bringing women and youth into WASH governance. Beyond the focus on existing positions however, he calls for focus on developing new and emerging frontiers in the sector where women and youth can offer leadership along the WASH value chain. Areas he identified included innovations using technology like e-payment platforms, designing, manufacture and distribution of gender sensitive sanitation products, WASH entrepreneurship and tapping into opportunities in capacity building and research leadership, where women generally have comparative advantage. He specifically called for investments in capacity building towards a critical mass of women and youth professionals for research leadership with training at Masters and PhD levels. He identified existing scholarship models for graduate training that can be amplified, and called for interrogation of the pathways of women in Science, Technology, Engineering and Mathematics (STEM) in relation to recruitment, retention and career progression towards leadership and beyond. WASH is an essential sector and the overarching question is about how to mobilize our human capital in youth and women, train and engage them. The overarching answer is about evolving an inclusive productive process of inputs and outputs in existing opportunities, in creating new ones, new frontiers, and new models by and for those well trained, ready to engage and proceed. The pathway forward includes addressing structural hindrances. The youth of today will get older and their children – the young men and women of tomorrow – will end up in the same spot and crying the same cry of yesteryears and our today.

“Every generation has their challenges and ours is with us including how to build an inclusive equitable society and sectors, Let us do it collaboratively,” he concluded.

To amplifying community voices and the interface between citizens and government to build collective capacities, ARISE mobilized and supported six youths and women from Korogocho and Viwandani informal settlements to participate in the conference and make presentations. The participants from Sidarec, Slum-Tv Kenya, U-Tena Youth Organization, Ghetto fm Mukuru, Slum child foundation, and Fuata mkwanja exhibited their activities in water and sanitation in their communities.

“We got a rare and a unique opportunity to make a brief presentation about our work in the line of Water, Sanitation and Hygiene to Ministry of Water, Sanitation and Irrigation Cabinet Secretary, Hon. Sicily Kariuki and other top delegation in our stand on the sidelines of WASPA Youth and Women Water and Sanitation conference 2021. We are happy to be working with African Population and Health Research Center, Sidarec, Slum-Tv Kenya, U-Tena Youth Organization and Ghetto fm Mukuru”, they said.

Exhibition

In addition, the community groups also discussed their work in a conference session in a joint presentation with Ivy Chumo, a Research Officer at APHRC and PhD Candidate at LSTM supported through ARISE Hub.

Innovations Award

Two community initiatives were awarded second and fourth place in the Community Category of the Conference Innovation competition dubbed Vijaana and Dada Water and Sanitation Awards. The two were feted with other competitors at a gala event officiated by the Dr. Andrew Tuimur, Chief Administrative Secretary, MWSI.

The two awardees were part of community participants in a Youth and Women Water and Sanitation Forum co-hosted by ARISE in May 2021 in Naivasha, Kenya.

Women at the helm of water and sanitation

Pre- conference (Group Photos; From left; women group and youth group)

Video links (Blessing and Florence)

In addition, APHRC partnered with the Women in Water and Sanitation Association (WIWAS) to convene a session on Strengthening the Role of Women leadership in the management of WASH at the conference. The session, moderated by Caroline Kabaria, created a forum for women leaders in the various Water Service Providers (WSPs), WASH related institutions and communities to speak candidly on the challenges faced by women and youth in accessing opportunities in the sector.

“The engrained social norms which trickle down to prejudiced hiring processes and limited training and networking opportunities has been a major contributor to the unequal employment opportunities throughout women career trajectory,” said WIWAS chair Dr. Leunita Sumba in her opening remarks at the session.

“Career progression plans in most organizations are steep and the barriers placed by the male dominance in the sector make it nearly impossible for women and youth to occupy positions of leadership. It is therefore necessary for women and youths to be proactive but also have support from those in leadership to create a level playing field,” said Margaret Maina, Managing Director Limuru Water and Sewerage Company.

