URBANIZATION AND HEALTH: OXYMORON OR OPPORTUNITY?

Megan Christensen, Health Advisor

October 14, 2016

For the first time in history, more than 50% of the world’s population lives in an urban area.

By 2050, 70% of the world’s population will be living in towns and cities. (WHO 2010)

URBANIZATION -A HEALTH HAZARD?!

Urban Population Growth

Between 1995 and 2005, the urban population of developing countries grew by an average of 1.2 million people per week, or around 165,000 people every day. (WHO Bulletin Volume 88, Number 4, April 2010)

Opportunities Threats

Access doesn’t always equal quality!

Concentrate health risks and introduce new hazards

Transition from rural to urban is chaotic, resulting in a disorganized urban landscape

Poor people are rapidly being absorbed into urban slums

For vulnerable populations - urbanization is a health hazard, ripe for humanitarian disaster

Economic benefits of living in urban settings

Increased access to services?

Scale, coverage and reach in population dense areas

Technology: multi-media platforms and mobile devices

Cost-effective

(Urbanization – An Emerging Humanitarian Disaster. N Engl J Med 2009)

A MODEL FOR ACTION?

A Possible Solution

URBAN

HEALTH

MODEL

Garner support from national/top leadership (MOH, urban development and planning): relationships = successful partnership

Build and strengthen capacity, especially at mid-level or closer to community (district, sub-county, county)

Create a vision with the community and it’s structures

Equity- identify, map and link the extreme poor

Develop and train a volunteer network- consider the role of youth

Reactive and strengthen local health committees: put existing policies to work

“Seeing is believing”: create living laboratories or facilitate exchange visits

Push factor

What is the recipe for success?

Community boundaries, what constitutes a household and a resident

Who are the extreme poor?

Community mobilization approaches: who, how many, and scope of work

Social cohesion, change agents and sub-systems

Availability of beneficiaries

System for replacement and enrolling new beneficiaries

Service provision and timing

Political considerations: lack voice and recognition; ignored in planning

Urban environments require special consideration

Expanding informal settlements that are unplanned

Rapid population growth coupled with frequent migration in/out

Lack of services, especially hygiene and sanitation, to meet demands

Substandard infrastructure

Poor coordination, incentives, lack of participation, supervision

Rise of unlicensed/informal providers and unregulated facilities

Insecurity and violence

Demographic shift

National policies that overlook needs of urban populations

Systems and resources for scalability

Challenges

Do your homework: collect data about your target group and influencing groups and USE this information

Foster relationships and know your beneficiaries; identify, map and target the extreme poor

Put the community at the center and engage them from the beginning to generate buy-in and ownership

Everyone has a role (it’s not just about moms and babies). Understand, define and support specific roles for all stakeholders

Recommendations

Use program evidence to advocate for change

Taskforces and consortia of civil society and NGOs/PVOs are powerful

Consider scalability and sustainability from inception

Have an exit strategy

Don’t overlook DRR

Plan and build resiliency

M&E, surveillance, CHIS & HMIS: use and strengthen the local systems

Recommendations

The child survival programs were supported by the American people through the United States Agency for International Development (USAID) through its Child Survival and Health Grants

Program. The portfolio was managed by Concern Worldwide, US.. The views, ideas, options, and comments expressed in this material do not necessarily reflect the views of USAID or the United

States Government