Urban Health: From Local Community Action to a Healthy Freetown

This Practitioner Brief has been produced based on the discussions and agreements that took place during the City Learning Platform (CiLP) meeting in February 2020. The meeting was hosted and coordinated by the Sierra Leone Urban Research Centre (SLURC), who also reported on the agreements.

Health is intertwined with living conditions in the city. Determinants of population health include inadequacies in the urban environment, especially linked with water, sanitation, and hygiene (WASH), waste collection, and housing conditions. Major health policies have historically not addressed these interlinkages, nor the specific concerns and circumstances of informal settlements, reflecting silos between health systems and urban stakeholders.

Improving health in Freetown requires an approach based on an engagement with residents of informal settlements about their health-related priorities, beliefs and experiences, as well as with already existing health support systems in the territories. This includes understanding and working with local and informal providers of health-related services, including local and traditional healers, and the use of participatory approaches.

There are important precedents and ongoing initiatives related to the management of previous health crises in Freetown – such as the Ebola outbreak – as well as in the daily activities residents are already undertaking to co-produce health services. Any approach to urban health should be built upon local lessons from those experiences.

There are important data gaps regarding the health conditions and determinants of health in informal settlements: practitioners and authorities should work with communities using participatory inclusive approaches to fill those gaps, ensuring that information from vulnerable marginalised groups is captured. This data would allow to identify priorities and health seeking behaviour, and design and implement health programmes, as well as improve monitoring of health service delivery and interventions by the Ministry of Health and Sanitation (MoHS).

Practitioners and authorities should approach health as part of a wider set of relations that take place within informal settlements, and with the rest of the city. Health is interdependent with livelihoods, housing and infrastructure, support networks, costs of mobility, personal bonds of care, societal norms and related vulnerabilities.

The concept, content and edition of this brief were developed by SLURC co-directors Andrea Klingel, Braima M. Koroma, and Joseph M. Macarthy, Research Officer Abu Conteh and Junior Researcher Mary Sirah Kamara; KNOW Research Fellows Stephanie Butcher and Camila Cociña, and KNOW Co-Investigator Alexandre Apsan Frediani. The first draft of the content of this Practitioner Brief was reviewed and commented by Annie Wilkinson and Haja Ramatulai Wurie. Layout developed by KNOW.

City Learning Platform (2020). Practitioner Brief #3: Urban Health: From Local Community Action to a Healthy Freetown. Practitioner Brief #3. Freetown: Sierra Leone Urban Research Centre.