During the session, Amb. Dr. Mary Khimulu presented the UNESCO World Water Assessment Program (WWAP) call to action to accelerate progress towards the achievement of gender equality in the water sector. The call is to decision makers across the board to accelerate concrete actions towards the achievement of “water access to all without discrimination; promoting women’s leadership in water management and governance; protecting women’s water rights and applying gender-equal financing, narrowing the gender gap between policy and practice, prioritizing the collection of sex-disaggregated water data and counter-fighting norms and stereotypes that disadvantage women and girls.”

WASPA CEO, Antony Ambugo, pledged to support in strengthening WIWAS through continuous collaboration as well as recruitment of members from WASPA members. Other members of the panel were WIWAS Male Champion Eng. Simon Thuo, Beatrice Langat, a senior research Officer at Kenya Water Institute, Monica Tuli Ag. Human Resource and Administration Director at Nairobi City Water and Sewerage Company.

The women in leadership positions were also encouraged to create enabling environments for the younger generation as they work towards positions of leadership.

“Do you leave the door open behind you or do you close it?” asked Linda Gwanda, the Communication and Corporate Affairs officer of the Water Sector Trust Fund fellow panelists and the audience.

The main outcome of the session was to setup a deliberate effort by WIWAS and its members to start mentorship sessions for youth and girls at high school and college levels.

Sheillah Simiyu, Francis Onyambu, Phylis Busienei, and Ivy Nandongwa joined the ARISE team at the conference where eight abstracts and presentations were made based on various ARISE and Urbanization and Wellbeing in Africa (UWB) research at APHRC.

11 08 2021

Mapping informal settlements in Sierra Leone: Researchers and co-researchers experiences in mapping urban spaces

This blog was co-produced by researchers and co-researchers in Sierra Leone to share our experiences mapping urban marginalized spaces.

We conducted GIS mapping of three informal settlements to identify key landmarks, physical features, environmental hazards, health risk areas and social groups. The purpose of this work is to use the map to aid participatory data analysis that will identify key health and wellbeing challenges within communities and make maps accessible to community members so they can use them as they wish.

Building our capacity

Our Field team in Sierra Leone is comprised of eight researchers (three women and five men) and 15 co-researchers from across three project communities (seven women and eight men). Before taking up the GIS mapping of project communities (Cockle Bay,

Dwarzark and Moyiba), we held series of workshops to build our capacity as researchers and co-researchers on how to use GPS for boundary mapping and Open Data Kit (ODK) to map services. Workshops were facilitated by CODOHSAPA’s mapping expert (Richard Bockarie) and the team’s capacity and confidence were improved for the intended task.

“We also learned about the GPS and surveying; it was the first experience for some of us. We acquired technical knowledge. We listened to each other; we held meetings. If we made mistakes, we would find ways to correct them and go back on the field. The mapping exercise also allowed us to know our communities better and what the real boundaries are of our communities.” (Co-Researcher)

Organizing the team and completing the mapping

Eight days was allocated for boundary and service mapping across three communities (five days for boundary mapping and three days for service mapping). Three researchers and five co-researchers were assigned to the Dwarzark community, three researchers and five co-researchers were assigned to the Moyiba community and two researchers and five co-researchers were assigned to the Cockle Bay community. One community pointer was assigned to each community. Dwarzark and Moyiba had more researchers due to larger land size and rugged terrain which makes it difficult to navigate. With limited equipment two GPS and three phones were allocated to each community.

Informal settlements have unique power dynamics. There are local chiefs found across these settlements who were installed by the local government either as tribal or community chiefs. They are charged with the responsibility of regulating customary or bye-laws in their communities. Before our activities began, community leaders (councilors, community chiefs, chairmen and chairladies) and other relevant stakeholders were informed about our objective. This was intended to enhance community buy-in.

In the field, the bigger group assigned to each community was divided into sub-groups in order to cover more ground and efficiently manage time. We also agreed that groups should have a briefing before and after every exercise per day. This was to help us build confidence and address unforeseen challenges.

