By Dr. Meggie Mwoka, African Population and Health Research Center (APHRC)
Over 60% of urban residents living in informal settlements in Kenya have limited access to basic facilities such as waste disposal, water and sanitation, poor housing, limited employment opportunities and the near absence of public sector services and law enforcement agencies. Moreover, informal settlements are food-insecure leading to both adult and child hunger. In 2012, data from censuses conducted in two major informal settlements in Nairobi, by the African Population and Health Research Center (APHRC) indicated that only 6% of households had access to piped water, 51% shared toilets and three households out of four have no garbage disposal arrangement.
These conditions contribute to poor health outcomes as demonstrated by morbidity and mortality indicators that are worse in informal settlements than in any other group in Kenya including rural residents. The high burden of infectious diseases including HIV/AIDS, tuberculosis and pneumonia is compounded by the growing incidence of non-communicable diseases– making them vulnerable in the case of an infectious disease outbreak or epidemic such as the current novel coronavirus (COVID-19).
About 73% of informal settlement residents fall below the poverty line. People in slums often have just enough money to live on and nothing extra.Majority work in the informal sector, with little to no security. In the occurrence of adverse events, the most common coping strategies are reducing food consumption, the use of credit and removing children from school. The current community mitigation strategies being put in place to “flatten the curve”- prevent and delay the spread of COVID-19 such as physical distancing, businesses working remotely, closure of educational and entertainment establishments reduces economic activity and people’s movement posing a great socio-economic burden to majority of individuals residing in informal settlements-who are already vulnerable to shocks. Distancing-based interventions have continued to prove difficult to enforce in informal settlements. Moreover, structural barriers such as inadequate water and sanitation impede their ability to practice the recommended hygiene measures to curb the spread of COVID-19 to protect not only themselves and their families but also the community at large.
With an expectation of tighter restrictions anticipated, the strategies to mitigate the spread of COVID-19 in informal settlements need to be put in place with urgency. We are looking at a growing economic and social crisis in this population if swift action is not taken. This includes increasing violence and crime including sexual and gender-based violence, increasing rates of unintended pregnancies and unsafe abortions related to school closures as evidenced during the Ebola Outbreak and increase in malnutrition among children and adults due to rising food insecurity. All these will further challenge current mitigation strategies, increasing the risk of potential unrest, like in West Point, Liberia during the Ebola epidemic, but also will contribute to protracted effects beyond the pandemic.
Some solutions which have been suggested include:
- Putting in place social protection systems such as cash transfers, subsidized health coverage and public infrastructures for social services to increase the resilience to allow societies to cope with crises. This can be learned from the Ebola outbreak in parts of West Africa where the lack of social protection measures aggravated poverty, unemployment, and informality, leading to a vicious circle of even greater fragility.In deciding the type of social protection mechanisms to put in place, certain considerations need to be taken. These include: Deciding who gets the protection, what kind of social protection (in-kind or cash), the logistics, capability of existing schemes to handle the strategy and sustainability, considering the uncertainties brought about by COVID-19. Some countries have already established such mechanisms, for example, Hong Kong is providing cash handouts of USD 1282 to about seven million of its permanent residents aged 18 and above to counter the economic fallout of the coronavirus.
- Community mobilization has proven as a central strategy for example in Uganda during the 2000 Ebola outbreak. It promotes enforcing of individual and household level strategies such as social distancing and supports surveillance such as the detection and swift reporting of suspected individuals.
- Putting in place emergency safe drinking water and hand-washing facilities in key locations in informal settlements and high-density public places. This involves ensuring emergency preparedness by providing water tanks, standpipes, hand-washing facilities and sanitizers along with hygiene messages particularly in crowded areas such as markets and bus stations.The role of the private sector will be critical in contributing to the resilience of these populations to handle the current pandemic and the necessary mitigation strategies. This includes using low cost innovations to promote provision of WASH facilities and services, provision of free and/or low cost hand-sanitizers and soap among others. A coordinated evidence-based multi-sectoral response strategy that involves government, private sector, research institutions, civil society, and the community is therefore critical to set up effective strategies within informal settlements.
Informal settlements have pre-existing vulnerabilities, COVID-19 is highlighting the distressing state of basic public health services among others within this population. Furthermore, the gaps in social protection systems are becoming glaring. COVID-19 amongst other viruses has shown how 21st-century epidemics can spread more widely and more quickly, affecting ever-greater numbers of people. In addition to how difficult it is to predict the nature, source and starting point of the next pandemic virus. Therefore, emphasizing the critical need to establish preparedness and surveillance mechanisms in sectors beyond health within informal settlements to not only tackle current but future pandemics. It’s no longer a matter of if, but when?
Image credit: Ninaras / CC BY-SA