Cudjoe Bennett, Senior Research and Knowledge Management Advisor
Office of Maternal and Child Health and Nutrition, USAID
The world is becoming increasingly urbanized. Urbanization is happening at a particularly rapid rate in low and middle-income countries. The majority of the world’s urban population lives in less economically developed regions.1 With rapid urban population expansion, some estimates have pegged the growth rate in sub-Saharan Africa at 4.1% per year. This is more than twice the rate in economically developed regions where urban population growth is about 2% per year.2
A bi-product of such rapid urbanization in low and middle-income countries has been the increase in informal settlements or slums, defined by UN-HABITAT as “densely populated areas with substandard housing and a low standard of living as depicted by the absence of one or more of the following: improved water supply, improved sanitation, sufficient living area, durability of construction, and security of tenure.”
Approximately 14% of the world’s population lives in slums.3 Having spent extensive time studying public health issues in dynamic informal settlements such as Khayelitsha (Cape Town, South Africa) and Kibera and Korogocho (Nairobi, Kenya), among others, I have seen the negative effects that poor water and sanitation, insecure and cramped housing, and poor access to essential health services can have on such vulnerable populations. Rapid urbanization further exacerbates substandard living conditions in informal settlements by increasing intra-urban health disparities, facilitating habitats for poverty and disease in the urban poor, and worsening the quality of health services. In this context, there is an urgent need to study urban health systems and the ways in which health services can be made more available, accessible, and acceptable to socioeconomically disadvantaged and culturally/ethnically diverse populations in these settings.
Figure 1. Conceptual Framework to Illustrate the Unique Needs of Vulnerable Urban Populations
This conceptual framework illustrates how individual, household, community, and institutional factors interact to influence health in the context of the urban setting. The framework was developed by the Health Research Program to explore the factors influencing health in an urban environment. Comprehensive approaches to improve maternal, newborn and child health outcomes for vulnerable urban populations in sub-Saharan Africa will require a multi-level approach, identifying and leveraging enabling factors while also addressing contextual factors.
In this light, I am heartened that USAID has recently directed attention towards improving the quality of life for the urban poor through a host of avenues. Specifically, the Health Research Program housed in the Office of Maternal and Child Health and Nutrition is interested in exploring innovative models to address the individual, community, institutional and policy factors that inhibit and enable improved health in urban settings. Currently, the Program is working with potential health and development partners to co-design these models through the Broad Agency Announcement (BAA), which is aimed at developing implementation research studies to test solutions to address the growing challenges of rapid urbanization and its impact on maternal, newborn, and child health outcomes. The BAA allows USAID and health development partners to leverage each other’s strengths and local expertise in a way that has rarely been done before. By focusing on the cross-sectoral nature of urban health, the Program aims to engage local government and private sector health providers, along with traditional health service providers, to lend their respective comparative advantages for a potential impact that may be greater than any single entity could achieve.
By designing rigorous studies embedded in existing service delivery platforms, there will be built in opportunities to learn about what does and does not work in a real-world setting. Furthermore, the embedded nature of these studies will forge the relationships that need to be strengthened in order to see sustained change and scale. It is my hope that the BAA will result in programs that help cities adapt promising practices and innovations to improve the quality of life in many of these communities. The time to act is now.
The Health Research Program’s Health and Applied Research Development (HEARD) project is building an implementation research collaboration on urban health that will bring together a diverse set of stakeholders. First HEARD will identify the need to assess nutrition and WASH among the poorest children and adolescents in urban settings in East Africa. This in turn will inform the research agenda as well as policy and advocacy development. As a result, HEARD will have a more holistic understanding of the problems and the evidence generated will be more accessible to stakeholder needs.
- United Nations, Department of Economic and Social Affairs, Population Division, 2015. World Urbanization Prospects: The 2014 Revision (No. ST/ESA/SER.A/366). United Nations, New York
- Fink, G., Arku, R., Montana, L., 2012. The health of the poor: women living in informal settlements. Ghana Med. J. 46, 104–112.