Reflection from Co-researchers on mapping community boundaries and services

A reflexive session was held after the mapping exercise with co-researchers and community pointers on the importance of the features mapped and the usefulness of the maps to their communities, successes, challenges and lesson learnt from the mapping exercise. The following reflections were share by co-researchers:

Identifying health and wellbeing issues and environmental hazards

“It is important to map the health centre. If the mapping shows that there are no health centres, we can show the government that help is needed. It gives us information on what should be improved.” (Co-researcher; Fatmata B Sesay Moyiba community)

“The health center is a key feature in the community because they help the community people. The environmental hazards are important to map also. In Dwarzark community, we do not have dumping site, so people use the drainage to dump the waste. But this is not good because if rain comes, it will overflow.

It is important to map these features to know what the issues are and to have improvement, for example constructing a dump site.” (Co-researcher; Zakiatu Sesay Dwarzark community)

“It was useful to map out important features within our communities. All of these features are important. In the Dwarzark community, those who are living in the upper part are very prone to disaster and deprived of certain facilities. Those who live down are a little better-off. These physical features are important to identify to gain in-depth understanding of the community.” (Co-researcher; Mohamed Sesay, Dwarzark community).

“All the features mentioned are important. The environmental features (flooding area and dumping area) are important to map. During this project, we categorized the communities as hillside or sea-side. The hillside communities have health hazards. Through the mapping and observation, we know where they are located, in which CDMC (Community-based Disaster management Committee, these are groups formed in every informal settlement to champion disaster mitigation activity within their communities.) were later notified, so that they would clean the areas.”

“The edge of the banking area is a particularly important feature to map. We need to identify this boundary. There are massive banking activities currently going on there which has changed the landscape of the community. Cockle Bay is situated on wet land and very prone to flooding.

We are very scared that one day high tide and heavy rain will happen simultaneously, which has never happened before, but if it does happen the community would be seriously damaged. We need to work as a community to prepare ourselves for this day. We wouldn’t be able to save our properties, but we need to be ready to save our lives.” (Co-researcher; Frank Bubu Kamara Cockle Bay community)

“The boundary mapping is also important; it helps the community to know what the boundaries are. For the seaside communities, it is important to map the boundaries because people are banking. So, in 5 years, we will be able use the map to asses and indicate the extent of the banking activity and the threat it poses to the community” (Co-researcher; Esther B. Sesay Cockle Bay community)

Supporting to strengthen accountability mechanisms to address identified challenges

“My position influences my access to services in the community. In hilltop areas, it is hard to have water access especially for young girls. So, we sensitized the water manager on this issue and allocated a certain time for young girls to fetch water to protect them. This allows us to reduce issues related to teenage pregnancies and early marriage.” (Co-researcher; Zakiatu Sesay Dwarzark community)

“I am also a community animator for NGOs working in my community. So, people know me because of this community work. It makes me feel good. I am also the community chairlady and I control 32 taps in the community. This taps really helps the community by protecting young girls from early marriage and teenage pregnancies. It also prevents school dropout by enhancing water access.” (Co-researcher; Jamestina Sia Bayo Moyiba community)

“I am a CDMC chairlady, so it is important for me to map out the dumping site to organize the CDMC team to clean these areas and reduce health hazards. All of the features are really important for me to map since they allow me to better understand and coordinate programme more efficiently.” (Co-researcher; Zakiatu Sesay Dwarzark community)

“We had to explain to the dwellers that we were not surveyors but mapping the community boundaries as part of the ARISE research project so that they would let us pass. We learnt a lot about the GPS mapping techniques. Now we are able to map anything. It also allowed me to know more about my community.” (Co-researcher; Saud Kamara Moyiba community)

Building capabilities and capacities

“There was a good working relationship between the researchers and co-researchers in the field as always. We divided the team in two sub-groups, but the information circulated well between the groups allowing the work to be successful. We would meet every morning and do a briefing on how to tackle challenges in the field. We were happy to do the work, so we got the best out of everyone. For most of the co-researchers, it was the first time we were doing this work, and we were very enthusiastic.” (Co-researcher; Mohamed Bangura Dwarzark community)

“The researchers were very caring and respectful to us which helped a lot to get the work done. There was a good working spirit, we ate together etc.… This good interaction really helped realize the work.”

“It is important to have good pointers that know the community well for the work to go faster and easier.” (Co-researcher; Jamestina Sia Bayo Moyiba community)

“We are happy because we learnt a lot. As co-researchers we did our work on our own. (Co-researcher; Issa Tuary Moyiba community)

Challenges in mapping informal settlements

Mapping informal settlements comes with lots of unforeseen challenges that might be encountered. These can range from challenges of equipment, personnel, personnel, time management, geographical terrains of communities or the community residents themselves.

We underestimated the size of Dwarzark and Moyiba community, so it took more days to complete. To complete the mapping than we had anticipated.
Dumping site on the coastline of Cockle Bay community
Photo credit: Samuel Saidu, Researcher.
The GPS had a technical fault which also delayed the pace of work. There were also doubts about whether to map certain areas as informal settlements or not. This is because some community zones had massive properties. In the end, the contested areas were mapped since the technical team and community pointers (who were selected because they lived in these communities) gave directions on how to draw appropriate boundaries.
Community members in Cockle Bay were fearful when they first saw the team mapping the boundaries. Community members repeatedly asked about whether it was part of the eviction process. The intervention of co-researchers and the community chief, allayed their fears. The community Chief assigned one community stakeholder to us so we could explain our objectives to residents. With support from the co-researchers and community pointers we were able to gain their trust.
It was difficult to take photos and map out boundaries on the coastline in Cockle Bay due to high tides. As a result, researchers had to wait for low tides to continue, causing delays.
Researchers and co-researchers climbing to map hill top areas in Dwarzark community.
Photo credit: Samuel Saidu, Researcher.
There were few incidents of accidental falls and minor injuries sustained by some co-researchers and researchers during the mapping exercise. They were taken to the community center for treatment and we tried to find better ways of navigating rugged terrain using ropes and support to each other to cross rivers and climb hills.
Resident in Moyiba community reported to us about incident of violence and robbery in a section of the community. That section of the community was inaccessible by the team for several days.

Although faced with many challenges we were able to complete the mapping exercise. It was a great experience for us all, as we learnt new things about our communities, exhibited great teamwork and had fun.

Upon completion of the boundaries and service mapping, a draft map was produced and a validation workshop convened. The validation workshop comprised of all those who participated in the mapping exercise such as researchers, co-researchers and community pointers. During the validation session, co-researchers were asked what they wanted to do with these maps within their communities and for ARISE data analysis. They stated that they want to use the map to advocate for development in their communities and also to change the behavior of people doing banking, building in hazardous locations and for proper waste management. We are continuing to support communities to take forward their priorities.

Notes

Produced by (Researchers) Samira Sesay, Abu Conteh, John Smith, Dr. Bintu Mansaray, Mary Sarah Kamara, Daphnée GOVERS, Samuel Saidu, Ibrahim Gandi and (Co-researchers) Mohamed Bangura, Mohamed Sesay, Zakiatu Sesay, Sinneh Turay, Hafsatu Kamara, Jamestina Sia Bayo, Fatmata B Sesay Suad Kamara, Issa Turay, Abdul Karim Kamara, Alieu Bah, Frank Bubu Kamara, Esther A Kamara, Abu Sesay.

MAPS (Boundaries and services)

11 07 2021

Supporting communities in the COVID-19 pandemic: ARISE community researcher experiences

We have been conducting participatory action research in three informal urban settlements (commonly known as ‘slums’) of Dhaka city since 2019. These three areas are Kalyanpur Porabosti, Nama Shyampur and Dhalpur slums. Nishika Samaddar Tumpa, Jeevan Ahmed Jumman, Bilal Hossain Jewel – who are co-researchers in the project – reflect on their experiences during COVID-19. The original blog was co-written in Bangla and has been translated into English by Afsana Yeamin, ARISE Bangladesh researcher.

From March 2021, the number of active cases and deaths due to COVID-19 have risen across Bangladesh. To prevent the spread of Covid, the government imposed restrictions on March 29, banning the movement of people and vehicles across the country . Despite the lockdown somewhat curbing the high rate of infection transmission, the country’s economy is severely affected. Most people living in slums in Dhaka city are poor and marginalized, and this second phase of lockdown, after the long-term lockdown of 2020, has hampered their earnings, throwing them into dire financial crisis.

ARISE Bangladesh continues its research work relentlessly even in the face of nationwide COVID-19 lockdown. A total of six young people (two young men and women from each study site) have been involved in this research project as community researchers (co-researchers). During lockdown, community researchers not only confined themselves to research work, but each of them has also been actively involved in various COVID-19 awareness and response activities in their respective areas. Here, three co-researchers from three slums areas shared their experiences of involvement in COVID-19 response activities during the second wave of COVID-19 in Bangladesh.

Nama Shyampur

Tumpa, one of ARISE Bangladesh’s co-researchers, is also a Community Organizer (CO) of BRAC Urban Development Program (UDP) in Nama Shyampur slum under ARISE Responsive Fund. In Nama Shyampur slum, with support from the ARISE Responsive Fund, BRAC UDP set up three hand wash stations and distributed soaps and detergents to enhance hygiene practice among slum dwellers during the second phase of lockdown, and nearly 1,000 households received masks. Additionally, 30 children were given school bags and stationery by BRAC UDP during lockdown.

I am currently playing a dual role as an ARISE co-researcher and CO of BRAC UDP. I have actively participated in the community-based COVID-19 preventive actions during the second phase of lockdown in Shyampur. My involvement ranged from planning to implementing those activities. During this lockdown, I organized multiple community meetings every month for raising awareness about COVID-19 among people residing in my areas. In those meetings, I discussed the necessity of wearing masks and the benefits of hygiene practice and demonstrated proper handwashing procedures. Yet, the irony is that I face various unprecedented situations during fieldwork as a woman and a frontline worker.

This year, during lockdown, while distributing masks among the people of our community, some people ranted at us. They said, “We are hungry; what is the point of wearing a mask?” During last year’s lockdown, some people who received financial or food assistance were expecting the same support this year. When they saw we merely distributed masks, they didn’t want to accept the free masks; instead, they started denying our advice and criticizing our activities. If we told them to wear masks, they replied, “Corona will not infect us.” When we advised them to maintain physical distance or avoid social gatherings, they said, “Who will do my work if I don’t go out? How will my family survive?” I handle such a situation based on the experiences of living and working in this slum. I first listened to their problems or complaints and then tried to explain the benefit of wearing masks or staying inside the home and how accepting free masks could save their money.

Dhalpur

Jumman is the male co-researcher in Dholpur slum and is also an active member of the local youth club of their slum – ‘Youth Associates’.

Although people have been made aware of using masks since the first wave of COVID-19 in Bangladesh last March, many people in our slum

are now reluctant to use masks as the number of COVID cases slowly declined at the end of 2020. In addition, awareness programs and relief distributions in Dhalpur slum were minimal during the second phase of the COVID-19 lockdown. So, our club members took the initiative to talk with local people and encouraged them to wear masks to keep them and their families safe during lockdown. As a co-researcher of ARISE, I, myself, bought bleaching powder and sprayed disinfectants in the alleys to clean our area during this second lockdown. Not only me, but the other members of Youth Associate also got involved in such cleaning activities.

While most of the people of my community encouraged us for our social work, people who fail to understand the motive of our activities often throw negative comments. For example, when I was spraying disinfectants, one said, “What they do is show-off”. Another person said, “They get money in return; therefore, they do such activities”. To mitigate this challenge, when they made such comments, I explained to them the benefit of spraying disinfectants. In addition, when doing awareness campaigns in our area, we tried to invite local leaders. These approaches helped us in gaining the community’s trust.

Kalyanpur Porabosti

Billal, a young social activist, is a co- researcher in Kollayanpur Porabosti. He and his local youth club, ‘Protimancha’, have been actively involved in COVID-19 awareness building in their slum from the beginning of the pandemic.

Though financial assistance or food support did not reach Dhalpur or Shyampur slums, the situation inside Kalyanpur Porabosti was somewhat exceptional. The World Food Program has been providing cash assistance of 3000 taka via Bkash (mobile banking) to about 1700 families with the help of BRAC UDP for the last ten months, and this support was continued during the second phase of lockdown. During lockdown, one of the political leaders of our area came at late night, at around 10 pm and distributed food (2.5 kg rice, 1 litre of oil, half a kg of onion, 1 kg of potato, 1 kg of sweet pumpkin and half a kilogram of lentils) to a few selected families. This assistance was negligible compared to the needs of the large number of people living in our slum, and the majority of the people receiving food assistance that day were known to that local leader and his acquaintances. A few days later, another organization came for relief distribution, but again, a handful of people in our area got it due to corruption and uneven distribution.

We, the two co-researchers and our club memebrs, have taken several initiatives to raise public awareness in our area during the second phase of lockdown, such as announcements via microphone, distributing posters or leaflets. The club members themselves raised funds for those activities. Apart from these, I took the initiative to organize a rally when IED (an NGO) approached us to create public awareness on Corona inside our slum. Moreover, during this lockdown, I visited various slum households and discussed the necessity of washing hands properly with soap to prevent COVID-19 infection, what to do when someone suffers from fever, cold and cough, and encouraged everyone to use masks going outside.

ARISE co-researchers, who belong to the marginalized groups living in the slums with financial and other constraints, are working as the change agents for their own communities. Linguist and philosopher Noam Chomsky has a famous saying, “Changes and progress very rarely are gifts from above. They come out of struggles from below”. ARISE community researchers are great examples of the ‘changes from below’.

09 07 2021

Nairobi’s CHVs to receive monthly stipend

Rosie Steege, Jane Wairutu and Linet Okoth report back on the passing of the Nairobi City County Community Health Services Act in June 2021 – welcome news for Nairobi’s Community Health Volunteers (CHVs) who have waited almost two years since the Bill’s inception.

The Bill sees Nairobi’s CHVs entitled to receive a monthly stipend of KSh 3,000 (approx. $30 USD) plus a further 500 ($5USD) contribution to the National Health Insurance Fund.

This payment is in exchange for eight days work in a month and is contingent on CHVs successfully achieving an 80% performance target. CHV performance is assessed by Community Health Assistants using a checklist. The checklist includes ten indicators, among them are the number of household visits, total number of referrals (e.g. referring children for immunisation or pregnant women for antenatal care), participation in community mobilisation and general reporting. The CHVs should perform in at least eight out of ten indicators to receive their payment.

Implications of the Bill

The passing of the Bill is an important milestone. CHVs form a key part of the health workforce, linking communities with the health system. Nairobi’s CHVs live and work in complex urban environments, many face particular challenges. Informal settlements lack basic public services – such as clean water and sanitation, waste management and health facilities – as well as proper governance and often face high levels of unemployment, crime and insecure tenure. Further, profiling of 386 CHVs in Mukuru S.P.A. in 2019 by SDI Kenya and Muungano wa Wanavijiji under ARISE found that CHVs are likely to serve over 1,000 households, far above the recommended 11-150 households for CHVs in urban areas.

Slums are also disproportionately impacted by COVID-19. The CHVs’ vital role in the ongoing COVID-19 pandemic demonstrates their agility to respond to shocks and their shifting and evolving demands. Their work recently gained them recognition from the Cabinet Secretary for Health, county governors, and the President.

CHV work is purely voluntary as stipulated in the community health services motto “our health our responsibility” this has however contributed to dissatisfaction and attrition among Nairobi CHVs. Passing of the Bill should see improved motivation among the cadre. Payment also provides a welcome opportunity to work towards Sustainable Development Goal (SDG) 8 – decent work and economic growth.

Payment of CHVs may also reap rewards for gender equity and SDG 5. SDI Kenya’s profiling under ARISE, found that 82% of Mukuru’s CHVs were women; the predomination of women in roles with the least pay and the least power is echoed globally. Fair remuneration for women’s work is critical as women may internalise and reproduce harmful gender norms that spill over into their interaction with their clients, damaging the broader development agenda. Therefore, Nairobi’s decision to increase payment for CHVs to 3,500Ksh may pay dividends. Evidence has shown that women’s participation in the paid health workforce results in improved health – both in the generation of wealth and also through the contribution of earnings to health promoting investments. Women have been shown to invest 90% of their earnings towards their families’ well-being compared to up to 40% invested by men.

ARISE’s contribution

ARISE partners LVCT Health with other community health actors at national level, provided input into the Bill and the memorandum to the proposed Bill. The memorandum advocated for expunging some components of the National Bill that were not in favour of, or excluded, the CHVs. These expungements were adopted by the health committee and included in the Bill through the National Community Health System Technical Working Group. LVCT Health were key to ensuring that the Bill spoke to the needs of CHVs working in informal settlements.

What’s next

Although a great step forward, this isn’t the end of the road for fair remuneration for CHVs. For one, we need to be cognizant of the fact that the payment accounts for CHVs might not be commensurate with the effort CHVs make in offering services.

CHVs in informal settlements are assisting some of the most underserved populations, given support and remuneration to allocate fair time to their roles without relying on additional income generating activities will further contribute to health and development gains for the vulnerable in society. Muungano’s profiling also revealed that women were also more likely to volunteer more hours than men, meaning that the paid time allocation may disadvantage women if they work additional hours without payment.

Secondly, formal evaluation of payment structures and their impact on community health delivery and the CHVs experiences is needed to understand if they payments are truly fair, or whether any perverse incentives or unintended consequences from the new policy surface. For example, close attention to the 80% performance target should be paid to ensure this does not distort health care provision or disadvantage men and women differently whose gendered roles in the community influence their ability to reach the targets. Additionally, work is required to ensure that CHVs who are eligible are receiving their stipends in a timely manner. Prior to this Bill CHVs were meant to be receiving a stipend of 1,300Ksh through implementing partners however, ARISE profiling demonstrated that often CHVs were receiving only half this amount putting enormous pressure on CHVs who were unable to rely on the income.

While Nairobi is not the only county to implement payment for CHVs in Kenya, this is not yet a national policy – advocacy for all CHVs to be remunerated regardless of where they reside and work is a must. This can be supported by reflexivity and transparency – sharing both the success and failures of implementing the policy for other counties, or indeed countries who may wish to follow their example.

06 07 2021

‘Normal’ or ‘New Normal’: Life in urban slums amid the COVID-19 pandemic

In this blog, three community researchers from three study sites Esha Akhtar Labanya, Sweety Akhtar and Md. Tanvir Islam explained how the second wave of the COVID-19 pandemic and subsequent lockdown affected their community. Md. Imran Hossain Mithu an ARISE researcher has translated this blog post from the original Bangla.

ARISE Bangladesh partner BRAC James P Grant School of Public Health (JPGSPH) at BRAC University has been conducting participatory action research in three urban slums (Kalyanpur porabasti, Dholpur, and Nama Shyampur) in Dhaka city since 2019. One of the features of this research is the active participation of community members in research activities. We have been working as community researchers in this study.

The COVID-19 pandemic has taken different forms in Bangladesh over the past year. To deal with this situation, the government of Bangladesh has taken various preventive measures, including a nationwide shutdown/ lockdown at different phases. However, Bangladesh has been in the second wave of COVID-19 since mid-March 2021. Therefore, to address the second wave of COVID-19, the government again declared a nationwide lockdown from 7 April to 30 May 2021. As a result, poor and marginalized people residing in urban slums, especially in Dhaka city, again got stuck in the complex web of pandemic consequences.

COVID-19 prevention measures in urban informal settlements

Dhaka is the most densely populated city in Bangladesh, with thousands of poor and marginalized people living in informal settlements in different corners of the city. Most slum residents live in tiny, congested single-room houses. In addition, around 10 to 15 families, even sometimes 60 families, share one single toilet and use a communal bathing space and water collection point. Many families also use one single communal kitchen. All these factors serve as the main hindrance in following COVID-19 pandemic-related hygiene and preventive measures.

During the nationwide first lockdown in March – June 2020, many people tried to follow some preventive measures. Local community leaders, landlords, and other influential inhabitants took different community-level initiatives and containment measures to prevent infection transmission. The initiatives included a roster plan for using communal bathing spaces, water collection points and kitchen, etc. However, after announcing the second phase of lockdown in April 2021, no such initiatives have been observed across the slums. There are not even any initiatives from NGOs or the government to disseminate COVID-19 awareness information in the slums. Most people are unaware of the new COVID-19 variant and the importance of wearing masks, frequent handwashing, and maintaining physical distances. As a result, they are reluctant to follow any preventive measures now. Like in pre-COVID times, people roam around the slums, gathering in tea stalls and local marketplaces without wearing masks. It is nearly impossible to maintain physical distancing in these overcrowded places.

Many people do not even believe in COVID-19’s existence or believe that poor people do not get infected as they do physical labour. A rickshaw puller from Shyampur said, “Corona is a disease for rich people; the disease does not infect the poor people who are working hard all day long.” These perceptions and attitudes are putting the slum dwellers at greater risk in the second wave of COVID-19 in Bangladesh.

Adhering to lockdown is a luxury

Long-term economic shocks as a result of COVID-19 have forced slum dwellers to go out searching for work. Most people living in slums are involved in poorly paid jobs such as ready-made garment (RMG) or factory workers and informal economic sectors (domestic workers, rickshaw pullers, van drivers, daily wage earners). The overall economy of Bangladesh was greatly affected by the first nationwide lockdown last March, and has not yet recovered, and the second lockdown has only intensified the adverse effects. Many slum dwellers lost their jobs, or their incomes have drastically decreased, and are battling to survive by spending their savings, selling their property, taking a loan, or borrowing money from relatives. The poor slum dwellers are immersed in the sea of starvation day by day. They are more afraid of their hungry stomach than they are of Corona. As their financial condition worsens, they ignore the lockdown, take risks of health, and look for a livelihood.

During the first lockdown in 2020, the government, different NGOs, and wealthy people provided various financial and food assistance to help poor slum dwellers. However, in the second phase of lockdown, neither the institutions nor individuals came forward to help. As a result, even though the poor may have somehow survived by getting help in the first phase of the lockdown, it has become difficult for them to survive without any help in the second lockdown. According to slum dwellers, where the poor slum population struggles to manage their daily foods, it is nothing but a luxury for them to follow lockdown. A resident of the Dholpur slum said, “We do not have rice in our house; what else can be happened by the corona!”

The ‘new normal’?

Now people are talking about the adaptation of ‘new normal’ of the pandemic. But what is ‘new normal’ or even ‘normal’? Is the ‘new normal’ the same for all? When we, people living in thousands of slums in Dhaka city, are struggling with daily survival with limited to no support from the government due to our unrecognized identity in the system, what is the ‘new normal’ for us? Is it staying at home during lockdown following government directives even if we starve to death? Or is it risking our lives by going out during lockdown for managing food and daily necessities?